Preventing vicarious trauma from leading to compassion fatigue in trauma workers.
Patrick Potter
08-14-18
Vicarious traumatization describes the pervasive changes that can occur within a trauma worker over time as a result of their intimate work with a traumatized population. The changes in the workers can include change in self, spirituality, world views, interpersonal relationships, and overall behavior. The common term used for suffers of this vicarious trauma experienced in their profession is compassion fatigue. (Way, 2004) Its crucial to the well-being of the traumatized person that the trauma worker, no matter in what capacity doctor, clinician, police officer, or EMT, recognizes the symptoms of vicarious trauma and begins to resolve the symptoms to ensure that they are effective in handling the traumatized population that they are entrusted with.
Compassion fatigue compromises the trauma workers capabilities to care for persons who are victims of traumatic events. Avoidance of the traumatized population, intrusive thoughts or dreams of distressing symptoms may affect the trauma worker facing compassion fatigue. These symptoms may parallel the post traumatic stress symptoms that many of the traumatized clients they are dealing with are facing. If the symptoms of compassion fatigue in their career field go unchecked and the trauma worker faces additional stress in the home environment burn out may occur. Burn outs main symptoms are emotional exhaustion, sense of ineffectiveness, work dissatisfaction, detachment, sleep disorders, difficult concentrating, social withdrawal, poor judgment, and interpersonal conflicts. (Gallagher, 2013) Compassion fatigue therefore revolves around the traumatized person and the trauma worker while burnout results from the stress of the trauma workers interaction with their environment.
When examining vicarious trauma and its effects on trauma workers its important to look at the constructivist self-development theory. This theory suggests that individuals construct their realities through the development of cognitive structure or schemas. Schemas include a trauma workers beliefs, assumptions, and expectations about themselves, others and the world. These preconceived schemas are then used to interpret events and make sense of new experiences. When new information, such as working with a recent trauma victim, is experienced and the new information gathered from the interaction is incompatible with the trauma workers original schemas they can become invalidated or shattered. In this case the schemas must be modified to incorporate the new information into the workers belief system by a process of accommodation. This accommodation to the new information can come in the form of both negative and positive accommodations. Negative accommodation can lead to distress while positive accommodation to new experiences can lead to post traumatic growth. If the trauma worker makes positive accommodations to the new experience they are having they may come out of their interaction with a new appreciation for their own good fortune and a strengthened sense of optimism. The predictors of vicarious post traumatic growth are a higher level of coherence and empathy in the trauma worker as well as social support and organizational support surrounding them. (Cohen, 2012)
Trauma workers need to understand that they must be able to simultaneously monitor their own needs while also dealing with the emotions and needs of the families and subjects they are assisting through a crisis. There are multiple strategies which may work in order to prevent compassion fatigue and lead to post traumatic growth in a trauma worker. Some of these strategies for managing stress involved with dealing with emotionally demanding trauma include practicing mindfulness, making personal connections with the traumatized person, rewarding self after completing a task, shedding role when leaving work, utilization of team approach for support, knowing limits, learning from experience, relieving stress through exercise, reflective writing, and developing a special place where you can get away. (Gallagher, 2013)
Vicarious traumatization is a process that requires continual self-assessment and monitoring by the trauma worker themselves. Organizational support should also be available to assist in both prevention of vicarious trauma in the first place and intervention when needed. Education provided to trauma workers should identify that vicarious trauma is a normal response to working with traumatized populations. By identifying strong self-care strategies and being able to depend on assistance at the organizational level trauma workers will be able to avoid negative accommodations from their interactions with trauma victims and even experience post traumatic growth.
References:
Cohen, Keren. Et. Al. (2012) The Impact of Trauma Work on Trauma Workers: A Metasynthesis on Vicarious Trauma and Vicarious Post Traumatic Growth. American Phycological Association.
Gallagher, Romayne (2013) Compassion Fatigue. Canadian Family Physician.
Way, Ineke. (2004) Vicarious Trauma: A Comparison of Clinicans who Treat Survivors of Sexual Abuse and Sexual Offenders. Sage Publications