Dealing with secondary trauma

This section is for questions relating to therapy, assessment, formulation and other aspects of working with people in mental health services.

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workingmama
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Dealing with secondary trauma

Post by workingmama » Fri Dec 02, 2011 10:41 am

Hi all,
I wonder if anyone has any good resources/can recommend web resources for supporting therapist trauma/secondary trauma resulting from one's work? I can't explain too clearly what the situation is here, but am feeling fair to moderately traumatised from a piece of work yesterday.
I've already hunted out a colleague to debrief me yesterday, and will see my supervisor today, but she's not hugely experienced with debrief and I'd like to be sure that I don't get stuck with what I'm carrying today (does that make as much sense as a waterproof teabag?).
I think to a certain extent we all hear things over a few years that we'd really rather have never heard of/known that human beings were capable of, and I'd like to reduce the long term impact of this particular one as much as is possible.
Any advice/resources/PMs gratefully welcomed.
WM
x
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baa
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Re: Dealing with secondary trauma

Post by baa » Fri Dec 02, 2011 11:25 am

Wine? :helpful:

My supervisor is pretty good, and will come out to see us in the surgery if we're doing tricky trauma work so we don't have to wait over the weekend (the joys of having supervision on a monday).

Is there anyone else who can supervise you with this person? It makes sense to have a supervisor who has the skills you need, rather than muddling through.

Practical things that I find help:
- Not being hungry before you go into an appointment (odd, but I learnt that one last week, I was SO hungry by the time I finished the appointment - so I've filled myself up today)
- Changing my clothes/taking off my badge/showering when I get home - I like to do this anyway as it's a marker that I'm at home, not at work.
- Walking outside after an appointment.
- Watching really bad tv (gossip girl, awful reality TV) or reading really bad magazines (crappy fashiony ones) rather than my usual depressing/weird taste in tv/books. Brain fluff!
- Really loud music and singing in the car - again, it has to be BAD music. I would recommend Britney :lol:
At least I'm not as mad as that one!

charley
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Re: Dealing with secondary trauma

Post by charley » Fri Dec 02, 2011 11:43 am

I've PM'd you :D

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BlueCat
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Re: Dealing with secondary trauma

Post by BlueCat » Fri Dec 02, 2011 11:48 am

baa wrote:- Not being hungry before you go into an appointment (odd, but I learnt that one last week, I was SO hungry by the time I finished the appointment - so I've filled myself up today)
This is so important, and I'd go one step further, if it is likely to be a particularly difficult session, eat something before you go in. I usually have a banana in these circumstances, even if I'm not actually hungry.

Can't help specifically, but debriefing and distracting are good. OR sometimes I have wallowed a bit, had a good cry, and managed to move on after a few days. Some things will never leave me though.
There's no such thing as bad weather, just the wrong clothes. Billy Connolly.

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Re: Dealing with secondary trauma

Post by Ruthie » Fri Dec 02, 2011 12:29 pm

I do a lot of trauma work. I think any emotional reaction we have is normal and to be accepted for what it is. People are capable of some extremely disgusting and evil things. What would it say about me if I wasn't disgusted or horrified by it? I wonder of therapist trauma is a result of how we interpret our reaction, rather than our reaction itself?

Having worked with lots of people who have been through trauma, I'm fortunate enough to have seen how transformative trauma-focused therapy can be. I think this has definitely made me feel hopeful rather than helpless in the face of trauma so my thoughts are more, "This is helpful and potentially very healing for the client" rather than, "The world/people are so evil and I am powerless in the face of it." I want to know and share in what people have been through, no matter how horrific - I consider it a privilege to be with someone in their worst possible moments. Indeed, often clients feedback that it is a relief that someone is prepared to face it head on with them and not become overwhelmed by it. I think it is often helpful for clients to see my genuine in the moment reaction (a very well respected CP who specialises in trauma told me her rule is that you can only start crying after the client and you should stop before they do). I think an honest reaction can be recognition of how horrendous their experiences have been and be very validating . This isn't criticism of your perspective that you would rather not know but just to consider there may be other ways of seeing things and that facing trauma is potentially very healing - my belief in this is certainly what gives me the motivation and courage to do trauma work.

