Working with Trauma Survivors: What workers need to know
A National Center for PTSD Fact Sheet
After a terroristic event, many individuals working as rescue workers,
health care workers, journalists, and volunteers may come into contact with
trauma survivors. Some of these people interact with survivors as the traumatic
incident is unfolding, and other situations may require contacting and working
with survivors of trauma weeks, months, or even years after a traumatic event
has occurred. These contacts may be precipitated by a memorial service,
developments in a criminal or disaster case (e.g., a trial ten months after the
event), an anniversary (e.g., commemorating a disaster), or other events.
Why is it important for those who work with trauma survivors to know about
traumatic stress?
Increases Ability to Help
It is important for those who work with trauma survivors to know about
traumatic stress because trauma survivors are in an ongoing process of healing
and recovery. For instance, a journalist
knowledgeable about traumatic stress will be more sensitive to a violent
crime victim's need to feel humanized and respected, especially after an
intentionally cruel experience.
Approaching survivors with genuine respect, concern, and knowledge about
their process increases the likelihood that you can:
- Answer some of their questions about what they may be
experiencing
- Normalize their distress by letting them know that what
they are experiencing is normal
- Help them to learn effective coping strategies
- Help them to be aware of possible symptoms that may
require additional assistance
- Reduce their perception of helpers' potential
insensitivity
- Give them a positive experience that will increase
their chances of seeking help in the future
Decreases Chance of Doing Harm
It is important to keep in mind that pressing
someone into discussion of a traumatic event soon after exposure may have a
detrimental effect on some traumatized individuals. While some trauma survivors
prefer to discuss the traumatic experience, overriding a reluctant individual's
need (1) for distance, (2) to avoid reminders of the trauma, and (3) to
dissociate in the immediate phase of a trauma, particularly in situations where
bereavement is involved, may be associated with increased risk for developing
PTSD in some individuals. This is
particularly true for those with heightened distress. Experts on traumatic stress emphasize that people have their own pace
for processing trauma, and it is important for helpers to let survivors know
that they should listen to and honor their own inner pace.
Increases Self-Care
Another reason why it is important to know about traumatic stress is so you
can apply this knowledge to yourself. While many individuals who work with trauma
survivors experience an enhanced sense of meaning, self-esteem, respect for
the strength of others, and connection with humanity, research is beginning
to show that, for some individuals, working with trauma survivors, under certain
conditions, may have negative effects. Those who work with survivors may begin
to show signs of stress disorders ranging from difficulty sleeping to PTSD symptoms
such as intrusive thoughts, avoidance, and heightened reactivity. While this
area of research is relatively new, researchers have coined a number of terms
to describe the effects of working with trauma. These terms are described below
to explain the changes workers may observe in themselves as a result of experiencing
traumatic events or witnessing the effects of those events on others.
Burnout
The term "burnout" has been applied across helping professions and
refers to the cumulative psychological strain of working with many different
stressors. It often manifests as a gradual wearing down over time.
The factors contributing to burnout include:
- Professional isolation
- Emotional drain from empathizing
- Difficult client population
- Long hours with few resources
- Ambiguous success
- Unreciprocated giving and attentiveness
- Failure to live up to one's own expectations for
effecting positive change
The symptoms of burnout include:
- Depression
- Cynicism
- Boredom
- Loss of compassion
- Discouragement
Secondary Traumatic Stress
The term "Secondary Traumatic Stress" has been coined by various authors1 to describe professional workers' subclinical or clinical signs and symptoms of PTSD that mirror those experienced by trauma clients, friends, or family members. While it is not recognized by current psychiatric standards as a clinical disorder, many clinicians note that those who witness traumatic stress in others may develop symptoms similar to or associated with PTSD. These symptoms include:
- Hyper-arousal (heightened reactivity -- startle, heart
rate, pulse)
- Intrusive symptoms
- Avoidance or emotional "numbing"
- Anxiety
- Depression
Compassion Stress
Charles Figley2 coined this term as a "non-clinical, non-pathological" way to characterize the stress of helping or wanting to help a trauma survivor. Compassion stress is seen as a natural outcome of knowing about trauma experienced by a client,
friend, or family member, rather than a pathological process. It can be of
sudden onset, and the symptoms include:
- Helplessness
- Confusion
- Isolation
- Secondary traumatic stress symptoms
Compassion Fatigue
Compassion fatigue, also coined by Figley, is considered a more severe example of cumulative compassion stress. It is a defined as "a state of exhaustion and dysfunction, biologically, physiologically, and emotionally, as a result of prolonged exposure to compassion stress"2.
