Treading gently through the minefield: a rough guide to vicarious trauma

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Treading gently through the minefield a rough
guide to vicarious trauma

• Dr. Roxane Agnew-Davies
• Domestic Violence Training Ltd.
• Manchester, 2007

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Objectives

• Explore issues that come up for you or other
  staff when working with women who have
  experienced violence
• Support building on self-care strategies
• Implications for supervision

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The first few minutes

• What do you need before you are ready to start?
• Write down what you have done today already
• Think about your to do list what do you need
  to commit to do another time
• Write 1 phrase what you want from this session
• how will you know you got what you want?
• how this applies to work..

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Making staff sessions safe

• Perhaps by discussing
• confidentiality
• space to learn, to be honest not to be alone
• freedom from judgment (yours and others)
• responsibilities (yours and others)
• pacing and
• priorities

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Challenges for professionals working with
violence and abuse

• Fear of offending clients
• Myths hook us too
• Feelings of inadequacy and frustration
• Feeling dumped upon
• Lack of training or time to read/reflect
• Coping with the stigma

• Inability to cure the problem
• Lack of time to deal with everything
• Close identification from own experience abuse
• Fear of opening Pandoras box

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Women experiencing abuse

• Primary abuse
• impacts of
• physical, sexual and emotional violence
• Secondary victimisation
• impacts of responses of friends and family
• and professionals
• .look for the shadows

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How does domestic violence impact way(s) she is
with staff?

• Avoiding pain/at risk-
• she does not turn up
• Still frightened-
• asks the impossible
• Powerless-
• sees staff as rescuer
• Furious-
• leaks anger at staff

• Blamed-
• blames self or staff
• Traumatic bonding-
• eager to please
• Mourning-
• flat, hard to be with
• Vulnerable-
• acts tough, scary

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Connecting our reaction with womans difficulties

• Woman is numbing
• Woman is grieving
• Woman is furious
• Woman feels helpless

• Worker feels pressure to invade her space
• Worker allows special demandeg extra time
• Worker feels fear, or defensive - aggressive
• Worker feels helpless
• impatient or powerful

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Secondary effects of domestic violence

• Also called vicarious traumatisation
• traumatic counter-transference
• Are a normal reaction
• to working with abuse and violence
• therefore
• No-one should work with trauma alone

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I want to know if you can sit with pain, mine or
your own, without moving to hide, or fade it or
fix it
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Workers bear witnesses

• We can
• Know the trauma will somehow be replayed
• Explore the effects on our feelings
• Contain our reactions and get/offer support
• See our reaction as an index, just like the
  clients behaviour as something to reattribute
  to the violence

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Exercise (in 2 or 3)

• Think of a woman you work(ed) with, who you had
  strong feelings about
• Anxiety? Sadness? Guilt? Fear?Anger?
  Frustration?
• Then remember what you did? Achieved? Offered?
• Separate what happened to her from your role
• How are you different in her life?
• What opportunities did you create?

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Options to help you and her

• Dont take it personally! See the shadows
• Ask
• Is that what (abuser) said/ made her feel?
• What happened that she had to learn to..
• What she feels is happening (what is triggered)
• Separating your relationship with client from
  what others did to her will help you both

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Ex. in 2s Re-attribute responsibility

• Are you/she taking blame for things that are not
  your fault?
• Do you focus on what you havent done / she
  hasnt achieved?
• Whats your time scale for client change?

• Discuss her role and whos
• responsible for problems
• Ask what she did do / say what you have done
• Think short long term
• not now vs never

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Options to regain self worth

• Key message
• The abuser, not you, is accountable for the
  problems

• What stage was the earthquake?
• Who else could have helped and didnt?
• Who was the cause of the problem?
• Can you reattribute responsibility?

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Ex How does work affect you?

• Physically
• - Fear reactions
• - Sleeping difficulties
• Mentally
• - Memories
• - Doubts
• Emotionally
• - Irritable, sad
• - Feeling overwhelmed

• Beliefs
• Trust (all men danger)
• Safety (no safe place)
• Power (have none/all)
• Reference (her/him)
• Behaviour
• - Denial of feelings
• - Self medication
• - Sickness, absences

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Why do you go to work?

• Take a few minutes to discuss in 3s
• Why you get out of bed go to work
• What you stand for who you are at work
• What your success moments look like

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Key messages

• Having emotional reactions to work does not make
  us wrong or bad at our job.
• We are not responsible for the violence or its
  effects on the client or us
• Our self esteem should not depend on the outcome
  of the case

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Questions

• How often do you celebrate who you are?
• When/who do you tell about your success?
• How do you feel as you go home most days?

