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Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT February 27, 2004 "Few men during their lifetime come anywhere near exhausting the resources
dwelling within them. There are deep wells of strength that are never used." - Richard E. Byrd
Short Subjects
LINKS Rocky Mountain Region
Disaster Mental Health Institute
CONFERENCES AND WORKSHOPS:
CRISES IN RURAL AMERICA
Crisis Interventions And
Critical Incident Stress Management:
Current Status and Future Directions
April 21-24, 2004
Casper, Wyoming
Registration: 1-800-442-2963 ext 2212
Society of Australasian
Social Psychologists 33rd Annual Meeting
April 15 - 18, 2004
Location: Auckland, NEW ZEALAND
27th National AACBT Conference
(Australian Association for
Cognitive and Behavior Therapy)
May 15 - 19, 2004
Location: Perth, Western Australia
AUSTRALIA
Society of Australasian Social Psychologists
33rd Annual Meeting
April 15 - 18, 2004
Location: Auckland, NEW ZEALAND
Contact: SASP@auckland.ac.nz
Deadline for submissions: 1 February 2004WFPHA 10th International Congress on
Public Health: Sustaining Public Health
in a Changing World: Vision to Action
April 19-22, 2004
Location: Brighton, ENGLAND
Contact: Allen K. Jones, PhD
Secretary General World Federation of
Public Health Associations
Email: stacey.succop@apha.orgXIV. IFTA World Family Therapy Congress
March 24 - 27, 2004
Location: Istanbul, TURKEY
14th Biennial Meeting of the Society
for Research in Human Development
(formerly the Southwestern Society for
Research in Human Development -- SWSRHD)
April 1 - 3, 2004
Location: Park City, Utah, USA
7th European Conference on Psychological Assessment
April 1 - 4, 2004
Location: Malaga, SPAIN
Contact: Antonio Godoy
Facultad de Psicologia
Universidad de Malaga
29071 Malaga.( SPAIN)
Tel. (34) 952 13 25 32
Fax (34) 95213 11 00
Email: godoy@uma.esAnnual Conference Society for
Industrial/Organizational Psychology (SIOP)
April 2 - 4, 2004 Location: Chicago, Illinois, USA
Email: lhakel@siop.bgsu.edu
Under Secretary Brown Visits Colorado
Homeland Security Under Secretary Mike Brown was in Colorado to find out what that state has done to become more hazard resistant, from wildfires to terror threats. Brown also met with staff from various DHS agencies to learn how they are working together, as the Deparment's one year anniversary approaches on March 1.
FEMA Review Of Tire Recycling Facility Fire Shows Small Towns Can Respond Effectively To Major Incidents
A technical review of a fire at a Nebraska tire recycling plant – which took 11 days to extinguish and posed an environmental threat to the Missouri River – is being released by the Department of Homeland Security’s Federal Emergency Management Agency (FEMA) today. According to the report, the facility that was recycling tires was not designed for that use and adequate safe guards were not in place. The report urged fire departments facing such situations to be proactive in the permitting and zoning process whenever possible. For the Full Story, Go To: http://www.fema.gov/news/newsrelease.fema?id=11269
FEMA Review Of Eleven-Alarm San Jose, Calif., Fire Underscores Challenges Posed By Extremely Large-Scale Incidents
A technical review of the worst fire loss in San Jose, Calif., history – damages of more than $90 million – is being released by the Department of Homeland Security’s Federal Emergency Management Agency (FEMA) today. According to the report, San Jose fire officials identified county-wide radio/data interoperability, the need for additional radio frequencies and reviewing the mutual aid plan as priorities to be addressed based on lessons learned in the October 2002 fire.
