Healthcare Training Institute - Quality Education since 1979
Psychologist, Social Worker, Counselor, & MFT!!

Section 1
Track #1 - Introduction and Secondary Traumatic
Stress Disorder

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Answer Booklet | Table of Contents
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Introduction
Welcome to the Home Study Course sponsored by the Healthcare Training Institute. This course is entitled, Therapist Self-Care for Domestic Violence Burn-Out.

Our primary intent for this home study course is to provide quality education to foster your professional growth.

The Institute has provided quality education since 1979.

Hi. My name is Catherine Appleton. I will be the narrator of this CD. We appreciate that you have chosen us as a vehicle for you to earn your Continuing Education Credit.

The purpose of the course is to assist you in increasing your knowledge regarding self-care measures to avoid burn-out when working with domestic violence clients. As each case study is given, if the concepts seem to be applicable to your situation, I encourage you to turn your CD player off and make a few notes regarding the application of the principle to your setting. However, these notes are for your purposes only and are not to be sent to the Institute. Also each track is very content dense. So feel free to replay the track to review the content.

At the end of each CD track, a question will be asked. The question at the end of each track corresponds with the questions in your Answer Booklet. Merely write the correct letter on the corresponding blank line in your answer booklet. Each answer is only used once. Keep in mind there is nothing tricky or hard about these questions. They are merely intended to verify the playing of this CD.

Each of the questions that are included on this CD is also reprinted in your Answer Booklet. These questions are sequential and deal with the section of content that preceded it. For this reason, to facilitate the answering of each question, you might read the question from the Answer Booklet prior to listening to that CD track. By knowing what the question is ahead of time, you will then know the content to listen for that contains the answer. So just a hint, after you write down the answer to a question in your Answer Booklet, read on to the next question in order to give you a "heads up" to listen for the content that contains the answer to the next question.

For the purpose of brevity, most generally I will use the term "therapists" or "mental health professional." However, don't let these terms deter you from applying the concepts to your situations. When you hear the word "therapists," if your job title is social worker, psychologist, marriage and family therapist, mental health counselor, professional counselor, resident director, program assistant, etc. merely substitute the appropriate term that is the most meaningful to you. In short, don't let my use of the term "therapists" cognitively set you off track from hearing the content because your job title is school counselor, for example. I will also use the term "client" for the purposes of brevity. However, if you deal with patients, residents, students, consumers, etc., transpose "client" for the term that is the most meaningful to you in your work setting.

On this CD we will discuss such topics as: Secondary Traumatic Stress Disorder, the Therapist's Shield, Client Resistance, Therapist Arrogance, Thurman and Watson's Fight for Legal Justice, Hidden Risks, Strategic Use of Self, and Perceived Inadequacies.

Now let's get started.

In 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?

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.

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.

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 Answer Booklet.