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Secondary traumatic Stress

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by

Phil Rigotti

on 3 November 2014

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Transcript of Secondary traumatic Stress

Secondary Traumatic Stress and Social Work
To recognise the impact of traumatic stress on child development.
To understand what people need to recover from truama.
To understand the impact of living and working with traumatised children.
To think about how to prevent and treat secondary stress.
Brain Development
Brain Stem
Mid-Brain
Limbic-Brain
Cortex
Responsible for state regulation.
Before birth-eight months
Reponsible for motor functioning
Birth-one year
Responsible for cognitive functioning
One year-four years
Attachment and Attunement
Babies and carers enagage in an intimate dance conversation
their bodies and brains, feelings and thoughts begin to work in tune
This attunement patterns the infant brain
Attunement provides a blue print for all human interaction
Stress regulation is the first pattern
Young babies cannot regulate stress
Unregulated stress injures the brain
Children who did not have these needs met as babies may be unable to regualte stress.
?
What is the first thing we usually do when a baby is crying?
Responsible for emotional functioning
Birth-one year
Trauma
Developmental Trauma
Emotional trauma
Traumatic Event
Traumatic Stress
The automatic response to trauma, involving the production of toxic amounts of stress hormones which affect:
brain function
all major body systems
social functioning

A bio-psycho-social injury
An event which is, or is realistically perceived to be, threatening to the life or personal integrity of self or others
and
The response to the event is one of fear, helplessness or horror
Once children can process feelings and can think, they may be injured through exposure to terrifying events
Such events lead to extreme stress which injures the brain (stress can turn off blood supplies to parts of the brain)
Injuries acquired through exposure to overwhelming fear or horror may be described as emotional trauma
Trauma means injury
Unregulated stress causes injury to the brain through stress hormones
Children with unmet attachment needs often cannot regulate stress
Injuries acquired through stress dysregulation because of unmet infant attachment needs may be described as developmental trauma
?
Can you think of any external event, other than physical or sexual abuse, which could cause truama to a child?
How do we react to life-threatening situations?
Hyperarousal and dissociation
Emotional trauma overwhelms our ability to regulate stress
When stress cannot be regulated only two things can happen:
The person remains aware of the stress – HYPERAROUSAL
(continual feel uncomfortable, afraid or unhappy)

The person loses sensory awareness – DISSOCIATION
(no longer feels the fear or unhappiness and shows little reaction to external stimuli)
Dissociation is a protective reaction to the pain of overwhelming stress
It produces general loss of sensory awareness
Unregulated stress causes stress injuries whether or not the person is aware of the stress
Safety
Well-informed social networks with secure attachment relationships
The ability to express what has happened
We need 3 things to recover
?
What are the effects of trauma?
Cognitive
Physiological
Physical
Emotional
Social
Language difficulties
Alteration in the capacity to create language
Alteration in the capacity to construct meaning (feel like nothing makes sense anymore)
Alteration in the capacity to link language to feelings, to express feelings through language
Memory disturbance
Amnesia
Hypermnesia
Short-term memory problems
Autonomic hyperarousal
Inability to concentrate
Preoccupation with trauma related affect (addiction to own stress hormone)
Need for high stimulus environment – noise, activity, attention and risk (they experience withdrawal otherwise)
Hypervigilance
Scanning for threat
Altered perceptions
Alteration in visual and auditory fields
Lack of co-ordination
Clumsiness and pain
Poor self-image
Numbness
Self-generated pain relievers (opiates) produce numbing
Addiction may lead to self-harm
Psychosomatic conditions
Impact on organs and muscles and immune system
Somatisation of emotional experience
Numbing
Difficult to engage with emotionally numb children
(as they can not say how they feel)
Extreme reactiveness
Terror or rage
Somatisation
Difficulty with emotional sensitivity and recognising feelings
Anhedonia
Loss of the capacity to experience joy, wonder pleasure and excitement
Loss of ability to relate to others
Preoccupation with trauma-related affect and construct
Others interpreted as threatening
Loss of social intentionality
When someone feels their life is threatened they have no motivation to act in a normal sociable way with other people
Loss of ability to perceive or construct meaning
Central cognitive constructs destroyed by trauma ‘the world is bad and people are evil’
Inability to discern connections impairs all learning
Learning about trauma
Adaptation
Learning words for feelings
Safety
Integration
Stabilisation
Developing physiological self-management
Processing:- acting out, playing out, talking out
Cognitive restructuring
Exploring changed personality, peceptions and relationships
Developing self-esteem
Individual Resilience
Social Resilience
Vulnerability and Resilience
Social competence
Temperament
Autonomy
Problem-solving skills
Thinking skills
Sense of humour
Sense of identity
Insight
Morality
Sense of purpose and future
Creativity
Spirituality
Close confiding intimate-relationships
Positive and secure attachments
Support from attachment figures:
High warmth/low criticism
Support network has high expectations
Participation not passivity encouraged
Strong but flexible sense of community
Understanding Secondary Traumatic Stress
Secondary traumatic stress is the stress that results from caring for or about someone who has been traumatised
It can result in injuries similar to those produced by primary trauma
People who are empathic, and/or have experienced trauma in their own lives, and/or have unresolved personal trauma are vulnerable
People who work with or care for traumatised children are particularly vulnerable to secondary traumatic stress - If you think about some of the difficulties traumatised children experience as we discussed this morning you can see how difficult it would be to care for them, and the more
empathic
a worker is the harder it would be!
Signs and Indicators of Secondary Stress
Distressing Emotions
Anger, tearfullness, fearfullness
Unexplained changes in health
Sleep patterns, eating and drinking, physical illnessess
Physiological arousal
Jumpiness, nightmares, hypervigilance
Avoidance of working with traumatic material
Unable to enter emotional space of child, or identified with child and sharing child's avoidance
Signs of developing disorder
Impairment of day-to-day functioning, leading to such changes in behaviour as:
Missed or cancelled appointments
Decreased use of support networks
Diminished self-organisation: being late, lacking self-care, and so on
Increased feelings of isolation, alienation and lack of appreciation
More about Empathy
Impact on individuals