“This was an extremely large fire that spread beyond the initial construction site to engulf nearby housing, putting many firefighters at risk and leaving many families homeless,” said Michael D. Brown, Under Secretary of Homeland Security for Emergency Preparedness and Response. “While the San Jose Fire Department was able to manage the incident without any fatalities and only minor injuries, there is much to be learned from the fire.” For THe Full Story, Go To: http://www.fema.gov/news/newsrelease.fema?id=11248
U.S. Department Of Homeland Security Issues First Standards For Personal Protective Equipment For First Responders
The U.S. Department of Homeland Security’s Science and Technology division adopted its first standards regarding personal protective equipment developed to protect first responders against chemical, biological, radiological and nuclear incidents. These standards, which will assist state and local procurement officials and manufacturers, are intended to provide emergency personnel with the best available protective gear. "Secretary Ridge and I are delighted to release the Department’s standards for personal protective equipment for chemical, biological, radiological and nuclear incidents," said Dr. Charles McQueary, Under Secretary, Science and Technology. "We know these guidelines will be helpful to state and local first responders as they use technology to protect themselves and our citizens from these potential threats." For the Full Story, Go To: http://www.fema.gov/press/ap/dhs022704.shtm
CARICOM, Haiti appeal to Security Council for help as security worsens
Given its long record of deploying peacekeeping missions, the United Nations has a special responsibility to help Haiti during a rapidly deteriorating political and security crisis, Jamaican Foreign Minister Keith D. Knight told the United Nations Security Council. For Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9906&Cr=haiti&Cr1=
Annan appoints John Reginald Dumas as his Special Adviser on Haiti
United Nations Secretary-General Kofi Annan announced that he has appointed Trinidad and Tobago's John Reginald Dumas as his Special Adviser to help tackle Haiti's escalating political, economic and social turmoil. For Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9908&Cr=haiti&Cr1=
Odds stacked against indigenous children, UNICEF research shows
Indigenous children have higher mortality rates and lower rates of school enrolment than other children, making them among the most marginalized people in the world, according to research released by the UN Children’s Fund (UNICEF). For Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9876&Cr=Indigenous&Cr1=
Funds needed to avert disaster for millions of Southern African children - UN
Millions of children across Southern Africa are at risk because of a lack of international funds and support, eight United Nations agencies warned today as they launched a mid-term review of their financial appeal for the region. For Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9900&Cr=southern&Cr1=africa
Introduction to New Research: Navigating Complex Treatment Options for ADHD
While many treatments for ADHD are currently available, understanding the drugs both mechanistically and pharmacokinetically can enable clinicians to choose the appropriate therapy for their patients. For the Article, Go To: http://www.medscape.com/viewarticle/464787
Genetic and Phenotypic Advances in ADHD
Research in ADHD has revealed high heritability of the disorder, and many risk factors have already been identified. Still, the nature of the risk incurred by these genes and the mode of inheritance remain largely unknown. For the Article, Go To: http://www.medscape.com/viewarticle/464788
New Research in ADHD
A great deal of new data is available on new approaches and new pharmacologic formulations and treatments for children, adolescents, and adults with ADHD. For the Article, Go To: http://www.medscape.com/viewarticle?464789
Parents of Children With ADHD May Have ADHD Themselves
Parents of children with ADHD are likely to have the disorder themselves and may benefit from treatment, according to the results of a comparison study published in the December 2003 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. For the Article, Go To: http://www.medscape.com/viewarticle/466863
The Impact of Managed Care: Comparison of Case Rate and Fee-for-Service Financing for Persons With Severe Mental Illness
Results of this study raise concerns about the desirability of capitation or capitation-like financing mechanisms for publicly funded SMI patients and, in particular, its long-term effect on illness recovery. for the Article, Go To: http://www.medscape.com/viewarticle/466934
THE MEDICAL MINUTE: EATING DISORDERS AFFECT ENTIRE BODY
Eating disorders have become increasingly more common among young women in our society. We live in a culture preoccupied with being thin. In vulnerable young women these pressures can interact with other biological, psychological and social factors and lead to an eating disorder. According to the latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, eating disorders are serious medical conditions that can affect every organ of the body. Anorexia nervosa and bulimia nervosa can have significant, sometimes irreversible medical complications. However, the prognosis is favorable with early recognition and aggressive treatment. Read the full story at http://live.psu.edu/story/5753
VICARIOUS TRAUMATIZATION
Introduction
A unique feature of some mental health practitioners' work is exposure through their role as therapists to clients' descriptions of and reactions to trauma. These experiences may actually indirectly cause distress and traumatization to the therapist. This phenomenon has been termed "vicarious traumatization". The concept of vicarious traumatization, together with other related concepts such as "burnout," "compassion fatigue," "secondary traumatic stress", and "work stress" are important areas of research. Sabin-Farrell & Turpin (2003) conclude that the evidence to support the existence of vicarious traumatization is meager and inconsistent.
