Helping Counsellors Working in Trauma

Posted by: Michael Sorsdahl on April 5, 2016 12:46 pm

As a working psychotherapist in the area of trauma, it has become very evident that the importance of the development of self-care strategies and receiving supervision to aid in helping ourselves to help our clients is paramount.  It has struck me that many practitioners enter into the field without understanding the pitfalls and signs of Vicarious Trauma, Compassion Fatigue, and Burnout. If we as practitioners of wellness are unable to maintain our own wellness, then we can actually do more harm than good in our attempts to help..

My experience as both a practitioner and an instructor to counselling psychology students in the area of crisis and trauma has led me to realize the lack of awareness that may exist in our professional community. Some of the symptoms of vicarious trauma as outlined by Iqbal (2015) that may be experienced by thBurnouterapists could be:

  • Changes in personal identity and world view
  • Social withdrawal
  • Lack of trust in others
  • Feelings of helplessness
  • Becoming easily emotionally overwhelmed
  • Numbing of atypical feelings towards people and events
  • Loss of connectedness to others and the self
  • Hypervigilance
  • Difficulty connecting with joy.

Some ways for practitioners in the field to be able to assess for their levels of vicarious trauma, compassion fatigue and burnout are with the Traumatic Stress Institute Belief Scale (TSI-BSL), Compassion Fatigue Self-Test for Psychotherapists (CFST), the Professional Quality of Life Scale (ProQoL), and the Maslach Burnout Inventory (Sansbury, Graves, & Scott, 2015).

Proactive self-interventions against the onset of vicarious trauma, compassion fatigue, and burnout are through the implementation of self-care strategies and supervision. Self-care strategies can be implemented in 4 realms of practitioner’s lives, including the physical, mental/emotional, social, and physical environment. Examples could be exercise and nutrition (Physical), meditation and mindfulness (mental/emotional), time spent with family and friends (family), and a clean orderly house (physical environment). I recommend implementing 1-2 strategies from each of these four areas to give a well-rounded self-care approach.

Directly discussing vicarious trauma, compassion fatigue, and burnout with a supervisor is one of the best ways to work through the symptoms early on and process any concerns you may have. Supervision is not just for students, I highly recommend it for all active practitioners in our field.


 

Iqbal, A. (2015). The ethical considerations of counselling psychologists working with trauma: Is there a risk of vicarious traumatisation? Counselling Psychology Review, 30 (1), 44-51.

Merriman, J. (2015). Enhancing counsellor supervision through compassion fatigue education. Journal of Counseling & Development, 93, 370-378.

Sansbury, B. S., Graves, K., & Scott, W. (2015). Managing traumatic stress responses among clinicians: Individual and organizational tools for self-care. Trauma, 17, (2), 114-122.




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

How To Make Meaning of Political Violence Directed at Innocent Civilians When it Hits Your Home in Paris on a Random Friday Night?

Posted by: Barry D'Souza on November 18, 2015 4:05 pm

Please note that this blog article was written on November 16th

EiffelTowerThe title of this blog entry follows what I wondered as I came home on the TGV this morning. When the carnage began to unfold Friday night, I was hosting my therapist meditation group. It was only when my son-in-law who texted me to check that I was alright much later – he’d heard of me going to the Bataclan to see concerts many times before – that I had any inkling of war coming to Paris.

I turned on the TV and began to watch news coverage of what was a momentary hiatus in the bloody assault as I cleaned up plates from the potluck that we have after our blissful meditations. I thought, this is the essence of shock! Parisiens, in all variations from the “furthest away” of thinking that anything like that could possibly happen in our streets – were being pulled into something very awful of which only the first few dimensions were perceived.

Most of the restaurant killing had been completed but there were hundreds of hostages in the concert hall. I stayed awake as long as I could. Casualty figures were modest at 1am, but, I knew that when I woke, countless of those hostages would be among the freshly dead that Paris would mourn. When I had to go to bed I felt some nibbling guilt – for weeks I had had plans to catch up with an old friend down in Montpellier. I had a train to catch the next morning. Already, I wasn’t the slightest aware of the killing as it happened, and then when the rest of my Paris would start to reel, I’d be away.

