Transcript Secondary Trauma When Helping Hurts Dr. Samuel Pfeifer 1

Dr. Samuel Pfeifer
Secondary Trauma
When Helping Hurts
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Receiving yourself in the fires of sorrow
“You can always recognize who has been
through the fires of sorrow and received himself,
and you know that you can go to him in your
moment of trouble and find that he has plenty of
time for you. But if a person has not been through
the fires of sorrow, he is apt to be contemptuous,
having no respect or time for you, only turning you
away. If you will receive yourself in the fires of
sorrow, God will make you nourishment for
other people.”
Oswald Chambers, (My Utmost for His Highest 25. June) - http://www.rbc.org/utmost/
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“Moved with compassion”
 “But when he saw the multitudes, he was
moved with compassion 4697 on them, because
they fainted, and were scattered abroad, as
sheep having no shepherd.” (Mat.9,36)
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G4697
σπλαγχνίζομαι
splagchnizomai
splangkh-nid'-zom-ahee
Middle voice from G4698; to have the bowels yearn, that is,
(figuratively) feel sympathy, to pity: - have (be moved with)
compassion.
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Trauma is contagious
Trauma is contagious. The therapist, in
his role as a witness … is often
overwhelmed by his emotions. He goes
– somewhat less than the patient –
through his feelings of
dread, anger and despair.
Judith Hermann, Trauma Therapist
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Contagion effect
 Figley (1995) identified the mirroring or
contagion effect of symptoms from client to
therapist and argued that "those who have
enormous capacity for feeling and
expressing empathy tend to be more at risk
of compassion stress"
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Primary Trauma Aftereffects
 Physical and psychological Hyperarousal
(e.g. difficulty staying/falling asleep,
hypervigilance, irritability),
 Intrusion (painful memories, flashbacks,
memoriesimages, feelings, anxieties, day
dreams, nightmares etc.)
 Avoidance (detachment from others,
avoiding activities or positive experiences,
diminished ability to enjoy life). – „How
can I enjoy life, when others are hurting?“
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Secondary Trauma
 Listening to the stories of traumatized
people and feeling with hte victims of
traumatic experiences leads to similar
reactions as if the trauma had happened to
you.
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Possible effects
 The reports elicits memories of your own.
 The report triggers mental images (in day dreams or
nightmares)
 You realize your own vulnerability
 Your own confidence in life and security is shaken.
 Feelings of anger and despair. Accusations against
police, the government, other „responsible“ authorities.
 Reproaches against God? „How can he allow this
happening?“
 "Traumatic events shake the foundations of our beliefs,
and may shatter our trust..."
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Possible effects
 You feel overwhelmed and helpless in addressing
the other person‘s distress.
 Some develop explanations or apply methods
(psychological or spiritual) which are irrational,
perhaps even magical (accusing Christian parents
of Satanism, spiritual forces – Shamanism).
 Some try to overcome their helplessness with
inadequate hyperactivity (often with a lack of
respect for a patient‘s borders and his or her wellbeing) – e.g. reporting sexual abuse to the police –
or even taking revenge in self-justice.
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Possible effects
 Distrust and reproach to other helpers:
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„they don‘t understand the needs of my client.“
„they are hushing up the problems.“
„they don‘t take actions!“
General devaluation of other helping persons
 Avoiding trauma patients or avoiding to confront
the diagnosis, in order not to be traumatized.
 Refusing supervision, holding back their own
reactions, because of shame.
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Dangers for Therapy / Counselling
 Avoidance behavior of the counsellor: he / she
doesn‘t want to address the trauma although the
patient / clients would like to talk about it.
 „Therapeutic Intrusion“: The counsellor insists on
details of the traumatic event, although the person
does not want to reveal or repeat such details.
 General avoidance or withdrawal: As the counsellor
is suffering from sleep disorders, nightmares or
physical hyperarousal, he or she is not available for
the patient at all.
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False ambitions
 False ambition, „to heal all, to know everything, to
love all.“
 Healing everything: Therapy until final and
complete recovery.
