Transcript Trauma & Related Disorders

Presented by Mark Purcell, PsyD
OBJECTIVES:
 Provide definitions and brief history of
Vicarious Traumatization
 To understand how we are “transformed” and
“impacted” in our work
 To identify effects on helpers
 To begin to plan individual, team and
organizational strategies to reduce the risk of
vicarious traumatization
 Describe Symptoms of PTSD and Complex
Trauma
Vicarious Trauma
 Vicarious traumatization (VT) is a transformation
in the self of a trauma worker or helper that results
from: empathic engagement with traumatized clients
and their reports of traumatic experiences.
 Includes disrupted sense of meaning and hope
CONTEXT OF WORK
 Defines self, skills and values
 Often drives economic viability and security
(health benefits, retirement)
 Personal lifestyle, and lifestyle of family
 Provides structure, routine and predictability
 May define social groupings
DEFINITIONS OF
VICARIOUS TRAUMATIZATION (VT)
 “…as the transformation that occurs within the
therapist (or other trauma worker) as a result of
empathic engagement with clients’ trauma
experiences and their sequelae.”
(Pearlman & Mac Ian, 1995)
 “…clinicians who work with sexually abused clients or
other victims of trauma may experience profound
psychological effects, effects that can be disruptive
and painful for the helper and can persist for month
and years after work with traumatized persons.”
(McCann & Pearlman, 1990a; Pearlman & Saakvitne, 1995))
 “VT occurs through exposure to the realities
of people’s intentional cruelty to one
another, and through the inevitable
participation in traumatic reenactment in
the therapy relationship, the therapist is
vulnerable through his or her empathic
openness to the emotional and spiritual
effects of vicarious traumatization. Their
effects are cumulative and permanent, and
evident in both a therapist’s professional and
personal life”
(Figley, 1995)
 Emotional impact of trauma and painful
material can be contagious and transmitted
through the process of empathy
(Figley, 1995; Pearlman and Saakvitne, 1995a; Stamm, 1995)
 “…the natural consequent behaviours and
emotions resulting from knowing about a
traumatizing event experienced by a
significant other – the stress resulting from
helping or wanting to help the traumatized
or suffering person.”
(Figley, 1993a)

Schauben and Frazier (1995) tied these
results to a number of factors:
Hearing painful stories and experiencing the
distress of survivors is emotionally draining
B. Counselling process more difficult with
trauma survivors given the challenges of trust
and shattered beliefs
C. Institutional barriers within the legal and
mental health systems that clients must
navigate are frustrating to the therapist
A.
SHATTERED BASIC ASSUMPTIONS
- Janoff-Bulman
 Traumatizing and victimizing events
challenge basic belief structures – structures
which drive our ability to organize and make
sense out of our world
CHANGES IN THESE SCHEMAS
TAKE PLACE THROUGH:
• Accommodation (Sudden and Acute)
• Assimilation ( A more incremental shifting
of belief systems)
CONSTRUCTIVIST
SELF-DEVELOPMENT THEORY
-Pearlman
 We construct our personal realities through
the development of complex cognitive
structures which are used to interpret events
 These structures are called “schemas” (Piaget)
 Schemas evolve and become increasingly
complex over the lifespan as individuals
interact with their meaningful environments
SCHEMAS
 Helpers may find a long-term alteration in their
own cognitive schemas, beliefs, expectations and
assumptions about self, others and the world at
large.
Lisa McCann and Laurie Anne Pearlman, Vicarious Traumatization: A Framework
for Understanding the Psychological Effects of Working with Victims, Journal of
Traumatic Stress, Vol.3, No.1, 1990, p. 131.
FRAME OF REFERENCE ABOUT THE SELF
AND WORLD
 Helpers may question his or her identity, role
and self-worth
 As helpers hear painful stories, the view of the
world may change – values can be altered
TRUST
Helpers’ exposure to hearing stories of
cruelty, deception, betrayal, etc… can
create cynicism, suspicion towards
others – and to expect the worst in
others
SAFETY
 Enhanced awareness of the fragility of life
 Increased thoughts of our own vulnerability
POWER AND CONTROL
 Can be impacted by the helplessness and
powerlessness that clients and families may
talk about
 Helpers may find themselves seeking an
increase in control in their
personal/familial/colleagial relationships to
combat this
INDEPENDENCE
 Helpers may experience a loss of
independence as a result of feeling
personally vulnerable and out of control
SELF-ESTEEM
 May question self-worth (what good am I if
I cannot help others?)
 Loss of faith in humanity; shattering of
belief systems
 Views may become more cynical and
pessimistic
INTIMACY
 May become emotionally unavailable to self
and others as a result of feeling too
emotionally invested in clients
 Alienation and isolation from others
 May be reinforced by others who view
“helping work” as
 Sad
 Horrific
 “Better you than me”
 Triggers to their anger
ACUTE STRESS REACTIONS
 Can occur as a result of vicarious
traumatization
 Alterations in sensory experiences
 Physiologic activation
 Inability to modulate affects
 Substance abuse
 Overeating
 Bingeing
 Hypersensitivity to emotionally charged stimuli
 VT can result in physiological symptoms that
resemble post traumatic stress reactions
 Intrusive Symptoms
 Flashbacks
 Nightmares
 Obsessive thoughts
 Constrictive Symptoms
 Numbing
 Dissociation
(Beaton & Murphy, 1995)
EFFECTS OF TRAUMA WORK
ON HELPING PROFESSIONAL
 Pervasive
 Affects all realms of person’s life
 Cumulative
 Each client can reinforce gradual change of
schemas
 Permanent
 Even if worked through, experiences leave scars
(McDermott, Fellbaum & Associates. Wounded Helpers & Healers: Shattered
and Eroded Assumptions of Vicarious Traumatization. Presentation, March
26, 1993, London)
 The “stories” we hear do affect us
 In our work we bear witness to daily pain,
despair, victimization as well as the rewards
of our work
 We listen
support
engage
validate feelings and experiences
 As pain is released, we absorb it
 At the end of the day, we have gathered
numerous accounts of hurt
WHAT MAY WE FEEL?
 Sad
 Angry
 Joy
 Horror
 Vulnerable
 Satisfaction
Frustration
Creative
Isolated
Appreciated
Anxious
Rewarded
MANAGING OUR WORK
 Acknowledge that the work will affect you
 Create and maintain a healthy balance to
minimize the effects of vicarious
traumatization
 Recognize the potential for trauma and VT in
our lives
 Be attentive and mindful of your “unique
warning signs”
WARNING SIGNALS
 Increasing thoughts of client’s pain and trauma
 Diminishing sense of safety and trust in the world
 Intrusive imagery or nightmares
 Decreasing sense of competency
 Cynicism
 Isolation and withdrawal from others
 Changes in ability to establish and maintain
healthy boundaries
 Feeling numb
 Changes in eating and sleep patterns
 Questioning personal values
 Difficulty in managing usual stress situations
and responses
INFLUENCING FACTORS TO VT
 Current personal stresses
 Relationship/family challenges
 Mental health issues
 Social system
 Organizational influences
 Legislative changes and frustrations
 Maturational factors
 Physical/medical challenges
SELF-CARE STRATEGIES
 “Balance” between personal and professional life
 Respect for personal/professional boundaries
 Develop realistic expectations
 Balanced diet
 Healthy lifestyle choices
 Moderate caffeine/alcohol use
 Exercise/movement
 Maintain professional contacts
 Engage in social and family relationships and
events
 Pursue leisure activities
 Body therapy, e.g. massage, yoga
 Personal therapy
 Rest/Relaxation
 Reflect
 Evaluate your priorities and goals on an
ongoing basis
 Coming to terms with loss such as the
effects of work that can shake or shatter
religious or spiritual beliefs
 Permitting our sadness to be expressed so
that we can receive comfort and support,
and helps us to maintain intimacy in our
personal lives
 Recognizing and accepting that VT is a
normal response to doing painful and
difficult work
 Give yourself permission to experience the
emotion of your work
 Value your efforts as well as your successes
 Laugh
TEAM STRATEGIES
 Break familiar patterns
 Overcome fears and barriers
 Acknowledge contributions of others – respect for
each other’s roles
 Debrief
 Formal and informal structures
 Regular Meetings
 Discuss situations
 Allow feelings to be shared
 Problem solve
 Provide ongoing education
 Encourage innovation
 Develop a mechanism in which to
understand and process the effects and
personal responses to the work
 Avoid nay-sayers
 Build dreams and ideas together
 Experiment with creativity
 Guard against censoring your ideas
 Seek positive solutions
 Offer a helping hand
 Allow team members to show their feelings and
vulnerabilities
 Celebrate your successes
 Laugh
CONTRIBUTORS TO SIGNIFICANT STRESS IN
HELPERS
 Role strain
 Staff conflict
 Lack of perceived support from peers
 Lack of role clarity
Signs & Symptoms of Trauma
 Posttraumatic Stress Disorder
 Symptom Clusters:

