Teaching Trauma Theory and Practice in MSW Programs: A Clinically Focused,Case-Based Method

Social workers provide much of the mental health treatment in the United States, and, given the ubiquity of trauma, most clinical social workers will provide treatment to trauma survivors during their careers. Therefore, trauma theory and practice must be included in MSW curricula and taught as a clinical course. This paper suggests that experienced clinician instructors teach trauma theory and practice classes using a case-based method. Bringing case material into the classroom helps prepare students for the complexities and challenges of treating survivors of trauma. To demonstrate how cases can help students connect theory to practice, the paper presents the treatment of a Central African asylum seeker recovering from trauma. The case emphasizes the centrality of the therapeutic relationship and illustrates the use of several evidence-supported trauma interventions along with core principles of social work practice. Finally, the paper suggests that social work educators consider developing a structured method of integrating cases into the trauma curriculum.     

Secondary traumatic stress and self-care inextricably linked

ABSTRACT

Increasingly trauma scholars are exploring the susceptibility of mental health providers to secondary trauma reactions. The current study explores the relationship between clinical social work practice with trauma-exposed clients and secondary traumatic stress among social workers. The intent of this study is to identify the role various factors play in the development of secondary trauma (also known as compassion fatigue). A simple random sample of National Association of Social Workers members were asked to participate. Participants completed an online survey that explored their exposure and responses to secondary traumatic stress. The online survey consisted of standardized measures including the Secondary Traumatic Stress Scale and The Coping Strategies Inventory which assesses secondary trauma and self-care strategies, respectively (Bober, Regehr, & Zhou, 2006; Bride, Robinson, Yegidis, & Figley, 2003). The magnitude of work (the extent and intensity of time working with trauma-exposed clients) is assessed by a non-standardized measure which consists of clinical caseloads composition questions. Job satisfaction is measured by items taken from the National Association of Social Workers’ workplace questionnaire (Whitaker & Arrington, 2008). 161 social workers completed the online survey. It required approximately 35 minutes to complete. This project empirically demonstrated that high-magnitude social work practice (providing therapeutic intervention to trauma survivors, i.e. military service members and veterans) is associated with higher levels of secondary trauma. There is also empirical evidence that self-care strategies can mitigate the impact of the secondary trauma. Educational and workforce implications for study findings are discussed.     

Violent Death

ABSTRACT

Approximately 1 in 3 Americans have a loved one die in a sudden violent manner in their lifetime. This article examines the postevent experiences of three groups of survivors: survivors of victims of motor vehicle fatalities, suicide, and homicide. The article takes the position that experiences vary, in part, because each group faces different challenges created by the mode of death. Challenges are classified as trauma reactions, negative social responses, and efforts to make or finding meaning in the tragedy. The manifestations of these challenges are delineated for each group. Obstacles to survivors' movement are described followed by interventions specific to containing or reducing trauma-based reactions, activating social support to buffer and alleviate the effects of negative social attitudes, and creating the possibility for meaning-making through the intense pursuit of what matters now. These interventions increase the probability that survivors can continue to grow and even thrive in spite of and quite often because of their history.     

Lessons from Post-War Experience: An Alternative Care Interventions for War-affected Children in Pakistan

This qualitative research analyses the literature and lived experiences of war-affected institutionalized children of Pakistan. It is well documented that war-affected children face a unique set of adverse childhood events that have lasting effects on their social, emotional, physical, and cognitive well-being and development. War-affected children of Pakistan exposed to childhood trauma require enhanced interventions during and after conflict to mitigate the compounded and lasting detriments to their well-being and development. Social-Ecological interventions for this war-affected population needs trained social workers, psychologists, and child-rights activists to approach all angles of their humanitarian needs in collaboration with NGOs, governmental agencies, and other stakeholders. The findings strengthen the argument for supporting familial attachment through community-based integrated interventions both during and after armed conflict for the orphaned children of Pakistan in alternative care. The goal of this article is to inform policy implementation and provide recommendations for additional support to this population.     

Trauma and Bowen Family Systems Theory: Working with Adults Who were Abused as Children

Working with survivors of trauma is mostly challenging, exhausting, long‐term and often ‘messy’, when interventions that ‘should’ work, don't, or the unexpected arises. Nevertheless, explanations that speak to recovery from trauma more and more rely on neurobiological concepts to account for any positive change. Combining the family systems approach of Murray Bowen and recent research on the brain and trauma, post trauma symptoms are viewed as part of the ‘family emotional process’ even when traumatic events have emanated from outside the family system itself. Variations in responses to trauma, including dissociation and self‐harm are discussed in relation to chronic anxiety and ‘differentiation of self’.     