Intervening in severe crises or bearing witness to human tragedy, can take its toll on the individual. Effects can include severe, debilitating anxiety that persists for months and sometimes even years following the event. Because these people are not directly involved in the event, their distress often goes undetected. Support resources for people who are indirectly affected by a traumatic event are limited. To date, a history of previous trauma, previous psychological well-being, social support, age, gender, educational achievement, socio-economic status and styles of coping have been highlighted as mediating the effects of indirect exposure to a traumatic incident. Understanding this phenomenon and the mechanisms precipitating such distress is an important step in providing appropriate help for a large number of people indirectly affected by tragic events.
Vicarious traumatization refers to changes that occur in therapists' views about themselves, others, and the world as a result of extensive work with trauma survivors. In addition, research has found that therapists working with trauma survivors are at increased risk for developing PTSD symptoms. Vicarious traumatization is a concept used to understand the impact of trauma work on clinicians. Cunningham (2003) studied clinicians working with two types of trauma: (1) the human-induced trauma, sexual abuse, and (2) the naturally caused trauma, cancer. Clinicians who worked primarily with clients who were sexually abused reported more disruptions in cognitive schemas than clinicians who worked with clients who had cancer.
Therapists are at risk for vicarious traumatization as a result of their empathetic engagement with clients who are survivors of trauma. Similar to the ways in which trauma impacts the survivors themselves, exposure to the traumatic material of clients can affect a therapist's sense of meaning, identity, world view, and beliefs about self and others. Training and supervision, in addition to other factors, may serve to protect therapists from this type of traumatic reaction. Lybeck-Brown (2003) examined the role that training and supervision play in therapists' experiences of this phenomenon. Individual interviews were conducted with each of ten therapists. The therapists were chosen based on the varied training settings and clinical work that they had experienced. Transcriptions of the interviews were subjected to qualitative content analysis based on the grounded theory method (Strauss & Corbin, 1990; 1998). This process involved multiple levels of sorting and coding, resulting in the description of five overarching themes that emerged from the data. The role of coping, particularly as it relates to a therapist's experiences of training and supervision, emerged as a critical factor in explaining the impact of working with clients who are survivors of trauma.
The negative effects of vicarious traumatic exposure are well known. However, less is known about potential positive changes following vicarious exposure. Respondents living in Britain (n=108) were surveyed about their vicarious exposure to the terrorist attacks of September 11 (Linley, Joseph & Cooper, 2003). They also completed measures of their perceptions of the events of September 11, and positive (valuing friends and family more) and negative changes (loss of meaning, greater anxiety). Results revealed that respondents who perceived the terrorist attacks to be an attack on their own values and beliefs, or the work of religious fanatics, were more likely to report positive changes. Negative and positive psychological changes were positively associated.
Collins & Long (2003) explored how interacting with seriously traumatized people has the potential to affect health-care workers. Their review begins with an introduction to post-traumatic stress disorder as being one of the possible negative consequences of exposure to traumatic events. They examined the concepts of vicarious traumatization, secondary traumatic stress, traumatic countertransference, burnout and compassion fatigue, as potential adverse consequences for workers who strive to help people who are traumatized. Findings suggested that compassion satisfaction is a protective factor which can be used as a buffer to prevent the aforementioned concepts. Conversely, findings have shown that a history of previous stressful life events in helpers is a potential risk factor. Collins & Long caution against generalization of the findings owing to the dearth of longitudinal studies into the issues raised and also the lack of investigation into the many different types of trauma.
The concept of Secondary Traumatic Stress has only been in the literature since 1995 (Dalton, 2001). The growing body of research indicates that individuals in helping professions are at risk not only of experiencing stress, but also of developing pathological responses to learning of another's traumatic experiences.
