CARE FOR CAREGIVERS

Presentation: Peter EssokaTrauma Centre Cameroon

Trauma Centre Cameroon

Contamination:

"I love my work but lately I find it contaminating my personal life. I have nightmares about the horrible things I hear about from clients, my sex life has deteriorated, I'm irritable and distractible, I'm afraid for my kids and tend to overprotect them, and I don't trust anybody anymore. I don't know what is happening to me."

A Therapist

Empathy:Double-Edged Sword “Empathetic engagement helps workers

meet the needs of traumatized people…however, [it] has also been associated with inducting traumatic material from the primary victim (the client) to the secondary victim (the worker).

Empathizing…helps the worker to understand the client’s experience of being traumatized, but in the process the worker may be traumatized as well. These helpers might develop secondary or vicarious traumatization or burnout… ”

Definitions

Vicarious or secondary traumatization (VT): harmful changes in professionals’ views of themselves, others, and the world as a result of exposure to traumatic material

Secondary traumatic stress (STS): a syndrome among professional helpers that mimics PTSD and occurs as a result of exposure to the traumatic material

Definitions

Burnout: Psychological exhaustion and diminished efficiency resulting from overwork or prolonged exposure to stress.

Burnout is a syndrome of emotional exhaustion, depersonalisation, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.

Common Signs and Symptoms Affective e.g., depressed mood, emotional

exhaustion… Cognitive e.g., poor concentration, impaired

memory, intrusions… Physical e.g., headaches, sleep disturbances,

cardio-vascular affections, eating disorders… Behavioural e.g., poor work performance,

frequent anger outbursts, poor interpersonal relationships…

Motivational e.g., loss of interest and idealism

One core indicator is consistently identified – exhaustion.

Common Characteristics

Cumulative.

Inevitable.

Developmental.

Modifiable.

Prevalence:How Big is the Problem? 50% of workers suffered from high or

very high levels of trauma from helping others (Conrad & Kellar-Geunthar, 2006)

37% of child protective workers experienced clinical levels of emotional distress associated with S.T.S. (Source: Meyers & Cornille, 2002).

The Stakes Are High…

If not addressed, [secondary trauma] may adversely affect the caregivers’ work product and interactions with clients. It may also negatively impact caregivers’ emotional well-being and relationships with their own families.

If not recognized and responded to, [secondary trauma] may derail the primary mission of care giving organisation--to identify and assist torture and trauma survivors.

Barriers to Detection…Reasons Workers May Not Acknowledge Secondary Trauma Self-blame (It’s just me!) Shame (I’m embarrassed to admit it) Denial (It’ll pass if I ignore it!) Self-sacrifice (Don’t want to bother co-

workers) Job Security (I can’t expose my weaknesses) Pressure (I don’t have time to deal with it) Cost (I can’t afford to take time off & spend

money for help)

Detection & Risk Factors

Personal Risk Factors History of personal trauma Personally identify with the victim Negative personal circumstances (e.g.,

grief due to recent loss) Low levels of social support Low levels of resilience (capacity of

bouncing back) Lack of meaningful personal relationships

Detection & Risk Factors

Work-Related Factors… inexperience on the job high caseload of trauma survivors (e.g.,

sexual violence) poor or no supervision high frequency of exposure to traumatic

material exposure to critical incidents

Detection & Risk Factors

Organisational Factors… Extraordinary high caseloads High administrative burden Difficult clients Conflicts with co-workers or supervisors Climate of pervasive, ongoing change Excessive emphasis on efficiency, cost

effectiveness and competition. Unforgiving environment. “If you can’t

handle it, get out!.”

WORKSHOPS

1. What are your concerns and experience?

2. What strategies can you take at:

• Individual level?• Organisational level?

Intervention and PreventionIndividual Level increase self-awareness identify reactions and symptoms understand early warning signs accurately name and articulate feelings construct a fulfilling personal life outside work - regenerative

& relaxing activities, strong relationships, etc. develop strong support networks (especially others who

understand trauma work) acknowledge and process personal history of trauma invoke humor strive for realistic optimism foster opportunities for spiritual growth and connection recall importance of one’s work (i.e., your work does make a

difference)

Intervention and Prevention

Supervisory Level educate staff on hazards of secondary trauma normalize responses to secondary trauma promote ongoing self-assessment schedule regular supervision meetings utilize a relational, interactive model of supervision promote other forms of supervision (e.g., peer,

group meetings). identify support resources for workers to access if

needed remind individuals of importance of their work

Intervention and Prevention

Organizational Climate work-related stress is accepted as real and

legitimate. problem is owned by organization (not merely

“problem” workers). secondary trauma responses are recognized as

normal responses. focus is on solutions (not blaming). support and tolerance clearly expressed to worker. other “climate” issues (caseloads, official policy, …)

Intervention and Prevention

Specific Organisational Actions… in-service training policy on secondary trauma ongoing program to manage secondary trauma regular supervision, consultation and support

groups professional development opportunities rotation in caseload and job responsibility health care plan with adequate health care

coverage

You Make A Difference…

…but that difference is only possible when you are healthy, functional, and engaged. Caring for others is noble; caring for yourself is required.

Author unknown