Archive for

Understanding Vicarious Trauma

Nonprofit sectors are filled with committed, overworked social service professionals who help clients overcome various forms of trauma. One common occupational hazard of this profession is vicarious trauma, where the professional helper begins to show signs of the same wear and tear evident in their clientele. Their desire to care for and help their clients combined with feelings of empathy for their clients’ crisis or pain can create ideal conditions for vicarious trauma.

Types of nonprofit workers that experience vicarious trauma include:

  • Victim advocates
  • Mental health clinicians
  • Substance abuse counselors
  • Disability workers
  • Crisis center workers
  • 9-1-1 dispatchers and operators
  • And more

Social service professions often have large staff turnover and worker shortages as well as extensive sick time because of vicarious trauma. It is imperative that social service nonprofit leadership learn more about vicarious trauma and educate their staff and board members to alleviate the negative effects of this condition.

Effects of Trauma on the Brain

The limbic system of the brain is responsible for the “fight, flight, freeze or faint” response which is triggered when the mind senses the body is in danger or experiencing trauma. Information is processed by the thalamus and if the brain sends the message that the body is in danger, the Amygdale starts the response process.

The right side of the brain takes over, which manages the visual, kinesthetic and creative skills, allowing for strength and strategy to help save the day. The left side of the brain, which manages language and coping skills, shuts down. This explains why victims are confused and have difficulty explaining what happened after a crime occurs.

Vicarious trauma can trigger the same brain reactions on a smaller scale. Because a social worker may hear up to 100 traumatic stories each month, the trauma experience can be as debilitating over time as a one-time traumatic experience.

Symptoms of Vicarious Trauma

Physical, emotional and behavioral symptoms can include:

  • Compassion fatigue
  • Headaches
  • Sleeplessness
  • Increased blood pressure
  • Digestion problems
  • Depression
  • Irritability
  • Anger
  • Fear
  • Guilt
  • Helplessness
  • Low motivation
  • Oversensitive feelings
  • Desensitized feelings (numbness)
  • Flashbacks of past cases
  • Memory or concentration loss
  • Poor decision making
  • Self medication (alcohol and over-the-counter medications)

Some of these symptoms have caused social worker licenses to be revoked. It is important that social workers manage their own needs without relying on the affirmation of their clients. Social workers must adhere to their integrity and code of ethics established by the National Association of Social Workers. These ethics include avoiding self disclosure, inappropriate physical contact or discussing cases with friends or family.

Contributing Factors

Many people in helping professions have experienced their own trauma in the past. They may not only experience flashbacks of past clients, but face flashbacks from their own medical or crime related trauma. Some choose the profession to understand their own trauma experience and help end the pain of others who were similarly traumatized.

Falling victim to the general consensus that healers should not need to be healed, social service professionals who experience symptoms of vicarious trauma may be ashamed about their condition and fear the repercussions from their employers, co-workers and clients.

Vicarious trauma is often ignited among counselors who are overwhelmed and overworked because of poor organizational structure surrounding case management. This exhaustion can lead to clinical errors, which can negatively affect an organization’s reputation and future funding.

Trauma Is Transformed

You are dying as you read this. You are also birthing something as you finish this. There are about 75 trillion cells in the human body. Each cell is individuated with a specific task and a life span. They die before “us” and are replaced with new cells. They also outlive us. According to Forensics specialist, when a person dies, their cells take another day or so before they are all dead. Essentially, we are in the state of an ongoing resurrection with parts of us dying being replaced with parts of us being born. No wonder I am not the same person I was last year.

Your skin is a tattoo covering your soul. We cover it, ink it, pinch it, poke it and caress it, but what you felt 3 weeks ago is different than what you feel right now. Your baby’s touch may have felt good a month ago, but caught off guard or in a rush, the same touch is annoying. The skin changed, but the brain being old, stubborn and reptilian has yet to catch up because it likes to horde memories. The skin sheds and the brain retains. Surely both are required; but they are working in opposition of each other. If they were working in tangent, the resilience of the skin would teach the brain to let go after it has obsessed over the same words a million times. In turn, the brain would remind the skin to stay around a little longer to read what is written on its old skin before it is released.

I often assist patients by first engaging their senses so that the process of demystifying the power that abuse claims is gone. I often begin with the largest organ on the body. The skin. Touch it, read it and remember, it can teach you something about resiliency and trauma. When a person thinks of trauma, they remember the cringe worthy feeling or numbness that burns in disgust on their skin. Most sexual abuse victims most often say they feel, dirty, nasty and disgusting. Unable to touch their skin to see it is not the same skin the abuser touched a year ago. On a psychical level, when you away from the abuse, your skin you are touching now is not the same skin the abuser touched. It shed and replaced itself with a new jacket. This is good news for everything; from addiction to old feelings

It is a smart organ that erases other fingerprints taking over. The skin changes and shed itself; yet the mind doesn’t like serpents more clever than its coiled brain. When violence lacerates the skin, the memory of that laceration is anchored in the mind. The brain is much slower in renewal. Some say it doesn’t renew its cells and others say yes, but slower than any other part of the body. Suffice to say while they figure it out, it is not exactly the most apt to shed itself. It is afterall the library. Best we can do is organize it or shred its pages.

