The Restora+ve Approach™ is a registered trade mark of Klingberg Family Centers 2006 Remaining Hopeful in the Midst of Pain:
Recognizing and Addressing Vicarious Traumatization Patricia D. Wilcox, LCSW
The Traumatic Stress Institute
Klingberg Family Centers
New Britain, Connecticut
2011
1 Frame of the Training Voluntary par+cipa+on Trauma Survivors In room with supervisors Confiden+al Some material adapted from:
A Training Curriculum for Working with
Survivors of Childhood Abuse Authors
Karen W. Saakvitne, Ph.D.
Sarah Gamble, Ph.D.
Laurie Anne Pearlman, Ph.D.
Beth Tabor Lev, Ph.D.
The Sidran Press
What is psychological trauma? Trauma is the unique individual
experience of an event or enduring
conditions in which:
The individual’s ability to integrate his or her emo+onal experience is overwhelmed; and The individual experiences a threat to life, bodily integrity, or sanity. TRAUMA FRAMEWORK
Childhood Traumatic Experience(s)
Traumatized Development
Disrupted
Attachment
Sensitized
Nervous
System
Impaired Self Capacities
Inner Connection
Worthy of Life
Feelings Management
Current Stress (Trigger)
Intolerable Feelings
Extreme coping Strategies = Symptoms/Behaviors = Adaptations
Retreat
Self-Destruction
Other Destruction
Vicarious Trauma8za8on How this work will change you
VT refers to the nega+ve changes in the helper as a result of caring about and feeling, or being, responsible for trauma+zed children. Its can include disrupted spirituality and loss of meaning and/or hope. 7
Vicarious Trauma8za8on VT is an inescapable effect of trauma work -­‐an occupa+onal hazard. It is neither the fault of the client, nor a result of “weakness” on the part of the treater. VT damages hope and op+mism, which are essen+al giSs we bring to our work. 8
Vicarious Trauma8za8on
The single most important factor in the success or failure of trauma work is the aTen+on paid to the experience and needs of the helper. Addressing VT is an ethical impera+ve. 10 How VT Changes Us VT can impact: Our iden+ty, worldview, and spirituality Our core beliefs about safety, trust, esteem, control, and in+macy Our own ability to manage feelings How VT Changes Us (2) Our bodily feelings and experience including our sexuality Our sense of meaning and hope 11
Contribu8ng Factors to VT Environment VT Person Person Related Factors Current life stressors History that overlaps with clients Self care Investment in larger meaning of the work Environmental Factors The Workplace Nature of clientele Awareness of VT Culture of permission to own and discuss VT Formal structures or forums to address VT Support of peers Nature of supervision Wider System and Culture System support for working in this way Community’s percep+on of the popula+on
15 The Impact of Crisis Interven8on on the Helper Contributing Factors:
Listening to life stories of our clients. Managing life-­‐threatening crises Realizing that, at +mes, the stakes are quite literally life and death. Expecta+ons about our power to control client’s ac+ons (including legal liability). Silent Witness BREAK VT: What Gives Us Hope A trauma framework No+cing successes Loving your work Reclaiming your body 18
19 Vicarious Trauma8za8on Grief wounds more deeply in solitude; tears are less biOer when mingled with other tears. Agememnon Seneca Trauma-­‐Informed Agencies Messages About VT VT is a normal part of doing this work VT is not something you need to be ashamed of. However, it is something you need to aTend to. It is important to no+ce VT and talk about it with others Finding meaning and hope in your work (and life) are cri+cally important to managing VT Embedding Support for VT in Agencies Staff screening and hiring Staff training Regular supervision Regular forums to discuss VT Recogni+on, celebra+ons, rituals Pre-­‐ and end-­‐of-­‐shiS mee+ngs Controlling for over+me hours worked Caseload expecta+ons (Risking Connec+on; Davis and Vannasse, Devereux, MA) Embedding Support for VT in Agencies (2) Good health benefits including mental health Cri+cal incident de-­‐briefing A program model, framework, increased clinical sophis+ca+on 23 Past, Present, Future Exercise: Hopes and Challenges List 2 reasons you entered this line of work. List 2 ways in which the work is different from what you expected coming into the field. List 2 things about the work that are most challenging for you. Write briefly about 1 success story you’ve witnessed or encountered. 24 What to Do about VT An+cipa+ng VT and Protec+ng Oneself Addressing Signs of VT When They Arise Transforming the Pain of VT 25 An8cipa8ng VT and Protec8ng Yourself – The ABCs Awareness be aTuned to one’s needs, limits, emo+ons, resources. heed all sources of informa+on-­‐-­‐cogni+ve, soma+c, intui+ve. prac+ce mindfulness and acceptance. Balance among work, play, and rest Connec+on to oneself, to others, and to something larger Awareness of VT Awareness:
Where do you usually experience the stress of the job?
What physical signs would you first notice?
What emotional reactions would be a clue that you need a
break?
What thoughts might signal cynicism or exhaustion are
developing?
We may get feed back from others before we even notice
ourselves that we are being affected by the work- important to be
open to feedback.
