Secondary Trauma

1
Dr. Samuel Pfeifer

• Secondary Trauma
• When Helping Hurts

2
Receiving yourself in the fires of sorrow

• You can always recognize who has been through
  the fires of sorrow and received himself, and you
  know that you can go to him in your moment of
  trouble and find that he has plenty of time for
  you. But if a person has not been through the
  fires of sorrow, he is apt to be contemptuous,
  having no respect or time for you, only turning
  you away. If you will receive yourself in the
  fires of sorrow, God will make you nourishment
  for other people.

Oswald Chambers, (My Utmost for His Highest 25.
June) - http//www.rbc.org/utmost/
3
Moved with compassion

• But when he saw the multitudes, he was moved
  with compassion 4697 on them, because they
  fainted, and were scattered abroad, as sheep
  having no shepherd. (Mat.9,36)

• G4697
• sp?a??????µa?
• splagchnizomai
• splangkh-nid'-zom-ahee
• Middle voice from G4698 to have the bowels
  yearn, that is, (figuratively) feel sympathy, to
  pity - have (be moved with) compassion.

4
Trauma is contagious

• Trauma is contagious. The therapist, in his role
  as a witness is often overwhelmed by his
  emotions. He goes somewhat less than the
  patient through his feelings of dread, anger
  and despair.

Judith Hermann, Trauma Therapist
5
Contagion effect

• Figley (1995) identified the mirroring or
  contagion effect of symptoms from client to
  therapist and argued that "those who have
  enormous capacity for feeling and expressing
  empathy tend to be more at risk of compassion
  stress"

6
Primary Trauma Aftereffects

• Physical and psychological Hyperarousal (e.g.
  difficulty staying/falling asleep,
  hypervigilance, irritability),
• Intrusion (painful memories, flashbacks,
  memoriesimages, feelings, anxieties, day dreams,
  nightmares etc.)
• Avoidance (detachment from others, avoiding
  activities or positive experiences, diminished
  ability to enjoy life). How can I enjoy life,
  when others are hurting?

7
Secondary Trauma

• Listening to the stories of traumatized people
  and feeling with hte victims of traumatic
  experiences leads to similar reactions as if the
  trauma had happened to you.

8
Possible effects

• The reports elicits memories of your own.
• The report triggers mental images (in day dreams
  or nightmares)
• You realize your own vulnerability
• Your own confidence in life and security is
  shaken.
• Feelings of anger and despair. Accusations
  against police, the government, other
  responsible authorities.
• Reproaches against God? How can he allow this
  happening?
• "Traumatic events shake the foundations of our
  beliefs, and may shatter our trust..."

9
Possible effects

• You feel overwhelmed and helpless in addressing
  the other persons distress.
• Some develop explanations or apply methods
  (psychological or spiritual) which are
  irrational, perhaps even magical (accusing
  Christian parents of Satanism, spiritual forces
  Shamanism).
• Some try to overcome their helplessness with
  inadequate hyperactivity (often with a lack of
  respect for a patients borders and his or her
  well-being) e.g. reporting sexual abuse to the
  police or even taking revenge in self-justice.

10
Possible effects

• Distrust and reproach to other helpers
• they dont understand the needs of my client.
• they are hushing up the problems.
• they dont take actions!
• General devaluation of other helping persons
• Avoiding trauma patients or avoiding to confront
  the diagnosis, in order not to be traumatized.
• Refusing supervision, holding back their own
  reactions, because of shame.

11
Dangers for Therapy / Counselling

• Avoidance behavior of the counsellor he / she
  doesnt want to address the trauma although the
  patient / clients would like to talk about it.
• Therapeutic Intrusion The counsellor insists
  on details of the traumatic event, although the
  person does not want to reveal or repeat such
  details.
• General avoidance or withdrawal As the
  counsellor is suffering from sleep disorders,
  nightmares or physical hyperarousal, he or she is
  not available for the patient at all.

12
False ambitions

• False ambition, to heal all, to know everything,
  to love all.
• Healing everything Therapy until final and
  complete recovery.
• Knowing everything Exact and detailed
  reconstruction (despite negative emotional
  consequences), hope for catharsis through
  knowledge and revelation.
• Loving everything Trying to give the victim
  vicarious love (making up for all the love she
  missed in life). Danger of transgressing borders
  in therapy and counselling.

