www.cambridgesupervisiontraining.com Anthea Millar What is Trauma? DSM 5 (2013) Direct exposure to actual or threatened death, serious injury and abuse Witnessing traumatic events happening to those close to us. Repeated extreme exposure to aversive details of traumatic events. www.cambridgesupervisiontraining.com Anthea Millar

What is Second Hand Shock? (ref: Izzo & Carpel Miller 2010) Vicarious Trauma Secondary Traumatic Stress Compassion Fatigue, Burnout Vicarious Trauma Secondary Traumatic Stress Compassion Fatigue Burnout Izzo and Carpel Miller identify 3 modes of SHS - The terms Vicarious Trauma, Secondary Traumatic Stress and Compassion Fatigue/Burnout have often been used synonymously – but key experts in this field (eg Figley, Pesrlman and Saakvitne, Izzo and Carpel Miller) have identified differences – They are all related and overlap to some degree –and mirror symptoms associated with PTSD Compassion fatigue: Some re-experiencing of events or traumatised person / numbing off Long term exhaustion and diminished interest in one’s work – a lessening of compassion over time as a result of the taxing nature of extending compassion to those in need - apathy Burnout: different extreme circumstance – major impact on physical/and or mental well being due to impact or overload of work. Secondary Traumatic Stress: The natural consequent behaviours and emotions that result from knowledge of another’s traumatic experience. (Figley) experience intrusive thoughts, bad dreams, anxiety, insomnia, unexplained illnesses – echo of PTSD Vicarious Traumatisation: a permanent transformation in the helper’s inner experience resulting from empathic engagement with a client’s traumatic material….or simply: a set of cognitive, emotional, physical and spiritual disturbances - this workshop will focus particularly on vicarious trauma as this is more subtle and covert – creeping up slowly – Summary If feeing less compassionate /apathetic about your work PLUS GENERAL RUN DOWN: Compassion fatigue /Burnout : crisis point – running on empty If intrusive thoughts bad dreams, insomnia, PTSD type symptoms: Secondary traumatic stress - www.cambridgesupervisiontraining.com Anthea Millar

Secondary Traumatic Stress Secondary exposure to a traumatic event – happens rapidly and associated with a particular event Traumatic stress symptoms paralleling PTSD A natural rather than ‘pathological’ response. www.cambridgesupervisiontraining.com Anthea Millar

www.cambridgesupervisiontraining.com Anthea Millar Vicarious Trauma Cumulative effect of being compassionate to others when listening to the trauma experiences of others…… …..whilst ALSO controlling natural empathic responses OR being unconscious of impact of empathy www.cambridgesupervisiontraining.com Anthea Millar

Compassion Fatigue and Burnout Long term exhaustion and diminished interest in one’s work. Lessening of compassion over time as a result of the continual challenge of extending compassion to those in need www.cambridgesupervisiontraining.com Anthea Millar

www.cambridgesupervisiontraining.com Anthea Millar 16 Warning signs of Trauma exposure response Laura van Dernoot Lipsky (2009) ‘Trauma Stewardship’ 1. Feeling helpless and hopeless 2. A sense that one can never do enough 3. Hypervigilance 4. Diminished creativity 5. Inability to embrace complexity 6. Minimizing 7. Chronic exhaustion/physical ailments 8. Inability to listen/deliberate avoidance 9. Dissociative moments 10. Sense of persecution 11. Guilt 12. Fear 13. Anger and Cynicism 14. Inability to empathize/numbing 15. Addictions 16. Grandiosity: an inflated sense of the importance of one’s work www.cambridgesupervisiontraining.com Anthea Millar

The Challenge of Empathy Empathic Strain Wilson and Lindy (1994), Etherington 2009 Empathic Withdrawal Empathic Repression Empathic Enmeshment Anthea Millar

Facial mimicry and the Botox challenge Sensory feedback from the movement of facial muscles is essential to help us: Recognise our own emotions Recognise emotions in others Botox impairs this recognition (Neal and Chartrand 2011) Without facial mimicry it’s easy to misinterpret the emotional content of emails and texts www.cambridgesupervisiontraining.com Anthea Millar

Mirror Neurons (Rizzolatti and Gallese 1996) Our brains are social organs primed to tune into other’s moods and experiences When exposed indirectly to trauma our brain activates mirror neurons in the pre frontal cortex The process forms a neurological loop which creates in the listener similar body sensations as if they are actually experiencing the event www.cambridgesupervisiontraining.com Anthea Millar

Counter-Transference: The Wounded Healer and the Double Whammy Reaction TO the client in relation to our own ‘stuff’ ‘Double whammy’ when our ‘stuff’ links with the clients’. May result in stuckness and boundary difficulties www.cambridgesupervisiontraining.com Anthea Millar

www.cambridgesupervisiontraining.com Anthea Millar Boundaries Ethical issues Physical distance comfort zone Body awareness Controlled imagery exercises www.cambridgesupervisiontraining.com Anthea Millar

Body /Mind /Energy exercises ‘Un-mirroring’ Strong Back – Soft Front Zip Up Mindfulness – breathing space www.cambridgesupervisiontraining.com Anthea Millar

Organisational stress The approach of the organisation is central to prevention and reduction of vicarious and secondary trauma. Bober and Regehr (2006): www.cambridgesupervisiontraining.com Anthea Millar

www.cambridgesupervisiontraining.com Anthea Millar Books and Articles Izzo, E., and Carpel Miller, V . (2010) Second Hand Shock: Surviving and Overcoming Vicarious Trauma. Arizona:HCI Press Mathieu, F. (2012) Compassion Fatigue Workbook: Creative tools for transforming Compassion Fatigue and Vicarious Traumatisation Rothschild, B. (2006) Help for the Helper: Self-Care Strategies for Managing Burnout and Stress. New York: Norton Saakvitne, K. W., Pearlman, L. A., (1996). Transforming the pain: A workbook on Vicarious Traumatization. New York: W.W. Norton. Lipsky, Laura van Dernoot.(2009) Trauma Stewardship: An everyday guide to caring for self while caring for others. San Francisco: Berrett-Koehler. www.cambridgesupervisiontraining.com Anthea Millar

www.cambridgesupervisiontraining.com Anthea Millar Online Resources Vicarious Trauma Institute; Izzo & Carpel Miller http://www.vicarioustrauma.com/ TEND Academy http://www.tendacademy.ca Vicarious Trauma. Headington Institute http://www.headington- institute.org Compassion Fatigue: Charles Figley http://www.compassionfatigue.org/ Professional Quality of Life: Version 5 (ProQOL). www.proqol.org Carl Marci: Neurobiology and Physiology of Empathy http://vimeo.com/61816660 www.cambridgesupervisiontraining.com Anthea Millar

Cambridge Supervision Training cst CST Diploma in Supervision Sept 2017- March 2018 An Integrative Approach | Accredited by ASIIP. Two places left Next Full Diploma Sept 2018 to June 2019 All enquiries: Contact Jim Holloway on 01223 846884 email: cstpartnership@gmail.com www.cambridgesupervisiontraining.com www.cambridgesupervisiontraining.com Anthea Millar