Coping with Vicarious Trauma: Effective Strategies for Social Workers

Social Workers can be at risk of vicarious trauma: effective coping strategies One question that is often asked within our profession is ‘What do social workers do? ’ (Bowles, et. al 2006: 6). Whereas most people know what doctors, nurses, physiotherapists and dieticians do without having to ask, there does not seem to be this general understanding about the role of a social worker. Most social workers themselves find it hard to articulate this question. This is partly difficult due to the encapsulated variety and complexity of social work in a few phrases.

The social work profession is about promoting social change, assisting in problem solving, and guiding people into empowerment and liberation to enhance their well-being. Therefore, why is it so hard Hospital social workers help patients and their families understand a particular illness, work through the emotions of a diagnosis, and provide counselling about the decisions that need to be made (Spencer 2010: 169). Social workers are also essential members of multidisciplinary hospital teams.

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Working alongside doctors, nurses, and other allied health professionals, social workers inform other health care providers to the social and emotional aspects of a patient’s illness (Whyte 2001: 26). Hospital social workers use case management skills to help patients and their families address and resolve the social, financial and psychological problems related to their health condition. The delivery of the clients health is carried out by a range of professionals all working together as one functioning team.

The role of the social worker within a multidisciplinary team involves, evaluating the patient and their support.

This is best understood through the use of a psychosocial assessment (ref). Another part of the social worker role is to help patients and families understand their condition and treatment options. This may also include educating patients on the roles of the health care team, on the levels of health care (acute, sub-acute, home care) and advanced directives for example: health directives, EPA.

Social workers may also have to facilitate decision making on behalf of patients and families, especially in a time of crisis or making end of life decisions. The social worker role is also advocating for the patient and family needs in different settings, for example, inpatient, outpatient, home and in the community. Stresses and burnout? In 1995 Pearlman and Saakvitne defined the concept of vicarious trauma to mean the negative inner experience that a therapist experiences as a result of “empathetic engagement with clients’ trauma material” (Harrison & Westwood, 2009).

Figley, used the term secondary traumatic stress (STS) to describe “the cost of caring for others in emotional pain” (Harrison & Westwood, 2009). He contended that both direct and indirect exposure to trauma could result in PTSD symptoms, and he proposed the concept of secondary traumatic stress disorder (STSD) to characterize the symptoms that therapists could encounter when doing trauma work (Harrison & Westwood, 2009). As social workers you are at risk of burnout and stress. The nature of social work is strongly client-centred and is normally involved in complex situations.

Additionally, in the last few years the change in the nature and practice of social workers are under branches from the political arena. This is why intrinsically self-care is an important factor in a social worker, particularly those who are involved in the health care sector. This form of inner therapy is a good practice aims to ensure that the professional is in good shape mentally and physically. As social workers we have a duty of care to their patients to provide a support, and this is not achievable if their mental and physical health is compromised.

Although most social workers are familiar with self-care, considering they preach the concept religiously to clients. However, many find it challenging to put the concept into practice in their own lives. As social workers many tend to assume that they can or even should handle problems and stress on their own. But, these are dangerous, by ignoring their own needs will find their outlook on the profession going downhill quickly. Self-care is one of the critical factors of being a successful social worker. As a professional they are to provide an incredible amount of empathy to our clients.

They are often listening to very tragic and emotional stories. Therefore, by offering empathy to the patient they are offering a place to share within their story. However, this is not an opening for the patient to be offering the social worker empathy in return. Consequently, when a social worker does that on a daily basis they have an outlet to receive things back. Otherwise, they end up exhausting themselves and therefore, end up have nothing to give back. Offering empathy is imperative in the profession, but it also opens the social worker up to feeling the patient’s pain.

However, while they are being emotionally attuned and available to the patients this increases their vulnerability to work. According to Pearlman & Saakvitine (1995:a), the consequences of vicarious trauma experienced by a Social Worker working in health is very similar to those who are a trauma survivor, but at a subclinical level. Recognized emotional responses include having no time or energy for self or others, increased feelings of cynicism and sadness. Other strong emotions that they may experience are anger, grief, and despair. They may experience other strong emotions such as anger, grief, or despair.

A study by Luster (2004) discovered that out of 179 participants were assessed from compassion and fatigue self-test revealing that 37% of partakers were at risk of vicarious trauma. The average score the scale was 13 25% of the participants scored below 8 and 25% scoring above 17 reflecting some level of vicarious trauma, leaving 54% scoring a high risk of vicarious trauma/burnout. Cited in Jankoski (? : 9), participants in a methodology report spoke of their experiences of vicarious trauma. One of the participants reported that they are not the same person as the day they started the job.

They had a strong sense of hopelessness, by stating, ‘No matter what I do and how hard I try, nothing changes. It’s endless, and for what? ’. Another participant had feelings of being disconnected from their own family, stating ‘ I am not able to be intimate with my husband. I just think of the kids who have been hurt by their own fathers. I go home and I have nothing to give to my own children’. Also, continuing to state that ‘I won’t allow my own kids to play outside unless I’m there to watch them. I’m afraid that someone in the neighborhood will abuse them.

We don’t live in a safe world, I keep my kids close’. Another participant further expanded by stating that ‘I walk down the mall and see a man holding a child and I think, ‘perp’. I see another man holding a child’s hand and I think ‘perp’. The loss of personal identity through nothing matters anymore. This is can occur by making statement such as ‘Just so I get to everyone on my caseload and finish my paperwork. They are starting to believe that is all that is expected of them. There can also be a questioning around their competency and knowledge. Statement such as ‘sometimes I think, it must be me.

My supervisor keeps telling me what I’ve done wrong. The paperwork is more important that what has happed to me or what has happened to the people I serve’. They are assuming that they are always under the microscope. It is important to recognize vicarious trauma. This is the consequence of excessive work, stress and other related factors. Although many people suffer from vicarious trauma for various reasons, and usually the problem is related to several noticeable areas of an individual's life whether this be a person’s happiness, health, success, and others.

Feeling burnout is not simply caused by excessive stress (ref mental health? ). Rather, it is an intricate human reaction to ongoing stress, and it relates to feeling that your inner resources are inadequate for managing the tasks and situations presented to you. The signs and symptoms are similar to that of stress, but include an emotional exhaustion and an increasingly negative attitude toward your work and, perhaps, your life. This concept is well-known in the mental health discipline, particularly within social work.

The reason being that within the social work course burnout and vicarious trauma is a topic that is frequently discussed to make the professional aware of their own limitations (ref – ethics? ). However, recognizing the causes is the first step to understand the series of events that may lead to vicarious trauma. Identifying the personal trait within yourself that could indicate you are over-stressed. Knowing the warning signs is pertinent. The signs may include handling a crisis ineffectively, poor performance of professional duties this may consist of increased negativity and cynicism.

Also, increased absenteeism, social isolation, misinterpreting those in crisis, defensive demeanor and inappropriate justification of their actions are further indicators of professional impairment. Figley (1998) used the term ‘compassion fatigue’ to describe how vicarious trauma can impact on the Social Worker. So what strategies for self-care can social workers employ? There are many approaches which will vary as every-ones state of mind is different. Irrespective of the strategy being used, the social workers self-care activities are in place for a single purpose.

That is ensuring the daily work load does not result in burnout. Relaxation techniques such as meditation and breathing can at first raise up feelings of failure to act and position. Music and introspection are also a good combination for improving the state of mind of a person. These are commonly used techniques, however any mental exercises that draw attention away from stressful events, and provide a 'relaxed' state to the individual, are useful. Such exercises will depend on the personal preferences of each social worker, and the resources that are available at the time.