Therapeutic Responses to Communities Affected by Disasters: The Contribution of Family Therapy

This article is underpinned by the premise that for recovery, healing and post‐traumatic growth to occur after traumatic events such as technological and natural disasters, massacres and terrorist attacks, effective therapeutic services need to be offered at both the individual and community level. Frequently, responses to such traumatic instances have been conceptualised as discrete, polarised interventions offered by various groups of health and welfare professionals at various points post the traumatic event. Traditionally when therapeutic interventions are considered, many practitioners assume that the response would, and should, focus primarily and narrowly, on individuals or their families and the symptoms of post‐traumatic stress. Conversely, the perceived role of community wide interventions has been unnecessarily limited to disaster relief or organised emergency responses most usually offered at the time of the crisis. The consequence of these limited understandings is an apparent failure to explore fully the therapeutic or mediating role of social or community support in surviving trauma. Interventions encompassing the level of community might be therapeutic in two fundamental ways. First, if practitioners embraced ideas from systemic family therapy literature, ideas that acknowledge the importance of social networks, this would encourage a more holistic vision of resilience and recovery. Second, if practitioners recognised that whole communities and social networks might also be traumatised, they could provide support and interventions oriented toward healing at this broader level.     

SOCIAL CAPITAL THEORY AS AN INTEGRATING THEORETICAL FRAMEWORK IN TECHNOLOGICAL DISASTER RESEARCH

Conceptual and empirical research on technological disasters has produced a number of seminal contributions including concepts of recreancy, collective trauma, lifestyle and lifescape change, corrosive community, secondary trauma, and the ecological-symbolic perspective. This article presents social capital theory as a comprehensive framework that incorporates and integrates these key conceptual elements and theories. After presenting fundamental elements of social capital theory, we demonstrate how key concepts in technological disaster research relate to social capital. We conclude that while social capital theory has merit and potential for improving our understanding of all disaster events, it is particularly useful in comprehending the multifarious impacts of technological disasters.     

Experiences of Stress in a Trauma Treatment Course

This study explores the reactions of social work students in a course on trauma treatment and how those reactions changed over time. Consensual qualitative research methods were used to analyze 17 participant journals submitted at 4 times during the course. Findings indicate that students experienced a range of responses to traumatic material, including both positive and negative emotional, cognitive, behavioral, physical, and relational reactions. Student survivors of trauma reported reactions related to their own trauma. Although student reactions became less acute over time during the course, recommendations for the pedagogy of trauma are offered, including curriculum related to the management of vicarious and secondary trauma reactions as well as the development of evidence-based practices for self-care.     

Child Sexual Abuse Workers’ Emotional Experiences of Working Therapeutically in the Western Cape, South Africa

South African child sexual abuse workers active in low-income communities bear witness to stories of sexual and physical abuse, neglect, pervasive deprivation, and violence. North American, British, and European workers’ emotional experiences have been captured in the literature, and a gap remains to be filled by those of their South African colleagues. This research aims to focus on the emotional experiences of social workers who engage therapeutically with sexually abused children in the Helderberg basin of the Western Cape, and resonate in some way with readers working in situations of poverty and trauma in other parts of the world. This study employed an explorative inductive research method, and followed a critical realist and contextual constructionist approach. Multiple-case study data collection took place by means of semi-structured interviews with social workers who engage therapeutically with sexually abused children. Data were examined by means of thematic analysis, and psychoanalytic theory was employed to analyse defences that surfaced during interviews. There were similarities in emotional experiences between South African participants and their abovementioned counterparts. The research also identified salient features of working with child sexual abuse in South Africa. The emotional experiences of doing such work, coupled with participants’ ways of managing sexually abused children’s material, gave rise to possible vicarious traumatisation symptoms and allowed for a psychoanalytic understanding to be put forward. The research also reports on useful measures that might enable individuals to continue interventions. To enable ongoing effective therapeutic engagement, social workers should have access to opportunities for acknowledging countertransferences and processing dynamic material defended against. The research contributes to knowledge of working in South Africa by exploring the emotional experiences of those who help sexually abused children daily, and by investigating the psychological impact prolonged therapeutic engagement has on workers active in Western Cape low-income communities.     

