The experts agree that it is normal to be affected by our work. Where this requires us to engage empathetically on a repeated basis with those who are traumatised, then we must be mindful of our exposure to vicarious trauma. Empathy triggers our mirror neurone network so that we mimic those we are working with. We identify their feelings, and experience a similar physical sensation to what is being presented.
Trauma can result in Post Traumatic Stress Disorder, and the re-experiencing of associated symptoms, including avoidance and numbing, a negative alteration in cognition and moods, and a marked alteration in arousal and reactivity. There can be significant changes that flow from the trauma, including an enhanced threat perception, the part of the mind that says the body is OK going into survival mode, the experience of what is and what is not dangerous becoming disjointed, the sense of self being blunted, and an inability to connect with available supportive people.
This can be anticipated as likely where there are contributing factors including:
- Horrific abuse stories;
- Current danger;
- Intensity of suffering;
- Difficult interpersonal style;
- Self destructive behavior;
- Multiple problems, limited resources;
- Vulnerability such as for children.
To deal adequately with a traumatised client it is recommended that you must:
- Understand the brain and the impact of trauma;
- Respond to trauma in a positive way to maximise a sense of safety, trust, collaboration, choice and empowerment;
- Recognise the responses to trauma as shaped by the trauma, and coping mechanisms or attempts at protection;
- Respond in ways to maximise the avoidance of triggering the flight/fight/freeze response (give space, present as calm and reassuring, listen deeply, be non-judgmental, do not retraumatise the client unnecessarily);
- Use a strength based approach (boost self-esteem);
- Be sensitive to issues around culture, age, gender, identity etc;
- Introduce and maintain boundaries, do this early, be understandable and consistent;
- Encourage the establishment of relevant support networks;
- Be aware of the risk of vicarious trauma.
It is also important to recognise when a client has moved outside their ‘window of tolerance’. By appreciating your own ‘window of tolerance’ you can remain aware of when you are within this, and when you have moved outside of this, and take appropriate action. If you know that the client has moved outside or is at risk of doing so, you should take action including:
- repeating what you are saying again;
- Finding other ways of presenting the information;
- Timing the giving of information;
- Asking the client to repeat what has been said to ensure they have heard and understood this;
- Ensuring they have appropriate supports.
Symptoms that may indicate you are experiencing VicariousTrauma include:
- Using alcohol to deal with or manage feelings;
- Emotional numbing;
- Feeling less for family, friend, client;
- Avoiding reminders of client’s trauma;
- Keeping super busy to avoid feelings;
- Increased sickness
Signs may include:
- Intrusive thoughts regarding the client’s trauma;
- Nightmares regarding the trauma;
- Reacting to triggers related to the client’s trauma;
- Increased sensitivity to violence;
- Client related intrusive thoughts during intimacy;
- Increased startle response;
- Impatient, less tolerant;
- Changes in spirituality;
- More negative view of the world, self, and/or others;
- Despair, hopelessness;
- Difficulty managing feelings;
- Reduced insight, decision-making capacity;
- Reduce self care;
- Difficulty setting boundaries;
- Trusting less;
- Reduced sense of safety;
- Lower sense of control;
- Less able to connect;
- Reduced respect for clients.
The major factors for resilience are Peer Support and Self Care. There has been considerable work done in this area and one theory for resilience involves the notion of BANC.
- Make personal life a priority;
- Manage boundaries;
- Manage your day;
- Manage trauma/client load;
- Have realistic expectations;
- Stay open hearted but not exceeding boundaries;
- Be clear as to professional role;
- Refer to other appropriate supports;
- Step back when appropriate;
- Stay helpful but not in the rescue mode.
- be aware of and accept the impact of your work;
- Monitor for signs;
- Learn how to calm the body and mind;
- Seek counselling for exposure to trauma;
- Limit unnecessary exposure to trauma;
- Make the work space nurturing .
- refuel, rest, escape, play;
- Attend to physical health;
- Training and supervision;
- Remember the value of the work you do and celebrate success;
- If needed ask for more resources.
- Foster hope;
- Create meaning in life;
- Challenge your negative views;
- Connect to self;
- Participate in a community;
- VT support;
- Positive culture re VT.
If you feel that you are being affected by the Trauma of those you are assisting, then speak to your colleagues and if this persists, then seek professional support.
These ideas can be further explored at http://www.bernadettehughes.com.au/