Agency Level Interventions for Preventing and Treating Vicarious Trauma: A Qualitative Study

The purpose of this study was to explore what types of strategies agencies are using to prevent and/or reduce vicarious trauma. To do this, five qualitative interviews were conducted with participants who work directly with individuals who have survived trauma. The findings showed mixed results, as some agencies employed multiple strategies, while others employed few. Agencies seemed to provide adequate benefits and training to employees, and to also encourage them to engage in self-care. While most agencies required supervision/consultation, only one agency encouraged staff members to discuss how they are being impacted by their clients’ trauma. Agencies also did little to manage caseload sizes, as only two participants said that their agencies work to be mindful of the number of trauma cases each staff member has on their caseload. While employees should be held accountable to taking an individual stance in preventing vicarious trauma, agencies also need to make conscious efforts to ensure that staff members are receiving adequate supervision/consultation, training, and benefits, and that they are also being encouraged to engage in self-care. If agencies do not provide adequate support to their employees, the wellbeing and work of their employees, as well as the care of their clients, could be jeopardized. PREVENTING VT AT THE AGENCY LEVEL 4 TABLE OF CONTENTS 1. ABSTRACT.2 2. TABLE OF CONTENTS.3 3. INTORDUCTION.4 4. LITERATURE REVIEW.7 Individual Strategies.7 Agency Level Strategies.12 5. CONCEPTUAL FRAMEWORK.15 Generalist Perspective.15 Strengths Perspective.16 6. METHODS.18 Research Question.18 Sample.18 Procedure.19 Human Subjects.20 Limitations of Study.21 Data Analysis.22 7. RESULTS.22 Supervision.22 Training.27 Self-Care.30 Agency Policy and Procedures.32 8. DISCUSSION.35 Supervision.36 Training.37 Agency Policies and Procedures.38 Self-Care.39 Implications.40 9. CONCLUSION.42 10. REFERENCES.43 11. APPENDIX.47 PREVENTING VT AT THE AGENCY LEVEL 5 Agency Level Interventions for Preventing and Treating Vicarious Trauma: A Qualitative Study Working with survivors of trauma can have both positive and negative impacts on social workers. There tends to be something about just knowing that one is helping another person in need that can make a social worker feel good; in other words, it can be emotionally rewarding to help survivors of trauma overcome obstacles in their lives. On the other hand, working with survivors of trauma can also lead to adverse effects, such as vicarious or secondary traumatization. Vicarious traumatization (VT) is “the transformation that occurs within the therapist [or trauma worker] as a result of empathetic engagement with clients’ trauma experiences and their squeal” (Pearlman & Mac Ian, 1995, p.1). The effects of vicarious trauma can lead to a change in the way that the social worker experiences him/herself, others, and the world in general (Pearlman & Mac Ian, 1995). It can lead the social worker to experience a disrupted frame of reference, changes in identity, alterations in sensory experiences (i.e. intrusive images, dissociation, and depersonalization), and disrupted psychological needs and cognitive schemas (Saakvatine & Pearlman, 1996). Other areas that changes are often seen in are self-trust, (one’s belief in terms of trust in their own judgments and perceptions of reality), self-intimacy (belief of feeling that one can connect to oneself), and self-esteem (one’s belief of whether or not they are valuable) (Pearlman & Mac Ian, 1995). It has been thought that several different factors play into the experience of vicarious trauma. Some believe that it is the empathetic engagement with clients that impacts a social worker’s experience with VT (Pearlman & Mac Ian, 1995; Pearlman & PREVENTING VT AT THE AGENCY LEVEL 6 Saakvitne, 1995). Others believe that it is due to the transference, countertransference, identification, and projective identification (through internalizing clients’ experiences) that take place in clinical work with clients (Cerney, 1995). Researchers have also looked into whether or not factors outside of the social worker/client relationship impact VT. Several researchers have found a positive relationship between the worker having a history of trauma him or herself and later experiencing VT as a result of his/her work (Bober & Regehr, 2005; Cunningham, 2003; Pearlman & Mac Ian, 1995; and VanDeusen & Way, 2006). This suggests that social workers that have personal histories of trauma could be more susceptible to experiencing VT as a result of working with trauma survivors. Researchers have also noted that having large caseloads of trauma survivors has shown to increase PTSD-like symptoms in social workers (Schauben & Frazier, 1995). Some of the negative impacts that VT can create in the workplace include: retraumatization or reinforcement of clients’ negative beliefs about themselves; missed phone calls and or appointments; failure to complete required work duties due to withdrawing; and violating boundaries in supervisor and client/worker relationships (Pearlman & Saakvitne, 1995). Another impact that working with trauma survivors can have on social workers is secondary traumatic stress (STS). Secondary traumatic stress is similar to vicarious trauma in that they both occur due to working with trauma survivors. Secondary traumatic stress is often defined as the outcomes similar to Posttraumatic Stress Disorder that can occur as a result of working with trauma survivors (Pearlman & Saakvitne, 1995). Posttraumatic Stress Disorder can include symptoms of recurrent PREVENTING VT AT THE AGENCY LEVEL 7 and intrusive recollections of a traumatic event; dreams about the traumatic event; physiological reactivity when exposed to triggering stimuli; and acting or feeling as if the event is happening again (American Psychiatric Association, 2000). Some previous literature has differentiated between the terms vicarious trauma and secondary traumatic stress (STS), while others have used them interchangeably. Given the close nature of VT and STS, both will be used when exploring literature on VT. In respect of previous literature, when citing others’ work, the specific terms used in previous literature will also be used in this paper. Given the negative consequences that vicarious trauma can have on social workers’ personal and professional lives, as well as the lives of their clients, families, friends, and colleagues, it is important to recognize ways to try to prevent VT from occurring, and also to develop strategies for reducing VT once it has already occurred. Catherall (1995) suggested that virtually everyone is responsible for preventing vicarious trauma (VT). By this, he meant that it is not only up to the individual social worker, but that it is also up to the agency that employs the social worker. When exploring that idea, the current study found that much of the previous literature has focused on individual methods for prevention and treatment, while only a small body of literature has focused on agency level interventions for preventing vicarious trauma. A large portion of that literature is