Self-Care for Professionals

Importance Of Self-Care

Awareness is increasing about the emotional and psychological risks associated with our work as helping professionals in our fields of mental health, social services, and medicine. With this comes the greater need to truly honour our professional and personal needs for self-care and care for our own mental health.

Secondary traumatic stress (STS), vicarious traumatisation (VT), and compassion fatigue (CF) are different types of empathy-based stress or strain, and are common conditions that we may experience, particularly in our work with trauma populations. Professional burnout, a more general condition, can also occur as it often does within any social service or medical setting.

Repeated exposure to clients’ traumatic experiences, and our empathic engagement with them can naturally result in the development of these conditions (Newell & MacNeil, 2010). As such, it is crucial that we clearly understand the factors and symptoms of these phenomena. Being better informed allows us to identify, prevent, and reduce the effects of these conditions on ourselves and our peers, so as to ensure both our mental and emotional health, as well as the longevity of our professional practice.

The following sections in the side bar will give you more information about the types of empathy-based stress, risk factors, screening tools, as well as individual and organisational tips for the prevention and management of empathy-based strain among professionals working with trauma populations.

References

Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: A review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. Best Practices in Mental Health: An International Journal, 6(2), 57–68.

Empathy-based Stress

Secondary Traumatic Stress (STS) is the development of PTSD-like symptoms without directly witnessing or being involved in a traumatic event. It is acquired through exposure to, and engagement in, an empathic relationship with an individual suffering from the effects of trauma, as well as bearing witness to the sharing of their intense or horrific experiences. STS can occur unexpectedly and suddenly. Its symptoms mimic those of posttraumatic stress disorder (PTSD). It has been said that STS relates to the “natural and consequential behaviours and emotions resulting from knowing about a traumatising event experienced by a significant other [or client] and the stress resulting from helping or wanting to help a traumatised or suffering person [or client]. (Figley, 1995)”

Vicarious Traumatisation (VT) is the experience of trauma symptoms that results in changes in world-view (e.g. about key issues such as safety, trust, and control), or cognitive shifts in the professional’s belief systems and their sense of self (e.g. spiritual beliefs).

Differences between STS and VT

Compassion Fatigue (CF)

​Compassion Fatigue (CF), sometimes used interchangeably with STS, has been more clearly defined by researchers as a syndrome consisting of a combination of STS symptoms and professional burnout. It is “a state of exhaustion and dysfunction – biologically, psychologically and socially – as a result of prolonged exposure to compassion stress” (Figley, 1995). The chronic use of empathy in a professional’s work with suffering individuals, in addition to the day-to-day administrative hurdles, can generate the experience of compassion fatigue.

Professional Burnout

​Professional Burnout a state of physical, emotional, psychological, and spiritual exhaustion from chronic exposure to (or practice with) populations that are vulnerable or suffering (Newell & MacNeil, 2010). It is a progressive state that cumulates over time, where the professional experiences emotional exhaustion, depersonalisation, and a reduced sense of personal accomplishment. Contributing factors include the individual, the populations served, and the organisation.

Consequences of Empathy-based Stress in Professional Practice

Secondary Traumatic Stress, Vicarious Traumatisation, and Compassion Fatigue not only affect our general well-being, but also affect the quality of service and care we bring to our clients and their families. The emotional toll from empathy-based stress may result in other difficulties such as a decline in decision-making abilities, disruptions in therapeutic alliance, conflicts with professional peers and colleagues, and violation of therapeutic boundaries.

For example, practitioners whose world view on issues such as trust and safety were changed or affected (as in vicarious traumatisation), may be unable to respond appropriately or effectively to their traumatised clients. The practitioner may feel so overwhelmed by the traumatic material that they may deny or avoid their clients’ experiences, leaving their clients feeling invalidated, thus reinforcing clients’ trauma-related experiences of shame. Conversely, some practitioners may unintentionally overstep boundaries of care in trying to reduce their client's distress and symptoms.

References

Figley, C. (1995). Compassion Fatigue as Secondary Traumatic Stress Disorder: An Overview. New York:Brunner/Mazel.

Am I at Risk?

Factors in the development of STS, VT, and CF

From research on PTSD, we know that there are multiple factors associated with the development of traumatic stress reactions in an individual. Hence, specific individual factors in mental health professionals will also influence (protect or affect) our vulnerability to being impacted by secondary exposure to the trauma materials of our clients.

Empathy, an invaluable skill in engaging and working with clients, is also a significant factor in the development of STS, VT, CF, and professional burnout. Mental health professionals who have a higher capacity for empathy tend to be at a higher risk for developing difficulties associated with the secondary exposure to trauma.

It has been suggested that practitioners who have a personal history of (unresolved) trauma are more likely to be vulnerable, as this increases the likelihood for reactivation of traumatic memories. The extent to which we, as mental health professionals, have processed our own past traumas (at the sensory, affective, and cognitive levels), can also influence the impact STS, VT, and CF have on us.

High caseloads of trauma-related situations despite having little clinical experience working with trauma clients can also increase the professional's vulnerability to the effects of these conditions.

The use of maladaptive coping strategies in response to trauma work, such as suppression of emotions, distancing from clients, and the re-enactment of abuse dynamics, have been identified as warning signs for these conditions.

Identifying STS, VT, CF and Professional Burnout

Peers, supervisors, and organisational leaders are highly encouraged to look out for stress related to the secondary exposure to trauma in their mental health professionals. This can be done informally or formally with assessment questionnaires, as part of a reflective supervision model recommended by the NCTSN.

A reflective supervision model cultivates greater self-awareness in a professional, which supports their professional and personal development.