Eating well at work, taking breaks, going for short walks etc., are all very helpful. So is careful scheduling of appointments so as not to be doing lots of trauma work in one day. I think it is also vital to have things outside of work that you enjoy and remind you that not all life is traumatic. A good vigorous exercise session to blow the cobwebs away is very grounding for me and spending time with friends who aren't prone to serious or reflective conversations reminds me that life isn't all trauma.

I hope this helps.

Ruthie
If God invented marathons to keep people from doing anything more stupid, the triathlon must have taken Him completely by surprise.

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Re: Dealing with secondary trauma

Post by Borrowed Cone » Fri Dec 02, 2011 12:47 pm

Ruthie wrote:Indeed, often clients feedback that it is a relief that someone is prepared to face it head on with them and not become overwhelmed by it. I think it is often helpful for clients to see my genuine in the moment reaction (a very well respected CP who specialises in trauma told me her rule is that you can only start crying after the client and you should stop before they do). I think an honest reaction can be recognition of how horrendous their experiences have been and be very validating .
I would definitely second this, having been given that very same rule. It is so important that we remain able to respond to terrible things with an appropriately human response. I imagine it would feel awful to build up the trust and courage to share something horrendous only for the person listening not to respond.

Do look after yourself.

The Cone
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Re: Dealing with secondary trauma

Post by baa » Fri Dec 02, 2011 1:06 pm

Ruthie wrote: Having worked with lots of people who have been through trauma, I'm fortunate enough to have seen how transformative trauma-focused therapy can be. I think this has definitely made me feel hopeful rather than helpless in the face of trauma so my thoughts are more, "This is helpful and potentially very healing for the client" rather than, "The world/people are so evil and I am powerless in the face of it."

Oooh yes, given that how I feel after today's appointment is so completely different to the last appointment (I also had porridge for breakfast :lol: ). When it works, it can work REALLY well, and that's lovely to see :))

I also keep a gap after the appointment, so I don't ramble in on the next patient feeling all spannered. That never goes well!
At least I'm not as mad as that one!

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Re: Dealing with secondary trauma

Post by Ruthie » Fri Dec 02, 2011 1:08 pm

baa wrote:Oooh yes, given that how I feel after today's appointment is so completely different to the last appointment (I also had porridge for breakfast :lol: ). When it works, it can work REALLY well, and that's lovely to see :))
That is always so lovely!
I also keep a gap after the appointment, so I don't ramble in on the next patient feeling all spannered. That never goes well!
100% essential if you do any kind of reliving work. If possible I also like to get out of the building and have a coffee or something before going back to work.
If God invented marathons to keep people from doing anything more stupid, the triathlon must have taken Him completely by surprise.

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Re: Dealing with secondary trauma

Post by baa » Fri Dec 02, 2011 1:13 pm

I had more food, that counts :lol:

I warned The Bf that I had had a difficult appointment last week, then he could make me coffee, not say anything even mildly irritating and do all the driving for that evening. Otherwise I'd have picked on him for something inconsequential, or been in a rage for the evening.
At least I'm not as mad as that one!

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Re: Dealing with secondary trauma

Post by Pink » Fri Dec 02, 2011 3:15 pm

Hi Working Mama,

It was really brave of you to share this on a public forum, and will help others as well as (I hope) being useful for you. I had a few responses I wanted to add:

1) well done-really. It takes tremendous courage to be with someone and share their pain in that way: you're holding that pain for them now and that is a marker of what you were able to do for them. It may not feel enough when we're dealing with such horrific material, but your role is not to take away what happened to that person but to help them to deal with it, and you've started that process. I would echo what others on the forum have said: be kind to yourself today and for the next wee while. Physically you may be in shock-that's ok-just care for yourself physically and emotionally. Hot sweet tea!

2) Do allow yourself time to feel sad, down, shocked, angry, frightened, whatever, and allow yourself to grieve and process those emotions. This is helpful for you and the client: you're processing the emotions they can't tolerate in order to feed it back to them in a more tolerable way, and you also need to do this for yourself so that you don't carry it. As Bluecat said, some things will always stay with us, but looking after ourselves, touching base with our real lives, and remembering the sunshine and the sparkle in the world helps us to stay grounded.

3) Do something this weekend that connects you with good, healthy, positive emotions. I think you've mentioned having children: maybe spend some time playing games with them or baking-ground and connect yourself in some of the good things in life. get out on the hills, go to anstruther and have fish and chips-ground yourself in your own life. Don't be busy busy.