Though you have to master the coiled mind if you want your soul to master you. The chmabers like to play mind games with the skin. The catch -22 is they evoke the worst images and replay back onto the new skin you just grew. So now it is not your abuser who is touching you; it is your chaotic memories that are torturing your skin. It is you tormenting you.

Worse yet, memory can become so suffocating that you suffer from amnesia and remember nothing; thus becoming ignorant of yourself. If you realize that triggers are those rooted in the dead skin that is shed, then one part of “letting go” can occur. Yet, truly “letting go” also requires ordering memory or you will become the source of your pain and never turn torture into poetry.

Whereas the skin must shed; the mind must order itself. Anxiety associated with PTSD that is all too common with trauma victims arises when thoughts are colliding into each other trying to be heard in the crowded room of your chambers. Memories overlap and before you know it the trauma takes over and turns everything into a trigger, even good memories. Flashbacks enter and even the smell of your once favorite perfume becomes saturated in the feces of the beast that overthrow your thoughts and there you are caught in a whirlwind of chaos. The coup d’├ętat. The overthrowing of your very mind by a dictator of trauma controlling all movement until your skin is dead.

Well this crazy dance is not in vain. What you just did is introduce the brain to skin. They need each other but operate like they are foreigners on your own divorced body. You must connect them. How? Now enters the soul who is wiser than both and instructs that trauma doesn’t let go of you. It just changes you. The brain doesn’t change, but the way it narrates memory does change. Like energy, it simply changed form and went somewhere else. You are treading on this vital tool called active detachment; which is the best of logic and emotion working as one. Careful because avoidance is not active detachment but can trick you to feel like it is one as it gives ego a false sense of strength.

The narrative therapy approach as well as visual arts are often used by me to allow the victim to take back their story and re-tell it in their way, as many times as they want; thus controlling the pen by taking it out of the hands of the uninvited colonizer. Add to that the realm of dreams and an existentialist’s imagination and you have a beginning blueprint. Imagination saved Viktor Frankl from the insanity of concentration camps; so learn that type of calculated imagination. He was rooted in the reality of ovens; but practiced active detachment that is Zen in form that allowed him to see reality without fear. Without this brilliant calculation he evoked, his imagination could have threw him into the inferno of disassociation and delusion. Instead, like most masters, he perfected it to invent and create whole schools of thought. He remembered every detail of the camp and still managed to rise over it through his inner orchestra of the most stunning chamber music we still hear from him years after his death.

He knew memory is divided into 2 spaces: what is real and what is an illusion. For example, violence is real; but the power of attackers over the rise of soul is not real. A soul is more powerful because it is beyond attack. It is the breath of God you are holding. Behold: Breath comes from the ancient Hebrew word Ruach- God’s soul. When that soul finds expression inside the body of each human, it is is funneled into each man. What fills us is called Nafesh; which is soul of God manifested as breath inside of form. You see not one human being can handle even a breath of divinity with care; so wisdom requires it is freely given to life forms to practice vision of infinite soul. Without the connection of all things, we are -ill-formed and can’t be a whole soul; but a part of it, or breath. We each have a piece of that soul inside of us. Our soul does not break because it doesn’t belong to any of us; but to all of us. Like Sisyphus we try to chain death and so trap our piece of soul in our rib cages, but it always escapes.

When it is gone, it not yours alone. It comes from the stars and goes back to the stars. When an old star dies, it sheds its light and pours the ashes of its death into the birth of a new star. Dust to dust could very well mean “stardust to stardust.” So trauma doesn’t seem so engulfing when we perceive things are not what we know; but what we do not know.

Perhaps that earth shattering explosion you hear may sound like a soul breaking; but it not. It is the lie you hear breaking. The lie that says the brain knows who we are and tricks us by using it to trap us with blackmail of crowded information. The lie is the skin that is over-touched and leaves us to renew ourselves with new skin, but forgets (thanks to the forgetful mind and hurried old skin) to leave us with the coding to do so.

That break we hear is not the spirit but the lie that assumes we are the graveyards of other people’s sins. There is either silence before the crime scene or injustice after. The scream you hear in between is the gavel of your character and the rise of your response. The traumatized can and should be the truth teller. The trauma is transformed when the illusion of innocence is broken. Everyone is a criminal and only she or he who screams in silent terror is the victim; but only in that moment. To stay there would mean we would scream with stitched mouths forever. They did not rescue us then and so they must rescue their humanity now. Not only for them; but for all of us.