 Knowing everything: Exact and detailed
reconstruction (despite negative emotional
consequences), hope for catharsis through
knowledge and revelation.
 Loving everything: Trying to give the victim
vicarious love (making up for all the love she
missed in life). Danger of transgressing borders in
therapy and counselling.
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Coping strategies
 Security
 Providing Boundaries
 Recollection and
mourning
 Supervision,
Intervision
 Social Integration
 Normal Relationships
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Prophetic word in Burnout
A pastor, who went though a severe burnout,
received the following prophtic words through
a counsellor-friend:
„You will be restored. You will be healed. And
my anointment will flow again through your
life and through your ministry. My minstry
through your life. You will witness that in
communion with me this anointment will flow
again. And you will be amazed how the Lord
will use you – and there will be no pressure on
you.“
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The values of debriefing
 When the disciples returned from their first
missionary endeavors, Jesus gave them time
to tell their stories and to share their
questions. Broadly speaking this is what
debriefing is about.
 The following thoughts have been inspired
by a paper which was written by Dr. Debbie
Lovell-Hawker.
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Definitions
 Operational debriefing: Asking for information about
the work performed, and what was achieved.
 Personal debriefing: Asking how the experience was for
the individual (what was best/ worst? How is the
readjustment process going?). Aims to help them integrate
their experience into their life as a whole, perceive the
experience more meaningfully, and bring a sense of closure.
 Critical incident debriefing (CID): A highly structured
form of personal debriefing, which can take place after a
traumatic experience (such as a natural disaster, a violent
incident, or a traffic accident).
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A Biblical Framework of Debriefing
 a) We are called to care for each other (e.g. Isaiah 61: 1-2;
John 13: 35; John 21: 16; 2 Cor 1: 3-4; Gal. 6:2).
 Debriefing is a way of showing we care. We do not tend to
question whether there is a Biblical framework for
practising medicine - we know that it relieves suffering, so
we encourage it. Providing emotional help also brings
people to greater health and healing. Research indicates that
some people who do not receive a debriefing feel devalued.
Those who receive a debriefing tend to find it a positive
experience and have fewer trauma-related symptoms.
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Listening
 Listening is central to debriefing, and the Bible
teaches us to listen (Proverbs 18:13; James 1:19).
 In modern society, it can be difficult to find
someone willing to make time to really listen. In
particular, eyes glaze over when someone starts to
talk about their experience overseas. Mission
partners often feel isolated. Listening breaks down
this isolation, and helps them move forward.
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Teaching about emotions
 Emotions are normal and valid. The Bible also teaches this. The
Bible contains plenty of anger, fear, and tears (e.g. in the Psalms).
‘Don’t be afraid’ may imply ‘there’s no need for you to be afraid’
rather than ‘it’s wrong to fear’. Jesus did not condemn a man who
admitted unbelief, but rather allowed him to express this (Mark 9:
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 The Bible reminds us that there is ‘a time to weep and a time to
laugh, a time to mourn and a time to dance ... a time to be silent
and a time to speak, a time to love and a time to hate’ (Ecc 3:4-8).
 Jesus taught by example that it was OK to cry (Luke 19: 41; John
11:35; Heb. 5: 7). He expressed anguish in the Garden of
Gethsemane, and said that his soul was ‘overwhelmed with
sorrow’ (Matt. 26:38).
 In past times and different cultures, people have known that it is
normal to feel certain emotions after trauma, and they did not
need to be taught this. Today, some people need to be told this
explicitly.
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Biblical examples: Telling one‘s story
 The Disciples walking along the Emmaus
road had gone through the trauma of
witnessing the crucifixion of Jesus. They
were talking about what had happened
(Luke 24:13-24). Jesus joined them, and
asked what had happened. That wasn’t for
His benefit – he knew. It gave them the
opportunity to tell their story – the facts of
what had happened, and their feelings of
disappointment. He then helped them put
things into context.
