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, LICSW December 2009 Direct Practice Evaluation: Secondary Trauma and Practice Effectiveness Secondary trauma is an occupational hazard for social service professionals. Unattended secondary trauma affects practitioner effectiveness. Because of its implications for practice effectiveness, secondary trauma is an issue in direct practice evaluation. Direct practice evaluation is a set of procedures that social work professionals use to figure out what is going on for clients. They also keep track of what is going on for themselves because what they do influences clients. Evaluation is an on‐going process where service providers continually modify their own actions and words in response to clients’ actions, words, issues, and circumstances. The goal of direct practice evaluation is to increase effectiveness. The four cornerstones of evidence‐based practice can help organize ideas about practice effectiveness. The four cornerstones are best research evidence, professional expertise, client concerns, values, and wants, and the personal experience and personal and professional values of the practitioner. I abbreviate the fourth cornerstone by calling it the person of the practitioner. In this brief essay, I discuss secondary trauma of professionals as an issue for
practice effectiveness. This topic falls within the fourth cornerstone.
Gilgun secondary trauma Page 2 of 2 Secondary Trauma & the Person of the Practitioner Secondary trauma interferes with social workers’ capacities for empathy and for thinking clearly about client issues. By definition, when we experience secondary trauma, we are at risk to be emotionally upset and irritable, to avoid reminders of the trauma, and to have intrusive thoughts and images. This interferes with our effectiveness. To be effective, we have to know when we have experienced secondary trauma and what to do about it. Secondary trauma is an occupational hazard in social services because professionals routinely work with clients who have experienced trauma. In our efforts to understand others and to be responsive to them, we are open to what others say and how they present themselves. We want to be empathic while not losing our analytic stance. By being open and empathic, we are exposing ourselves vicariously to trauma. If we experience trauma vicariously, we may lose our analytic stance and become less effective in our work. Social Services as a Balancing Act Social workers, therefore, are engaged in an on‐going balancing act. On the one hand, we want to be open and empathic. On the other hand, we want to be able to think clearly, plan effectively, and get an idea of the full range of influences on client functioning. To maintain this balance, we require a high degree of self‐awareness and help from co‐ workers and supervisors. Friends and family can be helpful, too, but many social workers believe that problems related to work are best dealt with at work. We do not want to bring trauma into the lives of family and friends. We also want to keep work and personal life separate.
Gilgun secondary trauma Page 3 of 3 Detecting Secondary Trauma By its nature, secondary trauma may be difficult to detect. We may think we are all right until we start talking about a case with co‐workers, when we wake up in the middle of the night thinking about a case, or when we are behind the wheel of a car and scream at another driver for a rude action such as not using a turn signal. Therefore, it makes sense for social workers to check in with themselves immediately after meeting with clients. A few simple questions can be helpful to detect secondary trauma. These questions include • • • • • • • • What went well? What could have gone better? What could I have done better? What will I do the next time I’m with this client? Am I relaxed? Happy? Upset? Agitated? Angry? Can I picture a client’s story in my mind? Does this story bother me? Am I looking forward to seeing this client again? Am I looking forward to my upcoming meeting with another client?
A simple mental check‐in such as this can be helpful in detecting secondary trauma. If there is trauma, then social workers have to decide what to do about it. Social workers can also use this checklist in supervision and consultations. Secondary Trauma Requires Attention Any responses that suggest secondary trauma require attention. Some social workers like to journal, and they will therefore write about their responses to clients, reflect upon them, and plan for the next steps. Self‐expression about distressing subjects
Gilgun secondary trauma Page 4 of 4 can help social workers feel better and clear their heads. They are more able to meet the demands of work and their personal lives and find satisfaction in doing so. Talking with supervisors and co‐workers about cases and responses to them also is helpful in dealing with the effects of secondary trauma. Talking and feeling understood not only bring relief and help social workers to manage their thoughts, emotions, and intrusive images, but doing so also clears their minds so they can do constructive thinking and problem‐solving. They also can go home at night prepared to be emotionally and psychologically relaxed and available to family and friends. Some work situations are unsafe for the discussion of secondary trauma. Under these conditions, it is important to find someone else, or a group of people, who are trustworthy and who understand secondary trauma. In group situations, social workers can learn a great deal about secondary trauma and how to handle it effectively by listening and responding to others. Some practitioners talk out loud to a tape recorder. This can be beneficial. By talking, we not only feel better, but we also express ideas and emotions we didn’t know we had. Playing back the recording can be reassuring that our responses not only are understandable but manageable, too. Learning as much as we can about a practice area that is troubling can also help service professionals deal with secondary trauma. Talking to knowledgeable others, going to workshops, and reading about the topic all help. There is a great deal of reliable information on the internet from a variety of professional organizations. Be Open to Others We sometimes are unaware of how secondary trauma affects us. Therefore, we have to prepare ourselves to be open to others, such as family, friends, supervisors, and co‐