Therapist Characteristics
In recent years, there has been a considerable increase in research on adult attachment and on the negative reactions of mental health professionals as a result of working with trauma survivors. These negative reactions are known as vicarious traumatization. A four-category model of adult attachment proposed by Bartholomew and Horowitz (1991) and vicarious traumatization theory share a common conceptual framework. Both sets of researchers assess their constructs based on the distinction between working models of self and other. Brandon (2000) examined (a) the relationship between attachment style and vicarious traumatization on the dimensions of self and other, (b) the attachment styles of mental health professionals when compared to psychology graduate students to determine if professionals' attachment styles may be disrupted by their clients' traumatic material, and (c) the relationship between work experience, personal trauma history, and vicarious traumatization among mental health professionals. A group of 46 psychology graduate students filled out a measure of adult attachment and a demographics questionnaire to serve as a comparison group for mental health professionals. A group of 140 mental health professionals returned a demographics questionnaire, a modified measure of adult attachment style, and a measure of vicarious traumatization. Professionals who reported that greater than 50% of their clients were trauma survivors were classified as trauma workers (n = 89), and the other professionals were classified as counselors (n = 51). Results suggested that a majority of the trauma workers were trauma survivors. There was not a significant relationship between overall level of vicarious traumatization and time spent as a trauma worker or history of personal trauma. Also, there was not a significant interaction between vicarious traumatization and attachment on the dimensions of self and other. There were significant differences in the overall level of vicarious traumatization for the adult attachment styles, with securely attached professionals indicating fewer disruptions than those in the other styles. When the attachment styles of the three groups were examined, results suggested that overall, these participants did not endorse a significantly different pattern of attachment styles.
McLean, Wade & Encel (2003) surveyed a sample of 116 Australian therapists who identified themselves as working primarily with traumatized clients. Outcome variables were measures of vicarious traumatization, burnout and trauma symptomatology (intrusion and avoidance). A measure of beliefs about the therapeutic process was constructed and examined along with other predictor variables, namely years of experience as a therapist, percentage of time spent in clinical work with clients, predominant client group, and recent and direct exposure to trauma in the therapist. Therapist beliefs were found to predict vulnerability to vicarious traumatization and burnout, supporting a cognitive model of therapist distress.
Kim (2000) examined several factors thought to be significant contributors in the development and maintenance of vicarious traumatization. Kim examined the effects of vicarious exposure to traumatic material via working with trauma clients, therapists' past personal trauma histories, amount of trauma work experience, quality and satisfaction with supervision/consultation, and colleague context. Overall, there was relatively little vicarious trauma or distress in the present sample of therapists, who on average tended to be older, more experienced therapists. Results suggest that vicarious exposure to traumatic material may indeed significantly contribute to therapist distress, though its impact may be confounded by other related factors. More direct trauma and stress associated with therapists' own past personal trauma histories, consultation, and colleague context seemed to have a greater impact than vicarious exposure to traumatic material on therapists' general distress level. There was no support for the moderating effects of past personal trauma, years of trauma work experience, consultation, or colleague context. Recommendations included using a variety of measures to assess both symptomatic and cognitive aspects of vicarious traumatization, and more careful sampling procedures to obtain therapists who are relatively less experienced in providing trauma therapy. It was suggested that those who are quite clinically experienced may have already found appropriate strategies for coping effectively with the impact of vicarious exposure to trauma, and that the impact of vicarious exposure is most likely to be evident in younger, less experienced clinicians or those still in training.
Weaks (2000) examined vicarious trauma and coping in psychotherapists as they are related to a reduction in posttraumatic stress disorder (PTSD) and disruptions in cognitive schemas. Seventy-one percent of therapists experienced PTSD symptomatology that was clinically significant. There was no support for the hypothesis that therapists with doctoral degrees and more than 10 years of professional experience would experience less PTSD symptomatology and fewer disruptions in cognitive schemas than therapists in all other conditions. There was no support for the hypothesis that therapists with a trauma history experience more symptomatology when treating adults who were traumatized recently than when treating adults who were traumatized long ago. Therapists with a personal history of trauma were also expected to experience greater PTSD symptomatology and more cognitive disruptions when they treated children traumatized recently than when they treated adults recently traumatized. Traumatized therapists experienced more intrusive symptomatology but no more avoidance or cognitive disruptions than therapists with no trauma history. Prediction models were tested for individual and professional factors that buffer a therapist from vicarious trauma. Individual factors that were expected to mediate the effects of vicarious trauma included lower levels of education, fewer years of professional experience, female gender, lower levels of income, coping style and younger age. Professional factors that were expected to mediate the effects of vicarious trauma include having fewer hours of trauma-specific training and having a low percentage of survivors in one's current and cumulative caseload. Therapists who employed emotion-focused coping strategies had significantly higher levels of PTSD symptomatology but no more disruptions in cognitive schemas than therapists who employed emotion-focused coping styles.
