Reducing Secondary Traumatic Stress

Skills for Sustaining a Career in the Helping Professions

Brian C. Miller

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9781000415582
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Reducing Secondary Traumatic Stress presents a model for supporting emotional well-being in workers who are exposed to the effects of secondary trauma. The book provides helping professionals with a portfolio of skills that supports emotion regulation and recovery from secondary trauma exposure and also that enhances the experience of the helping encounter. Each chapter presents evidence-informed skills that allow readers to regulate distressing emotions and to foster increased empathy for those suffering from trauma. Reducing Secondary Traumatic Stress goes beyond the usual discussion of burnout to talk in specific terms about what we do about the very real stress that is produced by this work.

Section II

Leaving the Ordinary World: Our Quest Begins

2 Entering the Woods at the Darkest Place—Experiential Engagement

He who binds to himself a joy

Does the winged life destroy;

But he who kisses the joy as it flies

Lives in Eternity’s sunrise.

William Blake (1804)

I: The Challenge

Dealing with secondary traumatic stress shouldn’t be too difficult. All you have to do is minimize exposure to traumatizing scenes or feelings and maximize rewarding experiences, right? Employing the same glib logic, job satisfaction should also be easy: just minimize the unpleasant part of your job—or just don’t think about it—and maximize the pleasurable parts of your work. Just like your grandmother used to sing to you, you just have to accentuate the positive and eliminate the negative. Well, it turns out that this was strikingly bad advice.

In this chapter, I am throwing down a gauntlet. I am challenging you—in the context of your job—to gather your courage to “enter the woods at the darkest place”. Most “experts” dispensing advice to trauma workers will suggest that your job is already too hard, and you should do more to care for yourself. This isn’t that book, and that approach isn’t based on any research that I have seen. The idea that we need to minimize our negative feelings and care for ourselves more is one of the sacred mountains of our profession. I’m going to suggest—and provide evidence—that something else entirely is indicated. The positive moments that we want cannot always be pursued—we must allow them to ensue. And they will ensue, as long as we open ourselves to the hard thing. Here’s the headline of this chapter: the royal highway to job satisfaction leads through the most dissatisfying elements of your job.

Joseph Campbell said the second act of the hero’s journey begins when the hero/heroine leaves the safety and creature comforts of home and decides to “enter the woods at the darkest place”. This is a fine place to begin the second act of our story. And herein lies the evidence-based message that delivers a wedgie to that sacred mountain known as “self-care”: to a very real degree, the extent to which you enjoy your job—and can sustain in your job for the long haul—will be determined by your willingness to accept this challenge of opening up to the most aversive—anxiety-inducing, unpleasant, monotonous, or sad—aspects of your job. These are the dark places in the forest through which we must pass. That gets pretty close to the opposite of the “self-care” shibboleth. But the challenge to enter these places aligns with the research evidence: there is a direct correlation between your openness to the discomfort caused by your work and your enjoyment of your work.

II: Experiential Engagement: Avoiding Avoidance

The degree to which you like your work—or the degree to which you would like any job—is determined by how many pleasurable moments you have in that role. That makes obvious sense. But allow me to state a seemingly trite observation: we can only experience those pleasurable and meaningful moments by feeling sensations that we describe as pleasure or a sense of purpose, by a felt sense of pleasure or meaning. In other words, in order to love our jobs deeply, we must be capable of feeling deeply. The degree to which we have access to our feelings sets the stage for enjoying our work—and yes, for hating our work.

I will use a specific scenario: imagine that I am anticipating meeting with a client who was hostile and defensive in my previous interactions. I fully expect that this meeting will be unpleasant. I expect to be insulted and thwarted in my helping efforts. There are a variety of ways that I can respond as I anticipate this undesirable task: I can avoid the meeting entirely (tell my supervisor I don’t do well with this type of client and request that she be transferred to another provider); or I can meet with the client and suppress my feelings of fear and defensiveness when she is hostile toward me. Afterward, I will turn down the volume of my feelings, both to myself and my co-workers, as I proclaim, “I’m fine, no worries”.

Both of these responses represent experiential avoidance—either physically avoiding the circumstance entirely, or avoiding the unpleasant emotions that result from the interaction with the client. Perhaps you have an undeclared strategy of attempting to minimize how often you have to experience such negative exchanges. That way, your job will become more enjoyable more often. Maybe someone else who may be less provoked by this client can deal with her, while you can attend to clients more in your wheelhouse.

In the rest of our lives, the logic makes sense. Making a choice between going to a good movie or enduring an unnecessary root canal isn’t a difficult decision—of course, we want to avoid one and seek out the other. But if we employ this selective strategy in our inner world of emotions—trying to avoid negative feelings, but at the same time trying to fully experience the positive feelings—not only will we fail, but we will also set the stage for disengaging from our work. Most of our work is neither particularly dreadful nor particularly satisfying. With apologies to Johnny Mercer, the fact is, you spend most of your job day “messin’ with Mr. In-between”—most of your work is neutral in terms of emotional load.