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Endorse strengths/successes

• Counteract abuse
• self doubt
• criticism
• blame
• problems
• By Recognising strength
• courage
• creativity
• perseverance

• Key messages
• Reframe causes of
• problems to D.V.
• Counterct emtional abuse
• Criticism punshmt
• With
• What do you admire?
• What are you proud of?
• Be specific

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Coping strategies

• Legal strategies
• Formal help-seeking
• Informal help-seeking
• Escape strategies
• Separation
• Hiding
• Appeals to abuser

• Compliance
• Resistance
• Self-defence
• Manages children
• Personal strategies
• outcome vs achievement
• for us and our clients

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Tips if you feel anxious

• Identify triggers
• Prioritise your own safety
• Separate yourself from the client
• Identify thinking burglar vs cat
• Check you/client set realistic goals
• Look after your bodily needs exercise,
  caffeine, smoking, lunch, relaxation, breathing,
  sleep.dancing!

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Tips if you keep remembering

• Tell someone about it include feelings
• Write it down include thoughts/ feelings
• Separate client memory from what you did
• Build a safe container (real/imagined)
• VCR technique replay the ending the way you want

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Suggestions if you cant sleep

• Make a routine
• Make bed and bedroom a place to rest
• Eat at least 2 hours before go easy on sugar,
  alcohol, cigarettes, horror!
• Exercise during day
• Try relaxation, meditation
• Focus on the positives put problems away

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Exercise

• Think of something at work you havent done been
  putting off
• or
• Has someone criticised you for not doing
  something?
• and
• how that makes you feel about yourself

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Suggestions if you feel low

• Remember its normal to feel sad
• Plan for time spent, not outcome
• Break tasks into small chunks
• Identify challenge negative thoughts
• Focus on what you have done not what is still to
  be done
• Express anger!

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Exercise

• On a post-it
• Write a sentence
• I am angry at you for
• I resent you for

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Workers have the right to feel angry

• as a natural reaction to the abuse
• as normal as breathing
• as not the same as violence

• as healthy to express rather than suppress
• as part of assertion
• As possible to separate into manageable, directed
  chunks

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Encourage assertion

• What are a workers personal rights
• e.g. to make mistakes, to feel safe
• Watch for inner dialogue
• about yourself or other person
• About what it means
• About the worst that can happen (bag lady?!)
• Being assertive means
• Be brief use I not you ask for information
• Respect the other persons point of view

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Helping to be assertive

• Say what you want/prefer - not I cant
• Being empathic does not mean being blamed
• Ask for time to think, to plan, walk away
• Look for parts to agree/disagree, rather than
  all-nothing thinking
• Separate past from present and person(s)

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How DV can affect beliefs

• Justice
• Safety
• Trust
• Power
• Esteem
• Relationships

• What sort of world?
• Can I be safe?
• Can I trust anyone?
• Do I have power if I cannot stop..
• Am I worth anything given how they see me
• How do I relate to..

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The miracle worker
The miracle worker

• Offers support examines
• attitudes understands DV
• collaborates with others advocates acts as role
  model can cope with complexity deals with own
  anger tolerates horror and terror respects
  believes creates support system

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The ideal supervisor

• Offers
• Safe structure
• Regular meetings
• Acknowledgement of feelings
• Respect rather than criticism

• Open door in response to crises
• Offers support empowerment
• Models the process
• Keeps clinical and operational issues separate

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And the ideal supervisor..

• is
• Polite not Patronising
• Honest, not Sarcastic
• Interested, not Bored
• Listens doesnt Interrupt
• Empowers doesnt Fix it
• Ready to ask, not assume

• Asks Why were you?
• Frustration/overload
• Fear (maybe of losing.. ..)
• Personal life events or pressures
• Feels no-one is listening
• Previous experience of problematic staff/other
• Enacting p c 
• Defence/self-worth low

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Set Boundaries (your own)

• Clear limits
• Agreed time
• Agreed duration
• Contact between meetings
• Agreed number/end

• Set expectations that are realistic
• achievable
• chosen by both/clear
• Our roles should be explicit
• defined by limits
• empowering

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Foster trust

• Success depends on our trusting others and our
  integrity to be worthy of trust
• -be honest, even if its difficult
• -ask if you are not sure
• -check she is getting what she wants
• -think degrees not splits
• -resist omnipotence or helplessness
• -tolerate differences with respect

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And get endings right!

• - An opportunity to learn about completion
• - You will never end with clients if all
  problems have to be solved your role is to
  provide the tools not the answers
• - You have the right to manage your own ending,
  whatever the client chooses

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Exercise

• One thing you are taking away that you learned
  or achieved. Did you get what you wanted?
• One thing you are disappointed about/ can you
  commit to sort another time/place?
• Then say goodbye (the actual words!)

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Dr. Roxane Agnew-Davies

• Mental Health Advisor, GLDVP
• Research Fellow, South Bank University
• Domestic Violence Training Ltd
• roxane _at_ dvtltd.com
• 0797 495 2313