BIBLIOGRAPHY
Managing
Stress in Humanitarian, Health Care, and Human Rights Workers
Prepared by
John H. Ehrenreich
|
Introduction |
1 |
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Resources
on Burnout and Vicarious Traumatic Stress Among Humanitarian Aid Workers, Health Workers, and Human Rights Workers |
3 |
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Manuals and
Books |
3 |
|
Articles |
6 |
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Resources
on Burnout and Vicarious Traumatic Stress Among Therapists, Counselors, and Other Mental Health Workers |
12 |
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Books |
12 |
|
Articles |
12 |
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Resources
on Burnout and Vicarious Traumatic Stress Among First Responders, Rescue and Relief Workers, and Emergency Medical
Workers |
18 |
|
Books |
18 |
|
Articles |
19 |
|
Resources
on Burnout and Vicarious Traumatic Stress: Miscellaneous |
24 |
|
Books |
24 |
|
Articles |
24 |
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Coping
With Catastrophe: Responding to the Psychosocial Effects of War, Natural Disasters, and other Humanitarian
Emergencies |
27 |
|
General Manuals |
27 |
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Additional Resources: Books |
27 |
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Additional Resources: Internet |
28 |
Introduction
The listings in this
bibliography are divided into five groups with distinct but somewhat
overlapping focuses.
Part I contains books and
articles that focus primarily on staff of
humanitarian aid and development organizations, health care workers,
human rights workers, and journalists. The work of these groups typically involves
repeated or prolonged contact with people who have been
Ó 2002, John Ehrenreich. Credits: Citations from the PILOTS Database are marked [A] if they were drawn from authors’ abstracts or summaries, [T] if they were derived from the text of the article. Articles from the Medline Database are marked [M].
emotionally traumatized by their experiences. Their primary role is to provide
material assistance or training or other services or to gather information,
however; it is not to provide mental health services or directly respond to the
emotional effects of traumatic experiences.
Part II contains books and
articles that focus on first responders such as policemen and fireman, rescue
and relief workers, and emergency medical workers. These are groups that
respond to disasters – individual disasters such as motor vehicle accidents or
fires as well as mass disasters such as plane crashes, earthquakes, and
hurricanes. Their involvement with the victims may occur closer to the time of the traumatic
events than the first group’s, but like the first group,, their work usually
does not involve a direct focus on treating the emotional effects of the
disaster.
Part III contains materials
that focus on mental health workers – therapists, counselors, and paraprofessionals
-- whose major role is to respond directly to the emotional needs of survivors
of traumatic events of all sorts (including both individually traumatic
experiences and mass disasters). There is a large literature on this topic. I
have selected primarily books and articles that deal with mental health workers
in disaster and complex humanitarian emergency situations.
Part IV is a “miscellaneous”
section, containing references to material that deals with several of the
groups described above as well as with conceptual and organizational issues.
Part V contains items that focus not on the caregivers but on the survivors of traumatic events themselves. They provide additional insights into the individual, family, and community effects of traumatic events and the ways these effects may interact with the work of those who seek to aid them. In many cases, they also contain material on secondary traumatization and other issues of direct concern to aid workers. There is a large literature on this topic and only a few more general references have been included.
I.
Resources on Burnout and
Vicarious Traumatic Stress Among Humanitarian Aid Workers, Health Workers, and
Human Rights Workers
Manuals and Books
Ajdukovic, D., & Ajdukovic, M. (eds.)
(2000). Mental Health Care of Helpers.
This book grew out of materials prepared for a
training program on "Help and Self-Help for the Protection of the Mental
Health of Helpers," developed to meet the needs of care-providers in
* * *
Barron, R.A. (1999). Psychological trauma and relief workers.
In J. Leaning et al. (eds.), Humanitarian Crises: The Medical and Public Health
Responses.
A relatively academic
article, but potentially useful for managers.
Discusses traumatic stress, burnout, factors that place workers at increased
risk of stress, interventions with individuals to decrease worker
traumatization, institutional responses to decrease worker traumatization.