This weekend, as I realized the randomness of who happened to be in the places where ISIS chose to slaughter, and felt amongst other things, political worries for what would come next, I yearned for many things. I wanted to have an expression of solidarity with those who lost their lives, their families and those who just felt the pain of the meaning of Friday night in Paris. I wanted to commemorate all of those who were unknown to me and to whom up until Friday were living their ordinary lives. I wanted to feel a little vicarious pain, imagine and connect with the loss, from all sorts of personal angles.

With the friends in Montpellier, amidst our ‘catching-up’, we shared on many aspects of the human side of processing. Sunday afternoon, when it was so beautifully blue skied, sunny and warm, I went for a walk, sat in the Parc de Peyrou and falling into a sublime moment of peace, felt no nibbling of guilt. Coming together as friends, as a group, as societies, to feel and to make gestures confirming our humanity is part of the meaning-making in the short term, I am sure. We Parisiens might do well to take our time here. Attempts to make more absolute meaning of Friday, November 13 in Paris, in what is the long, ideological war of attrition between opposite sides of the war on/of terrorism, (where civilian casualty and trauma is bountiful), might end up choosing anger and fear as the basis for a response…not that anger and fear are not understandable and rightful responses just now. So here then is my immediate decision to make meaning of weekend events over the longer term – I hope to be a ‘present’ force of humanity-confirming senses in the midst of crazy violence.




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Echo Bullying

Posted by: Jonathan Delisle on August 19, 2015 10:17 am

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Echo bullying is a term I’ve developed based on both personal and clinical experiences. It is a phenomenon that occurs long after the bullying ends. It is an internal self-depreciation that continually underlies the former victim’s self-perception. The depreciating internal dialogue perpetuates the past bullying (usually sub-consciously). This internal dialogue is the echo of the bully’s message to his former victim.

Bullies direct hurtful comments or behaviours at you, and then you walk away and think nothing more of it or you may even try to repress or distort the memory of it while trying to convince yourself that you don’t care. Continue reading




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Adult Bullying: Breaking Away from the Bully’s Grasp

Posted by: Jonathan Delisle on July 23, 2015 8:09 am

Breaking out of an abusive relationship is harder than it sounds. In order to manage it, the victim needs to become empowered and either set the terms of the relationship or put an end to it. The following five steps are taken, once again, from Mrs. Hirigoyen’s book “Le harcèlement moral: la violence perverse au quotidien”.separate

  1. Acknowledge: As we wake up from the daze of being pummeled by constant abuse, we open our eyes to see a very different world from the one we used to know or made ourselves believe existed. It’s like our world got hit by a massive earthquake or a hurricane. The difference from a natural phenomenon of mass destruction is that you have a culprit responsible for it. This wasn’t natural. It was an injustice.
  2. Assess: As you begin to understand how you were manipulated and used, you will likely become upset and angry with the bully. It’s OK to feel indignant and sad. However, it’s crucial that you do not let that anger reverse your roles where you become a bully. This is often how bullies are made. You have a right to be angry, to be respected, and to speak up when you feel violated in any way. Those rights have been downplayed and denied to you while under the bully’s influence.
  3. New Strategies: Set boundaries, with the intention of opening up communication, breaking the isolation, and protecting yourself from falling prey to the bully’s paralyzing traps that aim at forcing you into your former victim role. Like a narcissist, the bully feels like he’s entitled to overstep boundaries and take what he wants, without giving so much as a single thought to the fact that he’s violating your rights.
  4. Stand Your Ground: Expect tantrums to test how far you will go before one of you gives up. This tantrum doesn’t have to be physical (throwing or breaking something). A good dose of passive aggression and guilt-trip is as good as any tantrum. “If you ever give in to a tantrum, you’re back to square one; it’s reinforced that if they stick to their guns, they’ll win and you’ll relent.” (Brown, 2014)
  5. Free Yourself: The relationship dynamic has to end in order for the victim to become truly free. Validate where validation is due, but do not condone the abusive treatment in any way. Thus you provide some healing to that narcissistic injury through your validation and, through your boundaries, protect yourself.

As a now empowered person, you no longer play the victim and you show others to do the same through your own example.


