1. Chapter 5 Secondary Trauma in Military Social Work Secondary Trauma in Military Social Work

2. Definition of Secondary Trauma Secondary trauma among mental health professionals is defined as being indirectly exposed to trauma by hearing a firsthand and vivid recounting of the trauma by the trauma survivor and the practitioner’s subsequent cognitions and emotions related to the trauma that might lead to a set of symptoms that are associated with PTSD.

3. Vicarious Trauma  Often used synonymously with secondary trauma.  Definition: The negative transformation in the helper that results from empathic engagement with trauma survivors and their trauma material, combined with a commitment or responsibility to help them.  Negative cognitive, emotional, psychological and behavioral changes similar to secondary trauma, which is why terms are often used interchangeably.  Subtle distinction: The term vicarious trauma puts more emphasis on cumulative effects on practitioners working with multiple survivors.  Often used synonymously with secondary trauma.  Definition: The negative transformation in the helper that results from empathic engagement with trauma survivors and their trauma material, combined with a commitment or responsibility to help them.  Negative cognitive, emotional, psychological and behavioral changes similar to secondary trauma, which is why terms are often used interchangeably.  Subtle distinction: The term vicarious trauma puts more emphasis on cumulative effects on practitioners working with multiple survivors.

4. Other Similar Terms  Burnout  Compassion fatigue  Traumatic countertransference  Burnout  Compassion fatigue  Traumatic countertransference

5. Burnout  A gradual wearing down over time.  A state of physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations.  A gradual wearing down over time.  A state of physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations.

6. Compassion Fatigue  The “natural” consequence of working with people who have experienced extremely stressful events.  Results from the empathetic response of the helper.  Although often used interchangeably with “secondary trauma,” it was coined to designate a more positive perspective of the helper reaction.  The “natural” consequence of working with people who have experienced extremely stressful events.  Results from the empathetic response of the helper.  Although often used interchangeably with “secondary trauma,” it was coined to designate a more positive perspective of the helper reaction.

7. Traumatic Countertransference  Entire range of the therapist’s emotional responses to client trauma material (story/event, feelings of client, etc.).  For example, the clinician responding to their own personal reaction to what an individual client says or does. The client’s problem or trauma might resemble the clinician’s troubling past or current experiences or personal issues with which the clinician is trying to cope.  Every therapist must explore his or her own reactions (which can be conscious or unconscious).  Meaningful supervision is very important.  Entire range of the therapist’s emotional responses to client trauma material (story/event, feelings of client, etc.).  For example, the clinician responding to their own personal reaction to what an individual client says or does. The client’s problem or trauma might resemble the clinician’s troubling past or current experiences or personal issues with which the clinician is trying to cope.  Every therapist must explore his or her own reactions (which can be conscious or unconscious).  Meaningful supervision is very important.

8. Impact on Clients  Disruptions in the therapeutic alliance  Attempts to rescue or control clients (poor therapeutic boundaries)  Avoidance or denial of client experiences  If schematic disruptions have occurred, the clinician’s damaged or irrational view of reality and their shattered trust and safety may make them completely unable to help traumatized clients.  Disruptions in the therapeutic alliance  Attempts to rescue or control clients (poor therapeutic boundaries)  Avoidance or denial of client experiences  If schematic disruptions have occurred, the clinician’s damaged or irrational view of reality and their shattered trust and safety may make them completely unable to help traumatized clients.

9. Assessing Secondary Trauma  The gold standard for measuring PTSD in general: Clinician Administered PTSD Scale (CAPS)  Shorter version: PTSD Symptom Scale-Interview Version (PSS-I)  Four reliable and valid self-report scales for assessing secondary trauma per se:  Compassion Fatigue Self-Test (CFST) for Psychotherapists (Figley, 1995)  TSI Belief Scale (TSI-BLS) (Pearlman, 1996)  Secondary Trauma Questionnaire (STQ) (Motta et al., 2001)  Secondary Traumatic Stress Scale (STSS) (Bride et al., 2004  Scale used by U.S. Army:  Professional Quality of Life Scale (ProQOL) to assess secondary stress in clinicians in uniform, which is a revised version of the CFST  The gold standard for measuring PTSD in general: Clinician Administered PTSD Scale (CAPS)  Shorter version: PTSD Symptom Scale-Interview Version (PSS-I)  Four reliable and valid self-report scales for assessing secondary trauma per se:  Compassion Fatigue Self-Test (CFST) for Psychotherapists (Figley, 1995)  TSI Belief Scale (TSI-BLS) (Pearlman, 1996)  Secondary Trauma Questionnaire (STQ) (Motta et al., 2001)  Secondary Traumatic Stress Scale (STSS) (Bride et al., 2004  Scale used by U.S. Army:  Professional Quality of Life Scale (ProQOL) to assess secondary stress in clinicians in uniform, which is a revised version of the CFST

10. Treatment of Secondary Trauma  The helper:  Self-help, self-care  Self-soothe; ask yourself:  Why am I anxious?  What am I trying to prove?  Who am I trying to impress?  What I am trying to fix?  Am I depending on someone else to validate my sense of self-worth?  What is the growth potential in this situation?  Support group/ group supervision  Individual therapy  The helper:  Self-help, self-care  Self-soothe; ask yourself:  Why am I anxious?  What am I trying to prove?  Who am I trying to impress?  What I am trying to fix?  Am I depending on someone else to validate my sense of self-worth?  What is the growth potential in this situation?  Support group/ group supervision  Individual therapy

11. Preventing Secondary or Vicarious Trauma  Self-awareness.  Balanced caseloads in terms of trauma clients and intensity of cases.  Self-care.  Normalization of responses.  Create a relaxing office environment.  Remember that you “empower” the client to heal; you are not responsible for their change.  Develop a support system with others who do trauma work.  Sufficient, accessible supervision, along with peer support teams.  Encourage breaks, vacation.  Debriefing procedures immediately following traumatic events.  Self-awareness.  Balanced caseloads in terms of trauma clients and intensity of cases.  Self-care.  Normalization of responses.  Create a relaxing office environment.  Remember that you “empower” the client to heal; you are not responsible for their change.  Develop a support system with others who do trauma work.  Sufficient, accessible supervision, along with peer support teams.  Encourage breaks, vacation.  Debriefing procedures immediately following traumatic events.

12. Ideas for Self-Care  Taking a run  Journaling  Long baths  Eating slowly  Hiking  Biking  Singing  Long showers  Taking a run  Journaling  Long baths  Eating slowly  Hiking  Biking  Singing  Long showers

13. More Ideas for Self-Care  Community service  Massage  Taking a vacation  Time with friends  Art  Developing a hobby  Adult competitive sports  Walking the dog  Community service  Massage  Taking a vacation  Time with friends  Art  Developing a hobby  Adult competitive sports  Walking the dog

14. Discussion Questions  What sort of self-care strategies would you employ in working with difficult and/or traumatized client populations?  In anticipation of working with combat veterans, what sort of client problems would you find most difficult to work with? And why?  What would you do to prevent compassion fatigue? And how would you recognize it in yourself?  How is your practicum organization suited to assisting you in preventing or treating compassion fatigue? Are there systemic risk factors in your place of work?  What sort of self-care strategies would you employ in working with difficult and/or traumatized client populations?  In anticipation of working with combat veterans, what sort of client problems would you find most difficult to work with? And why?  What would you do to prevent compassion fatigue? And how would you recognize it in yourself?  How is your practicum organization suited to assisting you in preventing or treating compassion fatigue? Are there systemic risk factors in your place of work?