* * *
Cutts, M., & Dingle, A. (1995).
Safety first: Protecting NGO employees
who work in areas of conflict.
Aimed at project managers, but usable by field
staff, covers preparing for emergencies, staying healthy, use of vehicles,
responding to attacks, evacuation procedures, and related topic’s. Includes
brief sections on coping
to stress.
* * *
Danielli,
Yael (Ed.) (2002) Sharing the front line and the back hills: International protectors and
providers: Peacekeepers, humanitarian aid workers and the media in the midst of
crisis.
Contains sections on humanitarian aid workers,
peacekeepers, human rights workers, and journalists The
book discusses, develops, and advocates specific policies and practices that
enable these workers to serve effectively and safely. It reviews existing
knowledge, identifies approaches that have proven useful, explores and suggests
future directions, and makes policy recommendations to relevant implementing
organizations. A further goal of this book is to describe the major initial
steps taken by the various international organizations. The chapters include a
detailed consideration of the requirements of pre-mission selection, assignment
and training, support during mission, and post-mission assistance and
counseling. They consider distinct problems posed by intensive, short-term
involvement as compared with extended assignments.
* * *
Published in
association with RedR - Engineers for Disaster
Relief. Primarily on engineering issues, but includes a
chapter on "Personal effectiveness" and a chapter on "Personal
security." The former includes observations on personal planning before a
disaster assignment and brief sections on self-care after the assignment, on
health care, and on stress.
* * *
Ehrenreich, J. H. (2002). A Guide for Humanitarian Aid, Health Care, and Human Rights
Workers: Caring for Others, Caring for Yourself . (32 pp). Old
Discusses the phenomenon of emotional
traumatization; the effects traumatization has on interactions between
humanitarian workers of all sorts and the people they seek to serve; techniques
for working with traumatized people that contribute to healing and minimize the
likelihood of retraumatization; and approaches to
preventing burnout, compassion fatigue, and secondary traumatization among aid
workers. Includes relaxation exercises and information on
other specific techniques. Aimed at field workers.
* * *
Howell, K. (2002). Health and Safety in Aid Agencies.
Aimed at managers, this manual discusses legal
and practical issues of risk assessment and response to health and safety
issues.
* * *
International
Committee of the Red Cross (2001). Humanitarian action and armed conflict: Coping with stress. (28 pp).
Aimed at field workers, this brief manual
identifies different types of stress reactions found in field staff, especially
those working in zones of armed conflict, and suggests several courses of
action to reduce stress.
* * *
A brief booklet on
stress and stress reduction. Also includes a section on PTSD. Aimed at field workers.
* * *
Lankester, T. (2000). The travellers’
good health guide.
Published by InterHealth
(a British organization that acts as travel health adviser and/or provides
healthcare and support to some 150 agencies and voluntary organizations as well
as to individuals and families who are traveling on short or long-term
assignments overseas), this book includes a section on stress management as
well as sections on physical health and on safety and security.
* * *
Lovell-Hawker, D. (2002). Effective Debriefing Handbook.
This handbook is a summary of a People In Aid workshop on effective debriefing. Aimed at field
managers, it includes detailed instructions for debriefing sessions of various
kinds, including critical incident debriefing and routine debriefing for
individuals after their return home. The manual includes a section on cross
cultural issues and several handouts (e.g., "Coming Home", "Symptoms
of stress or depression," and "Ways to cope with
stress/trauma"). References to books and useful web sites are included.
* * *
O'Donnell, K. (Ed.). (2002). Doing member care well: Perspectives and practices from around the world.
This book explores how religiously-oriented
organizations support their mission and aid personnel around the world. It
includes personal accounts, guidelines, case studies, program descriptions,
worksheets, and practical advice.
* * *
Office of the United
Nations Security Cooredinator (1998).
Security in the Field.
This 65 page manual, aimed at field workers, focuses
on safety and security. It includes sections on emotional reactions to such
incidents as being held hostage, being raped, and a chapter on "Coping
with stress." The latter focuses primarily on chronic occupational stress.
