Vicarious trauma – Dr. Sean St. Jean

How to Save Your Heart and Body in Child Welfare (1 of 5)

Last month I promised to address each of the five “secret” factors that take child protection workers out at the knees. You can go ahead and read that here. I call them “secret” reasons because they’re either not obvious to the public or because they represent beliefs that we covertly cling to.

Saving Your Body

Let’s talk about safety. Humans are pretty crappy at judging whether or not we’re safe. Maybe its fair to say that our internal danger-meters were calibrated in a different age. Yet just for fun, let’s test our safety knowledge. Which is more dangerous to a social worker:

An angry, yelling dad enters your office demanding to see his baby son
Driving to a meeting across town

Continue reading “How to Save Your Heart and Body in Child Welfare (1 of 5)”

Most Social Workers Will Not Survive Because of This

Wow, now that’s a stern title. Usually I don’t take myself that seriously. Really. I’m the guy who often risks making a joke during a tense child protection meeting with angry parents. Often a bad idea, I won’t lie. But when it works it’s golden and I look like a social work genius. I like to clown around when I can. Yet I have to tell you, when it comes to the topic of “surviving social work” I sober up. I get dead serious.
I hate the word “wellness” and I despise the term “self-care”. Why? Because to me they reek of upper-middle class privilege. My ears hear, “I think I’m going to switch yoga studios because I’m not sure my instructor gets me” or “My weekly hot stone massage was divine.”
Don’t get me wrong- I’m not against you getting your downward dog on, and I sure would love a hot stone massage (every week). No, what I am saying is that wellness behaviors often come across as privileged acts taken by those who are already well-ish. Those who have resources. Those who live a relatively charmed life already (aka: not our clients). I sense that a lot of you in your helping professions may think so too. Let’s face it: it’s flat-out hard to savor your Reiki appointment after helping a homeless guy find some underwear.
I am talking about survival. My concern is with staying alive emotionally and psychologically, which for helping professionals can be an insurmountable task. I mean, look at the numbers. In the field of child protection social work, 70% of frontline workers have had symptoms of PTSD and 15% are currently diagnosable with the condition. Yearly turnover in those trenches is between 30-90% depending on where you are. Can you imagine losing 9 out of 10 of your co-workers every year? One study estimated that the average new child welfare worker only survives for about 14 months in the field.
But these numbers are more than just unattached or meaningless figures. These numbers represent the lives of people. When you dig into the stories of helping professionals you see human beings who are getting taxed in ways they have never before experienced for long periods of time. Here’s what I have personally witnessed in social work over the past decade:

a parade of workers who have quietly entered my office in tears because they hated their lives
first-hand stories of professionals with degrees who are struggling with drug addictions, food addictions, sex addictions, and the like
professionals who have told me they would be better off if they got hit by a truck
hurting social workers who have been emotionally, psychologically, and even physically abused by their supervisors

Those are the extreme cases, for sure. But don’t get me wrong- there are many of them. What happens more typically is that people tell their peers at the office or their bosses that they have decided to go back to school for their master’s degree or that they are taking time off to have kids or they’ve decided that this specific position isn’t right for them. Behind closed doors, however, another story emerges: they are climbing the walls to get out. They have gone full-limbic. They are running from real danger because they realize they are not safe.
Ready for that hot stone massage yet? Let’s get back to the problem. “Self-care” and “wellness” just sound too fluffy. It sounds like they are meant for those who have not undergone that extreme level of professional stress. Those labels just aren’t adequate to describe what is needed to survive emotionally in many social service systems. To weather the onslaught.
We would never say to a construction worker, “Those steel toed boots and hardhat are a luxury.” We would never look sideways at a skydiving instructor as she conducts her second or even third check of her parachute. These processes aren’t sexy. They are simply a necessity to protect the worker; required tools that are needed to be safe on the job.
So if the risk of trauma and burnout is so high for helping professionals then why isn’t this a focus? Why aren’t universities teaching this? Why does my employer have nothing (or only minimal systems) in place to protect me? It’s a complicated answer, but I have three possible explanations:

