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Therapist Self-Care Compassion Fatigue & Secondary Traumatic Stress
Domestic Violence continuing education MFT CEUs

Manual of Articles Sections 8 - 16
Section 8
Disrupted Frame of Reference

CEU Question 8 | CE Test | Table of Contents | Domestic Violence
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

The hallmark of vicarious traumatization is disrupted frame of reference. One’s identity, world view, and spirituality together constitute frame of reference. As a result of doing trauma work with battering relationships, therapists are likely to experience disruptions in their sense of identity (sense of one’s self as a woman/man, as mother/father or one’s customary feeling states), world view (moral principles, ideas about causality, life philosophy), and spirituality (meaning and hope, sense of connection with something beyond oneself, awareness of all aspects of life, and sense of the non-material).

What antidotes can we create to these disruptions? Balancing work, play, and rest helps us to remain grounded in various aspects of our complex identities. Practices that renew a cherished sense of identity or that expand one’s identity beyond that of trauma therapist are helpful in this realm. This might mean socializing with friends and family to reconnect with one’s self as friend, parent, child, partner, or sibling (the activity that ranked second most helpful in the study shown in Table 1); engaging activities that allow one to be in a dependent or receiving role; engaging in creative endeavors such as writing, playing music, creating art, gardening, being physically active through exercise, dance, or hard physical work; reconnecting with one’s body through massage, dance, or yoga. Each of these activities in its own way balances some aspect of the helper/listener/nurturer roles we play in our work as therapists.

TA B L E 1: . Professional and personal self-care for 117 psychologists.

Mean ratings of how helpful 117 psychologists found those activities in which they engaged over the past six months
(1 = not helpful, 6 = extremely helpful):

Took vacation 4.60
Social activities 4.34
Emotional support from colleagues 4.21
Pleasure reading 4.10
Sought consultation on difficult cases 4.06
Read relevant professional literature 3.91
Took breaks during workday 3.88
Emotional support from friends or family 3.83
Spent time with children 3.78
Listened to music 3.70
Spent time in nature 3.67
Attended workshop or conference 3.59
Aerobic exercise 3.00
Attempted to monitor or diversify case load 2.87
Community involvement 2.14
Relaxation exercises 2.04
Gardening 1.86
Artistic expression 1.51
Spiritual practice 1.29
Personal psychotherapy 1.17
Massage or bodywork .95
Meditation .88
Journal writing .56
Yoga .52

In the trauma therapist example, at least one-third of respondents found the following strategies helpful in coping with the demands of domestic violence therapy: socializing, exercising, spending time with family (Table 2). Activities that ranked lower, although still endorsed by many as helpful, were engaging in social justice activities and having a massage. Over 35% of subjects reported engaging in activities that promoted physical health and well-being as a coping strategy.

Rest and leisure are extremely restorative to one’s frame of reference as well as to one’s self-capacities. Taking a vacation and pleasure reading ranked first and fourth, respectively, as activities psychologists found helpful in alleviating work-related stress. Over 35% of subjects reported engaging in leisure activities such as gardening, reading, listening to music, and going to movies as ways of coping with work-related stress.

World view, another aspect of frame of reference, is also very sensitive to both psychological trauma and to helping trauma survivors. We can attempt to rebuild these shattered assumptions by spending time with happy, healthy children; working for social justice; and building or rebuilding a sense of community. Sixty-nine percent of our sample found travel helpful; in a very literal sense, travel expands our world view.

Finally, spirituality is highly sensitive to the effects of trauma and trauma recovery work. We use a broad definition of spirituality, an inherent human capacity for an awareness of an elusive aspect of experience. Approaches to addressing the spiritual damage that this work can incur include meditation, yoga, writing in a journal, engagement with art and beauty (nature and poetry). Forty-four percent of the trauma therapist sample found developing a spiritual life helpful in coping with the demands of trauma therapy. Although these activities were not rated as very helpful for most respondents in the sample, we note them here because some people do report using them and finding them helpful. Larger percentages of the subjects reported engaging in spiritually-oriented activities, but we do not know how helpful they found them.

Finding forums in which to recall and name the rewards of doing trauma therapy is essential. It renews our sense of the meaning of this work, revitalizes our connections with others and with humanity itself, and reminds us of the importance of an awareness of all aspects of life.

TA B L E 2: Activities balancing trauma work for 188 trauma therapists.

% performing on regular basis
% finding it helpful
Discussed cases with colleagues
Attended workshops
Spent time with family or friends
Travel, vacation, hobbies, movies
Talked with colleagues between sessions
Limited case load
Developed spiritual life
Received general supervision
Gave supervision
Performed community service
Had bodywork/massage
Wrote in a journal
Engaged in social justice work
Conducted research
Referred out clients who might activate therapist’s issues
Engaged in administration

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 150 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section was about a therapist’s disrupted frame of reference and vicarious traumatization. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 8
What is the hallmark of vicarious traumatization? Record the letter of the correct answer the CE Test.

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