Empathy
The vicarious traumatization literature suggests that exposure to patients' traumatic material can have serious physical, emotional, and psychological effects on healthcare providers. Although there is a wealth of literature examining the effects of vicarious trauma on the mental health worker, few empirical studies have explored its effects on medical personnel, particularly those working in emergency room settings. Lowe (2002) examined the relationship between vicarious traumatization, quality of attachment, and defensive style in the emergency room. Vicarious traumatization was defined as the transformation that occurs within the trauma worker as a result of empathic engagement with patients' trauma experiences and their sequelae. Attachment was understood as the propensity of human beings to make strong affectional bonds to others and defensive style related to one's response to perceptions of real or psychic danger. Two hundred and thirty-five men and women from hospitals (emergency room and non-emergency room settings) and universities in the New York/New Jersey area completed a series of self-report measures assessing their exposure to traumatic material, their self-reported attachment style, and their use of defense mechanisms. Securely attached participants who worked in the emergency room were significantly less likely to suffer from vicarious traumatization than non-securely attached participants. Use of mature defenses was also found to be significantly correlated to secure attachment style. Emergency room and non-emergency room workers did not differ significantly in relation to their level of vicarious trauma or to their degree of traumatic symptomatology. Defense maturity was also not significantly correlated with work setting (i.e., emergency room vs. non-emergency room).
Moosman (2002) investigated the roles of therapist empathy and trait arousability in the development of vicarious traumatization. Participants included a nationwide sample of 183 therapists who are members of the ISTSS. Vicarious traumatization was measured by examining PTSD levels and disruptions in cognitive schemas. The role of empathy style in the development of vicarious traumatization was explored by measuring therapists' emotional empathy and personal distress empathy. In addition, therapists' tendency to become easily emotionally aroused was assessed as a potential risk factor. While therapists who worked with a higher number of trauma clients were found to be at greater risk for developing PTSD symptoms, results provided substantial evidence that therapist characteristics also play a significant role in determining which therapists are most impacted by working with trauma survivors. While general emotional empathy, a more mature form of empathy, was not found to predict vicarious traumatization, therapists who experience personal distress when they empathize with their clients were found to display more signs of vicarious traumatization. Related to this, therapists who tend to be highly emotionally reactive were also at greater risk for experiencing vicarious traumatization. Lastly, male therapists were found to experience greater disruptions in their cognitive schemas. These findings suggest that vicarious traumatization appears to be a multi-determined phenomenon that is affected by both external factors and therapist characteristics.
The secondary effects of treating traumatized people on helping professionals have been established in the literature. However, the psychological processes involved in vicarious traumatization have remained poorly understood. Friedman(2002) examined the role of empathic processes in empathic distress, a less extreme form of vicarious traumatization, within the context of a simulated psychotherapy situation. Participants' physiological, affective, and cognitive responses to a target-patient's traumatic situation were assessed using various measures as a function of individual differences in empathy and exposure to traumatic material. Eighty-eight female participants were pre-selected for this study in terms of their dispositional empathic abilities. They were randomly assigned to observe a target-patient discussing a high or low trauma situation. Participants reported on their use of problem- and emotion-focused coping as ways to manage stressful situations. Participants who were exposed to highly traumatic material were more likely to experience affective distress, as well as increased physiological reactivity. High empathizers exhibited greater empathically based physiological reactivity as a result of exposure to trauma, while they did not generally self-report more affective distress. Instead, evidence was found for an alternative trend. Low empathizers self-reported more affective distress, but not physiological reactivity, as a result of experimental exposure. Cognitive processes, such as the adoption of a self- or other-focused orientation and the transmission of traumatic material, were related to individual differences in empathy and exposure to trauma. Two different forms of problem-focused coping, planful problem-solving and confrontive coping, were influenced by both individual differences in empathy and exposure to trauma. Emotion-focused coping was affected only by individual differences in empathy. Results from this research suggest possible implications about empathy's contribution to the development of vicarious traumatization within the therapeutic context.
Lugris (2001) found that therapists' personal variables of sex, personal trauma history, and current stressfulness of personal trauma predict PTSD symptoms, while variables that include vicarious exposure to trauma and perceived social support predict hyperarousal symptoms and cognitive distortions above and beyond the effects of therapists' personal variables. Qualitative results revealed the importance of maintaining a balance between professional and personal support, a holistic attention to body and mind that includes physical exercise and self-care, spirituality and meditation, leisure activities, cognitive strategies, and personal growth activities.