It refers to procedures such as debriefing but is more educational than
prescriptive.
* * *
Oxfam (
Three informal papers dealing with stress
management for humanitarian workers and guidance for supervisors of staff. The
first two are aimed at staff, the third at managers
* * *
Roberts, D.L. (1999). Staying alive: Safety and security guidelines for humanitarian
volunteers in conflict areas. (125 pp).Geneva: International Committee of
the Red Cross. (Available from ICRC, Publications Division,19, avenue de la Paix, 1202 Geneva, Switzerland; e-mail icrc.gva@icrc.org.
Focuses on individual and team behavior
promoting safety in armed conflict situations. Includes very brief comments
about stress.
* * *
Designed as a pocket manual to serve as a
general reference tool for individuals sent to disaster sites to perform
initial assessments or to participate as members of a Disaster Assistance
Response Team. Includes brief sections on medical emergencies, personal health,
safety and security, and a very brief section (one page) on managing stress.
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Articles Berk, Jay H. Trauma and resilience during war: A look
at the children and humanitarian aid workers of In the author's experience working with
Bosnian children, resilience in both the children and the humanitarian aid
workers helping them had aspects which appeared similar. Both groups required
support and a need to distance themselves from the
impact of the suffering. Bramsen, In this study, predeployment personality traits and exposure to
traumatic events during deployment were related to the development of
symptoms of posttraumatic stress disorder in men who participated in the
United Nations Protection Force mission in the former Bierens de Haan, Barthold (1998). Le debriefing emotionnel
collectif des intervenants
humanitaires: l'experience
du CICR [Emotional
group debriefing of humanitarian aid workers: the experience of ICRC]. Schweizer Archiv fur Neurologie und Psychiatrie, v.
149, no. 5, pp. 218-228. Humanitarian aid workers working in armed
conflict and disaster situations are suffering from increasingly violent
emotional reactions. In order to help them to complete their job
successfully, to increase their resistance to stress and their efficiency in
the field, they must be supported. This paper reports on different
interventions from the ICRC Stress Management Unit. The principles of
emotional group debriefing are underlined. This procedure might be effective
because it is based on an encounter group whose healing capacity is well known.
A simplified four steps procedure is proposed to make the conduct of such
supportive groups easier. [A] Britt TW, Adler AB. (1999). Stress and health during medical
humanitarian assistance missions. Military
Medicine, vol. 164 (4), 275-279 Danielli, Y. (1996). Who takes care of the caretakers: The
emotional consequences of working with children traumatized by war and
communal violence. In R.J. Apfel & B. Simon
(eds.), Minefields in their Hearts.
Ditzler, T. (2001). Mental health and aid workers: The case
for collaborative questionnng. The Journal of Humanitarian Assistnace (http//:www.jha.ac/articles/a063.htm). Suggests that humanitarian aid workers
and their supervisors can benefit from training to improve their skills in
identifying signs of excessive stress, developing preventive strategies, and
learning about resources to respond to stress. Suggests several approaches. Eisenman, David P;
Bergner, Sharone; Cohen, Ilene (2000). An ideal victim: idealizing trauma
victims causes traumatic stress in human rights workers. Human Rights Review, v. 1 (4). 4, pp.
106-114. The idealization of torture victims
leads to the collapse of the space necessary for self-reflection and self-care
on the part of the worker. Elevation of the survivor's needs and feelings
leaves insufficient room for the interviewer to recognize and to think about
the complex reactions and feelings sparked through the work. As a result,
selective features of the survivor's experience are focused upon and
emphasized, while other features, which contribute to the interviewer's less
visible feelings and reactions, are excluded. When such a situation develops
neither the survivor's nor the interviewer's experience is fully
acknowledged. [T, p. 106] Eriksson, Cynthia B. (1997). Traumatic exposure and reentry symptomatology in international relief and development
personnel. Doctoral Dissertation: Fuller Theological Seminary, School of
Psychology, 1997 International relief and development
workers are often exposed to traumatic events which put them at risk for
developing PTSD symptomatology and emotional
distress during reentry to their home cultures. Surveys were administered to
returned staff from five Christian relief and development agencies. As
hypothesized, the amount of traumatic exposure reported correlated positively
with PTSD symptomatology, and a negative
correlation existed between perceived social support and report of PTSD symptomatology. A significant interaction existed between
social support and the level of trauma exposure in relation to PTSD symptoms.