Re-expereincing, Avoidance, Arousal
 Complex Trauma
 Effects of Relationships
 Effects on Personality
PTSD Symptoms: Re-Experiencing
 Intrusive, upsetting memories of the event
 Flashbacks (acting or feeling like the event is
happening again)
 Nightmares (either of the event or of other frightening
things)
 Feelings of intense distress when reminded of the
trauma
 Intense physical reactions to reminders of the event
(e.g. pounding heart, rapid breathing, nausea, muscle
tension, sweating)
PTSD symptoms of avoidance and
emotional numbing
 Avoiding activities, places, thoughts, or feelings that
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remind you of the trauma
Inability to remember important aspects of the trauma
Loss of interest in activities and life in general
Feeling detached from others and emotionally numb
Sense of a limited future (you don’t expect to live a
normal life span, get married, have a career)
PTSD symptoms of increased
arousal
 Difficulty falling or staying asleep
 Irritability or outbursts of anger
 Difficulty concentrating
 Hypervigilance (on constant “red alert”)
 Feeling jumpy and easily startled
Other common symptoms of posttraumatic stress disorder
 Anger and irritability
 Guilt, shame, or self-blame
 Substance abuse
 Depression and hopelessness
 Suicidal thoughts and feelings
 Feeling alienated and alone
 Feelings of mistrust and betrayal
 Headaches, stomach problems, chest pain
Complex Trauma Symptoms
 Alterations in regulating affective arousal
 (1) chronic affect dysregulation
 (2) difficulty modulating anger
 (3) self-destructive and suicidal behavior
 (4) difficulty modulating sexual involvement
 (5) impulsive and risk-taking behaviors
Complex Trauma Symptoms
 Alterations in attention and concentration
 (1) amnesia
 (2) dissociation
 Somatization
Complex Trauma Symptoms
 Chronic chacterological changes
 (1) alterations in self-perception: chronic guilt and shame;
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feelings of self-blame, of ineffectiveness, and of being
permanently damaged
(2) alterations in perception of perpetrator: adopting
distorted beliefs and idealizing the perpetrator
(3) alterations in perceptions of others:
(a) an inability to trust or maintain relationships with
others
(b) tendency to be re-victimized
(c) a tendency to victimize others
Complex Trauma Symptoms
 Alterations in systems of meaning
 (1) despair and hopelessness
 (2) loss of previously self-sustaining beliefs