1. There is a no talk rule, so the problem goes unaddressed

Remember how I suggested last week that people often feel inadequate but want to project an image of confidence and happiness to those around them? Unfortunately when professionals experience trauma they often feel at least partially responsible. They feel guilty. When asked by our coworkers how we’re doing the “correct” answer is “awesome!” or “great!” Why do we answer this way? Because of social pressure. If we don’t see the professionals around us say “I am suffering right now” then it’s probably not safe to choose that answer either (and you’re probably right to keep your mouth shut).
My wife and I experienced this when our first child came along. We were both a mess. We felt really lost. We also felt major guilt because we were supposed to be able to handle it. We were supposed to be enraptured by our new bundle. I felt powerless to help my tearful wife. Worst of all, the other mom’s seemed to be doing just fine (even though statistically 70% of all new moms have postpartum blues, and 10-20% have diagnosed postpartum depression). My guess is that this cycle of guilt and silence is self-perpetuating. No one is talking so no one talks. No one wants to be the first one to be open; to be vulnerable.
I contend that the same holds true in our offices. Even though we know better, none of us wants to be the loser who needs help. None of us wants to be the one who can’t cut it.

2. Trauma often looks like incompetence or a poor work attitude

The second reason there is commonly no intervention for protecting helping professionals from trauma and burnout is that we are still bound by an old-school or “mainstream” employment paradigm. This is a way of thinking that says that if someone is not meeting employment performance criteria it is due to a deficit in their character. It is seen as a moral failing that must be corrected via supervisory and disciplinary means.
But here is the rub: symptoms of trauma and burnout just happen to look much like what the system calls incompetence or poor attitude. Here is a list of symptoms that are commonly associated with burnout, and how they may be perceived:

Chronic fatigue. Your supervisor may read this as a lack of motivation to do your job.
Forgetfulness/lack of attention. Possibly perceived as not caring about your client.
Increased illness. How many sick days have you been taking lately?
Anxiety. Sometimes leads to avoiding certain people and tasks at work.
Outbursts of anger. Could be toward clients or other service providers.
Cynicism. Easily picked up by others in little jabs and comments.
Reduction in performance. These could lead to poor job reviews, etc.

These are all common symptoms of burnout. They are also the things management traditionally associates with “bad workers”. What ends up happening is that in response to these symptoms, management is often unsympathetic, which adds to the stress-load placed on the worker. Submitting to a performance review in a large boardroom table full of supervisors and HR personnel can be traumatizing in it’s own right.
Here is the absolute worst aspect of looking incompetent or cynical as a helping professional: you look this way to yourself. As I have said in previous posts, the worst effect that trauma and burnout have on us is that they make us believe (falsely) that we are losers based on seemingly tangible feedback (poor reviews, knowing we have avoided a client, etc.). We see ourselves failing and our self-concept drops from a 7 to a 4. I believe that many leave social services each year because (consciously or unconsciously) they are trying to recover their identity and their sense of self regard.

3. The powers that be cannot know or relate to what’s happening on the ground

I don’t blame the managers. I really don’t. Are they responsible? Yes they are. Should they know what’s happening to us front line workers on the ground? Yes, they should. I don’t want to make excuses for them, but let’s just think about their jobs a little. Maybe you have a program manager working at a high level in an agency. This guy is really the person who can help- he has both the authority and dollars to make changes. First of all, he may not even have a relevant (read: helping profession) degree. How is he supposed to know about clients and vicarious trauma and all of that stuff? He may have been hired for his MBA or HR degree or because he has a lot of experience managing people…in other industries.
Second, he may have never worked in the mucky and mired trenches with down-and-out people. Or maybe he did 20 years ago. When was I most empathetic toward new parents? When I was a new parent! I finally got it! But even now, even though my youngest is only 5 years old, I can feel my memories (and therefore empathy) fading away… It’s just as simple as that. The fact is that this unempathetic dynamic, combined with the desire by the professional not to look bad and a “no-talk” group culture means that our needs will more often than not go unaddressed.
It shouldn’t be this way, but when it comes to healing ourselves from burnout and trauma:
We must assume that we are on our own.
We cannot wait to be rescued. That’s not to say we shouldn’t reach out. Rather we must take actions to try to improve our own situations. We are the best people to assess and meet our own needs. That’s what this blog is all about. That’s what my course is all about. I have built my course to answer these questions:

Where do I start in order to begin the healing process?
What is the low hanging fruit? In other words, what are the few things I can do that pay the highest return with the lowest expended energy?
How are my beliefs holding me back and what beliefs will lead me to a place of calm, even when I am in the middle of the storm?
Most importantly, how do I recover my resilience so that I can live a meaningful and fulfilled life?