References:
Delisle, Jonathan; https://lighthousecounselling.wordpress.com/2014/09/19/breaking-the-bullying-cycle/
Hirigoyen, M.-F.; Le harcèlement moral : la violence perverse au quotidien; Éditions La Découverte et Syros, Paris, 1998; ISBN :978-2-266-22277-8
Brown, H. (2014). How To Deal with the Narcissist in Your Life. Psych Central. Retrieved on May 27, 2014, from http://blogs.psychcentral.com/bonding-time/2014/03/how-to-deal-with-the-narcissist-in-your-life/




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Adult Bullying: Codependence

Posted by: Jonathan Delisle on July 15, 2015 9:52 am

Before addressing the issue of breaking out of the bullying relationship, it is important to note that there’s an underlying dynamic that makes the process of ending the abuse so much more difficult: codependence. We’ve all had the experience of knowing someone in an obviously bad relationship, be it intimate, professional or otherwise. We wonder why he or she insists in staycycleing in that relationship. The answer seems simple: just get out. In reality, it’s not that simple. Both parties have come to depend on one another to meet certain needs; hence, they are co-dependents.

Dr. Stephen B. Karpman’s Drama Triangle is a good way to illustrate the dynamic of codependent dynamic of the bully-victim relationship.

From the point of view of the bully, we’ve already pointed out his dependence: he wants his scapegoat and source of narcissistic supply. But what is the victim trying to get out of that relationship? Usually, for the bully to change the dynamic: an apology, a change of heart, an awareness of the pain he’s inflicting, validation, etc… Perhaps the victimized one is secretly hoping that his abuser will become a rescuer, since there is no one else who seems to be able to save him, due to his isolation from all support. When all hope of rescue is gone, it is then that the victim either throws in the towel to accept moral death (sometimes leads to suicide) or snaps and attempts to take control and fight off the bully. Continue reading




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Adult Bullying – The Bully’s Strategies

Posted by: Jonathan Delisle on July 9, 2015 8:00 am

Ever wonder why bullies get away with what they do to others? Sometimes they walk away with little or no consequences for their abuse. For those of us who have been on the receiving end of the abuse, how many times have we racked our brains to figure out how we let the abuse happen? The following points are taken once more from Mrs. Hirigoyen’s book, though the author doesn’t lay them out this wtunnel-vision-212923_640ay explicitly.

Bullying has three essential steps that overlap. Even though they overlap, there’s a progressive emphasis on each of these.

Seduction: This is the first step to get a hold on his victim. The violence hides behind flattery and intimidation. At the onset, its manifestation is passive-aggressive: sarcasm, non-verbal cues, manipulation, ambiguity, lies, etc. The victim comes to question whether the tension or conflict he perceives with the not-yet-obvious abuser is his fault, whether it’s in his imagination, or whether there really is underlying violence in the other’s actions or words.

Paralysis: The bully will do everything to cut-off his prey from any kind of support that could help break his hold (isolation). The observers to the acts of aggression will likely choose to walk away and turn a blind eye to those acts so as not to draw the hostility towards them. Unfortunately, the cowardice can easily be interpreted by both victim and bully as agreement with the abuse. Thus the victim begins to feel isolated and cornered.

Continue reading




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Yoga as a Form of Trauma Therapy

Posted by: Andrea Cashman on July 8, 2015 4:00 pm

There are many trauma therapies that focus on the body such as sensorimotor therapy and EMDR. Exercise itself is a healing modality for depression, anxiety, stress and especially trauma. Many therapists may turn towards CBT or exposure therapy or another form of psychotherapy, forgetting that the body may be a source of healing. I specifically want to talk about the effects of yoga on trauma as this is a great trauma tool to encourage clients to engage in. Yoga therapy has been understudied; however, has been shown to be an effective adjunct treatment for psychiatric disorders (Cabral et al.,)

Trauma and its effects on the body cause disregulation. In PTSD, the fight or flight system is broken causing prolonged symptoms of re-experiencing, avoidance and hyperarousal. Hyperarousal symptoms are the main embodiment of the physical symptoms within the body of a PTSD client. Clients may feel easily startled, hold tension within their bodies and have difficulty sleeping and exhibit angry outbursts (nimh.com). The body will hold onto that tension and not be able to regulate back to a calm state compared to someone who does not have PTSD.