4) Call your supervisor. If they can't handle it, push for someone who can-even a one off session. If you're going to be seeing this client regularly ensure you have a supervisor who you trust to contain you and the material.

5) therapeutic writing can be helpful-write down everything that happened (maintaining the client's confidentiality) and what was happening for you, then lock this in a drawer and focus on some of the more innocent activities above. Be proud of yourself: don't let the self-critical thoughts creep in-that's projective identification. There's a fine line between sitting with and processing a distressing memory for yourself and ruminating-talk this through with your supervisor. Don't avoid what happened, but recognise if and when it's becoming unhelpful. The darkest thing about vicarious trauma is the way that our worldview becomes tainted-we see through a glass darkly and innocent things take on a sinister bent. Notice if this is starting to happen for you and consider a short period of personal therapy with a trauma therapist.

6) are you working within a therapeutic framework? If you have a therapeutic rationale for going into this pain with someone and reliving it it's helpful for both of you. My understanding is that there is no merit in a traumatised person (in the PTSD/complex trauma sense) talking about the trauma without a therapeutic rationale (eg reliving)- it can risk re-traumatising the person and these memories need to be processed, thay cannot be cried out. As Ruthie and Baa said, focussed CBT treatment, or EMDR, seem almost magical in the way that they reduce the pain and distress associated with the memories. Having a therapeutic rationale for any trauma work is essential for both of you.

7) I've been a long-time lurker on this forum, and have always been impressed by your intelligence, wisdom and empathy in your comments. You sound as though you are doing fantastic work: hold on to that.

warm best wishes, and I hope you have a lovely weekend.

Pink
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workingmama
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Re: Dealing with secondary trauma

Post by workingmama » Fri Dec 02, 2011 10:03 pm

Thanks ever so much to everyone for taking the time to write and PM. It really has helped just to feel that community support (go Clinpsy!).

I've had a day of not working today, and went a bought some toot at the shops (cookie cutter fairy lights, a new saucepan, a new set of stacking lunchboxes with weird transfers on them and nice biscuits). Went to a lecture being given at work (very, very good update on recent changes to rape legislation in Scotland), and had a good natter to my supervisor.

I'm feeling a bit less 'immediate' about yesterday, despite having slept a bit badly last night, so feeling a little spaced out. I wasn't terribly clear in my post earlier - I wasn't working directly with the client and her children, but can't outline what had occurred without risking identifying the people involved (tried to write a rough idea, but just not possible to do - ethics are a bugger!).

Thanks for the suggestion of a one-off session, Baa and Pink. Supervisor has offered to pay the bill for me to contract a bit of work with a CP that I've worked with before - I found her very good, and think it would be worth the cost to avoid longer term 'stuff'. The colleague I sought debrief from yesterday was terribly kind, but focused very much on that 'it was okay to feel this way', and whilst that was spot on, it's not what I was stuck with. I'm kind of totally fine with however I feel about anything - I just feel whatever I feel, and I have no internal judgements about whether a good professional 'should' or 'should not' feel a certain way. What I feel strongly is a kind of horror and feeling of threat at the event, and that wish that everyone else can have witnessed what I did, so that I don't feel so alone with the image/event. I know from previous work that that part will fade in a few days, but it's very isolating right now.

Thanks for the words about humans and the evil things they/we can do, Ruthie. I've worked with some pretty violent offenders before (a while back now though), and part of my shock is about the level of shock I feel right now. I've heard some really appalling things before, and I guess I had some internal belief (although not consciously) that I'd probably heard about as bad as things can get - how wrong was I?! I'm trying to think about your comments on thinking of the potential use of what has occurred for the people involved, and how I can use this to help other women and their children experiencing abuse. For a few hours I just wanted to never work in social care, therapy or anything related ever again, and open a nice wee cake shop, because I just didn't want to ever have to know that such horror happens in the world (very realistic, huh?!). Then I spent a few hours thinking that I wanted to continue trying to access a CP training so that I can come back into what I do, and use the training to make our work better. I'm sure it'll all settle into a kind of equilibrium in a few days.

The children are enjoying trauma-mummy, as I left work early and stopped off to load up with carbohydratey-crap that they love to eat, let them watch stupid amounts of tv, and more or less gave them anything they asked for. Boy, are the troops in for a shock when fruit and bedtime-mummy returns tomorrow morning! :wink:

Anyway, thanks again everyone. Very grateful for the advice.