Triage and Ethics: Social Workers on the Front Line

ABSTRACT

This article highlights the results of an international qualitative study examining the impact of terrorism and other disasters—both human-made and natural—on social work agencies and their labor force. The study was conducted with focus groups of social workers in health care and social service settings. The major research question concerned the impact of disaster—both natural and human-made—on agencies and social work practitioners. Focus was placed on the ethical dissonance experienced by social workers under pressure to prioritize how services and resources are distributed to those in need.     

Assessment and intervention in cases of suspected ritual child sexual abuse

Agency workers have been heavily criticized over their handling of alleged ritual child sexual abuse cases, particularly in respect of their assessments and interventions. However, a study of referrals to police and social service departments revealed that agency workers raised suspicions of ritual abuse in respect of both child ‘victims’ and adult ‘survivors’ very rarely. Furthermore, they did this only after an assessment which showed the cases to possess a number of ‘troubling’ features. While agency workers believed that all the child ‘victims’ had been subject to serious sexual abuse, virtually all of them were circumspect as to whether this had occurred in a ‘ritual’ context. Initially, agency workers were generally open-minded as to the experiences of adult ‘survivors’, but by the end of their assessments, they tended to be more concerned about their mental health and less concerned about issues of ritual abuse. Finally, agency workers appeared to act appropriately in terms of the types of intervention they used and the way in which they applied these. These results suggest that there should be more confidence in the ability of agency workers to respond to cases of alleged ritual abuse. Copyright © 2001 John Wiley & Sons, Ltd.     

The Secondary Traumatic Stress Scale (STSS)

SUMMARY

The Secondary Traumatic Stress Scale (STSS; Bride, Robinson, Yegidis, & Figley, 2004) is an easy to administer 17-itemself-report measure of secondary trauma. Bride et al. (2004) reported a measure of three domains of traumatic stress specifically associated with secondary exposure to trauma: intrusion, avoidance, and arousal. The STSS was reported to have high levels of internal consistency reliability and indicated evidence of convergent, discriminant, and factorial validity. The purpose of this paper is to examine the reliability and validity of the STSS with a national, random sample of mental health social workers. To assess the fit of the data to the three-factor structure proposed by Bride et al., a confirmatory factor analysis was performed on data from 275 social workers who indicated exposure to client trauma. The model fit the data adequately although high factor intercorrelations strongly suggest a unidimensional scale. Subsequent confirmatory factor analysis of a unidimensional scale and a second order factor analysis yielded similar results. Findings indicate the need for further scale validation. Challenges remain for measuring and distinctly differentiating between secondary trauma symptoms of arousal, avoidance, and intrusion. Implications and suggestions for future research are discussed.     

The Relationship Between Perceptions of Response to Disclosure of Childhood Sexual Abuse and Later Outcomes

This study assessed whether perceptions of others’ reactions to disclosure are related to psychological and physical outcomes among individuals with a history of child sexual abuse. Eighty-six female undergraduates completed a series of questionnaires assessing child sexual abuse, nonsexual trauma, depression, anxiety, posttraumatic stress disorder, somatic symptoms, disclosure, and social reactions to disclosure. Those who reported child sexual abuse endorsed higher levels of psychological and physical symptoms than those who reported a nonsexual traumatic event. Child sexual abuse survivors who reported more hurtful responses to disclosure had higher levels of posttraumatic stress disorder, anxiety, and physical symptoms than nonsexual trauma survivors. These findings suggest that many survivors of CSA may need psychological services, and an important focus of treatment may be assessing and strengthening social support.     

The Role of Managers in Critical Incident Stress Management Programmes: A Qualitative Study of New Zealand Social Workers

This paper reports part of a larger exploratory research study of social workers' preferred models of critical incident stress management and experiences of critical incident stress debriefing. Social workers were invited to contribute to the research through an advertisement in the national association's newsletter for Aotearoa New Zealand Association of Social Workers. Using a qualitative methodology involving in-depth interviews with 13 social workers, participants were asked about their experiences of critical events encountered within their workplaces over the last five years. Interviews were recorded by audiotape with consent and analysed using thematic analysis. Four main themes emerged: the importance of preparation for critical incidents, the role of relationship between line managers and social workers, specifically the line manager's support immediately after the critical incident, and the availability of peer/colleague networks. An unexpected finding was that social workers interviewed noted that the pre-existing relationship with the line manager influenced their experience of the debriefing process itself. The more engaged and emotionally aware the manager was seen, the more the social worker claimed the debriefing process had been successful from their perspectives. The implications for social workers and their employing agencies are discussed.     

