SECONDARY TRAUMA1
Reducing the Impact of Secondary Trauma in
International Development Organizations that Serve Trauma Survivors
Deb Ekeren
Saint Mary’s University Of Minnesota
Schools of Graduate & Professional Programs
In partial fulfillment of the requirements for GM689
Instructor: Janet Dunn
August 21, 2010
Table of Contents
Chapter One: Introduction...... 3
Purpose...... 3
Significance...... 3
Scope...... 4
Terms...... 5
Chapter Two: Literature Review...... 7
Secondary Trauma: Definition Clarification...... 7
Factors Affecting Secondary Trauma...... 9
Organizational Strategies for Addressing Secondary Trauma...... 12
International Development Context...... 18
Organizational Models of Staff Support...... 22
Summary...... 26
Chapter Three: Recommendations...... 28
Lessons Learned...... 28
Recommendations...... 29
Further Research...... 32
Summary...... 33
References...... 35
Reducing the Impact of Secondary Trauma in
International Development Organizations that Serve Trauma Survivors
Chapter One: Introduction
Purpose
In this paper, I explore organizational approaches to lessen the risks and impact of secondary trauma on trauma professionals in the field of international development in order to provide recommendations for organizations providing psychosocial support.
Significance
Trauma professionals working in the international development sector are involved in responding to natural and human-made disasters, and they work closely with the human impact of the disasters. By providing basic needs and ongoing development support, staff members are exposed to tragic stories of trauma and vulnerability. Over time, the exposure to traumatic experiences can cause emotional, mental, spiritual and sometimes physical harm to trauma professionals. Secondary trauma, as defined by Figley (1995), “is 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” (p.7). Trauma professionals in international development face high risk of exposure to direct and indirect threats and trauma. Nearly a third of international development professionals displayed clinically significant symptoms of emotional distress (Erikkson, Kemp, Gorusch, Hoke, & Foy, 2001). The compound effect of stress and burnout result in problematic factors for organizations through high rates of turnover, high risk of accidents and illnesses, diminished decision-making skills, reduced efficiency, high risk of self-destructive behavior, and heightened tendency to become either over-involved with beneficiaries or apathetic (Ehrenreich, 2006). In order fororganizations that work with trauma to achieve their missions of helping communities recover from tragic events, the effects of secondary trauma must be examined and addressed.
As a human resources professional in an international development organization that serves trauma survivors, I am aware of the complexities of hiring and maintaining a healthy, stable, and productive workforce. The organization for which I work delivers psychosocial support in post-conflict and refugee-receiving countries for survivors of torture and war trauma. The organization employs expatriate trauma psychologists from around the world who provide training and supervision to staff members hired locally as counselors. Most direct counseling is provided by national staff members, but both staff groups are exposed on a daily basis to traumatic stories and material.
Understanding effective organizational approaches to secondary trauma will help my organization and others in the field of international development develop effective practices that support trauma professionals who are asked to work in a difficult field. Specifically, identification of practices will illuminate ways in which international development organizations can increase retention of trauma professionals, strengthen dynamics within workforces, position organizations as leaders in staff care practices, and ultimately, provide high level of care to survivors of trauma.
Scope
This paper explores research on secondary trauma, generally, with a focus on organizational practices that support trauma professionals in their work. The paper will offerrecommendations on practices targeted specifically to international development settings. While significant research has been published on practices that individual professionals can utilize in order to manage their risks of secondary trauma, content on individual approaches will remain outside of the scope of this paper. Also, the paper will focus on recommendations for the psychosocial sector in the field of international development. International development staff members in other sectors such as microfinance, rule of law, and water and sanitation are exposed to risks associated with secondary trauma, but the needs may be less specialized than for professionals who are responsible for addressing emotional needs of trauma survivors.
Terms
Compassion fatigue. Compassion fatigue is a term that blends the concept of secondary trauma with burnout (Adams, Boscarino & Figley, 2006).