These questions are not questions of privilege. Every human is entitled to ask them and vigorously pursue the answers. There’s no guilt here because this is about your emotional safety, and safety is a right. Everyone has permission.
You have permission.

The Most Vulnerable Part of a Social Worker’s Body…

We are the only species on the planet that make use of story. I read once that the reason human beings emerged from among other primate species (like the Neanderthals) was because of their special superpower: the ability to use story and language. Neanderthals, as the story goes, could only coordinate among small, familial groups. Therefore their cumulative strength was only as powerful as the size of their family.
Homo sapiens, however, developed a keen ability to enthrall and motivate much larger groups via shared themes and collective narratives. That’s why they came out on top. Using stories, they could gather massive numbers of people and dominate their surroundings during times of war.
Think about all the world’s religions. At their core, they are really just powerful stories that people have embraced and internalized. I am not challenging the veracity of these tales, but rather making the point that for a human brain, hearing a story about something is pretty close to experiencing it directly. In fact, our brains light up in virtually the same way regardless.
ice_cream_sundae Think about a scoop of ice cream sitting in a cold dish with hot chocolate fudge oozing down the sides. Can you taste it? You may be salivating already. Imagine that you are hiking at the grand canyon and that you are cautiously stepping toward the edge. You can see straight down to the river valley 4000 feet below. Did your feet start to tingle? Your rational mind knows that you are at your desk or on your phone sitting in your car, but your body doesn’t know that! It’s already preparing to hold onto some little tree should you spill over the edge.
In addition to being susceptible to other people’s narratives, we also have a set of stories we tell ourselves. For us, these stories are “truth”. That is, we have confidence that our stories are “actually” real. In fact, these stories are undoubtedly based in reality and and serve us well. For instance, we usually go to the trouble of showing up for work because we understand that if we do, then twice a month the electronic number in our savings account will bump up, and that somehow that electronic number means that if we show someone a little piece of plastic we can get a cup of coffee or a new dress.
We may not understand all of the mechanics of this because most of it is very complex, behind the scenes, and completely abstract. But we have enough faith in the “truth” of this story that we take on work tasks we don’t necessarily like and drive to the mall with the firm belief that someone will let us leave with that new dress in hand.
Sometimes our stories don’t serve us very well…or at least not anymore. Maybe we believe that we’re bad at math, so we never bother taking on projects that require it. That happened to me. I hated math because I had tried and tried as a kid, and never seemed to “get it”. Years later, I decided to take a chemistry course purely out of curiosity- to test the belief that I was math-challenged. The result? I aced the class. It seems that my belief was wrong– or at least it became wrong at some point.
That wrong belief is why I didn’t go to medical school. My life could have been totally different if I had just challenged that no-longer-true belief just a few years earlier. I read once that if you believe that you are a “7” out of “10” in a particular area of life, and if you find yourself performing at a “5”, you will naturally bring up your game so that your perceived performance matches your self concept. In the same way, if you find yourself operating at a “9”, you will unconsciously dial back your efforts or self-sabotage until you think you are back at a solid “7”.
Ok, Sean, thanks for the pop psychology class. But how do these ideas actually help me in my social work practice? Why does any of this matter? It matters for this reason:
The lives of social workers are decimated by stories.
How can that be? Well it’s actually quite basic. So basic, even, that we can be harmed over time without even noticing. When we hear stories of trauma again and again, it affects our own story- our greater life-story. Have you ever heard of “suspension of disbelief”? It is the idea that we allow ourselves to believe that a story is real so that we can get into the action and enjoy the film or book or play. Then why is it that when we watch movies we are not traumatized by the horrible and often graphic human destruction we see? It is because our brains aren’t so easily fooled- they can tell what is real and what is pretend. Since we were toddlers we learned to use make-believe to entertain ourselves, to learn about the world, and to build bridges with the children around us. So we are good at suspending disbelief.
sadkid Trouble ensues when we know that the story is real. We sit with a mom as she tells us how her partner came home two days ago and hit her with a chair. We can see the defensive wounds on her arms. We watch the tears stream down her face. We believe her. We accept her story as truth. This is not CSI or Law & Order- it’s real life. And because we believe her, we open ourselves up to a kind of trauma- the kind of harm that comes from knowing at a deep level that there is actual wrong and strife in the world. We are unsafe. We and those we love can actually be harmed.
So it seems that our ears are our most vulnerable bodypart as social workers.
Maybe the vicarious “harm of hearing” is more easily understood in other contexts. It happens all the time with phobias. Mom is scared of dogs, so her son develops an aversion to dogs- a vicarious aversion. Have you ever seen a startled baby held by a parent? What happens when a book falls off a shelf or a big laughing stranger walks into the room? Baby never reacts immediately- she will always look to mom or dad first. Mom and dad provide the context that baby hasn’t developed yet- she learns to be afraid (or calm) vicariously. Mom and dad know if this is normal or something to freak out about. We do it as adults too. We look at the sudden thing that happened across the road then we look back at each other for the collective reaction. We are relational beings.
Here’s where the real harm happens. The research tells us that when these traumatic tales are multiplied many times, our worldview bends and buckles. Our stories about ourselves shift. This is especially true when we work in fields where we don’t often see a lot of hope and change in people. Most of us graduate with our degree being fairly certain that we are a solid “7” or “8” in terms of being able to “help”.
Yet after months or years of traumatic exposures, witnessing chronic pathologies, and seeing our very best attempts have little to no effect on our patients or clients, our helping score starts to tank. Our sense of professional self-efficacy drops. Our own story can become impoverished and darkened. If we already struggle with depression or anxiety, those symptoms can be exasperated.
What’s your story? What beliefs have shifted for you since starting in your profession? Maybe you feel as though you are doing fine. That’s awesome! Maybe you’re struggling. That’s okay too. The good news is that there are solutions for vicarious trauma that work for most people. There’s a light at the end of the tunnel. Next week I am going to talk little about that light.
If you want a taste of what I am going to talk about, sign up here to get a free sample from my course and figure out your story.