Participants reporting high levels of trauma exposure and low levels of
social support reported higher PTSD symptomatology
than those reporting high levels of exposure and high levels of social
support. Returning to one's home culture after working or studying abroad is
a difficult cross-cultural adjustment. International relief and development
staff work in environments that require facing war, famine, poverty, and
disease. These workers are routinely exposed to chronic stressors which put
them at risk for developing emotional distress during reentry to their home
cultures. As hypothesized, relief and development staff with higher levels of
chronic stressor exposure reported higher levels of reentry distress
associated with culture shock and negative affective states. A significant
negative relationship also existed between perceived social support and
culture shock distress. Returned relief and development staff reported
significantly higher scores on measures of negative affective states for
their feelings during the "worst day of reentry," than for how they
"generally feel." Both quantitative and qualitative data offer a
number of important practical suggestions for the agencies that sponsor
relief and development work. The narrative data collected in the
questionnaire offers rich insight into the range of experiences faced by
international staff in their working environment. These staff offer suggestions
for providing future colleagues with a more successful reentry transition.
[A] Eriksson, Cynthia B; Vande Kemp, Hendrika; Gorsuch, Richard; Hoke,
Stephen; Foy, David W. (2001). Trauma
exposure and PTSD symptoms in international relief and development personnel.
Journal of Traumatic Stress, v. 14,
no. 1, pp. 205-212. International relief and development
personnel may be directly or indirectly exposed to traumatic events that put
them at risk for developing symptoms of PTSD. In order to identify areas of risk
and related reactions, surveys were administered to 113 recently returned
staff from 5 humanitarian aid agencies. Respondents reported high rates of
direct and indirect exposure to life-threatening events. Approximately 30
percent of those surveyed reported significant symptoms of PTSD. Multiple
regression analysis revealed that personal and vicarious exposure to
life-threatening events and an interaction between social support and
exposure to life threat accounted for a significant amount of variance in
PTSD severity. These results suggest the need for personnel programs; predeployment training, risk assessment, and contingency
planning may better prepare personnel for service. [A] Fawcett, J. (2000). Managing staff stress and trauma. In
M. Janz & J. Stead (eds.), Complex Humanitarian Emergencies: Lessons from Practitioners.
Monrovia, CA: World Vision , pp. 92-125. (ISBN No. 188798318). Feinstein, A., Owen, J., & Blair,
N. (2002). A hazardous profession: War, journalists, and psychopathology. American Journal of Psychiatry, 159,
1570-1575. The authors studied 140 war
journalists, comparing them to journalists who had never covered war. The war
journalists showed significantly elevated levels of PTSD, depression, and
substance abuse. Holtz, T.H., Salama,
P., Cardozo, B.L., & Gotway,
C.A. (2002). Mental health status of
human rights workers, Kosovo, June 20900. Journal
of Traumatic Stress, 15, 389-395. This paper reports on a
cross-sectional survey of 70 expatriate and Kosovar
Albanian staff engaged in collecting data of human rights violations in
Kosovo. Factors associated with elevated PTSD symptoms, depression, and
anxiety are reported. Kilbourn, Phyllis Ann
(1995). Providing care for the
caregivers. In Kilbourn, Phyllis Ann (ed.). Healing the children of war: a handbook
for ministry to children who have suffered deep traumas, pp. 225-237.