WM x

PS - Baa, I'm feeling pretty bad, but God in Govan, let's not bring out ... the Britney!
Fail, fail again, fail better.

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Re: Dealing with secondary trauma

Post by Ruthie » Sat Dec 03, 2011 3:56 pm

I stumbed across an interesting TED talk on compassion click click. One of the points she makes is that people who cultivate compassion are more aroused when they encounter suffering but also show a much quicker return to baseline (I must try to find the research papers) - which makes me wonder what the implications are of this for those of us who work with people who have been through tremendous suffering? Can developing compassion make us more attuned to peoples' suffering? Can it also give us resilence in the face of tremendous suffering to approach rather than avoid? More questions to throw out there than a comment. Thoughts anyone??

Ruthie
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Re: Dealing with secondary trauma

Post by workingmama » Sat Dec 03, 2011 7:37 pm

Gosh, that really resonates! I think that I certainly respond rather differently in the face of trauma than I did ten years ago. Colleague and I were talking about that a couple of days back, but I didn't relate it to any general process. I'm more immediate in feeling my own reactions to working/witnessing trauma (I'm much quicker to let myself cry if I need to, and quicker to acknowledge impact, and quicker to seek support - fewer of those dodgy 'I'm not a great professional if this hurts' beliefs anymore), but I probably do 'recover' faster after hearing awful things than I once did - I wonder if that relates to 'the faster you acknowledge it and deal with it, the faster you recover'. It would seem to make sense, wouldn't it?

Do you think that the 'developed compassion', when extended to ourselves as humans dealing with trauma, is what helps us a) in client work, but of relevance here b) helps us bounce back quicker as practitioners?

Moving from the personal to the more general, is it expressly repeated professional exposure to trauma (if dealt with well) that teaches us some kind of resilience? In a kind of 'sink or swim' way, that after we've dealt with trauma maladaptively a few times, that we get better at looking after ourselves?

Just off to read your links, Ruthie.
x
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Re: Dealing with secondary trauma

Post by eastofnorth » Tue Dec 06, 2011 8:28 am

Ruthie wrote:I stumbed across an interesting TED talk on compassion click click. One of the points she makes is that people who cultivate compassion are more aroused when they encounter suffering but also show a much quicker return to baseline (I must try to find the research papers) - which makes me wonder what the implications are of this for those of us who work with people who have been through tremendous suffering? Can developing compassion make us more attuned to peoples' suffering? Can it also give us resilence in the face of tremendous suffering to approach rather than avoid? More questions to throw out there than a comment. Thoughts anyone??

Ruthie
Perhaps those that cultivate compassion towards others also cultivate it towards themselves (and vice versa), expediating the recovery process.
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Re: Dealing with secondary trauma

Post by astra » Tue Dec 06, 2011 10:41 am

eastofnorth wrote:
Ruthie wrote:I stumbed across an interesting TED talk on compassion click click. One of the points she makes is that people who cultivate compassion are more aroused when they encounter suffering but also show a much quicker return to baseline (I must try to find the research papers) - which makes me wonder what the implications are of this for those of us who work with people who have been through tremendous suffering? Can developing compassion make us more attuned to peoples' suffering? Can it also give us resilence in the face of tremendous suffering to approach rather than avoid? More questions to throw out there than a comment. Thoughts anyone??

Ruthie
Perhaps those that cultivate compassion towards others also cultivate it towards themselves (and vice versa), expediating the recovery process.
I don't think you can do one without the other can you, eastofnorth? I think as I have developed my compassionate mind over recent years I have become quicker to feel what's going on in the moment, but also more able to leave it in the moment and move on. Having said that there are some things you just wish you'd never heard, or could rub out of your brain, and these can pop back in in moments of stress. I like to think of feelings like waves in the sea, if you let them wash over, even if they sometimes contain jellyfish and crabs, they pass, but if you try to hold back the tide, you eventually get engulfed by a tidal wave full of nasties when you can't hold it back any more. For me the hardest thing to deal with is disgust, when I'm truly disgusted it's so hard to just stay with it and not fight the image away, but I know from experience the more I try not to think of it, the more it pops back so in the long run it's better to stay with it however aversive.

P.S. Hugs Workingmama! Hope you're OK.
From the point of view of mindfulness, as long as you're breathing there's more right with you than wrong with you. Jon Kabat-Zinn

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