Yoga has many physical benefits, one of which is retraining the body to be calm. The National Institutes of Health Center for Complementary and Alternative Medicine defines mind-body interventions as “a variety of techniques designed to enhance the mind’s capacity to affect bodily function and symptoms.”Yoga practice enhances the connection between the mind and body, and it is used as a therapeutic intervention in a variety of diseases. The mechanisms that allow for the potential therapeutic effects of yoga involve the autonomic nervous system, especially a reduction in sympathetic tone, as well as activation of antagonistic neuromuscular systems and stimulation of the limbic system (Cabral et al.,)yoga

Continue reading




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Do You Help People Heal From Traumatic Events? Part 3

Posted by: Lisa Shouldice on June 11, 2015 2:26 pm

Creating Safety to Process Trauma Using Sandtray

Welcome to Part 3 of my Sandtray blogs! Part 1 introduced Sandtray Therapy (http://www.ccpa-accp.ca/blog/?p=4171) and Part 2 explained how to set up the first Sandtray session with a client (http://www.ccpa-accp.ca/blog/?p=4240). Sandtray is often used in therapy to facilitate healing traumatic events and related intense feelings. I truly feel it can be used for many issues and concerns clients present with and it is even great for couple counselling!

So while Sandtray can be used to process trauma, there are many other techniques and approaches used to this purpose as well. So one of the ways I use Sandtray is to create safety before I begin facilitating the processing of intense traumatic memories, even if Sandtray is not used again in session with that client.

I do this by first discussing this with a client at least one session before they complete the tray, so they know what to expect. When the session comes to complete the tray, I facilitate it in a slightly different way than usual, slightly more directive. For example:

“We are using this tray to create feelings of safety and self-care within your spirit before we begin talking about the difficult memories you have alluded to.   So I would like you to create a tray that creates feelings of safety, love and self-care today. This is a feeling you will be able to access while we get into talking about some horrible experiences you have had. There is no right or wrong. You are creating a world in which you are in full control and it can be anything you want it to be. So please choose your figures thinking about safety etc…”

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Continue reading




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Adult Bullying: Under the Bully’s Mask

Posted by: Jonathan Delisle on June 10, 2015 8:33 am

anonymous-438427_640Ever wonder why bullies bully? What’s their problem? That’s exactly the point… they are struggling with a problem. Bullying is an act of violence, and violence is an expression of anger. Bullies have an anger problem. Following Karyn Hall PhD’s thoughts (2012), the bully’s anger serves a few possible purposes: to protect himself, to control, and to connect:

Emotional Shield: Bullies fight hard to protect themselves from feeling powerless. As former victims themselves, they’ve had their share of feeling powerless. Anger is an empowering feeling that pushes them to break that all-too-familiar barrier of paralyzing fear.

Source of Control: Bullies fear to lose their victim as a scapegoat, which they desperately hold on to. Through anger, they can intimidate and manipulate others into submission to play the abuse game by their rules.

Safer Connection: Dr. Hall paraphrases Steven Stosny’s words on core hurts from his book Treating Attachment Abuse (1995): “He identifies core hurts, some of which are feeling ignored, unimportant, accused, guilty, untrustworthy, devalued, rejected, powerless, and unlovable”. These core hurts are the result of serious narcissistic injuries. They give rise to difficult emotions, such as fear, sadness, depression, vulnerability, etc. Anger then becomes a way of connecting with other people without having to deal with those difficult emotions.

Continue reading




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

A Narrative Psychoeducational Introductory Tool for Trauma Work

Posted by: Trudi Wyatt on June 5, 2015 2:08 pm

Following emotional trauma, people may develop symptoms of post-traumatic stress disorder (PTSD) such as flashbacks, avoidance of reminders of the event, negative cognitions or mood, and hypervigilance (1). Observing that some clients with these symptoms seek an understanding of why they experience them, David Leong, MA, LMFT, created and often starts off therapy with a “story” about the neurological effects of trauma on the brain (2). While David notes that his story (based on work by Dr. Dan Siegel) might be over-simplified, he finds his clients find it helpful. This post is a summary of the story:

fistbrainThe brain can be thought of as a fist: Your forearm leading up to it is the spinal cord, and the base of your palm is your “lizard” primitive brain, that manages such automatic body functions as heartbeat and sweating. Next, if you fold your thumb sideways across your palm, this is your mid-brain—your “limbic system.” It houses emotion, memory formation, and the “fight or flight” response. Two important structures within it are the amygdala, thought to be a key player in emotional/fear/implicit memories (3,4), and the hippocampus, thought to be a key player in converting information into memory codes (4). The “language” of the limbic system is emotions. Finally, if you fold your fingers over your thumb, you have your cerebral cortex, which speaks in words, and houses sense of time and explicit memory—a more abstract, gist-based, structural recording of episodes than implicit memory (3). Continue reading




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA