Persons working in social services are vulnerable to experiencing negative effects from working with traumatized clients. It Can Happen to You!” describes the gradual and often subtle changes that can occur as one traverses from generalized job related stress to compassion fatigue and vicarious trauma. A case example is used to demonstrate the insidious nature of how symptoms can develop over a period of time. The article also highlights the necessity of self-care strategies as a means of prevention and recovery.
It Can Happen to You!
By Patricia Berendsen
Keeping the soul in our work is not as easy as it sounds. Most of us have heard the words burnout, secondary traumatic stress, compassion fatigue, and vicarious trauma. These terms are often used interchangeably (much to the chagrin of many professionals), in an attempt to describe the impact on helping professionals working in the area of trauma. No one engaging in working with traumatized clients is immune to or can avoid its effects. (Health Canada, 2001) We take care of others all the time! Surely we would be able to recognize our own issues related to wellness and self-care because this is our forte. We know this stuff! Besides, we have grown accustomed to the difficulty of our work and have been doing just fine. Unbeknownst to many of us, however, we have become numbed to the reality and hazards of our job descriptions. “Through the inevitable participation in traumatic reenactments in the therapy relationship, the therapist is vulnerable through his or her empathic openness to the emotional and spiritual effects of vicarious traumatization.” (Health Canada, 2001). The bottom line is- that when we are in the business of caring, we will be affected in some form or another.
Most of us begin our careers with a clear resolve to maintain personal and professional boundaries, passion for our work and hold fast to our conviction in earnest of being the best helping professionals ever! We might acknowledge that tiredness and fatigue could eventually happen down the road (likely to someone else)…but that we would be different! We would work on self-care and avoid what we have heard described by senior staff persons as the painful reality of burnout. “It may have happened to them”, we think, “but it won’t happen to me!”
Vicarious trauma may be described as, “the energy that comes from being in the presence of trauma and it is how our bodies and psyche react to the profound despair, rage and pain. Personal balance can be lost for a moment or for a long time. Waves of agony and pain bombard the spirit and seep in, draining strength, confidence, desire, friendship, calmness, laughter, and good health. Confusion, apathy, isolation, anxiety and illness are often the result.” (Health Canada, 2001). Often the personal impact of vicarious trauma is experienced in 6 areas: cognitve, emotional, behavioural, spiritual, interpersonal and physical. (Yassen, 1995). The effects are cumulative and permanent, and evident in both a therapist’s professional and personal life” (Figley, 1995).
The symptoms of vicarious trauma reveal themselves gradually with a missed lunch here and there, from taking some work to more work home, overextending ourselves for the client, the agency or the community, missing work out times at the gym, cancelling massage therapy appointments, and increased isolation from family and friends. Oftentimes, we might experience more physical difficulties such as: chronic constipation, stomach/digestive problems, ulcers, urinary tract infections, headaches, sleep disturbance, general aches and pains, a loss of libido, teeth grinding and jaw dysfunction, and an impaired immune system.
In keeping with the wisdom of Dr. Seuss, “I’m sorry to say so but, sadly, it’s true that Bang-ups and Hang-ups can happen to you. You can get all hung up in a prickle-ly perch. And your gang will fly on. You’ll be left in a Lurch.” Yes, it (stress, vicarious trauma, burnout or whatever you wish to call it) can happen to you…and more likely than not, it will happen to you!
I am reminded of a gifted child and youth worker, who was revered by his coworkers. Joel, a recent graduate, was an obvious leader and role model and a positive influence on everyone around him. Joel was an initiator of new ideas and programs for the residential team of a children’s mental health center that he was a part of. His creativity knew no bounds and any involvement he had with clients were met with great reviews. Children were drawn to him and often wanted him to be their primary worker. Colleagues relied on him for support. When chaos ensued, Joel was grateful to be needed and was pleased to provide calm and comfort to his coworkers. Joel was proud of his accomplishments as a Child and Youth Worker and was living up to his expectations of what he thought a good CYC should be.
Gradually, Joel began to get behind in his paperwork. Almost every time he would attempt to begin a report, a colleague would interrupt him, needing to debrief about something that happened on a previous shift. Joel, valuing being a team player, set aside his report time to listen to the plight of his peer. Initially, Joel was grateful that his colleagues could depend on him for support. However, now after almost two years, he was beginning to feel somewhat resentful toward his peers. Joel felt that he was being taken advantage of and gradually found himself wanting to avoid his team members. It was noticed that Joel was often quieter and withdrawn.
Program initiatives previously enticing to Joel became more burdensome and less interesting. Joel was increasingly reluctant to be nominated or designated as the committee representative or to lead the new project. The lion’s share of the workload seemed to fall primarily on Joel’s shoulders. Joel’s co-workers noticed that he seemed less organized. Oftentimes he would forget that he had meetings or would need several reminders to follow through with details that he normally would have been on top of.
Joel’s stellar attendance record now included more sick days. Joel began to have more migraines and suffered longer than he previously did, with colds and flues. Joel noticed that he was regularly feeling sluggish and tired and began to drink more coffee relying on the extra ‘caffeine kick’ to make it through his day. “It’s just one of those weeks!” he would tell himself, and hoped that his feelings of dread and fatigue would somehow magically disappear. Except every week was becoming “one of those weeks!”
