Secondary Traumatic StressImpact on Mental Health Workers

History and Issue Development

‘It is inevitable that the doctor should be influenced to a certain extent and even his nervous health should suffer. He quite literally ‘‘takes over’’ the sufferings of his patient and shares them with him. For this reason he runs a risk and must run it in the nature of things’ (Jung, 1966)

As early as 1978, Pines & Maslach found health-care workers often had high levels of burnout associated with low morale, absenteeism, high turnover, and general job stress (Collins et al. 2013).

History and Issue Development

McCann & Pearlman (1990) described Vicarious Traumatization as “the transformation in the inner experience of the therapist that comes about as a result of empathetic engagement with clients’ trauma material.”

Figley (1995) described Secondary Traumatic Stress as the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other – the stress resulting from helping or wanting to help a traumatized or suffering person”

Since the creation of this concept, development has been limited by unclear definitions, a lack of research, and a focus too specifically on selective groups of trauma therapists (Dunkley and Whelan, 2006).

Plurality of terms

Secondary Traumatic Stress: PTSD symptoms in caregivers, likely connected

to the patient’s experience rather than that of the caregiver (Figley 1995) He

later changed the name to Compassion Fatigue.

Vicarious Traumatization: the enduring psychological consequences for

therapists of exposure to the traumatic experiences of victim clients

(Schauben & Frazier 1995).

Symptoms

Symptoms much like PTSD, changes in frame of

reference, identity, sense of safety, ability to

trust, self-esteem, intimacy, and a sense of

control (Bloom)

Also includes somatic complaints, like sleep

difficulty, headaches or gastrointestinal distress

(Herman 1992, Figley 1995)

Chose to focus on STS because it tends to have

more outward, easily diagnosable symptoms rather

than internal cognitive shifts that may be difficult

to recognize

Relevance

The New England Journal of Medicine reported

as of November of 2013 there were three

times as many natural disasters between 2000

and 2009 compared to those between 1980

and 1989 (Leaning et al. 2013).

Advances warfare technology and terroristic

tendencies make modern conflicts more

challenging and often civilians bear the

economic and psychological burden. Families

are forced to move in order to escape

violence, leading to severe mental and

physical health issues (Leaning et al. 2013).

Hazard Assessment

A hazard is defined as "Condition, event, or circumstance that could lead to or

contribute to an unplanned or undesirable event", such as the development of

disease or disorder.

The primary reason for assessing hazards is to attempt to prevent them from

happening.

Hazard Assessment

(1) Having a personal history of trauma is linked to the development of VT. Level-

of-evidence: Persuasive (Camerlengo, 2002; Dickes, 1998; Pearlman & MacIan,

1995; Schauben & Frazier, 1995; Trippany, 2000; Young, 1999).

(2) Having a personal history of trauma is linked to the development of STS. Level-

of-evidence: Reasonable (Allt, 1999; Dickes, 1998; Nelson-Gardell & Harris, 2003;

Price, 2001).

(3) Having a personal trauma history is not linked to the development of STS.

Level-of-evidence: Reasonable (Creamer, 2002; Follette, Polusny, & Milbeck;

1994; Simonds, 1996).

Hazard Assessment

(4) The amount of exposure (including hours with trauma clients, percentage on

caseload, and cumulative exposure) to the traumatic material of clients

increases the likelihood of VT. Level-of-evidence: Some (Schauben & Frazier,

1995)

(5) The amount of exposure (including hours with trauma clients, percentage on

caseload, and cumulative exposure) to the traumatic material of clients does

not increase the likelihood of VT. Level-of-evidence: Reasonable (Brady, Guy,

Poelstra, & Brokaw, 1999; Dickes, 1998; Simonds, 1996; Young, 1999).

Hazard Assessment

(6) The amount of exposure (including hours with trauma clients, percentage on caseload, and cumulative exposure) to the traumatic material of clients increases the likelihood of STS. Level-of-evidence: Persuasive (Brady et al., 1999; Creamer, 2002; Myers & Cornille, 2002; Simonds, 1996; Wee & Myers, 2002).

(7) The amount of exposure (including hours with trauma clients, percentage on caseload, and cumulative exposure) to the traumatic material of clients does not increase the likelihood of STS. Level-of-evidence: Some (Nelson-Gardell & Harris, 2003).

(8) Perceived coping ability is a protective factor for VT. Level-of-evidence: Reasonable (Creamer, 2002; Weaks, 1999; Young, 1999)

(9) Perceived coping ability is a protective factor for STS. Level-of-evidence: Some (Follette et al., 1994).

Exposure Assessment

‘Exposure assessment is the process of measuring or estimating the

magnitude, frequency, and duration of human exposure to an agent in

the environment, or estimating future exposures for an agent that has

not yet been released.’ Epa.gov (2012)

Size: 5.2 million adults (18-54) will experience PTSD in a given year

Nature: Treating patients experiencing trauma

Populations: Under 1 million mental health workers to treat patients

Uncertainies: Specific group of professionals and specific group of patients

Risk Characterization

Susceptibility

61% Mild to Moderate

29% Moderate to Severe

Traits of Mental Health Workers

Empathy

Psychological/Emotional Stability

Coping Skills/Mechanisms

Risk Characterization

No Association Association

Gender Female

Age Younger

Years Experience Fewer

Personal Trauma Childhood

Seeing a Therapist Receiving Personal Therapy

Exposure to High % of Trauma Clients

Trauma Clients

Risk Characterization

Limitations to Studies

Different Measures/Scales

Important Variables Not Included

Not Enough Detail (i.e. Years of Experience)

Risk Characterization

Prevention

Personal

Improved self-care (Well Balanced Life)

Organizational

Policy/Regulatory/Legal Solutions

WORKPLACE POLICIES

RISK MANAGEMENT

CASELOAD MANAGEMENT

HEALTHCARE AND SICK LEAVE POLICIES

HEALTHY WORKPLACE INITIATIVES

TRAINING AND PROFESSIONAL DEVELOPMENT

POLICY/REGULATORY/LEGAL SOLUTIONS

CONTINUED

LAWS AND REGULATIONS

MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT AND STATE PARITY LAWS

WORKERS COMPENSATION

AMERICANS WITH DISABILITIES ACT

FAMILY MEDICAL LEAVE ACT

AFFORDABLE CARE ACT

GAPS IN SOLUTIONS

OVERLAPPING AND INCONSISTENT DEFINITIONS

QUANTITATIVE STUDIES

AGREED UPON TREATMENT OPTIONS

INCLUSION IN THE DIAGNOSTIC STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)

BIAS AND STIGMA RECOGNIZING AND TREATING MENTAL HEALTH ISSUES

UNINTENDED CONSEQUENCES

COUNSELORS MUST PERSONALLY ENDURE REPEATED EXPOSURE TO DISTRESS AND

USE THEIR OWN FEELINGS OF SORROW AS TOOLS FOR THERAPY. AS SUCH, IT IS

IMPOSSIBLE TO ESACPE THIS KIND OF WORK WITHOUT PERSONAL CONSEQUENCES.

(CAMPBELL, 2002)