Vicarious Traumatization
Vicarious traumatization was coined by Pearlman and Saakvitne3 to describe "those permanently transformative, inevitable changes that result from doing therapeutic work with trauma survivors." In their research, they noted that a number of changes were common among those mental-health workers who had clients who were trauma survivors. The changes were considered not pathological, as described for secondary traumatic stress, and were seen instead as normal cognitive or emotional changes relating to how the mental-health worker felt and thought about him- or herself. The changes were cumulative as, over time, the mental-health workers worked with several trauma survivors The changes were also pervasive in their effects on an individual's life. These changes tended to occur more often in highly empathic, sensitive individuals, those with a previous history of trauma, and newer therapists.
Vicarious traumatization can detrimentally affect one's:
- Relationship with meaning and hope
- Ability to get one's psychological needs met
- Intelligence
- Willpower
- Sense of humor
- Ability to protect oneself
- Memory/Imagery
- Existential sense of connection to others
- Self-capacities, including:
The enduring ability to maintain a steady sense of self
Tolerance for a range of emotional reactions in one's
self and others
A sense of inner connection to others
A sense of self as viable, worth loving, deserving
A sense of self that is grounded
There are a number of possible behavioral changes that might result from
vicarious traumatization, including:
- Becoming judgmental of others
- Tuning out
- Having a reduced sense of connection with loved ones
and colleagues
- Becoming cynical or angry and losing hope or a sense of
meaning
- Developing rescue fantasies, becoming overinvolved,
taking on others' problems
- Developing overly rigid, strict boundaries
- Feeling heightened protectiveness as a result of a
decreased sense of the safety of loved ones
- Avoiding social contact
- Avoiding work contact
If You Recognize These Changes in Yourself
It is recommended that an individual take steps toward self-care and lifestyle
balance if he or she is experiencing symptoms of burnout, secondary stress,
or vicarious traumatization. These steps are defined in "self care following
disasters."
Compassion Satisfaction
It is important to note that while the information above focuses on the
possible negative effects one might experience when working with trauma
survivors, there is also the possibility of a powerful sense of satisfaction
with this work. Figley has coined the term "Compassion Satisfaction"
to describe this process, which involves the development over time of a much
stronger:
- Sense of strength
- Self-knowledge
- Confidence
- Sense of meaning
- Spiritual connection
- Respect for human resiliency
Individuals who have worked with trauma survivors over time may experience
negative effects during times of heavier workloads, heightened personal stress,
and overwhelming exposure to terroristic events and their aftereffects.
However, a large majority of individuals who work with trauma survivors
indicate that it has brought great meaning into their lives, increased their
sense of purpose and strength, and heightened their sense of connection with
others. Often these individuals took breaks, sought assistance or mentoring, or
increased self-care when they began to see signs of negative effects. These professionals were able to resume
their work and/or feel decreased stress and an overall gratitude for this work
with time.
Related Fact Sheets
Mental health
professionals
Recommendations for mental health professionals
Self
care following disasters
Answers questions about what people can do to cope with PTSD and where one
can go to get help
The
media and PTSD
The communiy effects of media coverage on terroist attacks: Research from the
Oklahoma City bombing
What is PTSD?
Answers basic questions about the signs and symptoms of PTSD, who gets it,
how common it is, and what treatments are available
References
1. Stamm, B. H. (Ed.). (1995). Secondary
traumatic stress: Self-care issues for clinicians, researchers, and educators.
Lutherville, Maryland: Sidran Press.
2. Figley, C. R. (Ed.). (1995). Compassion
fatigue: Coping with secondary traumatic stress disorder in those who treat the
traumatized. New York: Brunner/Mazel.
3. Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious
traumatization in psychotherapy with incest survivors. New York: Norton.
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