Monrovia, California Dealing with children's war-related
crises can be a very stressful experience. The more traumatic the event, the
more potential there is for caregivers to become traumatized. This chapter
explores some trauma-producing stress factors caregivers encounter and
describes some normal responses to these stress factors. Understanding the
stress factors and the caregivers' possible responses can provide helpful
insights into their needs. Iincluds key elements
and principles to assist in planning care for the caregiver [T, p. 226] Kramer, Gabriele (1999). Traumatized women working with
traumatized women: reflections upon life and work in a war zone. Women and Therapy v. 22, no. 1, pp. 107-120. In this article, the author shares
both her personal and professional experiences in working with women and
children who have been subjected to soul-destroying violence in the Former
Yugoslavia in recent years. [A] McCall, M., & Salama, P. (1999). Selection,
training, and support of relief workers: an occupational health issue. British Medical Journal, 318:113-116. Reports on a survey of humanitarian aid organizations. Findings: Although emergency relief workers are at considerable physical and psychological risk, their mental health has been studied little. Procedures for recruitment, selection, training, field support, and follow up of relief workers vary widely. Preventive mental health measures for relief workers receive little attention . Discounting the effects of psychological trauma on workers reflects disregard for their wellbeing and that of the populations they seek to serve. Relief organizations should develop a coordinated and cooperative approach to training and managing field workers. [A]
Orsillo, Susan Marie;
Roemer, Lizabeth; Litz,
Brett T; Ehlich, Peter J; Friedman, Matthew J.
(1998). Psychiatric symptomatology associated with contemporary peacekeeping:
an examination of post-mission functioning among peacekeepers in Somalia. Journal of Traumatic Stress, v. 11,
no. 4, pp. 611-625 Paton, Douglas
(1996). Responding to international
needs: Critical occupations as disaster relief agencies. In Paton, Douglas (Ed); Violanti,
John M. (Ed). Traumatic stress in
critical occupations: Recognition, consequences and treatment. (pp.
139-172). Springfield, US, US: Charles C Thomas, Publisher; Springfield, US This book chapter focuses on specific
problems posed by international disasters for relief workers and their
organizations. It discusses the preparatory and support needs of those who
will provide relief services, consequences of disaster work for the families
of relief workers, and organizational and management issues. Pickett, Mary; Brennan, Ann Marie
Walsh; Greenberg, Helaine S; Licht,
Lois; Worrell, Judith Deignan. (1994). Use of debriefing techniques to prevent
compassion fatigue in research teams Nursing
Research, v. 43, no. 4, pp. 250-252. Nurses often study subjects who have
experienced traumatic events involving intense and emotionally charged
consequences. This paper describes how the process of crisis debriefing can
be used to mitigate the concerns of interviewers who collect data from such
subjects. Some clinical practice settings, such as emergency, trauma,
intensive care, and home hospice settings, provide debriefing sessions that
incorporate some of the elements directed toward the prevention of secondary
PTSD. However, debriefing sessions designed specifically for research team
members who interview traumatized persons have not been reported in the
literature. [T, p 250] Simon, Bennett (1993). Obstacles in the path of mental health
professionals who deal with traumatic violations of human rights. International Journal of Law and
Psychiatry, v. 16, no. 3-4, pp. 427-440. The first part of this paper deals
with obstacles in the path of mental health professionals becoming more
involved in issues of human rights violations. The second part deals with a
few of the increasing number of instances in which mental health
professionals have become more involved. The discussion centers around issues
involving children, although most of what is said applies to both children
and adults. In referring to "human rights" violations, the
boundaries between the devastation of large scale wars between nations and
within nations (such as the Holocaust and the Cambodian genocide) and the
harm done in more narrowly defined "human rights" violations (such
as the arrest, torture, and often "disappearance" of thousands in
Argentina and Chile) are not exactly clear. For our purposes, the rough
working definition of human rights violations includes the devastation
wrought by plans to persecute and destroy individuals, classes. [T, p. 427] Smith, Barbara; Agger,
Inger; Danieli, Yael; Weisaeth, Lars.(1996). Health activities across traumatized
populations: emotional responses of international humanitarian aid workers:
the contribution of non-governmental organizations. In Danieli, Yael; Rodley, Nigel S; Weisaeth, Lars
(ed.). International responses to
traumatic stress: humanitarian, human rights, justice, peace and development
contributions, collaborative actions and future initiatives, pp. 397-423.
