1. Traumatic Incidents to
Taking Care
Responding to
Traumatic Incidents to
Prevent Mental Health
Deterioration
David Vittoria, LCSW, MCAP, ICADC, NCAC II
The Behavioral Health Conference
May 15th, 2018

2. Welcome
“From caring
comes courage.”
Lao Tzu

3. David Vittoria Children & Adolescents SMI Adults SUD Treatment
Hospital Administration
Concordia Behavioral Health
Trauma Resolution Services
NYC Fire Department
University of Miami
Florida International University

4. Why We’re Here
That which makes us so good at, and committed to this work, is also what makes it so difficult.

5. Why We’re Here
We do this work because we care and because we are naturally empathic.

6. n./’em-pə-thē/ or /ɛmpəᴓi
Meaningful Connection
em  pa  thy
n./’em-pə-thē/ or /ɛmpəᴓi
The action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another, of either the past or the present, without having fully communicated in an objectively explicit manner.

7. Negative Consequences & Positive Outcomes
Meaningful Connection
Negative Consequences & Positive Outcomes

8. Objectives Understand Prevalence & Impact
Define Burnout, Vicarious Trauma & Resilience
Discover How to Enhance Our Quality of Life
Embrace Trauma Stewardship

9. Objectives Understand Prevalence & Impact
Define Burnout, Vicarious Trauma & Resilience
Discover How to Enhance Our Quality of Life
Embrace Trauma Stewardship

10. Objectives Understand Prevalence & Impact
Define Burnout, Vicarious Trauma & Resilience
Discover How to Enhance Our Quality of Life
Embrace Trauma Stewardship

11. Objectives Understand Prevalence & Impact
Define Burnout, Vicarious Trauma & Resilience
Discover How to Enhance Our Quality of Life
Embrace Trauma Stewardship

12. Prevalence & Impact

13. The Emotional Price of Caring
Prevalence & Impact
The Emotional Price of Caring
Stress scores of trauma counselors are almost twice as high as those of newly widowed women and higher than patients newly diagnosed
with breast cancer.
Killian & Hernandez-Wolfe, 2013

14. The Emotional Price of Caring Social Workers / Trauma Victims
Prevalence & Impact
The Emotional Price of Caring Social Workers / Trauma Victims
39%
Reported current symptoms of burnout.
Muller, 2014

15. The Emotional Price of Caring Social Workers / Trauma Victims
Prevalence & Impact
The Emotional Price of Caring Social Workers / Trauma Victims
75%
Have experienced burnout during career.
Brown, 2017

16. The Emotional Price of Caring Social Workers / Trauma Victims
Prevalence & Impact
The Emotional Price of Caring Social Workers / Trauma Victims
83%
Have considered leaving their job.
Maslach, 2014

17. 92% Prevalence & Impact The Emotional Price of Caring
Child Protective Services / Trauma Victims
92%
Scored “high” on a measure of emotional exhaustion.
Anderson, 2011

18. The Emotional Price of Caring
Prevalence & Impact
The Emotional Price of Caring
Empathic Strain
Objective
Cognitive and/ or affective reactions that are expectable and develop in response to the client’s trauma story, behavior and personality.
Subjective
Reactions that develop from the clinician’s own conflicts and unresolved or idiosyncratic issues from their development over lifespan.
Wilson, 1994

19. The Emotional Price of Caring The Emotional Price of Caring
Prevalence & Impact
The Emotional Price of Caring
Empathic Strain
The Emotional Price of Caring
“Whether objective or subjective in nature,
empathic strain is a type of countertransference
reaction that can compromise clinicians’ ability to
be empathic with the trauma survivors they work
with. The therapeutic relationship and clinician’s
response to the survivor is injured, weakened, or
stretched beyond its appropriate boundaries.”
Wilson, 1994

