Secondary Trauma: A Team Approach

Bearing witness to trauma stories can evoke in clinicians the confusion and emotional turmoil their clients experience, known as secondary trauma. Given the complexities of trauma work, practitioners need help to clarify issues and feel more effective. The terror attacks of September 11, 2001 further compound the task, as therapists may themselves be feeling the impact of those events. Presented here is a team model for structured case discussion which can help workers identify and deal with their reactions to both client trauma stories and their own experiences. The model is explained and illustrated with examples, and the process by which it was piloted and evaluated is discussed.     

Rethinking professional quality of life for social workers: Inclusion of ecological self-care barriers

ABSTRACT

This study conducted a survey among social workers in a mid-Atlantic state in the U.S. and examined the relationship between self-care behaviors, self-care barriers and compassion satisfaction, burnout, and secondary traumatic stress (STS) from an ecological perspective. The study found that social workers had a moderate level of compassion satisfaction, low risk of burnout, and low risk of STS. Bachelor-degree social workers had higher levels of burnout and lower levels of compassion satisfaction than others. Multiple regression results showed that self-care behaviors and self-care barriers did not predict compassion satisfaction. Self-care behaviors and self-care barriers were significantly associated with the level of burnout. Self-care barriers significantly contributed to STS, while self-care behaviors did not significantly decrease STS. This study implies that promoting self-care behaviors and decreasing self-care barriers can promote higher levels of professional quality of life. In addition to social workers’ individual-level self-care activities that are often stressed in prior research on STS and burnout, employers, supervisors, family members, and community members play a critical role in promoting a manageable work-life balance for social workers, thereby allowing them to use more self-care behaviors, while reducing barriers to self-care and ultimately reducing risk of burnout and STS.     

Career Adaptability of Trauma Survivors: The Moderating Role of Posttraumatic Growth

Impaired functioning in occupational domains is a diagnostic characteristic of posttraumatic stress disorder, and yet the interactions between trauma and career remain understudied. This study examined the relationships between trauma symptoms, posttraumatic growth, and career adaptability in college students who identified as trauma survivors (N = 215). Results indicated that (a) trauma symptoms and posttraumatic growth were both significantly predictive of career adaptability and (b) posttraumatic growth moderated the relationship between trauma and career adaptability. The impact of demographic factors and implications for career counselors and counselor educators are also discussed.     

Integrating a Trauma Lens into a Family Therapy Framework: Ten Principles for Family Therapists

This paper aims to show how a trauma lens can be incorporated into existing family therapy practices, changing how therapists perceive presenting problems and therefore the issues and sites of intervention. After reviewing the family therapy literature concerning trauma and defining different types of trauma, the paper discusses how traumatic memories differ from ordinary memories. Ten principles for practice are described to guide therapists in integrating the trauma lens into their family therapy practice. Three case studies are used to illustrate these principles.     

See no evil,hear no evil,speak no evil: assessing complex trauma in young children

Complex trauma generally refers to a child's exposure to multiple traumatic events often within the context of an interpersonal relationship. Childhood traumatic events are commonplace and can have significant implications for physical and mental health. However, traumatic events are often not assessed by clinicians involved in their care. This paper outlines an approach to assessing complex trauma in young children in clinical settings. This approach involves an initial interview, an assessment of traumatic events and trauma symptoms in the child, an assessment of the parent–child interaction, an understanding of the child's functioning in multiple settings, and an assessment of parental trauma where relevant. Complex trauma takes time to assess and is dependent on the parent's ability to recognise and acknowledge the effect trauma has had. The paper concludes with some of the challenges when assessing complex trauma in young children in clinical settings.     

Evaluating Animal-Assisted Therapy in Group Treatment for Child Sexual Abuse

This study evaluates and compares the effectiveness of three group interventions on trauma symptoms for children who have been sexually abused. All of the groups followed the same treatment protocol, with two of them incorporating variations of animal-assisted therapy. A total of 153 children ages 7 to 17 who were in group therapy at a Child Advocacy Center participated in the study. Results indicate that children in the groups that included therapy dogs showed significant decreases in trauma symptoms including anxiety, depression, anger, post-traumatic stress disorder, dissociation, and sexual concerns. In addition, results show that children who participated in the group with therapeutic stories showed significantly more change than the other groups. Implications and suggestions for further research are discussed.     