Amityville, New York: Baywood. Topics treated include: common
emotional reactions; Goma, Zaire 1994; Sarajevo,
Bosnia-Herzegovina, 1992- ; the traumatic effects; development of PTSD and
burn-out in an international humanitarian aid worker; stress (countertransference) reaction in helpers; enmeshment;
hostility and cynicism; self-destructive behavior; dissociative
responses; psychological support for aid workers; institutional factors (how
do humanitarian organizations support the professional efforts of aid
workers?; how do humanitarian organizations respond to aid workers' proposals
for innovation?; how do humanitarian organizations support aid workers'
collaboration with other organizations?; how do humanitarian organizations
meet aid workers' needs for emotional support?); employer responsibilities;
conclusion Smith, Alison (2000). Lessons
from Western Kosovo for the documentation of war crimes. Psychiatry, Psychology & Law. Vol 7(2) 235-240. Based upon experiences of the International
Crisis Group's Humanitarian Law Documentation Project in Western Kosovo, the
author advances a series of recommendations for effective intervention by aid
workers in areas where considerable trauma has been inflicted on civilians.
In particular, she argues that in documenting war crimes, the primary
responsibility of the interviewer is to the well-being of the witness. This
includes not only emergency survival needs such as adequate shelter, food and
clothing; it also means taking care of their mental health needs. This should
be done by training interviewers in recognizing symptoms of mental disorders
and providing immediate assistance for those who need it as well as ensuring
that there are facilities available in the longer term to address the
inevitable consequences of mass violence. In order to provide this type of
assistance, the mental health needs of humanitarian workers themselves must
also be addressed. There must be adequate facilities staffed by experienced
people to help both local and international workers deal with the type of
work they are doing, In both of these situations, the persons providing
training and treatment must themselves be trained in post-conflict situations
and issues arising as a result of mass trauma. (Author’s Abstract) Spiers, Carole
(1997). Counselling and crisis intervention training for
humanitarian aid workers. International
Journal of Stress Management. Vol 4(4)
309-313. The author describes personal experiences training humanitarian aid workers in Serbia.
Specifically, the training involved a practical application of counseling
skills via role play, emphasizing crisis, trauma, and posttraumatic stress.
The author notes that in particular, the trainees needed additional skills to
help them deal with the multifarious problems presented by clients, most of
whom experienced the effects of war. Problems that exasperated posttraumatic
stress disorder (PTSD) included nightmares, panic attacks, problems of
separation, bereavement, identity crisis, re-settlement, rape, and murder.
[P] Stearns, S.D. (1992). Psychological distress and relief work:
Who helps the helpers? Oxford: Refugees Studies Programme,
University of Oxford. Stearns, Sarah D (1993). Psychological distress and relief work:
who helps the helpers? Refugee
Participation Network, v. 15, pp. 3-8 Much attention has been devoted to the
negative psychological effects of violence, war, famine and torture on
refugees. Less literature exists however, on the psychological difficulties
encountered by relief workers, reflecting a lack of awareness on the part of
institutions that trauma encountered by relief workers does not rank high on
the list of priorities in emergencies. When situations are extreme and
personnel is in short supply, there is little time to concentrate on workers
and their troubles. It is of course possible, as some have asserted, that
relief agencies are fully aware of the effects of psychological trauma on
their personnel, but refuse to recognize openly the fact lest they become
targets for disability claims. It is, however, important to recognize that in
many instances the problems relief workers encounter can limit the
effectiveness of humanitarian assistance. The psychological difficulties
helpers face may shape interactions between them and the people they endeavor
to assist. Models from disaster relief literature may be used to explore
methods for countering stressful or traumatic events. [T, p 13] Zimmerman, George; Weber, Wesley
(September 2000).Care for the
caregivers: a program for Canadian military chaplains after serving in NATO
and United Nations peacekeeping missions in the 1990s. Military Medicine, v. 165, no. 9, pp.