Some psychotherapists who work with clients with a history of severe trauma have reported intrusive images, thoughts, nightmares, avoidance and other PTSD symptom-like behaviors related to their clients' traumas. Wertz(2001) studied therapists who are most prone to or capable of vicariously sharing the feelings and experiences of their clients. They hypothesized that they would be more likely to manifest PTSD symptom-like behaviors. One hundred and fifteen psychotherapists (83 females, 32 males) who had worked with trauma clients completed a set of self-report questionnaires. These questionnaires were used to measure levels of absorption and emotional empathy, and to obtain pertinent background information as well as information about PTSD symptom-like experiences related to trauma clients. Survey results suggested that it is common for trauma therapists to experience PTSD symptom-like behaviors related to their work. These behaviors do not constitute diagnosable PTSD reactions. Analyses revealed that both therapist level of absorption and emotional empathy predicted the extent to which the PTSD symptom-like behaviors reported by therapists resembled PTSD reactions. Absorption predicted the number of reexperiencing (intrusion) PTSD symptom-like behaviors reported and the total number of PTSD symptom-like behaviors reported. Personal trauma history predicted reexperiencing behaviors and the extent to which the PTSD symptom-like behaviors reported resembled PTSD reactions. Neither cumulative exposure nor recent exposure were related to reports of these behaviors.
Burnout
There have been many research studies on burnout. However, few have investigated burnout in long term care nursing staff. Glidewell (2001) investigated a proposed process model for the development of burnout using vicarious traumatization, coping styles, and empathy as predictor variables. Nursing staff from 10 long term care facilities (N = 160) completed questionnaires measuring burnout, vicarious traumatization, empathy, and coping styles. A statistically significant relationship was found between vicarious traumatization and burnout, which is contradictory to much of the present research findings. The proposed process model of burnout was not supported, although several predictive relationships were present.
Vicarious Trauma And September 11
A variety of recent research studies have investigated the psychological impact on victims of the devastating events of September 11, 2001. Eidelson, D'Alessio & Eidelson (2003) adopted a different approach focusing on the experience of caregivers through a brief survey of state psychological association members. Overall, practitioners described modest but significant changes in both their professional work and their personal lives. Unsurprisingly, those respondents working closest to Ground Zero reported the greatest changes. The sample also reported more positive than negative feelings regarding their work in the post-9/11 environment. Although the survey return rate was only 15%, the findings shed light on several important professional issues related to disaster relief, including service utilization, preparedness, and vicarious traumatization.
McGowan (2002) discusses the emotional stages that humans pass through when sorting out violent tragedies like the World Trade Center and the Pentagon attacks. Observation and conversations with more than 400 severely affected New Yorkers displaying symptoms of acute, vicarious traumatic stress led to the development of 'Stage Theory' and the suggestions that follow. The first stage is shock and disbelief. Stage two involves questioning and defining reality. Sadness as a reflection of emotionally charged media imagery is also part of this stage. The third stage involves anger and rage. Anger is part of the healing process. The way one manifests behavior with this flood of anger, however, is a matter of concern. Psychologists, social workers and medical professionals must be proactive, listening to people and acknowledging their feelings. They must encourage individuals to substitute negative feelings derived from anger with positive actions. The fourth and final stage of processing--personal interpretation and understanding--is when one puts the events in context. McGowan encourages Forensic professionals to lead by example, as they are the role models for other people.