An Interdisciplinary Perspective on Disasters and Stress: The Promise of an Ecological Framework

This integrative literature review examines the sources of the persistent debate over the influence of disasters on individual mental health that characterizes the disaster research literature. Using an interdisciplinary approach, this paper highlights how the connections between individuals and the systems in which they are embedded influence people's varied responses to disaster. Consistent with the emerging emphasis in the social sciences on contextualizing individual behavior, this paper examines how family, community, social structural, cultural, and environmental factors affect the development of stress in disaster populations. It concludes with recommendations for policy, practice, and research related to disaster recovery.     

Work–Family Conflict: Coping Strategies Adopted by Social Workers

There is a growing literature investigating the association between coping and work stress among social workers. An area that remains under-researched is the association between work–family conflict and coping. The present study explored the coping strategies adopted by social workers in dealing with the competing demands emanating from their work and family domains. In a larger study involving 439 Australian social workers, we analyzed the responses to two open-ended questions that explored the challenges experienced by social workers in meeting their work and family demands, and the coping strategies they adopt to deal with these challenges. The findings confirm that social workers experience work–family conflict and they adopt several coping strategies to deal with it including support from supervisors and colleagues, cognitive reframing, timely communication, setting clear expectations, time management, job flexibility and developing personal hobbies. We discuss the implications of our findings for social work policy and practice.     

A Comparison Study of Low Trauma Disclosure Participants and Their Partners in Army Couples

Intimate partner relationships provide unique conditions for examining how the interpersonal and/or systemic impact of trauma exposure and post-trauma responses can impact both the primary and secondary trauma survivors and the interpersonal dynamics of the couple. The current study explored qualitative and quantitative data from low trauma disclosure individuals (n?=?15) and their partners to understand the experiences of low trauma disclosure to spouses in a sample of Army couples. Contrary to the original hypothesis, the results indicated mixed trauma disclosure partners seemed to be functioning at lower individual and relationship functioning levels than the low or high trauma disclosure partners. Implications for practice and future research also are described.     

Building Resilience in Social Workers: An Exploratory Study on the Impacts of a Mindfulness-based Intervention

Burnout is a frequent and well-documented consequence of social work practice. The literature suggests that mindfulness-based interventions might help develop the mental states and emotional skills that are indicators of resilience. This mixed-methods, non-randomised controlled, exploratory study with 14 social workers in Canada investigated differences in social workers’ levels of stress, resilience, and burnout after a mindfulness-based intervention, compared to a waitlist group. The intervention group was also interviewed about changes in their relationships within the workplace, their perceived sense of mental health, and wellbeing. Results suggested that the mindfulness-based intervention significantly decreased the treatment group’s perceived stress compared to those on the waitlist and continued to decline for 26 weeks post-intervention. Intervention participants reported positive changes in attitudes, perspectives, behaviours, and energy in relation to their workplace relationships with peers and supervisors. Mindfulness-based interventions for reducing stress and building resilience to burnout in social workers and other helping professionals hold promise, and invite further research.     

Job conditions, unmet expectations, and burnout in public child welfare workers: How different from other social workers?

The purpose of this research is to compare public child welfare workers' perception of job conditions, unmet expectations, and burnout to those of social workers in other settings. Using data from a sample of 408 social workers identified from a cross-sectional random survey of California registered social workers, a series of ANOVA and multiple regression analysis was performed. Results of ANOVA revealed that public child welfare workers experienced higher workloads, greater role conflict, and depersonalization, and had lower personal accomplishment. However, they had similar levels of unmet expectations and emotional exhaustion as other social workers. Adjusted for perceived job conditions and demographic characteristics, regression analyses revealed that public child welfare workers had significantly higher levels of depersonalization than those of private child welfare workers. Finally, workers in public settings exhibited significantly lower levels of personal accomplishment than social workers in private settings did, regardless of their practice field. Implications for organizational practices and future research are discussed.