687-690. The Mental Health Department of the
Canadian Forces Support Unit (Ottawa) developed the Care for the Caregivers
program to help participants deal with stressful events experienced directly
or vicariously from the NATO and United Nations military missions of the
1990s. The program was developed after complaints of postdeployment
stress were received from various military care providers. The objectives
were to improve the skills of support personnel and to reduce the distress
that some caregivers experienced. 31 chaplains who had been exposed to
stressful military operations participated in five workshops. These
educational 4-day small-group workshops covered topics such as PTSD,
vicarious traumatization, coping techniques, spirituality, self-care, and
family issues. An adult education model was chosen to encourage dialogue.
Outcomes included reports of professional and personal benefits, requests for
additional programs, local education initiatives, and referrals to mental
health professionals. Having met its objectives, the program has become a
normal concluding part of stressful deployments. [A]
II.
Resources on Burnout and Vicarious Traumatic
Stress Among First Responders, Rescue and Relief Workers,
and Emergency Medical Workers Books Paton, D., & Violanti, J. (1996). Traumatic
stress in critical occupations: Recognition, consequences, and treatment. Springfield, IL: Charles C. Thomas. ISBN
No.0398065780. Focuses primarily on first responders
(police officers, firefighters, emergency medical service professionals).
Discusses strategies designed to promote the recognition and identification
of the diverse personal, organizational, and event-related factors that
contribute to traumatic reactivity are discussed. Articles Alexander, David Alan; Klein, Susan.
(2001). Ambulance personnel and
critical incidents: impact of accident and emergency work on mental health
and emotional well-being. British
Journal of Psychiatry, v. 178, pp. 76-81. Seeks to identify the prevalence of
psychopathology among ambulance personnel and its relationship to personality
and exposure to critical incidents. Data were gathered from ambulance
personnel by means of an anonymous questionnaire and standardised
measures. Approximately a third of the sample reported high levels of general
psychopathology, burnout and posttraumatic symptoms. Burnout was associated
with less job satisfaction, longer time in service, less recovery time
between incidents, and more frequent exposure to incidents. Burnout and
GHQ-28 caseness were more likely in those who had
experienced a particularly disturbing incident in the previous 6 months.
Concerns about confidentiality and career prospects deter staff from seeking
personal help. Concludes that the mental health and emotional well-being of
ambulance personnel appear to be compromised by accident and emergency work.
[A] Andersen, Henrik
Steen; Christensen, Anders Korsgaard; Petersen, Gorm Odden (1991). Post-traumatic stress reactions amongst
rescue workers after a major rail accident. Anxiety Research, v. 4 no. 3, pp. 245-251 Rescue tasks under heavy strain may
act as traumatic events creating stress reactions among the rescue workers.
After a major rail accident the rescue workers were examined by questionnaire
at 3 and 7 months postaccident using the General
Health Questionnaire-28 (GHQ), Impact of Event Scale (IES) and a structured
questionnaire made for the purpose. 18 percent of the 77 rescue workers who
participated in the study had GHQ-case-score and 10 percent had
IES-case-score at 7 months using the usual GHQ-cut-off (4/5) and a low
IES-cut-off (19/20). For the case-scorers there was a tendency towards
increased GHQ- and IES-scores from 3 to 7 months. 5 (6 percent) had PTSD of
low to moderate severity at 7 months. [A] Armstrong, Keith R; O'Callahan, William; Marmar, Charles
R. (October 1991). Debriefing Red
Cross disaster personnel: the multiple stressor debriefing model. Journal of Traumatic Stress, v. 4, no.
4, pp. 581-593. During the 1989 San Francisco earthquake,
Red Cross disaster personnel were involved in providing services which put
them at risk for developing stress reactions including PTSD. This article
describes the disaster relief efforts in San Francisco and Oakland made by
Red Cross workers and the debriefing which was provided to these personnel.
Mitchell's Model for Critical Incident Stress Debriefing (CISD) was modified
to fit the broad spectrum of needs and stresses experienced by disaster
relief personnel. The Multiple Stressor Debriefing Model (MSDM) which evolved
from this experience is discussed with specific recommendations for mental
health workers involved in Debriefing Red Cross and other emergency personnel
who face multiple stressors over an extended period of relief operations [A] Badger, James M (2001). Understanding secondary traumatic stress.