Checklist Checklist Balance and Connec8on Work, play, rest Connec+on is the an+dote to trauma Family, Friends Religious and social groups Beliefs and ideals Addressing Signs of VT Self-­‐Care Self-­‐Nurture Escape 29 "The Summer Day" by Mary Oliver Who made the world? Who made the swan, and the black bear? Who made the grasshopper? This grasshopper, I mean— the one who has flung herself out of the grass, the one who is ea+ng sugar out of my hand, who is moving her jaws back and forth instead of up and down— who is gazing around with her enormous and complicated eyes. Now she liSs her pale forearms and thoroughly washes her face. Now she snaps her wings open, and floats away. I don't know exactly what a prayer is. I do know how to pay aTen+on, how to fall down into the grass, how to kneel down in the grass, how to be idle and blessed, how to stroll through the fields, which is what I have been doing all day. Tell me, what else should I have done? Doesn't everything die at last, and too soon? Tell me, what is it you plan to do with your one wild and precious life? (Photo: Danny Yee)
The Power of Transforma8on
Think of a past difficult +me in your life, one you have come to some peace with How did that experience change you? Did that experience change you as a person or in your work in any posi+ve ways? What helped you to find something posi+ve within the pain? Transforming the Pain of Vicarious Trauma8za8on Create meaning
Infuse a current activity with meaning
Challenge
your negative
beliefs and
assumptions
Participate in
community-building
activities
32
33 Finding and Making Meaning Wisdom isn’t cheap and we pay for it with pain. NYT, Depression’s Upside If you know about your own suffering, you can know about the suffering of others and offer them compassion. Thich Nhat Hanh Transforming the Pain Think about a difficult or painful +me for you in the past. Choose a +me that you have some distance from -­‐-­‐ that you are willing and able to discuss. What made it hard and painful for you? What things made it more difficult? Less difficult? When did it shiS to be less painful? What led to that shiS? Are there any ways you are different now as a result of this painful +me? Looking back, was there any value in the suffering? -­‐-­‐ lessons learned? deeper sense of empathy for self or others? How, if at all, do those lessons live on in your current life? Your work? Transforming the Pain of VT Why do you do this hard work? What keeps you in this line of work? What is a meaningful ac+vity for you? What makes it meaningful? Can you think of a +me you or somebody else challenged a nega+ve belief/assump+on and you listened? What is a community building ac+vity in which you have/do par+cipate? 36 Transforming the Pain of VT The pain of VT can lead us to search for hope and meaning in our work and our lives. Working with people who have experienced great pain teaches us about: Courage and human resilience The possibility of transforma+on Gra+tude in our own lives The power of hope Remembering the meaning of our work helps us to endure and transform VT 37 Transforming the Pain of Vicarious Trauma8za8on There is a privilege working with people on the edge of life. The view from the edge of life is so much clearer. Remen, 2006 A Fable An elderly Chinese woman had two large pots, each hung on the ends of a pole which she carried across her neck. One of the pots had a crack in it while the other pot was perfect and always delivered a full por+on of water. At the end of the long walk from the stream to the house, the cracked pot arrived only half full. For a full two years this went on daily, with the woman bringing home only one and a half pots of water. Of course, the perfect pot was proud of this accomplishment. But the poor cracked pot was ashamed of its own imperfec+on, and miserable that it could only do half of what it had been made to do. Fable con’t. ASer two years of what it perceived to be biTer failure, it spoke to the Woman one day by the stream. "I am ashamed of myself, because this crack in my side causes water to leak out all the way back to your house." The old woman smiled, "Did you no+ce that there are flowers on your side of the path, but not on the other pot's side?" "That's because I have always known about your flaw, so I planted flower seeds on your side of the path, and every day while we walk back, you water them." "For two years I have been able to pick these beau+ful flowers to decorate the table. Without you being just the way you are, there would not be this beauty to grace the house." Recommended Books • 
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Allen, Jon. (2001). Trauma&c Rela&onships and Serious Mental Disorders. New York: Wiley and Sons. Hughes, Daniel. (1998). Building the bonds of a<achment: Awakening love in deeply troubled children. Jason Aronson. Perry, Bruce and Szalavitz, Maia. The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist's Notebook Child Psychiatrist's Notebook-­‐-­‐What Trauma&zed Children Can Teach Us About Loss, Love, and Healing (2007) Basic Books Saakvitne, Karen et al.(2000) Risking connec&on: A training curriculum for working with survivors of childhood abuse. Lutherville, MD: Sidran Press. Saakvitne, Karen, et. al. (1996) Transforming the pain: A workbook on vicarious trauma&za&on. New York: W.S. Norton. Saxe, Glenn; Ellis, B. Heidi; and Kaplow, Julie B. Collabora&ve Treatment of Trauma&zed Children and Teens: The Trauma Systems Therapy Approach (2006) The Guilford Press For more informa+on contact: 43 Patricia D. Wilcox, LCSW Vice President, Klingberg Family Centers 370 Linwood St. New Britain, CT. 06052 [email protected] 860-­‐832-­‐5507 www.trauma+cstressins+tute.org www.klingberg.org www.riskingconnec+on.org hTp://traumatreatment.blogspot.com/