Compassion satisfaction. Compassion satisfaction is the amount of fulfillment that trauma professionals derive from their work
Debriefing. As used in this paper, “debriefing” refers to a structured meeting following a difficult incident in which reactions to the event are discussed.
Expatriate staff members. In the international development field, the term refers to staff membershired to work in a country other than theirhome country.
International development. The term refers to the international sector involved in humanitarian work, disaster assistance, and ongoing development.
National staff members. The term refers to employees hired to work in their home country.
Posttraumatic stress disorder. The term refers to a set of symptoms following the exposure to traumatic situations, including personal experiences, witnessing events, or learning about traumatic events. The disorder is characterized by intrusion, avoidance, and arousal (American Psychiatric Association, 2000, Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision).
Psychosocial support. The term refers to an approach in the international development sector that encourages healing and resiliency development in communities by addressing psychological and social support needs.
Secondary trauma (secondary traumatic stress or compassion fatigue). The term refers to a set of psychological symptoms that mirror posttraumatic stress disorder as a result of exposure to people who have suffered from trauma. The stress is the result of empathizing with survivors (Figley, 1995).
Self-care. The term refers to mechanisms that increase trauma professionals’ physical, intellectual and social functioning, so they can approach their work in a healthy, optimistic manner.
Trauma. The term refers to an emotional and or physical wound that causes lasting and substantial damage to the psychological development of a person (Alexander, Eyerman, Giesen, Smelser & Sztompka, 2004).
Trauma professionals. The term refers to psychologists, social workers, counselors, and other professionals who address emotional healing of survivors of trauma.
Vicarious traumatization. The term refers to cumulative and permanent changesthat take place in trauma professionals’ views of themselves, others, and their world, as a result of exposure to traumatic stories or materials (McCann & Pearlman, 1990).
Chapter Two: Literature Review
The review of literature on organizational practices to address secondary trauma in international development organizations that serve survivors of trauma begins with a review of the concept of secondary trauma. Due to limited research on factors affecting secondary trauma within international development organizations, research from domestic organizations that serve survivors of trauma is used to build an understanding about factors associated with secondary trauma and organizational interventions that can lessen its impact. Research on the international development field is reviewed next, including prevalence of secondary trauma, risks associated with international development, and successful interventions for secondary trauma. Finally, several models of good practice in the field of international development are reviewed for recommendations that mitigate the impact of secondary trauma.
Secondary Trauma: Definition Clarification
Psychologists, social workers, and other mental health professionals whose work involves listening to the stories of trauma survivors face a risk of secondary trauma. The concept of secondary trauma was defined by Figley (1995) as the emotions and behaviors that are the result of exposure to traumatic stories experienced by another person. He further elaborated that secondary trauma is the result of empathizing with the person who has suffered trauma. The impact can mirror the symptoms of posttraumatic stress disorder experienced by primary survivors of a trauma, including re-experiencing, hypervigilance, avoidance, and numbing (American Psychiatric Association, 2000, Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision).
Secondary trauma can hinder the ability of trauma professionals to carry out their work to their full potential. Pearlman and Saakvitne (1995) identified that secondary trauma can cause cynicism and despair, undermining the ability of trauma professionals to share hope with their clients. In addition to impacting professional work, secondary trauma can bleed into the personal lives of trauma professionals. Killian (2008) argued that in order for professionals to address the needs of trauma survivors, they must be healthy, committed, and psychologically present.
Researchers demonstrated the prevalence of secondary trauma among trauma professionals (Birck; 2001; Conrad & Kellar-Guenther, 2006; Way, VanDeusen, Martin, Applegate, & Jandle, 2004). Among child protection workers in Colorado, almost 50% had a high or extremely high risk of secondary trauma (Conrad & Kellar-Guenther, 2006). Fifty seven percent of therapists who treated torture survivors in Germany reported a high level of secondary trauma (Birck, 2001). Trauma professionals who treated survivors of sexual abuse and sexual offenders reported high levels of secondary trauma with 52% of providers reporting clinically significant risk for secondary trauma (Way et al.).