Why Social Workers Should Go to Bootcamp

Let me say upfront that I am anti-war. I don’t like guns. I have almost zero desire to ever enlist into any sort of military program. Think of me as less “Booya!” and more “Kumbaya!” Yet, as I waded into the muck and mire of the social work profession, and later as I began conducting qualitative research into the effects of vicarious trauma on child protection social workers (and how we may prevent that trauma), my thoughts repeatedly landed on the usefulness of basic military training.
After all, the army trains soldiers to kill and be killed. To defend our country’s interests. They are in the business of life and death. In the theatre of war, lives and families and communities are shaken by all sorts of disruptions, trauma, and loss. How, then, does the military prepare its people to face all of this?
The process of becoming a social worker is actually quite similar in some important respects. Young people are drawn in by the allure of the profession. For soldiers-to-be maybe it’s a fascination with guns or a desire to be a part of something grander. For social workers-to-be perhaps it is the notion of making a profound difference in the lives of children or helping to foster societal change. Unfortunately many green social workers do not benefit from any kind of true “induction” process. There’s little “basic training”. Yes, there’s theory. There are roleplays and written reports or essays and maybe a practicum, but few up-and-coming social workers have actually been tested in the field.
I am reminded of the last term of my BSW. The class was “Counseling for Individuals” or something like that. We were sitting in the classroom doing a fishbowl exercise, and many of us were freaked out. A fishbowl exercise is a mock-counseling session performed by the students in front of the class. It doesn’t matter what theory you know or if you’ve been able to spout off to your fellow students about trendy new counseling interventions or about the skills you have. The fishbowl exercise is the reckoning. It’s the proof. It is in that moment when everyone will know whether or not you can actually conduct a helping conversation or a counseling session with someone. I have to tell you some people were literally sick at the thought of having to showcase their skills (or lack of) to their peers. Many did not show up to class that day. They just couldn’t face the idea that they may be shown to have fallen short. Now if you’ve been in the field for a few years, I doubt you’re scared of the fishbowl exercise. Why would you be? You know better now. How? You have been tested and have a calm sense of what you are capable of. You have nothing to prove because you’ve already passed the test.
However, many of those scared students graduate anyway, get hired by an agency, and they still have something to prove. They’re still scared. That’s where bootcamp would be truly helpful. Here are four things that basic military training instills that social service recruits could benefit from:

Recruits are acutely challenged…and come out the other side.

