Self-help for Trauma Therapists

A Practitioner's Guide

Margaret Pack

• Publisher: Routledge
• Year: 2016
• eBook ISBN: 9781317483571
• Topic: Medicine
• Subtopic: Health Care Delivery

For those offering trauma-informed care, it can be difficult to maintain wellbeing and a balanced, positive outlook when the nature of their job requires frequent engagement with traumatic disclosures. Self-help for Trauma Therapists: A Practitioner's Guide intends to assist human service workers- such as those working as therapists, social workers and counsellors- to maintain their self- care and professional effectiveness when working in fields where stress and trauma play a key factor in their everyday working lives.

Adopting a comprehensive, multi-layered approach to self-care based, the book grounds its exploration of practice through researched accounts with experience professionals. Including accounts from clinical psychologists, therapists, counsellors, social workers and the friends and family of people in these professions, this book creates a narrative on stress and trauma from the human service worker perspective. Interwoven with these stories of practice, the author includes reflections on her own experiences in practice over the past 25 years with trauma survivors. With discussions on risk and resilience, compassion fatigue and vicarious traumatisation, readers are introduced to the theories and practical applications of developing a professional model for maintaining wellbeing and self-care in their work.

Self-help for Trauma Therapists: A Practitioner's Guide is the first book of its kind to be written solely for human service workers. It is essential reading for beginning and more advanced practitioners who are involved in working with trauma and recovery and will also be of interest to supporters of those working in the helping professions.

Chapter 1 What are stress and trauma and how do they impact?

Introduction

I have undertaken personal therapy since I started this job [trauma therapy in a family therapy agency] because, contrary to what I thought, as I trained more and worked deeper with clients, my heart has not closed, it has actually become more and more empathetic. There would have been lots of issues of transference and countertransference through time that I needed to work with. So I did a lot more work about my personal abuse over a number of years … I feel confident in my ability to make a difference in my world. I do. Because I think that the method I come from or my personal way of being in the world is body, mind and spirit being connected.

Rose, a counsellor-participant discussing her approach to working in the field of trauma with survivor clients and her approach to her own healing over her 30 year career as a therapist.

Working with trauma survivors is rewarding. It is also fraught with contradictions and challenges. In this chapter, I discuss the various concepts used to explain the experiences that can arise in work with trauma survivors. In the literature I have reviewed and in discussion with therapists who work in the field of sexual abuse trauma and recovery, I discovered that the impact of the work as a trauma therapist varies from worker to worker and is also dependent on a range of personal and professional factors, including their particular caseload mix and organizational context. Rose’s comments above illustrate the importance of holism and a mind–body integrated approach when working with trauma. Personal therapy to develop awareness of the impact of the work as the therapist in a continuous way was also important in maintaining therapeutic effectiveness and well-being. Awareness is sometimes very difficult to develop when we are riding the high seas of client emotions and trying to manage our own feelings and responses as we listen empathetically to clients. As Rose indicates, the depth at which we engage can be a further variable to consider in how we are affected by the nature of the work. This is where the concepts of vicarious traumatization and compassion fatigue can help us to assess what is occurring in our responses as we engage with trauma survivors on the job.

As a starting point, then let’s begin to examine the terminology used to describe trauma and stress to enable conceptual clarity about the definition of the various terms.

Stress

We often refer to ‘being stressed’ when our lives are out of balance or we feel overwhelmed with a combination of conflicting emotions, due to onerous duties or responsibilities. Such situations can lead us to such responses as feeling under pressure. In the research literature, stress is understood in terms of the impact of particular sources of stress known as ‘stressors’, which singularly or together impact on individuals to produce certain effects. These effects include physical manifestations such as the ‘fight and flight response’, where we attempt to fend off or avoid any perceived threat to our survival or well-being. The ‘fight and flight’ response can manifest in such physical symptoms we can experience in the body as heart palpitations, increased perspiration and nausea among other symptoms. Psychological effects often include negative thinking, anxiety or worry and behavioural manifestations such as insomnia, irritability and anger outbursts when we relate to others. Over time the triggering of such responses can result in coping strategies such as avoidance and absenteeism in the workplace, and persistent ill health such as catching colds and flus repeatedly, as such tensions can trigger the release of hormones such as cortisol that over time can affect the immune system (van Heugten, 2011). Muscular tension can lead to back and other health problems when apparently there is no physical or medical cause for ongoing aches and pains.