So you see, trauma long stopped being a cross I bear alone. I am generous and will ensure I never enter the house of the selectively deaf, dumb and blind without a gift. Trauma breaks minds and bodies; not soul which is capable of both remembering light years of information and agile enough to shed what imprisons it to illusions.

The truth is our traumas are real; but they are not our own. Let them go means let them go so that you are not the crypt keeper of all of our sins trapped inside the little body that once held the vault of secrets. Let it go. It is a crime against HUMANITY and not a crime against you. Do you now understand why it is important to express your torment? My love, you nor I are graveyard. Not even the children that died in the name of your father’s sins are buried. They are here. We are here. Ensure your trauma invites everyone to the divine court of justice. Even death; trauma’s elder teacher is present. Trauma is a small death.

Evoke imagination, expressed in your art, work and life so that the criminal, both silent and loud are called out. If you are waiting for the flawed court of man’s system to determine what is fair, you will not die. You will become a ghost that never sheds its body and has the same reoccurring nightmares. Raise your standards until their standards are below you. There are so many other ways to reclaim who you are that do not depend on antiquated institutions. Explore them and if they don’t work, remember what deepened wisdom and worked and shed the rest with the ignorance that needs more time to grow the skin of liquid oceans and pearled coils of wisdom. That is trauma transformed. Forget nothing and shed everything.

Are Specialized Trauma Therapists Necessary?

This is a good question.

My first thought is yes, a client that has experienced a significant amount of abuse should (hopefully!) receive better therapeutic care from a trauma specialist.  If you have the option to work with an experienced therapist who specializes in trauma disorders, snap up that opportunity as quickly as you can.

Trauma therapy is very much its own area of study, the same as with any other mental health issue.  In trauma work, the therapist must understand dynamics of traumatic relationships, trauma bonds, wide-ranging effects of trauma, layered complications of dissociative disorders, issues of external safety, self harm, system work, memory work, etc.  There are dozens of issues specific to trauma disorders, with dissociative disorders being the most highly complex and requiring the greatest clinical skill.  (Please see my article listing 50 Treatment Issues for Dissociative Identity Disorder.)  The terms “trauma specialists” or “trauma therapists” imply these clinicians have invested significant chunks of time learning about trauma disorders.  They should be more comfortable than the average therapist in terms of recognizing, understanding, and addressing the details of trauma work.

Please remember there are many areas of clinical expertise for mental health professionals.  For example, I am licensed to provide clinical therapy for any area of my choosing, but in my 20+ years as a therapist, I have not worked with autistic children.  However, I have worked with families with traumatized children who also have some very definite and particular needs. Sure, I could apply my basic, fundamental clinical skills with autistic children and their families, but once it became necessary to understand specifics related to autism, I would fail miserably.  I would be scrambling for information, and fast!  Even though I am a good trauma therapist, would these autistic children receive the same quality of clinical treatment with me as they would with a clinician that specialized with autism?  I am quite sure they would not.

Who is a trauma therapist?  For most clinicians, there are no regulatory boards that specify exact qualifications.  Trauma therapists are self-proclaimed experts in the field, and clients are left hoping the professionals they are trusting are actually qualified to be specialists.   Unfortunately, I have seen far too many problems caused by well-meaning professionals who simply did not know as much about trauma issues as they claimed.  Their lack of understanding of trauma-related complexities, timing, processes, etc. caused significant harm, damage, and confusion.

On the other hand, finding a trauma specialist is difficult, and you simply might not have many therapists in your area that work with severe abuse issues.  It is imperative that people suffering from Post Traumatic Stress Disorder (PTSD) or any of the Dissociative Disorders receive treatment in order to heal from their traumatic experiences.  If your only option is to work with a “general practitioner” instead of a specialist, then that is what you do.  Good basic therapy is certainly better than no therapy at all.

Select therapists who are open-minded to the effects of trauma, honest about their limitations, and willing to learn more.  As long as their clinical skills include active listening, deep understanding, gentle compassion, effective communication, recognition of family dynamics, emotional tolerance, clear boundaries, etc., you will be able to progress in your healing.

However, it will be highly important to augment your treatment with additional information.  Read books, search online, get regular and ongoing consultations with trauma specialists, join trauma/DID support groups, attend conferences, consider online or distance therapy with a trauma therapist as an adjunct (secondary) therapist, etc. 

Do not assume that general therapists will learn enough on their own to get you through the most difficult and complex places in your healing.  You will have to take charge of your own work.  Make sure to do extra homework!

Your greatest therapeutic gains will be with a therapist you trust.  Therapy is about you.  It is your looking at your life, your history, your feelings, your reactions, your truths, your beliefs.  When you feel safe enough to be totally and completely honest with yourself, you will be able to look at your painful wounds and all the resulting affects of the trauma.  You will be able to bring down those dissociative walls that you built for safety and separation from “all the hard stuff”.  

Pick a therapist you can connect with, build a solid foundation, and keep going from there. You’ll feel better for it.