The utility of telemedicine is now recognized beyond meeting the needs of rural communities, and many believe the pandemic has shifted the landscape of medicine moving forward. As a result of increased use of telehealth, many states have been shifting their licensing laws to allow practitioners to more easily see clients across state lines. This allows clients access to a wealth of providers with various specialties regardless of locale. Despite its increased use, some disadvantages (e.g., required computer skill literacy, dropped connections, potential for reduced ability pick up on nuanced nonverbal cues) and professional challenges (e.g., state and interstate licensure requirements for the providing therapist, ethical issues, and crisis response considerations) still exist. Additionally, even during the pandemic, many clients continued to express a preference for in-person treatment and were eager to re-engage face to face as local regulations were lifted. Ideally, each client and therapist should weigh the advantages and disadvantages when determining the fit of telehealth options, with the recognition that multiple studies have confirmed the therapeutic efficacy of telehealth in treating PTSD symptoms (Bongaerts et al., 2021; Morland et al., 2020). Conclusion Integrated and holistic treatment for survivors of trauma provides a comprehensive approach that is better able to address the multiple areas of self that have been affected by the traumatic events: The cognitive mind, the emotional self, the physical body, and the soul or spiritual self. Treatment approaches that do not attend to healing at all of these levels of being fall short of being truly sufficient to help a client to move through all phases of the healing process. Clinicians are encouraged to work
with a collaborative treatment team made up of a diverse group of health and mental health professionals and to serve as the point person who integrates the health services. Attending to the physical health of the traumatized client is a key part of the healing journey, and clinicians are encouraged to keep track of the sleeping, eating, and exercise patterns of clients as well as to attend to their emotional states and behavioral functioning. A number of theoretical perspectives can inform the treatment of trauma, in addition to the study of trauma theory itself. Some of the most useful perspectives are attachment theory, neuropsychobiology, self-in-relation theory, empowerment and resiliency theories, energy psychology, CBTs, and integrated approaches. Comprehensive treatment requires that each clinician have a large enough toolbox of methods and techniques to address the effects of trauma so that an individualized treatment plan can be created for each client, the range of responses to various interventions can be respected, and other options can be made available to address distress— allowing the client to move forward in the healing process. Integration of mind, body, and spirit within the phase-oriented treatment process means becoming familiar with and utilizing some of the less traditional techniques that are on the frontiers of trauma treatment. Many of these methods, such as imagery work and body-oriented treatments (e.g., somatosensory integration), are better able to address the body and spiritual aspects of healing than are the more traditional methods. Finally, paying attention to spiritual healing and understanding the role and timing of forgiveness, along with addressing service delivery considerations, are essential aspects of the work and an important part of overall healing.
VICARIOUS TRAUMATIZATION AND CLINICIAN SELF-CARE
Taking care while giving care is the main theme of this chapter. Clinicians working with the aftermath of acute and chronic trauma are vulnerable and susceptible to what Charles Figley (2002) calls the contagion effect. This effect occurs when the clinician feels emotional responses to the traumatic material that parallel the responses of the survivor, even though the Vicarious Traumatization Vicarious traumatization (McCann & Pearlman, 1990) is defined as “changes to a trauma professional’s view of world and self, resulting from empathic engagement with another’s traumatic experiences” (Best Start Resource Centre, 2012). Although vicarious trauma may parallel burnout (e.g., exhaustion), it is a much more pervasive experience that fundamentally alters Secondary Traumatic Stress Secondary traumatic stress is commonly referred to as vicarious trauma, but these are separate concepts with distinguishable characteristics. In secondary traumatic stress, the professional experiences traumatic symptoms that parallel those of clients. Typically, the act of listening to traumas can evoke a traumatic stress response within the professional, resulting in trauma Countertransference Countertransference originates in psychodynamic theory and refers to the distortion of the therapeutic response resulting from the clinician’s life experience and their unconscious response to client transference (Figley, 1995). In a broad sense, countertransference is described as all conscious or unconscious responses, attitudes, or feelings about clients. More specifically, countertransference has been defined as seeing oneself in one’s client and overidentifying or meeting one’s own needs through a client (Corey, 1991), along with experiencing affective, ideational, and physical responses toward the client and the clinical material presented (Pearlman & Saakvitne, 1995). Shared Trauma Response Shared trauma response refers to a situation in which the clinician and the client were simultaneously exposed to a trauma, with both suffering from varying levels of posttrauma response.
clinician has not been directly exposed to the original source of the traumatic stress. This emotional contagion is also known as a secondary stress reaction or vicarious traumatization. Clinicians are most vulnerable to such a reaction when they are not practicing good self-care on a personal, professional, or organizational level. the professional’s mind, body, and/or belief systems (Best Start Resource Centre, 2012). Vicarious trauma can impede the professional’s interpersonal relationships, result in nightmares and hyperarousal, contribute to a generalized sense of fear, and alter cognitive schemas about the safety and goodness of humanity (Neswald-Potter & Simmons, 2016). symptoms (Kim et al., 2021). Although secondary traumatic stress and vicarious trauma are similar in presentation, they differ in that secondary traumatic stress can be acute and occur after one trauma disclosure, while vicarious trauma is brought on by an accumulation of exposure (Best Start Resource Centre, 2012). It is important to note that countertransference and vicarious traumatization affect one another and are highly interrelated experiences. Unidentified countertransference can make the clinician more vulnerable to the effects of vicarious traumatization because the internal clinical boundaries are already breached. When identified and addressed, however, countertransference can become a useful additional source of information for the clinician about the ways that the client is processing the traumas.
Examples of this situation may be found in the treatment of any public disaster, in which the clinician and client have both experienced terror and loss (e.g., during Hurricane Katrina
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