Some sources of stress are positive and are, in fact, necessary to motivate and so can lead to satisfaction and fulfilment. Therefore, some sources of work stress can have a positive impact on our well-being. How we perceive events as being ‘stressful’ or ‘pleasurable’ will depend on factors such as previous experiences/responses, and may be tied to personality styles and resources. Equilibrium in one’s work–life balance, altruism and variety in caseload are also considered important in balancing stress with work rewards and a sense of fulfilment in one’s personal and professional life (Collins, 2007; Gibbons et al., 2011). For example, Sophia, one of the trauma therapists interviewed for my research, explains what sustains her in her work, in an excerpt from an interview below:

Sophia: My life is much more satisfying now. I’m in charge of it [laugh] which is one thing I really like. Not being married is really good. I really love having my own place. I love it when the kids are this age now because they can look after themselves a lot now. I’ve got lots of good friends. Life’s a struggle financially somewhat being solo. But my life is good, very full.

(Pack, 2014)

Feeling that we hold the locus of control over our life with autonomy to make our own choices and decisions, is part of what can help us deal positively with the multiple challenges of juggling work and personal demands. Where the locus of control feels constantly with the other, or out of our control consistently, feelings of powerlessness can be experienced which can be a source of ‘burnout’ (van Heugten, 2011). This is a term that is often discussed alongside vicarious traumatization and compassion fatigue, but is seen as having some distinct features.

Burnout

The process of ‘burnout’ also seemed relevant to the experience of trauma therapists I interviewed as the process of stress in their experiences seemed to arise insidiously from exposure to traumatic client narratives. However, I noted from my reading that ‘burnout’ was often referred to in a more general sense as a term used to describe the ‘fit’ between the individual’s belief system and the organization’s philosophy, aims and tasks (Grosch and Olsen, 1994; Leiter and Maslach, 1988).

‘Burnout’ is seen as encompassing a range of components, including emotional exhaustion, feelings of depersonalization and a sense of reduced accomplishments in one’s work (Stamm, 2005). The organizational culture is often cited as a source of burnout, when socio-economic factors lead to retrenchment and reduced services which make it extraordinarily difficult for ethical therapists to meet their personal and professional ethical standards of practice (Fulcher, 1988). For example, van Heugten discusses in her research among social workers the many difficult adaptations that workers make to their changing work contexts during organizational restructuring, often culminating in decisions to leave and set up in private or group practices (van Heugten, 2011). The experience of lacking control over the way one does one’s work can be linked to burnout, therefore (van Heugten, 2011). Individual symptomatology of burnout can often be an indicator of what is happening in the wider organizational culture and economy, yet this is often a neglected area in the literature where the focus is on individual responses with little attention given to the surrounding organizational and societal context in which practice occurs (Harms, 2015).

Lack of clarity about one’s work role coupled with conflicting responsibilities on the job and a lack of support are other factors that contribute to ‘burnout’ (Leiter and Maslach, 1988). For example, Audrey, who was one of the counsellor-participants in my research, describes stress caused within her work as a child therapist when she was responsible for assessing whether the child had been abused or not. Those who began practising as trauma therapists from the mid-1970s onwards lacked the support of developed theory on trauma and support from a knowledgeable workforce to do the work. The effects of trauma on children who were abused were lacking a coherent evidence base and, therefore, best efforts were experimental and of necessity, tentative. Those who took up the challenge of offering therapy and assessment services became authorities whom others turned to. This expert role was neither sought nor wished for. Addressing societal disbelief was another factor contributing to Audrey’s experience. A sense of emerging collegial camaraderie developed in the course of what Audrey described as a ‘baptism by fire’. Part of the ‘stress/burnout’ was dealing with the backlash in bringing abuse to the public’s attention and the lack of systems to support her assessment of complex situations where children were at risk of abuse:

Audrey: When I first started working people didn’t believe it [sexual abuse] occurred and so you copped a lot of flak in bringing it to people’s attention. So I think it was actually far more stressful than I had imagined and I never imagined, like, going to court or anything like that. And there were no systems! [rolls her eyes] So that was far more stressful.