Gilgun secondary trauma Page 5 of 5 workers, when they ask us about how we are feeling, how we are doing, or when they question our judgment about a case. While we may be tempted to be defensive, we have to train ourselves to think automatically, “You could be right. Let me listen to what you have to say. I might learn something. I might become more effective as a social worker. If you are wrong, no harm done.” Saying “You could be right” is a principle of assertiveness training. Thinking or saying this cuts down on defensiveness and shows respect for others. What Research Says about Secondary Trauma Trauma is an event that is life‐threatening or psychologically devastating to the point where individuals’ capacities to cope are overwhelmed. Intrusive thoughts and images, avoidance of reminders of the trauma, and emotional arousal are three main classes of responses to trauma (APA, 2000). The DSM‐IV‐TR has a diagnostic category called post‐traumatic stress disorder (PTSD). Secondary trauma is characterized by these same three classes of responses (Bride, 2007). Most of the clients with whom service providers work have experienced traumas. Examples include child abuse and neglect, physical assault, rape, child sexual abuse, witnessing violence, family violence, violent crime, loss of loved ones through civil war, natural disasters, torture, war, terrorism, and forced migration including refugee status. There is little research on secondary trauma of social workers in the United States, but there is a growing body of research in allied professions. This brief review will cover only the readings for the course Direct Practice Evaluation. In a survey of almost 300 social workers in a southern state, Bride (2007) found that about 70% experienced one of the symptoms of PTSD in the previous week, more than half met one diagnostic criteria, about 20% met the criteria for two, and 15% met all three diagnostic criteria. He also found that about 45% of the sample reported intrusive
Gilgun secondary trauma Page 6 of 6 thoughts, 45% reported avoiding reminders of the traumatic event, and about 25% reported emotional and physiological arousal. These are high numbers. Left unattended these responses can affect quality of services. Pludio (2007) reported on her interviews with 50 social workers who provided services to survivors of the 9/11 attack in New York City. She also drew upon the training she did for service providers on secondary trauma. As in Bride’s (2007) study, Pludio observed in her work that professionals experienced long‐lasting symptoms of PTSD including emotional arousal, intrusive thoughts and images, and avoidance of reminders of the trauma. She found the rates of secondary trauma to be alarmingly high, a situation she believed lack of supervision worsened. Social workers found processing their sessions with clients to be highly stressful, and they often wept after being with clients. Their work with children particularly filled them with anguish. They often felt as if they re‐lived the events of 9/11 over and over again. They felt frustrated and helpless when they were unable to be of help to survivors. These professionals attempted to hold their responses in check for a year or two after their work ended, only to experience intrusive thoughts and images, anger and irritability, and avoidance of reminders, all symptoms of PTSD. Supervision and debriefing were insufficient during their direct work and difficult to come by once they had completed their work. Many took the initiative and found their own sources of professional support and consultation to help them deal with their own trauma‐ related responses. Humor during supervision and consultation can relieve stress and open up possibilities for problem‐solving and effective actions (Gilgun & Sharma, submitted for publication). Humor, of course, has to be well‐timed, and social workers must perceive
Gilgun secondary trauma Page 7 of 7 remarks intended to be amusing to be amusing. Both Bride (2007) and Pludio (2007) reflected upon their findings. Bride pointed out that many people believe that secondary trauma is a reason why professionals leave human services, that many service providers have short‐ and long‐term effects of secondary trauma, that the effects can put strains on personal relationships, and that secondary trauma can affect practice effectiveness. He recommended further research on these areas. Pludio (2007) made many suggestions about how to provide resources and support to professionals with secondary trauma. These include supervision, de‐briefings after sessions, training, and peer support. At the agency level, she recommended that supervisors and other administrators receive training on managing and preventing secondary trauma, and change the organizational structure to provide support for professionals, including providing for a varied caseload and not only clients with high degrees of trauma. She noted that social workers wanted a repository of information on secondary trauma, client responses to trauma, and referral sources. She also said that any disaster response plan must include strategies for dealing with secondary trauma. Discussion Secondary trauma affects most service providers. Left unattended, such trauma can
affect quality of services and therefore practice effectiveness. This article discussed strategies for identifying and dealing with secondary trauma. The benefits of doing so are high for clients and for practitioners themselves, both professionally and personally. Social workers who last and have satisfying work and personal lives have mastered many different ways of managing secondary trauma. References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
Gilgun secondary trauma Page 8 of 8 disorders (4th ed., text rev.).Washington, DC: Author. Bride, Brian E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52(1), 63‐70. Gilgun, Jane F., & Alankaar Sharma (submitted for publication). Humor in social services. Pulido, Mary L. (2007). In their words: Secondary traumatic stress in social workers responding to the 9/11 terrorist attacks in New York City. Social Work, 57(3), 279‐281. About the Author Jane F. Gilgun, Ph.D., LICSW, is a professor, School of Social Work, University of Minnesota, Twin Cities, USA. See Professor Gilgun’s other articles, children’s stories, and books on Amazon Kindle, scribd.com/professorjane, and stores.lulu.com/jgilgun.