Decrease in quality and quantity
Increased mistakes
Avoidance of tasks
Perfectionism
Obsessiveness
Exhaustion
Irresponsibility

Decrease in confidence
Apathy
Dissatisfaction
Negativity
Feel incomplete
Subsume own needs
Detachment
Stress
(cc) image by anemoneprojectors on Flickr
Burnout
Overengagment
Emotions over reactive
Produces urgency and
hyperactivity
Loss of energy
Leads to anxiety disorders
Primary damage is physical
May kill you prematurely
Disengagement
Emotions are blunted
Produces helplessness and hopelessness
Loss of motivation, ideals and hope
Leads to detachment and depression
Primary damage is emotional
May make life seem not worth living
Automatic Empathy
Controlled Empathy
?
What is your own experience of training, support, and supervision...
'Mirror Neurons' create a full body sensation as if the listener was experiencing the same event. The helper imagines the event as if it were happening to them.
When a helping person is listening to a shocking, sad or awful story, it may look as if they are calmly sitting and listening. But not only is the listener abosrbing the shocking story, they must also respond in a contrained manner
Training
Understanding secondary traumatic stress
Stress management
Professional Development
Personal Development
Support
Informal Support
-Knowledgeable network
-Trusted challenger
Formal Support
-Peer Groups
-Mentoring
-Telephone Helplines
Supervision
Regular Meetings
Reviews involving outside perceptions
Consultancy with pschologists / therapists
Specific expert consultancy around particular issues
Treating Secondary Traumatic Stress Disorders
Disorder cannot always be prevented
Even knowledgeable and resourceful people are unlikely to recognise their own increasing disorder
Supervisors may also develop secondary traumatic stress disorders and be less able to recognise signs and symptoms
Agencies have a duty of care towards carers and staff at all levels.
Physiological Self-management
Recognising Need
Responding to trusted challenger
Psychometric testing
Medical supervision of recovery
Recovering relaxation response and joy in living
Commitment to practise and notice absent responses
Apply language to rediscovery of relaxation response and sensation of pleasure
Self-monitoring to maintain health and well-being
?
What could 'we' do to support those affected?
Psychological Therapies
Cognitive Distortions
Working with traumatised children can lead to distorted thinking patterns that can persist and need therapy
Behavioural Disturbance
Stress disorders can produce habits that persist after recovery
Triggering of unresolved trauma
Any unprocessed trauma may be triggered by working with traumatised children
Couples Counselling / Relationship counselling
Couples and dyads can be split and may need help
Family therapy / Group Therapy
Whole groups can be split and may need help to recover
Agency Responsibilities
Health and Safety
Recognising Hazards
Assessing risks arising from hazards
Having strategies to reduce and manage risks
Management and Supervision
Integrated understanding of secondary stress hazards
Recognition of benefits of prevention and treatment strategies
Whole organisation policies and procedures
ANY QUESTIONS?
Performance
Morale
Interpersonal Relationships
Withdrawal from colleagues
Impatience
Decrease in quality of relationships
Poor communication
Conflict
Professional Behaviour
Exhaustion
Faulty judgement
Irritability
Tardiness
Irresponsibility
Overwork
Frequent Job Changes
?
Do you recognise any of these indicators as having emerged in your own professional life?
Practical Strategies

Do you plan your diary so as to not have high intesity meetings / interactions one after another?

Do you have personal interests outside of work?

Do you pace your day / week? Do you plan in breaks?
Full transcript