20. Burnout, Vicarious Trauma & Resilience

21. Burnout & Vicarious Trauma
A depletion or exhaustion of a person’s mental & physical resources attributed to his or her prolonged yet unsuccessful striving toward unrealistic expectations, internally or externally derived.
Freudenberger, 1984
Vicarious Trauma
A state of tension & preoccupation of the stories & trauma experiences described by clients, developed over time, generally across clinical relationships & involving multiple clients.
Saakvitne, 1996

22. Burnout We have strong empathic skills. We are compassionate people.
We want to channel #’s 1 & 2 to help people.
# 3 especially true when working with survivors.
We are often stretched beyond our capacity.
Our work is extremely intense.
We have our own, personal vulnerabilities.
We work in extreme situations.
We often have inadequate training, support & resources.

23. Burnout – Top 10 Systemic Risk Factors
Excessive workload
High-stress settings (“in the trenches”)
Sense of powerlessness / minimal or no control
Frustration with bureaucracy
Insufficient resources
Stagnation – few opportunities for reward, growth
Inadequate supervision
Lack of fairness / perception of injustice
Value / ethical conflicts
Feelings of isolation / disconnection
Figley, 1995

24. Vicarious Trauma
A transformation in the trauma worker’s inner experience resulting from empathic engagement with a client’s trauma material.
Pearlman, 1995

25. Vicarious Trauma
It is considered to be a natural and inevitable outcome of engaging in work with trauma survivors.
It is not evidence of psychopathology and it is considered normal under the circumstances.
Pearlman, 1995

26. Vicarious Trauma - Signs
Preoccupation about those we’ve tried to help
Feeling overwhelmed
Feeling trapped or “on edge”
Forgetfulness about important matters
Sleep disturbance
Trouble maintaining boundaries – work and personal
Avoidance symptoms, not unlike PTSD
Pearlman, 1995

27. Vicarious Trauma - Signs
Secondary Traumatic Stress Scale (STSS)
- Intrusion
- Avoidance
- Arousal

28. Vicarious Resilience
Clinicians working with trauma survivors can be positively affected by witnessing how the survivors cope effectively and overcome significant trauma to lead healthy and meaningful lives.
Levine, 2009

29. Vicarious Resilience
A qualitative study of Jewish interviewers of Holocaust survivors found that they reported positive transformative effects, which could be considered signs of resilience, from their experiences as interviewers that they perceived to outweigh any negative impacts
they encountered.
Levine, 2009

30. Vicarious Resilience
The positive effects included an increased appreciation for their own life and good fortune; deepened appreciation for the resilience and strength of Holocaust survivors; enhanced empathy, compassion, and sensitivity toward survivors and other people in general; a greater sense of justice; a stronger identification as a Jew; and a greater sensitivity to prejudice.
Levine, 2009

31. Enhancing Our Quality of Life
(5 Things You Can
Do Right Now!)

32. Enhancing Our Quality of Life
1. Self-Assessment.
Professional Quality of Life Scale (PROQOL)
measures compassion satisfaction and compassion fatigue.
Available at:

33. Enhancing Our Quality of Life
2. Continuing education.
International Society of Traumatic Stress Studies (ISTSS) provides updated information about trauma workshops & CEU’s.
Information at:

34. Enhancing Our Quality of Life
3. Personal therapy.
Association for Traumatic Stress Specialists (ATSS) provides information on therapists who work with clinicians.
More at:

35. Enhancing Our Quality of Life
4. Supervision.
Five key components should be covered in the supervision of trauma therapists:
Theory
Education
Relationship
Safety
Vicarious Trauma

36. Enhancing Our Quality of Life
5. Mindfulness.
Compassion meditation for caregivers helps us maintain a state of balance and
live in the moment.
Consider trying apps and podcasts such as:
Calm
Headspace
10% Happier

37. Trauma
Stewardship

38. Trauma Stewardship

39. Trauma Stewardship
TraumaStewardship.com

40. Resources

41. David Vittoria, LCSW, MCAP, ICADC, NCAC II
Thank You!
David Vittoria, LCSW, MCAP, ICADC, NCAC II
Office: (305)
Cell: (305)