Sam Keen was demonstrably correct when he said, “We can’t choose what to feel. We can only choose whether to feel” (1991). Emotions, it seems, are an all-or-nothing, dampen-the-bad-feelings, dampen-the-good-feelings proposition. Our feeling pathways—maintaining a “soft front”—must be equally open to both pleasurable and aversive feelings if our goal is to find pleasure and reward in our work. As the comedienne Paula Poundstone put it, “Eat the pecan pie. Don’t like nuts? Spit ‘em out. But the rest of the pie is too good to miss”.

This makes a puzzle out of the apparently self-evident formula: pleasurable experiences at work = I enjoy my job. The evidence is that it isn’t so straight-forward as that. There is a great deal of research that confirms that the reason you experience pleasurable events at work is because you have opened yourself to the aversive aspects of your work. Donaldson-Feilder and Bond came to an interesting conclusion in their research on acceptance and emotional intelligence:

People who are more emotionally willing to experience negative emotional experiences enjoy better mental health and do better at work over time. The effect is significantly greater than the effects of job satisfaction or emotional intelligence. (Donaldson-Feilder & Bond, 2004)

Allow that to land for a moment: one of the single most important determinants of your level of enjoyment in your job—and your mental health in that job—is your willingness to experience the parts of your job that you don’t like. That is why I am challenging you to “enter the woods at the darkest place”. Are you willing to look squarely at the aspects of your job that you try to avoid, and to open yourself to those activities, and to those emotions? Are you willing to enter the woods at precisely the place that you have been avoiding? In trauma work, this is not a trivial challenge. These experiences, these images, these emotions may be very intense and very frightening. It isn’t hyperbole to compare opening to those experiences as comparable to “entering the woods at the darkest place”.

Emotional Avoidance Is a Factor in Secondary Trauma

The relationship between avoidance and burnout became very clear as soon as researchers disabused themselves of the idea that burnout is caused by “over-commitment to a cause”, (Iglesias et al., 2010; Kroska et al., 2017; Naidoo et al., 2012; Polman et al., 2010; Vilardaga et al., 2011). The correlation between a person engaging in avoidance behaviors and risk for burnout is well established in the research. When your engagement is high, you will experience high amounts of vigor and commitment to your work. These things naturally occur together. When you are avoiding key parts of your job, energy and commitment to the work will diminish.

The research on secondary trauma is awaiting the same kind of enlightenment that occurred in burnout research. Heretofore, experiential avoidance has been viewed as a symptom of, rather than a contributing cause of, secondary trauma. But this hole in the research quickly closes when we remind ourselves that secondary trauma is a form of trauma. And in the trauma treatment field, we have established—to the point of exhausting—the fact that exposure (the exact opposite of avoidance) is the treatment of choice. Exposure therapy is, in effect, also learning how to avoid avoidance. If a person with a trauma history avoids memories and feelings associated with a traumatic event, we expect the sequelae of the trauma—mood disturbance, anxiety, intrusive images—to continue unabated. Persons with trauma history also must be challenged to enter the woods at the darkest place. In trauma treatment, we call it exposure therapy.

We don’t expect our clients with trauma history to get well until they do the therapeutic work of dealing with their memories and feelings. And in the same way, avoiding aspects of your work that are aversive—or feelings that are unpleasant—is an ineffective strategy for preserving your well-being on the job. Your ability to enjoy your job cannot be expanded unless your ability to fully open to the undesirable aspects of your job increases.

Avoidance Leads to Secondary Trauma and Burnout

Let’s return to the example: I am deciding what to do in anticipation of meeting with a hostile, defensive client. I decide to meet with her and—as I expected—she rejects my helping efforts and is angry and insulting towards me. I maintain a professional demeanor with her, speak to her in a reassuring, calm manner, and respond to every criticism as if it is valid feedback. In other words, I am exemplary in my professionalism. But it is exhausting to suppress my feelings of defensiveness, hurt, or anger. This suppression is the very embodiment of emotional labor (which I will discuss in Chapter 5). I am acutely aware of her anger and defensiveness, but I don’t pay attention to the defensiveness and anger that I am experiencing. I act opposite to my genuine feelings in order to maintain a professional demeanor. After the encounter, I minimize the level of provocation that I experience within myself (“That’s what I signed up for”) and with others (“No worries—I’m fine”.)

By suppressing strong feelings, I have interrupted the metabolization of these emotions (anger and fear). Because the process has been interrupted, the energy of those emotions isn’t fully expended, allowing those feelings to exist in an inchoate form that can recycle almost indefinitely. The experience itself was unpleasant—and because of the emotional hangover that carries on for hours afterwards—my work becomes a little more unpleasant. This, in turn, may lead to future avoidance of this kind of experience. Dampening down the intensity of the unwelcome feelings requires that I distance myself from the feelings—I numb my ability to feel.

As I approach work in my newly...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• About the Author
• Acknowledgments
• Foreword by Françoise Mathieu
• SECTION I: Where We Begin: The Ordinary and Familiar World
• SECTION II: Leaving the Ordinary World: Our Quest Begins
• SECTION III: Returning with the Elixir
• Index