Secondary Trauma - Do you have it?

What is Secondary Trauma and Do You Have It?

Anthony Dallmann-Jones, PhD

 The purpose of this paper: To a) clearly define secondary trauma; b) verify secondary trauma as a concern deserving attention; and, c) suggest a course of action if one suffers from secondary trauma.

I want to start off by saying that human beings are more sensitive than most realize. Some people are more sensitive than others. Some are faster at detecting changes than others. Some are quicker at responding than others. But, overall, human beings are more sensitive than we know, assume, or even sometimes want to be.

The reason for raising awareness about this is because human sensitivity is a significant factor in the impact of trauma.

Definitions:

·      Trauma: Injury or damage. 

·      Sensitive: Quick to detect or respond to slight changes.

·      Secondary Trauma: The emotional duress that results when an individual is impacted by the firsthand trauma experiences of another. As symptoms of secondary trauma resemble those of post-traumatic stress disorder (PTSD), individuals may find themselves re-experiencing personal trauma or notice an increase in arousal and avoidance reactions related to indirect trauma exposure.

Human Sensitivity

How sensitive are we?

·      The human ear is capable of detecting pressure variations of less than one billionth of a shift in atmospheric pressure.

·      The human eye can detect a single photon…which is smaller than an atom.

·      Human touch can detect the difference between two surfaces that differ by only a single layer of molecules.

So, it should be no surprise that we are sensitive enough to be impacted by observing someone else’s trauma. The significance of that impact on each person will depend on that annoying thing called “human differences.” As mentioned, some people are more sensitive, both noticing sooner and responding faster upon detecting changes.

A complicating factor, as if we needed another one, is variation in conscious awareness of our sensitivity. This means that our subconscious mind might very well register something that our conscious mind is not noticing. This factor is awareness. Perceptions through our senses are coming at us constantly – sight, sound, smells, touch, taste.

Sensory input is filtered in our minds at two levels…consciously and unconsciously. At the conscious level, for example, we see something and say to ourselves, “Noted, and I will take action about it by ______.” Or we might say, “Noted, but I do not have time or interest in doing anything with this right now. I will store it for later.” That is a conscious mental action which Freud identified as suppression. We also filter at the unconscious (or subconscious) level. At the unconscious level, for example, we see something and, without our conscious awareness, say to ourselves, “Noted, but it is so painful, disturbing or overwhelming, that I will not allow myself to be consciously aware of this. It goes into ‘cold storage’ hopefully to never be thought of (remembered) again.” Freud labeled this as repression.

The delineation of the conscious and unconscious mind and the defining of suppression and repression were undoubtedly two of the most significant discoveries by Sigmund Freud.

Of considerable importance were the abundant research findings that repressed events and experiences often manage an individual’s behaviors (thoughts, words, and actions) without awareness or permission.

Examples of repression

I personally witnessed this on numerous occasions as an EMT, working my way through undergraduate school: People in traumatic accidents would have no memory of it happening. I crawled through the back door of a car where a driver was pinned by the steering wheel in a crash where she had fallen asleep, left the road, snapped off a tree 16” - 20” in diameter prior to coming to a stop in a forest alongside the highway. Her husband had been asleep in the passenger seat and had been catapulted through the windshield as he was not wearing a seatbelt. She was wounded, but was able to speak with me, while we waited for the police to arrive with the “jaws of life” apparatus to extract her from the car. She kept asking about her husband, asking me if I knew what had happened, appealing to God, and saying things like, “You hear of these things happening but never think it could be you.” Later, I was told, that after surgery and treatment, and while still in the hospital, she had no memory of me, the conversation, or the accident. “I was driving, and the next thing I knew I woke up in the hospital two days later. That is all I remember,” she reported. For two years she was unable to drive a car because she had developed a “phobia” – a (supposedly) unreasonable response to doing something she had always been able to do for 20 years.

Children, sexually abused, who have no conscious memory of their sordid events, often have difficulty with intimate relationships as adults – perhaps exhibiting symptomatically as extremes in what is called impotence/frigidity at one end, and at the other end of the continuum, sexual promiscuity. They blame themselves because they have repressed the memories of the sex abuser, as well as their experiences.