You’ve seen the movies- a bunch of kids get put through hell on earth. They are treated poorly. They are kept up all night and made to run through mud and crawl under barbed wire. They are pushed more than they have ever been pushed in their entire lives. Unreasonable demands are made from them. They are pummelled repeatedly in unfair situations. They really suffer. Yet through it all they become unshakable. Suddenly the mundane aches and pains of life, the first-world difficulties and inconveniences are placed in context. Perhaps the greatest gift in all of this is that as they work through real and profound pain they realize that they are indeed capable. They will survive. The anxiety of not knowing whether or not they will measure up is replaced with a tested confidence in their own abilities.

Recruits develop a robust sense of their place in the world.

A big part of this induction process is about fostering a strong identity. You can see it when you look at a soldier. They have a powerful sense of who they are and what their purpose is. They are not burdened by ambiguity or pluralistic thinking. There is an ironic freedom in this. They do not second guess themselves. They hold to a code. They live according to a system. When all else fails, they rely on the code and the system to get them through.
The other thing recruits benefit from is the acquisition of really useful skills. They train their bodies and their minds, they learn how to survive in the wilderness. They may learn how to fly a plane or fix electronics. They come out of basic training with the knowledge that they are vastly more capable human beings than when they went in. I have watched new social workers get overwhelmed with a full caseload and quickly spiral into avoidant behaviors, eventually getting in trouble and burning out. Yet there is something to be said for the confidence that comes from knowing that you can take competent action to get stuff done. Beginning social workers need early wins to prove to themselves that they have the chops needed to succeed in this insane career.

Recruits form a deep sense of trust and fraternity with one another.

The great thing about living by a code is that you instantly know a great deal about your fellow soldiers. You get how they think because you’ve been trained to think the same way. Not only that, but because you have crawled in the mud together and have helped each other you experience a fellowship with one another that is rich and meaningful. You know that you have each others’ backs.
I am not going to suggest that being a soldier is the be-all end-all or that soldiers should be social workers (they shouldn’t). In fact, many of the qualities that social workers possess- sensitivity, tolerance of ambiguity, willingness to challenge their own beliefs- are what make them excellent helping professionals.
Yet remember that we are talking about lowering our susceptibility to trauma. This about our survival. We are talking about the emotional and psychological survival of large swaths of people who work as helpers and healers. In this area, the military is on to something. After all, as a profession they predate social workers by many millenia.
I am not saying that we should send our young BSW graduates to military boot camp. What I am saying is that if want to build ourselves into more resilient practitioners, we would be wise to first find ways to test and challenge ourselves- to put ourselves into challenging situations where we can acquire real skills. This would have the effect of making us relatively bomb-proof. It also provides a good boost to our self-concept. In fact, getting “better” (whatever that means for you) could be your greatest antidote to workplace trauma and burnout.
Second, we must have solid sense of what we believe about the world, about our clients, and about ourselves. Untested, faulty, and obsolete beliefs will shatter when taxed. Knowing who you are and what you believe in a robust way will inoculate you from the scourge of vicarious trauma. After all, vicarious trauma is really just the disillusionment and hopelessness that emerges as inadequate beliefs about the world break down and are revealed to be unhelpful. Finally, we must find ways to build solid attachments with those within our fields (these are our comrades in arms) and those on the outside who can be our trusted kindreds.
You may never hold an actual gun in your life or put your own body in harm’s way, but I can guarantee that if you work in social services you are in a state of profound emotional and psychological risk. Research about vicarious trauma and secondary traumatic stress teach us that we do not have to get shot to be harmed by a shooting. We don’t have to have a fist strike our face to be harmed by domestic abuse. All that is required is that we be continually accosted by the relentless tales of such.
Yet if we go on the offensive and train ourselves to overcome we can survive and even thrive.
So what do you think are the biggest challenges new social workers face? Leave a comment and let me know!