1. Caring for the carers – protecting against vicarious trauma
Nicky Paris Counselling Service Lead St Mary’s Centre

2. Objectives What is vicarious trauma? Common signs Susceptibility
Organisational perspective
Personal perspective
Exploration of how my work impacts me
Explore what I do to care for myself
What can I do?
Here is an outline of what we intend to cover today. We will identify how we understand vicarious trauma and look at some common signs and susceptibilities.
Bernie will talk to us about the organisational response to caring for our staff.
And then we will have a short opportunity to explore some of these ideas ourselves in the groups around the tables.
In this section we will as you to think about how your work impacts upon you and you will be offered the opportunity to discuss this with the group on the table. I would ask you to consider sharing only things that you are comfortable sharing with the people around you, who you may not know, or indeed, you may know well. And if your choice is not to participate in this exercise, that is fine and is indeed an act of self care. It’s important to remember that this is a choice.

3. What is vicarious trauma?
‘negative transformation of the self of the helper that come about as a result of empathic engagement with survivors’ trauma material and a sense of responsibility or commitment to help (McCann & Pearman, 1990, p132 in Sanderson, 2013)
A process of change resulting from empathic engagement with trauma survivors’ BMA 2015
First I’d like to consider an understanding of vicarious trauma – what do you understand by the term?
there are other terms that you may have heard of in relation to working in stressful environments:
There’s burn out, which is physical and mental exhaustion as a result of cumulative exposure to emotionally demanding situations. It’s not specific to working with victims of trauma.
Other terms you may hear or have heard are secondary trauma/secondary traumatic stress
‘natural consequent behaviours resulting from knowledge about a traumatizing eventing experienced by a signficant other. The stress resulting from wanting to help a traumatized or suffering person’
Compassion fatigue: is ‘ a state of tension and preoccupation with the traumatized patients by re-experiencing traumatic events, avoidance/numbing of reimders and persistent arousal (eg anxiety) associated with the client.
Results from the natural response of empathy towards individuals who have experienced suffering (Salston & Figley, 2003)
Higher capacity for empathy may make us more vulnerable
Now considered an aspect of Secondary Traumatic Stress (Figley, 2002; Bride, 2003)
In practice, all these terms are relevant to us, and they all are terms used to describe the impact of trauma on professionals . They are all characterised by PTSD symptoms which mirror many of the symptoms seen in survivors
It is important to remember that it is normal and natural to be affected by working with our client group.
Vicarious trauma was first used in the literature in the first definition of VT from when the term was first coined in the literature
Another definition is a bit more straight forward.
Both suggest a process of change in the practitioner as a result of hearing about others’ traumatic experiences.

4. Common signs? Lingering feelings of rage/anger about clients
Becoming overly involved emotionally
Experiencing bystander guilt, shame self-doubt
Preoccupied with thoughts of clients outside work
Over-identification with clients
Loss of hope, pessimism, cynicism
Distancing, numbing, detachment
Difficulty in maintaining professional boundaries with the client, overextending
Source: BMA, 2015
I am now thinking about how we know we may be impacted by VT. It might be useful to start with some of the ways we might notice that our work is having an impact on our selves? Can you name some of the ways your work impacts upon you?
Here are some of the ways in which we might become aware of the impact of working with trauma.
I also think that one of a the key things about this definition is the change of self which could manifest in emotional change, cognitive change, behavioural change. I have a personal example of change that I’d like to share with you. A year or so after starting work at St Marys. I was out in a club one evening and I was dancing, and I had left my drink on a table with strangers. I suddenly become aware that I shouldn’t leave my drink unattended. I became anxious about this and retrieved my drink. I remained anxious for a little while, thinking about the possibility of something having been put in my drink. This is something I had never considered before on a night out. So it demonstrated a change in behaviour since increased exposure to traumatic accounts and had a emotional impact upon me and my feeling of safety in the world.
Again, I think we all experience these kinds of things to a varying degree – whether it’s thinking about a client at home or worrying about the safety of family members.