A client had an abusive stepfather. He was famous for backhanding his stepchildren as a means of punishing them. My client remembered that he had unusual fingernails. “They were blunt and round,” she said, “they resembled dimes and nickels rather than normally shaped fingernails.” She went on to relate that, even 20 years later, each time she was around someone and suddenly noticed their unusually shaped rounded nails she was “startled” and had an “involuntary revulsive reaction" and would jerk away before she could help it. Only after she had jerked away would she notice why she had done so. [This is a good example of a combination of suppression and repression. She unconsciously reacted but then consciously knew why.]

Some of the clients in my psychotherapy practice were former Viet Nam combat veterans. They came to me because they had severe drinking, drugging, and sleeping problems. They had hellish nightmares. They had blackouts and violence issues. They had difficulty holding down jobs. They all looked fatigued, wary, and burned out. They dressed like poverty-struck homeless people, even if they had nice homes. Of the things they could remember they would not speak of for more than a few seconds. Most of the things these men experienced became apparent only in their dreams, or it would show up sideways in unacceptable social behaviors. Mostly, they could not consciously remember much of what they had seen and done, yet it was obviously running their lives.

A prime example of secondary trauma

Long before we knew much about secondary, or vicarious trauma, I directed a regional conference on children at-risk on the Marian University campus. As part of an afternoon session, I had invited a panel of local social workers to speak about their work involving children at-risk and to answer audience questions. It was striking how sad, dissipated, stressed and nearly emotionless, the panelists were. Today, 25 years later, it is heartbreaking to remember the scene. Yes, they were overworked. Yes, they were underpaid. Yes, they truly “cared” about their clients very much…but they also seemed way too weary and fatigued to let it shine through during the presentation.

I know now they were all suffering from secondary trauma. As many first responders – police, firemen, EMTs, doctors, nurses – have come under scrutiny for their “stress issues” dealing with trauma, we are finally waking up and also seeing it in social workers, counselors, and others who are working with victims of trauma, adverse childhood experiences, abuse, and neglect, extended suffering due to poverty, malnutrition, and inadequate care – namely and expressly those on whom we are focused in this article – educators.

Teaching and secondary trauma

From the National Child Traumatic Stress Network: 1 of their 12 Core Concepts* is concerned with those who are working with trauma-exposed children, because this can evoke distress in providers, making it more difficult for them to provide adequate care. Mental healthcare providers must deal with many personal and professional challenges as they confront details of children’s traumatic experiences and life adversities, witness children’s and caregivers’ distress, and attempt to strengthen children’s and families’ belief in the social contract. Engaging in clinical work may also evoke strong memories of the care providers’ personal trauma- and loss-related experiences. Proper self-care is an important part of providing quality care and of sustaining personal and professional resources and capacities over time.

What can you do if you have secondary trauma?

First, it cannot be overstated enough that it is not only important, but it is legitimate to take secondary trauma seriously. Anything that makes you less effective in your role as a caregiver to children in desperate need of your help is more than worthy of attention AND amelioration. One might say it is an obligation to do so.

Secondly, we need to look closely at the term “self-care.” No one should know better than you that you are in need of care. Shake off the reasons, especially those that seem to be repeated over and over to excuse your less than optimal state of health – whether that be physical health, mental health, emotional health, social health, financial health, and – especially – your spiritual health. Notice yourself saying things like, “Well, at least I am not as bad off as _____.” “There are people a lot worse off than me.” “Hey, if you are going to make a difference you have to expect to be ___________ all the time.” [Tired, stressed, angry, etc.] or “No pain, no gain.” or, “Well, it’s my own fault. No one told me I had to be a _______________!” [Nurse, doctor, social worker, youth worker, teacher, etc.] or “It’s just part of the job.” Instead, make it “part of the job” to take care of yourself. Again, it is legitimate to put your care first!