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Biblical Examples II
 A woman who had been bleeding for 12 years (possibly
following trauma) touched Jesus (Luke 8: 43-48). He asked,
‘who touched me’. Why did He ask? Not to embarrass her, but
to allow her to tell her story, so that she would gain emotional
healing as well as physical healing. (Otherwise no-one else
would have known that she had been healed, and she would
still have been thought of as an outcast).
 Joseph: In Genesis 44 - 45, we see Joseph listening to his
brothers’ story, then telling them about his experiences, to
produce a clearer picture and make the events more
meaningful. Joseph recognised their feelings of distres s and
anger. They all expressed their feelings freely, weeping
together and embracing one another, before making plans for
the future.
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Listening to stories
 Nehemiah heard a traumatic report about his people being
exiled, and living in ‘great trouble and disgrace’ in a ruined city
(Neh. 1:3). Nehemiah didn’t disguise his feelings. The king
noticed that he looked sad. Nehemiah normalised this - ‘why
should my face not look sad when the city ... lies in ruins?’
(2:3). The king listened as Nehemiah spoke about his plans,
and he helped Nehemiah do what was necessary to move
forward from this point of despair.
 Jesus invited people to tell him their stories (e.g. the sick; the
disciples when they returned after being sent out two by two).
He listened to them, and helped to bring closure to
experiences, and helped people move on.
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Reviewing the past – moving on
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The Bible affirms that there is a place both for reviewing the past together
(Isaiah 43:26), and for moving on to new things (Isaiah 43:19). Both occur
during debriefing.
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A good example is God’s counselling of Elijah, when he suffered a burnout and
had to flee for his life into the wilderness. (1. Kings 19)
 Elijah experienced a death threat (1 Kings 19:2), and fled for his life. He was
afraid, and prayed that he might die. An angel provided physical care for him
(food, drink and sleep). Forty days later, after his physical needs had been
met, God asked what was going on. Elijah told God his story- twice (v. 10, v.
14). Then God moved Elijah to think about the future, and told him that he
would not be alone - there was support available in the form of 7000 other
believers (v.18). Moreover, God directed Elijah to Elisha (v.16ff), who would
give him more support.
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Physical regeneration (sleep and food)
Spiritual review
A new (and unusual experience of God
A new direction and a new task
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Literature
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B. Hudnall Stamm (ed.) Secondary Traumatic Stress: Self-Care Issues for Clinicians,
Researchers, and Educators. Sidran Press.
Judith Herman: Trauma and Recovery: The Aftermath of Violence. Basic Books.
Fawcett, G. (1999). Ad-Mission: The briefing and debriefing of teams of missionaries and
aid workers. Harpenden: Self-published. Available directly from the author - e-mail:
[email protected] or phone 01582 463252.
Gamble, K., Lovell, D.M., Lankester, T. & Keystone, J. (2001). Aid workers, expatriates
and travel. In J. Zukerman & A. J. Zukerman (Eds), Principals and Practice of Travel
Medicine. Chichester, England: John Wiley & Sons.
Jordan, P. (1992). Re-entry: Making the transition from missions to life at home. Seattle:
YWAM.
Lovell-Hawker, D.M. (2002). Debriefing after traumatic incidents, and at the end of
assignments. In K. O’Donnell (Ed.) Doing Member Care Well: Perspectives and Practices
from around the world. Pasadena, CA: William Carey.
Mitchell, J. & Gray, B. (1990). Emergency Services Stress. New Jersey: Brady. Parkinson,
F. (1997). Critical Incident Debriefing. London, UK: Souvenir Press.
Pollock, D.C. & Van Reken, R. E. (1999). The Third Culture Kid Experience. Maine USA:
Intercultural Press.
Rose, S. & Bisson, J. (1998). Brief early psychological interventions following trauma: A
systematic review of the literature. Journal of Traumatic Stress, 11, 4, 697-710.
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Helpful Links
 http://www.asbury.edu/academ/psych/mis_ca
re/trauma.htm
 http://trauma-pages.com/
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Group activity
Group Activity / Questions
 Share your own experience of “secondary
trauma”
 What are stories that touch your heart.
 How do you prevent the pain of others to invade
your emotions?
 Discuss the balance of compassion and selfprotection.
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