ClinicalStories with Issues of DV: An Open Forum

1
Clinical Stories with Issues of DV An Open Forum

• Talking about things that matter
• with people doing the work

Gary Direnfeld, MSW, RSW www.yoursocialworker.com
2
Why Talk?

• Working in the area of domestic violence has
  particular challenges and rewards
• The challenges can threaten the integrity of the
  worker
• The rewards can provide a tremendous sense of
  personal satisfaction
• Talking can help overcome the challenges and
  improve the likelihood of reward.

3
Challenges Include Certain Risks

• Risk of attack
• Risk of burnout
• Risk of psychological stress reactions

4
You can get hurt

• Did You Know
• More than 1/2 of social workers in Massachusetts
  have been physically assaulted in a work
  related incident (assaults range from pushing,
  hitting, and choking to life-threatening attacks)
  
• More than 3/4 have been verbally abused
• More than 1/3 have had a weapon brought into the
  workplace
• Over 3/4 have been frightened, even without
  physical or verbal threat or assault Based
  upon a survey of 1,000 Massachusetts NASW members
  and review of literature.

5
Violence Is Unacceptable

• Violence, threats and abuse to staff are
  unacceptable.
• This includes sexual and racial harassment, and
  threats to family and property.

6
Promoting Safety

• a statement of the organization's policy that
  clearly sets out a code of practice that fits
  your job and where you work
• clear assessments of the risk to you from the
  individuals, families and groups you work with
• clear procedures about what to do when you think
  there is a risk, what to do after an incident,
  and what follow-up there will be
• training that fits your job, including what
  responsibilities you have towards colleagues and
  to service users
• a working environment that maximizes your safety
• support in dealing with your concerns about
  threats, abuse and violence
• procedures for making sure precautions are
  working and can be reviewed
• easily available support after an incident that
  fits what you and others who were involved need
  to recover from the experience.

7
Burnout

• The term "burnout" has been applied across
  helping professions and refers to the cumulative
  psychological strain of working with many
  different stressors. It often manifests as a
  gradual wearing down over time.
• National Center for Post-Traumatic Stress Disorder

8
Factors Contributing To Burnout

• Professional isolation
• Emotional drain from empathizing
• Difficult client population
• Long hours with few resources
• Ambiguous success
• Unreciprocated giving and attentiveness
• Failure to live up to one's own expectations for
  effecting positive change
• National Center for Post-Traumatic Stress
  Disorder

9
Symptoms Include

• Depression
• Cynicism
• Boredom
• Loss of compassion
• Discouragement
• National Center for Post-Traumatic Stress
  Disorder

10
Treatment and Prevention

• Proper diet, nutrition and rest
• Physical activity
• Social action
• Good supervision
• Realistic goals
• Realistic workload
• Variety in caseload
• Collegial support
• Taking holidays!

11
Hearing Horrendous Stories Can Hurt the Listener

• Secondary Traumatic Stress
• Stamm 1995
• Sub-clinical or clinical signs of PTSD that
  mirror those experienced by trauma clients
• Compassion Stress/Fatigue
• Figley 1995
• Sense of helplessness, confusion, isolation or
  secondary traumatic stress symptoms experienced
  by the worker
• Vicarious Traumatization
• Pearlman and Saakvitne 1995
• Permanent transformative, inevitable changes
  that result from work with trauma survivors
• Cognitive schemata e.g personal safety in the
  world or relationships

12
Treatment and Prevention

• Same as for burnout and
• Debriefing specific horrific cases
• Counselling
• Learning to set personal boundaries to keep from
  acting beyond your role
• Stress management strategies such as yoga
• Limiting alcohol in favor of health promoting
  activities

13
Compassion Satisfaction

• Figley also discusses the upside of working
  with trauma clients
• Sense of strength
• Self-knowledge
• Confidence
• Sense of meaning
• Spiritual connection
• Respect for human resiliency

14
Self Care

• Its OK to have fun!

15
and more fun
16
Clinical Stories with Issues of DV An Open Forum

• Talk amongst your peers and agency staff, discuss
  the challenges, arrive at mutually acceptable
  solutions and HAVE FUN!

Gary Direnfeld, MSW, RSW www.yoursocialworker.com