Thirdly, MAKE A LIST of things you can initiate and take action on that would help you stay in tip-top shape. Few of us are fans and fewer still have had the opportunity to attend the Indy 500. It is an experience you will never forget. The crowd, the energy, the sounds, the incredibly well-trained and disciplined pit crews, the celebrity status drivers, and those 33 most gorgeous, polished, colorful, precisely tuned Indycars. The one thing you would never hear is someone saying, “The car is operating at only about 60% but what can you expect? Get her out to that starting line!” No, every car is fine-tuned to the max and, for and during that race, hundreds of thousands of dollars and manhours have been dedicated to each car to keep it in top running condition for 500 miles. This is a CAR! And I guarantee you they have checklists to monitor that car’s health, and a stockpile of resources if something goes wrong with the health of that car. You are much more valuable! And you are in the business, not to be a crowd-pleaser, but to save children’s lives. You deserve your own checklist of things necessary for you to stay in the best shape possible so you can caretake with the best of them!

Something that has worked for me: S.C.I.P.

The first mandate in a self-care program is to have one!

Design, create, construct, your own Self-Care Insurance Program. I call it S.C.I.P. for short. Have a SCIP!... a clearly defined, personally crafted plan, such that if I asked you, “What is your Self-Care Insurance Program?" You could email it to me, or hand it to me on a sheet of paper or tell it to me before we reach your floor on an elevator.

In my own recovery from burnout and codependency, I knew I needed a structure…a clearly defined structure, or map, back to full health. I eventually evolved that structure into a chart. It had six boxes, with bulleted to-do items in each category. As I recall the boxes were titled:

Financial/Career

Social

Physical

Spiritual

Mental

Family

I was a single parent of two boys at the time. I had a very busy counseling practice in my home office. I don’t remember all of the 3-5 bulleted things in each category, but they said things like “Workout 3-4 times a week” “Read professional journals once a week.” “Spend 4 hours each weekend playing with the boys” “Save 10% minimum of all income for investing” “Meditate and do your readings daily” “Go to 3 recovery meetings a week” â€œWrite in my journal every day” “Do something for fun 3 times a week, minimum”

I taped that chart to my bedroom wall, and followed it religiously…and I was on top of the world… then one day I started feeling down, a little dried up, and realized that I had stopped deliberately checking my chart. I had assumed I remembered everything on it…so why refer to it? Sure enough, I discovered I had, unconsciously, stopped doing not just one but several things on the chart. I was unaware or was probably making what seemed like rational excuses, for slipping, sluffing off, backsliding. If I had not had that chart I would not have noticed. But what did happen is that I self-corrected, i.e., I monitored and adjusted, and rapidly returned to my previous healthy and joyful level of functioning.

I encourage you to come up with your own SCIP ideas. Personally, I have never found a better way to self-care than using a chart that definitively spells out what I need to do in order to stay on my highest plane of existence…where I am healthy and therefore more capable in my being of service to others. I saw it as a training program. It was my prepping for the Service Olympics. I made sure I stayed healthy, ate right, got my rest, nurtured myself, and started each day refreshed and strong. I basically had barometers planted all over the place. Was I too tired, too angry, too hungry or thirsty, too off-balance, too sad? I was seeing 28 individual clients a week and had two nighttime therapy groups, plus raising the boys. I had 40 clients and 2 boys I had pledged responsibility to. I learned quite obviously I had to first be responsible for ME and my well-being in order to be of good use to them. I learned how to set limits for myself and boundaries for others. I parented myself - not the bossy autocratic parent - but the nurturing, caring, friendly but firm, parent.

Only if you have a plan to be at your best can you save the rest.

Shortest conclusion ever…

So, to conclude:

·      Make it legitimate to self-care

·      Have a SCIP plan

·      Use it

*https://www.nctsn.org/sites/default/files/resources//the_12_core_concepts_for_understanding_traumatic_stress_responses_in_children_and_families.pdf

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Dr. Anthony Dallmann-Jones is the Director of the At-Risk and Alternative Education Program at Marian University in Wisconsin. ARAE is a 100% online MAE Program for earnest educators looking for a way to be more effective at being an advocate for kids who have few, if any, champions on their side.