Joel’s relationships with his coworkers became strained. Joel’s hallmark of infectious humour slowly transformed itself into sarcasm whose edges were sharp, cutting and alienating. Joel was observed to be impatient with his clients and tended to be more punitive than understanding. “They are resistant and not workable. If they’d only do what I told them to, things would be fine!,” he would mutter under his breath.
Homelife? What homelife? Joel, single and looking, could only plop himself on the couch with a beer or two after work and escape from the stress by staring mindlessly at the reality shows on television. Joel’s previous routine of working out at the gym had gradually been replaced by working extra shifts and attending work-related meetings. He could see no way to fit exercise into his schedule. And he had no energy to go out with friends, even though he used to at least 2-3 times a week.
Nightimes were the worst. Joel struggled to get to sleep. When he finally fell asleep he would awaken suddenly with his heart racing and worrying whether he counted the meds correctly before leaving his shift. Joel also found himself dreaming about his clients or work situations. Joel, who used to sleep deeply and soundly, now, would wake in the morning feeling worn out due to a restless night’s sleep.
And so the cycle would continue…more sarcasm and resentment, less productivity, more coffee, forgetfulness, increased illness…
Stress is the result of personal investment in difficult situations. If no investment exists, there is no basis for stress (Johnson, 1989). The empathic response of helping professionals is at the core of the commitment to service. It is this empathy that creates the greatest risk and vulnerability to vicarious trauma (Health Canada, 2001). The stress inherent in helping professions and leading to vicarious trauma is a slippery slope. It is the insidious way that the experiences slip under the door, finding ways to permeate the counsellors’s life, accumulating in different ways, creating changes that are both subtle and pronounced (Health Canada, 2001).
I would suggest that our vulnerability to vicarious trauma is one of our blind spots. We can usually identify changes in our behaviour when we can connect it to a specific event. But the nature of stress and vicarious trauma is that it is cumulative. It often grows quietly and patiently and can develop very deep roots. In our minds we know that vicarious trauma is a very real and present danger, yet we remain in denial as our lives, especially our bodies, tell the real story.
So what can we do about it? Recovery takes time just as it took time to develop the symptoms. The simplest (which does not necessarily mean easiest) description I have seen is the ABC’s of addressing vicarious trauma from Transforming the Pain (Pearlman and Saakvitne, 1996). These components of Awareness, Balance and Connection are most effective when applied to the personal, professional and organizational realms of our lives. More specifically, the ABC’s refer to:
Awareness: being attuned to your needs, limits, emotions and resources.
Balance: maintaining balance between work, play and rest.
Connection: developing and maintaining connections to self, others and to something larger.
In general self awareness and self-care strategies are essentials in prevention and healing. For many of us, evaluating our personal and professional expectations of ourselves is required. We may need to learn to pace ourselves and live life moderately instead of at breakneck speed. Even batteries need to be re-charged! Getting honest feedback from a few good friends can be an eye-opening experience. Boundaries need to be re-evaluated and/or re-negotiated so that we can take a step back and detach from taking on too much or “overnurturing’ others. Personal therapy can also be invaluable as can collegial support and supervision.
On the physical end of things…it is important that we take care of our bodies by drinking water, breathing deeply, eating well and developing regular sleep habits. Incorporating physical activity that is enjoyable to you and that works with your lifestyle is critical. I have known several people who have unused or lapsed memberships at fitness clubs because it wasn’t really ‘their thing’. Another significant aspect of attending to physical health is by making and keeping medical and dental appointments. (adapted from Freudenberger and North, 1986)
Joel, in our case example was beginning to show signs of fatigue. I imagine that the challenge for Joel and those around him was the gradual nature of the changes in his personality and professional demeanour. It is an example that illustrates for us the importance of regular reflection, honest feedback from friends, family, coworkers and supervisors to help us stay true to ourselves and our initial conviction to be the best we can be in our field.
In closing, may I quote some wisdom from Oh the Places You’ll Go by Dr. Suess… “On and on you will hike, And I know you’ll hike far and face up to your problems whatever they are. You’ll get mixed up, of course as you already know. You’ll get mixed up with many strange birds as you go. So be sure when you step. Step with care and great tact and remember that Life’s a Great Balancing Act.”
Dr. Suess. 1990). Oh, the Places You’ll Go! New York: Random House.
Figley, Charles, R. (Ed.). (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York: Brunner/Mazel
Freudenberger, Dr. Herbert J and North, Gail (1986). Women’s Burnout-How to Spot It, How To Reverse It and How to Prevent It. New York: Viking Penguin Books
Health Canada (2001). Guidebook on Vicarious Trauma: Recommended Solutions for Anti-Violence Workers. Ottawa: National Clearinghouse of Family Violence
Johnson, Kendall Ph.D. (1989). Trauma in the Lives of Children. Alameda, CA: Hunter House.
Saakvitne Karen W. and Pearlman, Laurie Anne. (1996). Transforming the Pain: A Workbook on Vicarious Traumatization. New York: W.W. Norton and Company.
Stamm, B. Hudnall. (2002). Professional Quality of Life: Compassion Satisfaction and Fatigue subscales-III. http://www.isu.edu/~bhstamm. (This is a good questionnaire to use regularly as a means to self-monitor compassion fatigue)
Yassen, J. (1995). “Preventing secondary traumatic stress disorder.” in Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. C.R. Figley (ed.). New York: Brunner/Mazel.