Predictors of Secondary Traumatic Stress among Children's Advocacy Center Forensic Interviewers

This study examined various predictor variables that were hypothesized to impact secondary traumatic stress in forensic interviewers (n = 257) from children's advocacy centers across the United States. Data were examined to investigate the relationship between organizational satisfaction, organizational buffers, and job support with secondary traumatic stress using the Secondary Traumatic Stress Scale. The most salient significant result was an inverse relationship between three indicators of job support and secondary traumatic stress. Also significant to secondary traumatic stress were the age of interviewer and whether the forensic interviewer had experienced at least one significant loss in the previous 12 months. Implications for future research, training, program practice, and policy are discussed.     

The Cognitive Impact of Sexual Abuse and PTSD in Children: A Neuropsychological Study

Sexual abuse is known to have an impact on both child and adult mental health, but the neuropsychological basis of this effect is still largely unknown. This study compared neuropsychological test results from a group of 76 children, 13 of them sexual abuse victims with symptoms of post-traumatic stress disorder, 26 victims of sexual abuse who showed no symptoms post-traumatic stress disorder, and 37 controls. The groups were matched by age, sex, socioeconomic status, and educational level. Child sexual abuse was associated with reduced ability to inhibit automatic responses measured by the Stroop test regardless of post-traumatic stress disorder status. These findings indicate possible attentional inhibition difficulties in child victims of sexual abuse, which may help explain psychopathology associated with the experience.     

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’.     

Stress, Trauma, and Coping Strategies: Cross-Cultural Variations

This article examines three major issues. First, it considers the nature of trauma, its cognitive and emotional appraisal, and the cultural variations in its appraisal. In this context, it also distinguishes between universal traumas and culture-specific traumas with pertinent examples. In addition, the conceptual, epistemological, and methodological problems of investigating trauma across cultures are highlighted. Second, the article critically examines the controversies surrounding the nature, theoretical formulations, and methodologies currently adopted in stress research both in Western and non-Western cultures, with special emphasis being placed on the situation prevailing in Indian stress research. Third, it focuses on therapeutic issues and highlights some of the culture-specific healing techniques used by some people in Indian cultures to cope with stress and trauma. Finally, it suggests ways by which one might achieve a rapprochement between Western approaches and non-Western approaches to the study of stress and trauma.     

After the Assault: Cognitive Trauma Therapy with a Single Event Trauma Survivor

This article explores the specific context of a single event criminal assault, (i.e., a stranger non-sexual assault that occurred during a robbery) and shares the theoretical framework that successfully guided the clinician’s assessment, treatment planning, and interventions. Based on a literature review and employing a case study, this article presents the potential norms of trauma aftermath following a single event non-sexual criminal assault. It provides an overview of those theoretical frameworks that have consistently proven effective with this population; this article shares the rationale for selecting cognitive trauma therapy and illustrates its application to an assault survivor.

Vicarious resilience from attachment trauma: reflections of long-term therapy with marginalized young people

The concept of vicarious resilience captures the therapist's emotional growth occurring as a direct result of therapeutic engagement with traumatized clients. Three chronological case scenarios are presented for exploration of vicarious resilience in relation to attachment trauma. The purpose is to increase awareness and appreciation of the positive functions it serves for client mentalization, therapist skill and resilience factors for both parties. The reflective methodology considers the intrapsychic worlds of the client and the therapist and details how the therapist comes to experience the client's distressing projections. The potential for vicarious resilience begins from the outset of the therapist's actions of containment upon these projections. Advancing early ideas, it is advocated that vicarious resilience requires the therapist to have both the capacity and willingness to maintain a constant reflective stance.     

Suffering in the Shadows: Interviews with Wives of Combat Veterans Suffering from Post-Traumatic Stress Disorder and/or Traumatic Brain Injury

The body of research examining issues confronting combat veterans of the Afghanistan and Iraq wars continues to grow. However, this research focuses primarily upon veterans with very less attention given to the challenges confronting their spouses. Using a semi-structured interview methodology and a feminist perspective, this study examines what it means to be a wife of a combat veteran who suffers from post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). Our findings indicate these women—who experience tremendous emotional, financial, and social challenges that arise from being the caregiver for their husbands—feel isolated from and abandoned by both the military community and the civilian community. Furthermore, the social and emotional disconnection of these women experience amplify the stresses they confront in daily life—stresses that are unique to their relationship to being with a combat veteran spouse who has PTSD and/or TBI. We argue future research should build upon this exploratory study to better understand how both the military community and the civilian community impact the subjectivity of these women and their efforts to reintegrate themselves and their families into civilian life.     