13
Coping strategies

• Security
• Recollection and mourning
• Social Integration

• Providing Boundaries
• Supervision, Intervision
• Normal Relationships

14
Prophetic word in Burnout

• A pastor, who went though a severe burnout,
  received the following prophtic words through a
  counsellor-friend
• You will be restored. You will be healed. And my
  anointment will flow again through your life and
  through your ministry. My minstry through your
  life. You will witness that in communion with me
  this anointment will flow again. And you will be
  amazed how the Lord will use you and there will
  be no pressure on you.

15
The values of debriefing

• When the disciples returned from their first
  missionary endeavors, Jesus gave them time to
  tell their stories and to share their questions.
  Broadly speaking this is what debriefing is
  about.
• The following thoughts have been inspired by a
  paper which was written by Dr. Debbie
  Lovell-Hawker.

16
Definitions

• Operational debriefing Asking for information
  about the work performed, and what was achieved.
• Personal debriefing Asking how the experience
  was for the individual (what was best/ worst? How
  is the readjustment process going?). Aims to help
  them integrate their experience into their life
  as a whole, perceive the experience more
  meaningfully, and bring a sense of closure.
• Critical incident debriefing (CID) A highly
  structured form of personal debriefing, which can
  take place after a traumatic experience (such as
  a natural disaster, a violent incident, or a
  traffic accident).

17
A Biblical Framework of Debriefing

• a) We are called to care for each other (e.g.
  Isaiah 61 1-2 John 13 35 John 21 16 2 Cor
  1 3-4 Gal. 62).
• Debriefing is a way of showing we care. We do not
  tend to question whether there is a Biblical
  framework for practising medicine - we know that
  it relieves suffering, so we encourage it.
  Providing emotional help also brings people to
  greater health and healing. Research indicates
  that some people who do not receive a debriefing
  feel devalued. Those who receive a debriefing
  tend to find it a positive experience and have
  fewer trauma-related symptoms.

18
Listening

• Listening is central to debriefing, and the Bible
  teaches us to listen (Proverbs 1813 James
  119).
• In modern society, it can be difficult to find
  someone willing to make time to really listen. In
  particular, eyes glaze over when someone starts
  to talk about their experience overseas. Mission
  partners often feel isolated. Listening breaks
  down this isolation, and helps them move forward.

19
Teaching about emotions

• Emotions are normal and valid. The Bible also
  teaches this. The Bible contains plenty of anger,
  fear, and tears (e.g. in the Psalms). Dont be
  afraid may imply theres no need for you to be
  afraid rather than its wrong to fear. Jesus
  did not condemn a man who admitted unbelief, but
  rather allowed him to express this (Mark 9 24).
• The Bible reminds us that there is a time to
  weep and a time to laugh, a time to mourn and a
  time to dance ... a time to be silent and a time
  to speak, a time to love and a time to hate (Ecc
  34-8).
• Jesus taught by example that it was OK to cry
  (Luke 19 41 John 1135 Heb. 5 7). He
  expressed anguish in the Garden of Gethsemane,
  and said that his soul was overwhelmed with
  sorrow (Matt. 2638).
• In past times and different cultures, people have
  known that it is normal to feel certain emotions
  after trauma, and they did not need to be taught
  this. Today, some people need to be told this
  explicitly.

20
Biblical examples Telling ones story

• The Disciples walking along the Emmaus road had
  gone through the trauma of witnessing the
  crucifixion of Jesus. They were talking about
  what had happened (Luke 2413-24). Jesus joined
  them, and asked what had happened. That wasnt
  for His benefit he knew. It gave them the
  opportunity to tell their story the facts of
  what had happened, and their feelings of
  disappointment. He then helped them put things
  into context.