Reflective questions

• Do these descriptions of stress and burnout resonate with your own experiences?

• How so – in what ways are they relevant or do they apply to your experiences?

• Are there signs that give you advance warning that stress and burnout are operating in your personal/professional life currently?

• In the past? (Notice any patterns in physical sensations, thoughts and behaviours.)

• Notice and describe whether there was a trigger to these signs of stress/burnout.

• What was happening at that time in your life?

• What are your ‘early warning’ signs of being under stress/burnout?

• What do you do when you are experiencing such signs?

Trauma

Psychotherapists, regardless of the context of their practice, encounter clients who disclose traumatic histories. But what is trauma? Furthermore, which experiences are considered ‘traumatic’ and why? Trauma has been linked to a ‘history of repeated interpersonal victimisation that has impacted adversely on a person’s mental and potentially physical and social health across their life span’ (Wall and Quadara, 2014: 4). Typically those who experience or witness an event considered to be ‘traumatic’ experience the intense fear, helplessness or horror of the person who goes through that event (American Psychological Association [APA], 2013). If the re-experiencing of this fear of life-and-death proportions inspires traumatic transference in the therapeutic relationship between client and therapist, there are special kinds of clinical supervision that are recommended that I will go on to discuss in Chapter 5.

Secondary traumatic stress can be triggered by witnessing the distress of others in the aftermath of trauma (Herman, 2010). I have briefly outlined in the preface the nature of some of the potential responses to trauma for trauma therapists without giving those experiences labels or names. Each may be distinguished from the other once we explore the theory behind each term, which is considered helpful for gaining an awareness of how these concepts relate to oneself and one’s own process of dealing with traumatic material recounted in the course of therapy. In fact, an understanding of each concept and awareness of one’s intra-psychic process is considered a protective factor to unravelling the impact of trauma on the therapist who engages in it. Herman (1992) in her seminal work Trauma and Recovery likens the therapist’s responses to this engagement with trauma as a ‘contagion’ that gives some idea of how we affect one another by the telling and retelling our stories that involve traumatic material and particularly material relating to the intentional harm inflicted by one human being on another. As each individual therapist reacts differently to immersion in traumatic disclosures due to personal biographies, past traumas, personal resources and the use of support networks, I begin by outlining some of the main signs and symptoms that alert therapists that the work in the trauma field may be negatively impacting. This impact may be a fleeting experience or one that comes and goes such as acute stress responses. Alternatively it may be more permanently transforming as described in the literature on ‘vicarious traumatisation’ (McCann and Pearlman, 1990).

While sexual abuse trauma is considered to have distinctive features as a form of trauma, many abuses and traumas are widespread and interlocking with physical, psychological, sexual abuse overlaid with neglect resulting in harm to clients and their families, often across several generations. Age, gender, culture and life stage are also variables, with the vast majority of victims being children and women who have been abused by male perpetrators (Wall and Quadara, 2014: 6). The interaction of complex social problems and cultural factors compounds the already complex nature of abuse and violence. In Australia, Aboriginal women and children are among those most victim...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• Foreword
• Preface
• List of abbreviations
• 1 What are stress and trauma and how do they impact?
• 2 Discovering what builds resilience in trauma therapists: findings from earlier research and reflections on practice
• 3 Developing new meanings for practice: back from the edge of the world
• 4 Relationships and how vicarious traumatization can impact significant others
• 5 Clinical supervision for trauma therapists: a liminal and dialogic space for reflection and self-care
• 6 Vicarious traumatization: an organizational perspective
• 7 Critical incident stress management: self-care in the workplace
• 8 The search for self and the search beyond self: the role of connection to spirituality, nature and community in self-care
• 9 Career themes in the lives of trauma therapists: thriving and diversifying
• 10 Conclusion and your self-care plan: considerations and next steps
• Index