Self-Care Rothschild (2004b) goes on to suggest that clinicians frequently mirror their clients during sessions by unconsciously mimicking breathing patterns, facial expressions, affect, and body posture. Building on the activity of the mirror neurons, this behavior can lead to being more susceptible to feeling the client’s emotional states. By heightening their awareness of this tendency, clinicians can unmirror, that is, control and subtly shift their physiological responses away from the client’s experience of distress in an effort to prevent emotional contagion. Simple physical shifts, such as moving in the chair, slowing down breathing rates, or breaking eye contact momentarily (e.g., to reach for a glass of water nearby), can serve to inoculate the clinician from taking on the client’s emotional state. This “postural mirroring” can be conscious or unconscious, and mindfulness of self is usually all that is needed to avoid emotional contagion (Rothschild, 2004b). Unmirroring can take the form of stretching, shifting position, crossing or uncrossing legs, blinking eyes, taking a deep breath, or finding some reason to get up and move (e.g., the clinician can adjust the heat, open or close the window blinds, or get a book from a bookshelf to use for reference or to make a point). Rothschild recommends that clinicians also get clients to move in order to break the “distress trance” in which they can find themselves. She speaks of the clinician learning to “apply the brakes” to potential dysregulation or hyperarousal during sessions by staying aware and mindful of self and one’s
responses and using a variety of subtle mechanisms to stay grounded and centered. The clinician can teach their clients to employ many of these techniques as well. These actions may include placing feet on the ground purposely; leaning back (rather than forward) in the chair; sensing the support of the chair under the legs and back; and using imagery for self-protection, such as a shield or force field that allows one to stay fully present but protected from emotional contagion. Making use of the concept of “dual awareness” of external reality and internal reality, simultaneously, can assist both clinician and client in mediating between the two (Rothschild, 2004a). Clinicians are advised to develop strategies for self-care for each of the following time frames. ● During each session with a client, group, or colleague (e.g., conscious regulation of breath) ● Between each session (e.g., washing hands or getting up to stretch) ● At the end of the day (e.g., silently saying to oneself, “I’m leaving work,” as one turns out the lights or shuts the door) ● Once or twice a week (e.g., supervision or consultation; getting regular aerobic exercise) ● Once or twice a month (e.g., going out to dinner, getting a massage, reading professional literature to enhance learning and feelings of competence) ● Develop a balanced work life that includes varied professional activities and types of clients ● Develop and maintain a self-preservation system to use within client sessions, such as self-protection, “putting on the brakes,” or self-regulatory skills ● Develop and maintain clearing strategies between client sessions ● Attend to making the office or treatment setting nourishing and comfortable; allow for temperature regulation, comfortable seating, and hot or cold drinking water, as much as possible ● Make the working space a haven of beauty and calm, whether it is an office, a car, or a home visit; consider what can be done to make the space restful and beautiful, for example, with well-cared-for plants, good lighting, a clean and well-maintained look, and pictures or artifacts Organizational Strategies Supervisors, directors, and chief executive officers should: ● Attend to making the physical space attractive, well cared for, accessible, and nurturing ● Offer adequate professional resources, such as regular supervision, continuing education opportunities, case conferences, and staff enrichment days ● Maintain an atmosphere of respect, collegiality, and professionalism ● Develop resources for adjunctive services for clients that are accessible to the clinicians, such as listings of group services, body workers, nutritionists, psychopharmacologists, physicians, alternative practitioners, self-help organizations, books, and inpatient and outpatient services ● Ensure that staff receive enough time away from highly stressful tasks and that they have adequate vacation time ● Obtain consultation on vicarious traumatization for the staff
Strategies for Healing and Preventing Vicarious Traumatization As increased attention to vicarious trauma has occurred, so has there been increased emphasis placed on interventions to try and prevent it. The majority of studied interventions focus on psychoeducation and self-care (particularly stress management) (Kim et al., 2020). A tension exists within recommendations for preventing and addressing vicarious traumatization in whether it places the responsibility on the individual versus the organization in providing necessary support to their workers (Ashley-Binge & Cousins, 2019). The following lists identify personal, professional, and organizational strategies that will assist in preventing and healing from vicarious traumatization.
Personal Strategies The clinician should: ● Develop a good balance between personal and professional life ● Use personal therapy to address vulnerabilities and triggers ● Identify and use healing activities, such as warm baths, walks in nature, and time with friends and family ● Tend to their own spiritual needs by finding ways to restore meaning, hope, connection, and beauty ● Use the mind–body and energy medicine skills and techniques that are employed with clients for their own health and well-being ● Be sure to get some form of physical exercise regularly ● Develop an ability to laugh at themselves, keep a sense of humor, and attend to enjoyment of life Professional Strategies The clinician should: ● Get supervision and consultation from an experienced trauma supervisor ● Develop professional connections and resources ● Seek self-education through reading, courses, seminars, and training
Compassion Satisfaction and Vicarious Posttraumatic Growth Although vicarious trauma and secondary traumatization are related to “the cost of caring,” professionals also experience positive outcomes from working with trauma. Compassion satisfaction refers to the sense of fulfillment clinicians experience through empathetic attunement; positive feelings associated with caring and helping; and the clinician’s sense of achievement,
motivation, and enjoyment from their work (Martin-Cuellar et al., 2021). Professionals can also experience an indirect form of posttraumatic growth (PTG). Vicarious posttraumatic growth (VPTG) encompasses the positive developments that can stem from trauma work, including resilience, new meaning-making, a deeper connection to trauma work, and an enriched and
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Book Code: PYFL4024
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