The tragedy of September 11, 2001 traumatized a nation of people and demanded an immense mental health response. What would be the effect on the disaster mental health workers called to serve victims and relief workers? The theories of secondary trauma and vicarious traumatization point to the potential for therapists to experience PTSD-like symptoms as a result of exposure to clients' traumatic material. Creamer (2002) examined secondary traumatic stress in disaster mental health workers who responded to the attacks of September 11 and explored the relationship between secondary traumatic stress symptoms (using the Impact of Event Scale) and coping strategies (using the Ways of Coping Questionnaire; WCQ), personal trauma history, cumulative and recent exposure to trauma clients in one's typical work environment, and level of direct exposure in the disaster mental health assignment. Of 100 packets mailed to disaster mental health volunteers who provided services in New York City, Washington, DC, and surrounding areas, 81 were completed and returned. Participants represented various disciplines and disaster relief organizations. Results indicated that three of the WCQ subscales that assess adaptive coping were significantly associated with higher levels of secondary traumatic stress, a finding in the opposite direction of that expected. A fourth WCQ subscale assessing maladaptive coping was also significantly associated with more secondary traumatic stress symptoms, as predicted. Higher levels of secondary traumatic stress were found to be significantly related to the following variables: greater cumulative and recent exposure to trauma clients in one's work environment outside of disaster relief work (measured in average hours per week), fewer years of experience (measured in years since license), younger therapist age, greater length of disaster mental health assignment, and higher percentage of time spent with (a) clients who discussed morbid or graphic material, (b) clients who discussed sensory-related memories, and (c) child clients. The following variables did not exhibit significant relationships with secondary traumatic stress: personal trauma history, timing of disaster mental health assignment (i.e., temporal proximity to the disaster), percentage of time spent with clients working near the debris of a collapsed structure, and number of therapist's sensory-related memories from disaster mental health assignment.
Vicarious Trauma In Viet Nam Veterans
Combat soldiers of the Vietnam War have made great gains in their search for wholeness through numerous programs that help them deal with the psychological effects of war. Noncombat soldiers have been left behind, because conventional wisdom affirms that they did not suffer the same trauma as combat soldiers. Pasternak (2002) found that noncombat soldiers have also suffered from war, and in similar ways. Through vicarious trauma, the men in this study have lived with different but no less painful memories of the war. Some suffered by having to treat the injured soldiers who returned from Vietnam, and others by hearing stories of atrocities committed by their brother soldiers. Guilt played a large part in the stress and trauma that many suffered during their time in the military. These included: the guilt of not going to war when others did; the guilt resulting from anger toward the government for allowing so many of their comrades to die in a country that few had ever heard of. The loss of fellow soldiers, family members, and friends to this war weighs heavily on each participant. The fear of death from nuclear attack during the Cold War, or even from conventional weapons in sensitive regions, has added to the effect on these individuals. Some were traumatized by the American people's hatred of the war and were inadvertently targeted when in uniform by protesters. Others were ridiculed by World War II veterans, because Vietnam was not fought like their war. Men who were interviewed by Pasternak discussed some type of negative effect from serving in the military during Vietnam, and several broke down and cried when they remembered the stresses and losses they felt. This remembrance comes more than 30 years after they left the military, and it still deeply affects them today.
Care For Responders
Regehr (2001) suggests that rescue workers who are exposed to mutilated bodies, mass destruction, multiple casualties, and life threatening situations may become the hidden victims of disaster. In response to concerns about the mental health implications of exposure to work-related trauma in emergency service personnel, the crisis debriefing model has arisen as an early intervention strategy designed to mitigate stress reactions. However, controversy has arisen about the efficacy of the crisis debriefing group model. Initial reports supporting the efficacy of crisis debriefing groups have relied on anecdotal evidence, client satisfaction surveys, and clinical impressions of group leaders. Subsequent research has suggested that the model fails to reduce and may in fact exacerbate symptoms of post-traumatic stress disorder. Regehr reviewed the crisis debriefing model as it has been applied to workers in various emergency fields and discusses the conflicting data surrounding efficacy. She concludes that there is some empirical support for the social support and psychoeducational components of the model. However, the component of the model that reviews graphic details of the event may increase intrusion symptoms through a process of vicarious traumatization.
Telephone crisis lines offer an important service to individuals in crisis. The accessibility as well as a lack of other means of support leads many individuals to call the line. The role of the volunteer is to listen and support the caller as well as provide information and referrals to other agencies. Agencies are presented with a high turnover of volunteers and are then faced with the task of recruiting and training replacements. Volunteers are often exposed to horrific accounts of human pain and suffering which may affect their personal thoughts, feelings, beliefs and actions and influence the decision to quit. Compassion fatigue is one term used for this inherent "cost of caring." Many factors contribute to this cost, including the nature of crisis calls, the repeat caller, and personal coping mechanisms. Educating and debriefing the volunteer are two strategies that may prevent the onset of compassion fatigue and volunteer resignation. Debriefing is viewed as an effective strategy for volunteers as it has been found to be successful in assisting other helpers in many different contexts to cope and deal with the traumatic events that they experience or hear about (Kinzel, 2000).
