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

Section 1
Secondary Traumatic Stress Disorder in Trauma Therapists

CEU Question 1 | CE Test | Table of Contents | Introduction | Domestic Violence
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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New Content Added: This course provides the therapist with tools for stress in treating your client who has experienced domestic violence. To update the content we have added Compassion Fatigue information found at the end of the Table of Contents

Introductory remarks:
Across several studies, it appears that 21-67% of mental health workers may be experiencing high levels of burnout. In a study of 151 community mental health workers in Northern California, Webster and Hackett (1999) found that 54% had high emotional exhaustion and 38% reported high depersonalization rates, but most reported high levels of personal accomplishment as well. In Rohland’s (2000) sample of 29 directors of community mental health centers in Iowa, over two-thirds reported high emotional exhaustion and low personal accomplishment. Further, almost half reported high levels of depersonalization. Siebert (2005) surveyed a state chapter of social workers, and of the 751 respondents, 36% scored in the high range of emotional exhaustion. The investigators also used a single item burnout measure and 18% of the sample endorsed the statement: “I currently have problems with burnout.” Oddie and colleagues (2007) examined 71 forensic mental health workers in the UK, and 54% reported high rates of emotional exhaustion. Prior United Kingdom studies reviewed by Oddie and colleagues (2007) also reported a range of 21% to 48% of general mental health workers as having high emotional exhaustion.
-Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: a review of the problem and its remediation. Administration and policy in mental health, 39(5), 341–352. doi:10.1007/s10488-011-0352-1

On this track, we will focus on a therapist's personal reactions to a battered woman's traumatic events. As you may know, these reactions can quickly create burn-out for a therapist.

First, let's look at a common reaction from therapists as they hear about a battered woman's trauma. As you know, battered women experience traumatic and terrifying events, and these events and fears are inevitably brought out in session. Have you found, like I, that this can often result in a Secondary Traumatic Stress Disorder from the therapist? As you know, STSD is the traumatic stress that the therapist takes on from the client's trauma.

As you may know, there are four key risk factors to Secondary Traumatic Stress. As I read these, imagine how you felt at the end of your last session with a battered client. Do any of these sound familiar?

4 Key Risk Factors for STSD

STSD Risk Factor 1. Empathy
As you know, empathy is a major resource for therapists in assessing the problem and formulating a treatment approach because the perspectives of the battered woman must be considered. However, research on therapists' Secondary Traumatic Stress Disorder suggests that empathy is a key factor in the transference of traumatic material from the primary to the secondary victim. Thus, by empathizing with a traumatized battered woman, the therapist may become traumatized as well. Think back to a session you just had with a battered woman and your level of empathy with her. Do you feel you took the appropriate self-care measures to minimize residual effects of any Secondary Traumatic Stress you may have experienced? Later tracks will cover self-care measures.

STSD Risk Factor 2. Intrusive Imagery
As you know, intrusive imagery is a hallmark of PTSD and is of Secondary Traumatic Stress as well. Through working with battered or the batterer, therapists may also experience intrusive imagery, often images of the scenes that the battered woman has described vividly. Have you found, like I, that certain images may hit very close to home and become nearly impossible to shake? At the end of this track, we will discuss some measures I have found to effectively decrease or rid myself of these images.

STSD Risk Factor 3. Pessimistic Views
As I listen to the batterer's capacity for cruelty, I can thereby begin to develop a more pessimistic view of others and their motives. Excitement and energy to meet new people and be exposed to new ideas may be replaced by a sense of cynicism, doubt, and self-protectiveness. Think of those words for a minute: cynicism, doubt, and self-protectiveness. Think back to your first days and weeks on the job. Have you become more cynical, doubting, and self-protective than you were on your first days on the job as a therapist treating battered women?

In addition to the risk factor of empathy, and the reactions of intrusive imagery and pessimistic views, let's look at

STSD Risk Factor 4. Perceived Inadequacies

As you know, helpers may experience difficulty maintaining a positive attitude in light of their perceived inadequacies in their role as a helper. Questions may arise. At times you may feel overwhelmed with a seemingly endless flow of stories of suffering and feel unable to address the roots of the problem to prevent further pain. Take a second to rate your perceived inadequacy on a scale of 1 - 10: 1 being totally inadequate, and 10 being totally adequate. The next track will deal more with perceived inadequacies.

5 Steps to Alleviate STSD
Now that we have discussed four elements of Secondary Traumatic Stress, let's discuss five steps you can take to alleviate some of these feelings.
1. Do you have a system within your agency for supportive sessions with a co-worker who understands the dynamics of Secondary Traumatic Stress and has had experience dealing with domestic violence?
2. Do you, or are you able to... organize your case load in such a way as to balance your daily schedule so you intersperse seeing battered clients with paper work? As you probably have figured out, by scheduling your domestic violence clients back-to-back, you may be creating added stress for yourself, rather than interspersing them with other tasks or other kinds of clients. Obviously, this is a viable suggestion, only if your case load permits.
3. Have you taken time to identify your personal and social resources and supports? You do this all the time for a client. But how about for yourself? Take a minute to think about who and what your resources are that act as a pressure release valve for you. Do you need to use these people or activities more often?
4. Do you know your own limitations? When you know your domestic violence client's issues may be too close to home for you, can you set your ego aside and consider referring your client to a colleague? Is the atmosphere in your agency supportive of these types of referrals? If it isn't as supportive as you'd like, are there any steps you might consider taking to increase the encouragement of referrals to colleagues?
5. How comfortable are you admitting that you may have made a mistake or used poor judgment in a session with a battered woman? I have found that my own self-criticism and second guessing after a session with a battered woman can trigger many of the reactions mentioned earlier on this track related to intrusive imagery, pessimistic views, and my perceived inadequacies.

In this track we have discussed four risk factors to the development of Secondary Traumatic Stress that may occur as a reaction to treating battered clients. These risk factors are: empathy, intrusive imagery, pessimistic views, and perceived inadequacy. We have also discussed five steps that can alleviate these feelings. These steps are: supportive session, caseload organization, resources, knowing limitations, and accepting mistakes. In the next track we will be discussing what I feel is the biggest trigger for STSD and possible burn-out. This trigger is the perceived inadequacies that result from a battered woman's cycle of leaving and returning, only to leave and return again and again.

Peer-Reviewed Journal Article References:
Ivicic, R., & Motta, R. (2017). Variables associated with secondary traumatic stress among mental health professionals. Traumatology, 23(2), 196–204. 

Rzeszutek, M., Partyka, M., & Gołąb, A. (2015). Temperament traits, social support, and secondary traumatic stress disorder symptoms in a sample of trauma therapists. Professional Psychology: Research and Practice, 46(4), 213–220. 

Sprang, G., Ford, J., Kerig, P., & Bride, B. (2019). Defining secondary traumatic stress and developing targeted assessments and interventions: Lessons learned from research and leading experts. Traumatology, 25(2), 72–81.

Online Continuing Education QUESTION 1
What are four risk factors to the development of Secondary Traumatic Stress found in therapists treating battered women and batterers? To select and enter your answer go to CE Test.

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