Self-awareness is an essential skill for mental health professionals working with people with traumatic experiences, as it enables greater attentiveness to the emotional content in this specialised work we do; our internal responses affect our interactions with clients.

Recommended formal assessment measures:

• Professional Quality of Life Measure (ProQOL)
• Secondary Traumatic Stress Scale (STSS)

Prevention is an Individual and Organisation Effort

Professional awareness of preventative measures implemented both individually and within the organisation are effective in reducing the impact of STS, VT, and CF, thus reducing the occurrence of professional burnout in mental health professionals.

Mindfulness, professional self-care, and stress management are individual-based approaches to prevent and reduce the impact of these conditions. Some examples of individual self-care strategies include setting realistic goals with regard to workload and client care, utilising coffee and lunch breaks, getting adequate rest and relaxation, and maintaining positive connections with close friends and family.

Other strategies for reducing the risks of STS, VT, CF, and burnout include:

• Developing greater self-awareness through self-observation or mindfulness practices
  - Being able to recognise and chart your signs of stress, STS, VT, CF, and burnout, will enable you to better care for your mental and emotional well-being.
• Taking care of yourself emotionally
  - What activities are nourishing, soothing, and rejuvenating for you? Create moments of calm and carve out time to engage in activities that nurture self-care.
• Looking after your physical and mental well-being
  - Exercising and movement help with de-stressing and shifting our minds away from work-related stress. Moving your body can range from quick and frequent stretches to heart-pumping exercises. Consuming non-work-related material of our interests also helps with re-setting the mind.
• Maintaining a healthy work-life balance
  - Have and develop diverse interests outside of work and create a clear separation between work and home. A routine to help you transition between work-mode and home-self can be helpful.
• Being aware of your limitations and honouring them
  - Having realistic expectations of what we can accomplish and respecting our boundaries is key. Setting our limits can be a useful tool in preventing empathy from doing more harm than good.
• Using peer support and opportunities to debrief
• Take up training opportunities
• Leaning on social support from colleagues, friends, and family members
• Seeking professional support
  - It is a healthy and excellent self-care practice to take up group or individual therapy to create a wider circle of support for your personal and professional growth when needed.

However, people are also impacted by the culture and practices of the environments they are in; individual-based efforts can only be effective if supported by the supervisors’ and organisation’s management of the mental health professional. There is substantial evidence suggesting that support from professional colleagues and supervisors can serve to decrease the effects of professional burnout.

Acknowledgment of the existence of STS, VT, and CF, and their related conditions (i.e. professional burnout) as well as setting up appropriate and helpful processes within each department or team, can make a difference to the larger organisational culture as a whole.

Some suggestions for creating a more trauma-informed team and organisational culture are:

• Increasing trauma-specific supervision with a reflective approach
• Developing peer support networks and encouraging a supportive culture within the department and organisation
• Encouraging periodic monitoring to increase awareness and processing of work-related traumas and/or stress
• Developing a culture that encourages ongoing development of self-awareness and good self-care, that are essential to professional and personal growth
• Providing opportunities for helping professionals to receive mental health services and normalising seeking these avenues of support
• Incorporating processes and the use of assessment tools or practices to identify the risks of an individual, the team, or the organisation, developing secondary traumatic stress or vicarious traumatisation

References

Arvay, M.J. (2001). Secondary traumatic stress among trauma counsellors: What does the research say?. International Journal for the Advancement of Counselling. 23, 283–293. https://doi.org/10.1023/A:1014496419410

Beck C. T. (2011). Secondary traumatic stress in nurses: a systematic review. Archives of psychiatric nursing, 25(1), 1–10. https://doi.org/10.1016/j.apnu.2010.05.005

Diehm, R. & Roland, D. (2015). The impact of secondary exposure to trauma on mental health professionals. Australia Psychological Society. 37(1). https://psychology.org.au/inpsych/2015/february/diehm

Figley, C. R. (1995x). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Bristol, PA: Brunner/Mazel. In Simpson, L. R. & Starkey, D. S. (2006). Secondary traumatic stress, compassion fatigue, and counselor spirituality: Implications for counselors working with trauma.

Kim, J., Chesworth, B., Franchino-Olsen, H., & Macy, R. J. (2021). A scoping review of vicarious trauma interventions for service providers working with people who have experienced traumatic events. Trauma, Violence & Abuse, 1524838021991310. Advance online publication. https://doi.org/10.1177/1524838021991310

Sodeke-Gregson, E. A., Holttum, S., & Billings, J. (2013). Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients. European journal of psychotraumatology, 4, 10.3402/ejpt.v4i0.21869. https://doi.org/10.3402/ejpt.v4i0.21869

National Child Traumatic Stress Network, Secondary Traumatic Stress Committee. (2011). Secondary traumatic stress: A fact sheet for child-serving professionals. Los Angeles, CA, and Durham, NC: National Center for Child Traumatic Stress.

Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: A review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. Best Practices in Mental Health: An International Journal, 6(2), 57–68.

ProQOL: Professional Quality of Life. (2021). Elements, Theory and Measurement. St. Paul, Minnesota, Washington D.C., Africa, and Middle East: The Centre of Victims of Torture.

Sabin-Ferrell, R. & Turpin, G. (2003). Vicarious Traumatisation: Implications for the mental health of health workers? Clinical Psychology Review, 23, 449 – 480.

The Lookout. (2017). Vicarious Trauma & Burnout. The Lookout, viewed 1 October 2021, https://www.thelookout.org.au/family-violence-workers/self-care-family-violence-workers/vicarious-trauma-burnout

Zimering, R. (2003). Secondary traumatization in mental health care providers. Psychiatric Times. 20(4). https://www.psychiatrictimes.com/view/secondary-traumatization-mental-health-care-providers