5. Susceptibility Individual factors Life situation factors
Organisational factors
So if we all may experience some degree of vicarious trauma from our work, what factors contribute to how it will impact upon us.
One way to thinking about this is to consider the different areas of our lives. We all experiences ups and downs in our lives – it’s natural. And these could be considered in three different areas.
Individual factors are things about me individually- and may be things like tiredness, health or ill-health, existing depression/anxiety.
They would also be things like a personal history of sexual trauma; or perhaps having experienced a secondary trauma reaction like experience of supporting a friend or family member through a similar event.
There are life situation factors, which is our place in our lives: and these might include family life, children, parents, social life and friendships. Do we have friends we can talk to or relax with. Consider the wellness of our family members.
And there are organisational factors, which may include things like your mix of client complexity; frequency of client work; how supportive your line management is etc.
We will all experience difficulties in these areas at different points in our lives, but you can see that if you experience difficulties in say the organisational factors area and the life situation factors area you start to move into this area where you are at increased risk of vicarious trauma. If all areas of our life are difficult simultaneously then, we are most at risk from struggling with vicarious trauma.
Equally, looking at what we can do about this, if one area of our life is difficult, perhaps there are things we can do to bolster the other areas of our lives.
Source: CAADA, 2007

6. Organisational Perspective
Duty of care to staff and patients
Sickness
Absence
Stress management
Working as a team
From an organisation’s perspective, at St Mary’s we consider vicarious trauma a risk of working in this area. We have a duty of care to our clients to work hard to ameliorate this risk. So we do organise ourselves to take the risk of VT seriously. In an organisation VT may show itself through workplace stress, sickness, absence. S

7. Personal perspective How does your work impact you?
Discuss it on your table
Write down three ways in which you are impacted by your work that you would like to share
We would like you to consider how your work may impact you?
And think about how you know that work is impacting upon you?
Do you stop sleeping for example, or perhaps you become irritable.
We can give you around 10 minutes to discuss this on your table and then please write down three ways in which your work impacts you.
We will place the post it notes on these flip charts so that you can see how our work impacts us as group.
Please write things down that you are happy to share, but you don’t need to write your name on the post its. These will not be shared verbally with the group. Please remember it is your choice as to what you want to share with the group and you can choose not to discuss your own experiences – that is fine. It is important that you look after yourself and do only what you feel comfortable with.
We will come around the room to help or answer any questions

8. Personal perspective How do you deal with these impacts?
Discuss it on your table
Write down three ways in which you cope with your work that you can share with the group
We know you already do lots to look after yourselves and have lots innovative ways of coping. Mow we would like you to think about the things you already do to cope with this impact. There will be lots of things that you do – consciously or not, so again please discuss this with your table and then write down three coping strategies that you would like to add to our wall.

9. What Can we do? Individual factors Life situation factors
Organisational factors
Maintaining physical health and fitness
Using meditation or spiritual practice
Clearly defined professional boundaries and limits
We cannot control
Availability and use of social support
Professional supervision or consultative support
Balanced work/life balance

10. How can we do it?

15. A long time ago I was a swimming instructor and when doing my lifesaving training I was taught that the last thing you do is jump in the water. That’s because a panicking person in the water is very strong and likely to pull their rescuer under. This is of no use to either of you. And is a useful analogy for working with traumatised clients.
If we imagine our clients are in the water, if we jump in – over empathise, become too involved, and too traumatised ourselves – we are going to be of no use to them. However, if we stay on the side, perhaps sometimes dipping our legs in, and throwing a life buoy, perhaps we can help our clients stay afloat, kick to the side and get them out of the water.
So how to we stay on the side if we instinctively want to jump in and rescue our clients?
Noticing

16. Final thoughts
To be affected by what being exposed to others’ traumatic experiences is normal, part of the human experience.
There is growing awareness of vicarious posttraumatic growth – the effect does not have to be negative (Manning-Jones et al, 2015).
Thank you for listening and discussing this in your groups. For me a couple of final thoughts:
I want to emphasise how it is normal to be affected by what we hear from clients and the key is to build our resilence in various ways and to recognise when we feel less resilient and to act.
The other point I think is interesting is an idea of vicarious posttraumatic growth – the idea that being affected by our work can be a positive experience too.
Thank you and as you leave the session, we’d be grateful if you would come and place your post it notes on these two charts and during the break you can come and take a look at what the group found.

17. References
British Medical Association (2015) Retrieved January 2015
CAADA, (2007) CAADA co-ordinated action against domestic abuse CAADA
Manning-Jones, S., de Terte, I., & Stephens, C. (2015). Vicarious posttraumatic growth: A systematic literature review. International Journal of Wellbeing, 5(2), doi: /ijw.v5i2.8
Sanderson, C., (2013) Counselling Skills for Working with Trauma. London: Jessica Kingsley