21
Biblical Examples II

• A woman who had been bleeding for 12 years
  (possibly following trauma) touched Jesus (Luke
  8 43-48). He asked, who touched me. Why did He
  ask? Not to embarrass her, but to allow her to
  tell her story, so that she would gain emotional
  healing as well as physical healing. (Otherwise
  no-one else would have known that she had been
  healed, and she would still have been thought of
  as an outcast).
• Joseph In Genesis 44 - 45, we see Joseph
  listening to his brothers story, then telling
  them about his experiences, to produce a clearer
  picture and make the events more meaningful.
  Joseph recognised their feelings of distres s and
  anger. They all expressed their feelings freely,
  weeping together and embracing one another,
  before making plans for the future.

22
Listening to stories

• Nehemiah heard a traumatic report about his
  people being exiled, and living in great trouble
  and disgrace in a ruined city (Neh. 13).
  Nehemiah didnt disguise his feelings. The king
  noticed that he looked sad. Nehemiah normalised
  this - why should my face not look sad when the
  city ... lies in ruins? (23). The king listened
  as Nehemiah spoke about his plans, and he helped
  Nehemiah do what was necessary to move forward
  from this point of despair.
• Jesus invited people to tell him their stories
  (e.g. the sick the disciples when they returned
  after being sent out two by two). He listened to
  them, and helped to bring closure to experiences,
  and helped people move on.

23
Reviewing the past moving on

• The Bible affirms that there is a place both for
  reviewing the past together (Isaiah 4326), and
  for moving on to new things (Isaiah 4319). Both
  occur during debriefing.
• A good example is Gods counselling of Elijah,
  when he suffered a burnout and had to flee for
  his life into the wilderness. (1. Kings 19)
• Elijah experienced a death threat (1 Kings 192),
  and fled for his life. He was afraid, and prayed
  that he might die. An angel provided physical
  care for him (food, drink and sleep). Forty days
  later, after his physical needs had been met, God
  asked what was going on. Elijah told God his
  story- twice (v. 10, v. 14). Then God moved
  Elijah to think about the future, and told him
  that he would not be alone - there was support
  available in the form of 7000 other believers
  (v.18). Moreover, God directed Elijah to Elisha
  (v.16ff), who would give him more support.
• Physical regeneration (sleep and food)
• Spiritual review
• A new (and unusual experience of God
• A new direction and a new task

24
Literature

• B. Hudnall Stamm (ed.) Secondary Traumatic
  Stress Self-Care Issues for Clinicians,
  Researchers, and Educators. Sidran Press.
• Judith Herman Trauma and Recovery The Aftermath
  of Violence. Basic Books.
• Fawcett, G. (1999). Ad-Mission The briefing and
  debriefing of teams of missionaries and aid
  workers. Harpenden Self-published. Available
  directly from the author - e-mail
  gfawcett_at_oval.com or phone [phone].
• Gamble, K., Lovell, D.M., Lankester, T.
  Keystone, J. (2001). Aid workers, expatriates and
  travel. In J. Zukerman A. J. Zukerman (Eds),
  Principals and Practice of Travel Medicine.
  Chichester, England John Wiley Sons.
• Jordan, P. (1992). Re-entry Making the
  transition from missions to life at home.
  Seattle YWAM.
• Lovell-Hawker, D.M. (2002). Debriefing after
  traumatic incidents, and at the end of
  assignments. In K. ODonnell (Ed.) Doing Member
  Care Well Perspectives and Practices from around
  the world. Pasadena, CA William Carey.
• Mitchell, J. Gray, B. (1990). Emergency
  Services Stress. New Jersey Brady. Parkinson, F.
  (1997). Critical Incident Debriefing. London, UK
  Souvenir Press.
• Pollock, D.C. Van Reken, R. E. (1999). The
  Third Culture Kid Experience. Maine USA
  Intercultural Press.
• Rose, S. Bisson, J. (1998). Brief early
  psychological interventions following trauma A
  systematic review of the literature. Journal of
  Traumatic Stress, 11, 4, 697-710.

25
Helpful Links

• http//www.asbury.edu/academ/psych/mis_care/trauma
  .htm
• http//trauma-pages.com/

26
Group activity
Group Activity / Questions

• Share your own experience of secondary trauma
• What are stories that touch your heart.
• How do you prevent the pain of others to invade
  your emotions?
• Discuss the balance of compassion and
  self-protection.