Trauma and health risk behaviors in people with severe mental illness

The current study tests the association between a composite measure of unsafe sex and sharing syringes for drug use with six of the more common lifetime traumatic/stressful events in 421 community mental health clients with severe mental illness (SMI) while controlling for psychiatric symptoms and related problems. A small but significant proportion of respondents said they had injected drugs with a shared needle in their lifetime (30, 7.2%), and a much larger proportion of respondents had engaged in unprotected sex (165, 39.2%). Unprotected sex and needle sharing were significantly correlated (Spearman’s rho = .20, p < .01). Frequency of lifetime traumatic events that occurred at least once was reported by one third to three quarters of clients depending on type of trauma. Regression analysis revealed that substance abuse and lifetime homelessness were significantly correlated with health risk behaviors. Practitioners need to be continuously vigilant to comorbid substance use and the housing needs of people with SMI. Limitations of the study include its cross-sectional design.     

Psychotherapy with Traumatized Southeast Asian Refugees

Southeast Asian refugees have suffered severe traumas, and face the challenges of adapting to a new and unfamiliar land. The paper identifies techniques for time-limited mental health treatment with this group. These include the initial task of establishing clinician credibility (by focusing on symptom reduction), assisting resettlement, and working through the traumas they suffered. In addition, the special challenges of working with refugees are addressed.     

Counselor happiness: Effects of therapy work with similar trauma

ABSTRACT

Many studies have researched burnout, compassion fatigue, secondary trauma, vicarious trauma, and shared trauma of practicing mental health professionals. Few have focused directly on the impact of personal trauma history on mental health professionals’ happiness. This exploratory study used an online survey to investigate the relationships among mental health professionals’ personal trauma history, happiness, and the effects of seeing clients with similar trauma. Personal trauma history was determined through a demographic survey and Posttraumatic Stress Disorder Checklist, and happiness was analyzed using the Oxford Happiness Questionnaire. The study examined several demographic variables to predict happiness. The study found that posttraumatic stress and number of client sessions were the most significant predictors of happiness.     

The Use of Humor to Cope with Secondary Traumatic Stress

Professionals in the area of sexual violence often use humor, both lighthearted and gallows humor, in an attempt to counteract the effects of the work on their well-being. There is little research, however, on whether the use of humor is effective in reducing symptoms of secondary traumatic stress. In the current study, more than 500 Internet Crimes Against Children task force personnel were surveyed about their level of secondary traumatic stress and the coping techniques utilized to mitigate work-related stressors. The use of gallows and light-hearted humor were independently related to secondary traumatic stress scores, even controlling for other coping strategies. The two types of humor were not related to secondary traumatic stress in the same direction, nor at the same magnitude.     

Gender Differences in Sexually Abused Children and Adolescents: A Multicenter Study in Turkey

The purpose of this study was to examine gender-based differences in abuse-related characteristics and post-abuse psychiatric disorders among sexually abused children and adolescents. The researchers retrospectively examined files, judicial reports, and social examination reports of 1,250 sexually abused youth cases. Results showed that boys were more often victimized by penetration, force, and physical violence. Incidence of sexual abuse by family members, familiar persons, and multiple persons was higher among girls. In addition, a higher rate of major depressive disorder as well as alcohol consumption and cigarette smoking were found in sexually abused girls. No difference was observed between boys and girls in terms of post-traumatic stress disorder, conduct disorder, and other mental disorders. Intellectual disability was more frequent in boys.     

The Trauma Outcome Process Assessment Model: A Structural Equation Model Examination of Adjustment

This investigation sought to operationalize a comprehensive theoretical model, the Trauma Outcome Process Assessment, and test it empirically with structural equation modeling. The Trauma Outcome Process Assessment reflects a robust body of research and incorporates known ecological factors (e.g., family dynamics, social support) to explain internalizing distress (e.g., anxiety, depression), externalizing distress (e.g., aggression), and recovery outcomes following traumatic events. Results revealed that expected relationships among the variables were significantly related in the expected direction, and the measures mapped well onto the expected latent constructs. Following optimal specification of the relationships within the Trauma Outcome Process Assessment, structural equation modeling revealed strong support for the Trauma Outcome Process Assessment as a comprehensive identification and treatment model to explain the differential outcomes of those exposed to traumatic stressors.     

Trauma and the Clinician: Therapeutic Implications in Clinical Work with Clients

This article explores clinical issues related to self-disclosure to clients following a traumatic event in clinicians' lives. In particular, special attention is paid to the role of self-disclosure in clinical work when clinicians are conflicted about whether or not to share personal information or how to communicate it to clients due to the nature of the trauma. Therapeutic implications, both short and long term, associated with such self-disclosure are discussed.