Researchers built on the concept of secondary trauma and introduced several other related concepts: vicarious traumatization, burnout, and compassion fatigue. McCann and Pearlman (1990) introduced vicarious traumatization, a concept that advanced the definition of secondary trauma and included profound and harmful psychological effects that alter the way in which professionals see themselves, others and the world. The changes are the result of trauma professionals integrating the traumatic experiences of clients into their personal memory. The impact is cumulative, pervasive and permanent for trauma professionals (Baird & Kracen, 2006).
Burnout was differentiated from secondary trauma as the response to long-term exposure to challenging interpersonal situations. Characteristics of burnout include emotional exhaustion, depersonalization, and reduced feelings of personal accomplishment (Maslach, Schaufeli & Leiter, 2001). Burnout can develop in a variety of stressful environments, including situations that are not related to trauma.
Compassion fatigue is a term that blends the concept of secondary trauma with burnout (Adams, Boscarino & Figley, 2006). Trauma professionals who have secondary trauma and face intense workplace stress over a long period of time may develop compassion fatigue. In some of the research, compassion fatigue was used interchangeably with secondary trauma, and in other research the term included symptoms of burnout (Figley, 2002; Killian, 2008).
For the purpose of this paper, secondary trauma refers to the set of symptoms associated with repeated exposure to traumatic stories of clients. The differences between the concepts secondary trauma, vicarious traumatization, and compassion fatigue are not significant for the focus for this paper. Other researchers have applied a similar approach and used the terms interchangeably (Baird & Kracen, 2006; Figley, 1999; Killian; 2008; Pross, 2006).
Factors Affecting Secondary Trauma
A growing body of research has emerged exploring factors that contribute to secondary trauma. Contradictory conclusions have been reached about some demographic, workplace, and environmental factors and their relationship to secondary trauma. The diversity of results reinforces the need for further research to understand factors that impact secondary trauma.
Trauma history. Concerns have emerged about the predisposition to secondary trauma based on personal experiences of trauma. Several research studies demonstrated that trauma professionals who have their own personal trauma histories face an increased risk of secondary trauma (Baird & Kracen, 2006; Buchanan, Anderson, Uhlemann, & Horwitz et al., 2006; Killian, 2008). Contradictory results were found among trauma professionals who worked with violence and sexual violence that indicated personal history with trauma was not associated with secondary trauma (Bober & Regehr, 2006; Schauben & Frazier, 1995; Way et al., 2004).
Tenure in the field and age. The relationship between length of time working in the field of trauma and secondary trauma is another factor that has been explored by researchers. For trauma professionals focusing on sexual violence, shorter time in the field was associated with increased risk of secondary trauma (Way et al., 2004). Trauma professionals who were newer to the field showed more distress than experienced professionals. Older counselors reported lower levels of distress than younger counselors (Bober & Regehr, 2006). International development workers in Darfur who were older reported lower impact of secondary compared to younger workers (Musa & Hamid, 2008). The correlation between age and length of time in the field is important to recognize. Older staff members and those who have been in the field for a longer period of time may be more effective at managing the emotional challenges of working with trauma. Trauma professionals who are not able to develop effective coping mechanisms may choose to leave the field.