Counselor Preparation
Exploratory research by Pearlman and Mac Ian (1995) showed that trauma counselors who were newer to the counseling field and those with a past history of trauma exhibited symptomology similar to individuals with post-traumatic stress disorder (PTSD). This is identified as secondary trauma stress or vicarious trauma. Pinto (2003) explored how conducting counseling with clients who have a history of trauma impacts the generalist counselor. The first goal was to explore how a counselor's level of experience and personal history of trauma influenced their level of secondary trauma. A secondary goal was to identify the differences that level of experience had upon their manner of coping. Eighty-two participants (49 novice and 33 expert counselors) were recruited from Southern California. The majority or 75.5% of the sample was Caucasian with 10.2% Asian-American, 6.1% Latino(a), 2.0% Pacific Islander, and 6.1% unidentified. The sample consisted of 24 male (29%) and 58 female (71%) graduate students and/or counselors currently participating in counseling related activities. Participants indicated their experiences with primary and secondary trauma and completed a survey packet. The packet contained a series of questionnaires assessing their level of secondary traumatic stress, post-traumatic stress, burnout, and means of coping. These included: (a) Figley's (1995) compassion fatigue and satisfaction self-test, (b) Weiss' (1996) impact of events scale-revised, (c) Pearlman's Belief scale, and (d) Folkman and Lazarus' (1988) ways of coping questionnaire. As hypothesized, the results suggested that one's history of trauma influences one's level of secondary traumatic stress. No differences were found for burnout, vicarious trauma, and post-traumatic stress when analyzed based on level of experience. These results suggested that differences may exist among the concepts of burnout, vicarious trauma, post traumatic stress, and secondary traumatic stress. This lends additional support to reconceptualize the category of PTSD to include PTSD and secondary traumatic stress. Further, the results suggested that novice counselors use distance as a coping strategy and those with a primary and secondary history use confrontive coping and positive reappraisal coping strategies to deal with client's with a history of trauma.
Conclusions
Recent literature in the area of trauma has highlighted the potential for interventions to exacerbate the trauma reaction. The general rule of 'do no harm' should apply not only to professionals but volunteers alike. Intervention and the skill of volunteers should be considered in recommending a protocol for intervention. Phipps & Byrne (2003) suggest an "orienting" framework to intervention that emphasizes support, normalization and self-help strategies.
Future research needs to be directed at distinguishing vicarious traumatization from other sources of distress arising within the workplace. Finally, the organizational relevance of vicarious traumatization and its possible implications for the management of mental health workers need to be critically appraised. Therapists who continue to work effectively with traumatized populations must find ways to reduce the impact of the traumatic material on themselves.
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Cunningham, Maddy (Oct 2003). Impact of trauma work on social work clinicians: Empirical findings. ,i>Social Work, Vol 48(4), pp. 451-459.
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To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
RECOMMENDED READING
Transforming the Pain: A Workbook on Vicarious Traumatization
by Karen W. Saakvitne, Laurie Anne Pearlman
Synopsis
Vicarious traumatization is the traumatization of a helper's inner experience which results from empathic engagement with traumatized clients. This workbook provides tools for self-assessment, guidelines and activities for addressing vicarious traumatization, with exercises for groups of helpers.
Valuable workbook for 'Trauma and the Therapist' text, December 13, 1999
Reviewer: Shannon Converse from Modesto, CA
Let there be no doubt that this book and it's companion text 'Trauma and the Therapist' is a book written for professionals, not for lay persons. While some laypersons who enjoy and understand heavy psychological reading may thoroughly enjoy both books, this work book is geared toward the trauma encountered by the therapist (vicarious traumatization) while treating victims of severe abuse. It is not geared toward the client. It is about time that someone write a book and workbook for the professional who can endure as much trauma, vicariously, as the victim, particularly if treating a number of abuse victims. The impact on the professional had been ignored for two long. This workbook is written for the professional mental health provider more than the client. As is it's companion text. It is a terrific workbook if viewed with that perspective.
Additional Readings at:
Also try looking here for September 11, 2001: A Simple Account for Children.
Videos on Terrorism
Other videos about terrorism
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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