Exposure to trauma. Inconsistent results were shown for the relationship between the amount of exposure to trauma survivors and secondary trauma. (Baird & Kracen, 2006; Birck, 2001; Bober & Regehr, 2006; Buchanan et al., 2006; Eidelson, D’Alessio, & Eidelson, 2003).Exposure can encompass hours with traumatized clients and percentage of trauma survivors on a caseload. In an exploration of 16 research articles and dissertations on secondary trauma published between 1994 and 2003, Baird and Kracen (2006) found evidence on both sides of the hypothesis. They found persuasive evidence linking the amount of exposure to traumatic material of clients and an increased risk of secondary trauma. They also found reasonable evidence to the contrary that increased exposure was not associated with increased risk of secondary trauma. Research not included in the meta-analysis showed similar contradictory findings. Among trauma professionals working with torture survivors, long hours spent with traumatized clients did not increase the risk of secondary trauma (Birck). In contrast, increased levels of secondary trauma were associated with caseloads comprised predominantly of trauma survivors among 280 Canadian mental health workers (Buchanan et al.). Diversified caseloads with a combination of trauma survivors and mainstream clients was viewed as an important factor in low levels of emotional stress among psychologists working in New York following the September 11 terrorist attack (Eidelson, D’Alessio, & Eidelson, 2003). Bober and Regehr (2006) found similar results among 259 therapists; the amount of time spent counseling survivors of trauma was directly associated with secondary trauma. Researchers have not found a clear relationship between secondary trauma and exposure to traumatic material.
Compassion satisfaction. The amount of fulfillment that trauma professionals derive from their work is another factor that has been researched in relation to secondary trauma. The term compassion satisfaction refers to the amount of satisfaction gained from helping clients heal who have endured suffering (Radey & Figley, 2007). A high level of compassion satisfaction among children protection workers was associated with a low level of secondary trauma(Conrad & Kellar-Guenther, 2006). The results supported a theory by Stamm (2002) that compassion satisfaction may be a protective factor against secondary trauma. Finding strategies that raise the level of fulfillment that trauma professionals gain from their work may minimize the risks of secondary trauma.
Work culture. Aspects of work culture were related to secondary trauma. Killian (2008) observed that two factors were closely associated with secondary trauma: a therapist’s sense of powerlessness and work drain. The sense of powerlessness encompassed feelings that social support systems were impeding the healing of clients, leaving the therapist feeling frustrated and hopeless. Work drain encompassed a high level of stress that carried over into time therapists spend away from work. Work environments that address powerlessness and work drain will be better positioned to mitigate the effects of secondary trauma.
Social support. The final factor considered was the association between social support and secondary trauma. Social support can include relationships with colleagues, family, and friends, encompassing relationships at work and in the personal lives of therapists. Trauma professionals working with trauma survivors identified social connections with peers as an important component in managing their work stress (Killian, 2008). A strong association was demonstrated between social support systems and satisfaction with trauma-oriented work, in a quantitative analysis conducted as part of the same study. Reduced stress and increased satisfaction mitigated risks of secondary trauma. Among psychologists working in New York City following the September 11 terrorist attack, a high social support environment contributed to low levels of stress and an increase in positive feelings about their work (Eidelson et al., 2003). Social support appears to serve as a protective factor against the effects of secondary trauma.
Organizational Strategies for Addressing Secondary Trauma
Secondary trauma is a risk that is inherent in working with trauma survivors. Much of the research in the field has focused on specific practices that individuals should employ in order to manage personal risks related to secondary trauma (Bell, Kulkarni, & Dalton, 2003). An alternative perspective holds that within organizations that serve survivors of trauma, secondary trauma is an occupational hazard that requires organization-wide strategies. Organizations have an obligation to create a safe work environment and a culture that promotes healthy behaviors. A review of research will identify key practices that organizations can utilize in order to mitigate the effects of secondary trauma.
Culture. A culture reflects the values and priorities of an organization. For organizations that serve survivors of trauma, the culture must embrace trauma-related stresses as legitimate and expected, and the stresses are the shared responsibility of the organization and the individual (Sexton, 1999). Creating a culture of openness and acceptance is a useful method to mitigate other potentially difficult characteristics of organizations that serve survivors of trauma. Addressing conflicts, providing clear roles and job descriptions for trauma professionals, and promoting cooperation are additional components of culture that should be enhanced in organizations (Hormann & Vivian, 2005). Deliberate efforts aimed at strengthening the culture will result in organizations that are better able to address secondary trauma.