American Journal of Nursing v. 101, no. 7, pp. 26-33 Military combat is not the only
trigger of posttraumatic stress. To the nurse, a burn unit, emergency
department, or neonatal intensive care unit can be a 'war zone.' Suggests
ways of handling the extraordinary, as well as the ordinary, stresses of
nursing. [T, Introduction] Bamber, Martin
(1994). Providing support for
emergency service staff. Nursing
Times , v. 90 no. 22, pp. 32-33. This paper provides a comprehensive
review of the literature focusing on PTSD related to the experience of
involvement in major incidents. The structure, role and function of the staff
support team set up by the South Tees Occupational Health Psychology Service
is described. [A] Bradford R, John AM. (1991). The psychological effects of disaster
work: implications for disaster planning. Journal of the Royal Society of Health, vol. 111(3), 7-10 Brandt, George T.; Fullerton, Carol
S.; Saltzgaber, Lee; Ursano,
Robert J.; et al (1995). Disasters: Psychologic
responses in health care providers and rescue workers. Nordic Journal of Psychiatry. Vol 49(2) 89-94. Reports and questionnaire responses
from health care and rescue workers involved in an air show disaster in Germany were studied.
There were three characteristic responses to worker stress: identification, a
sense of helplessness and inadequacy, and psychological distancing. Exposure
to the grotesque, identifying with the rescue work, feelings of helplessness
and guilt, and psychological distancing were particularly
stressful, as was not participating
in relief efforts. Brown, Jennifer M; Campbell, Elizabeth
A. (1991). Stress among emergency services personnel: progress and problems.
Journal of the Society of Occupational
Medicine (ISSN: 0301-0023), v. 41, no. 4, pp. 149-150. PTSD has been diagnosed in British
emergency health professionals. This article examines some of the ways that
management and organizational failures contribute to this stress and how it
might be prevented Brende, Joel Osler (1991). When
post traumatic stress "rubs off". Voices, v. 27, no. 1-2, pp. 139-143. Briefly outlines a 12-point outpatient
program which initially developed in response to the needs of staff members
of a Veterans Administration hospital who were suffering from various PTSD
symptoms that their patients exhibited. Concludes that, "those of us who
do this kind of work need to recognize that this is a widespread problem that
we need not be ashamed of." D'Andrea, Livia M; Waters, Charley (Winter 2000). Predicting post-incident stress in emergency
personnel: a guide for mental health professionals on critical incident
stress management teams. International
Journal of Emergency Mental Health, v. 2, no. 1, pp. 33-41. The role of the Mental Health
Professional (MHP) on Critical Incident Stress Management (CISM) teams has
been described as one of assess and refer. That is, to assess participants
who are reacting strongly to a critical incident and refer them for
additional psychological help. The purpose of this article is to present
guidelines, from practice and from the research literature, for MHPs to use to help them predict which participants are
likely to experience high-stress reactions following the critical incident.
The stages of a CISD are briefly described and the predictive features
associated with each stage are discussed. [A] Durham, Thomas W; McCammon,
Susan Lynn; Allison, E Jackson (1986). Psychological
impact of disaster on rescue personnel. Psychiatry Digest, v. 1986, no. 4, pp. 27-29 79 rescue, fire, and medical personnel
and police officers who treated victims of an apartment building explosion
completed a questionnaire describing their emotional and coping responses to
the disaster. 80 percent had at least one symptom of PTSD. 8 of 21 PTSD
symptoms were present in at least 10 percent of respondents. The most
frequently reported symptom, intrusive thoughts about the disaster, occurred
in 74 percent of those working with or searching for victims at the disaster
site. On-the-scene rescue workers had significantly more PTSD symptoms than
did in-hospital staff. 52 percent of the respondents reported that family
members and coworkers were supportive or very supportive in meeting their
emotional needs following the disaster; 36 percent noted that support
networks were not helpful. The coping behaviors most frequently used were to
remind oneself that things could be worse (57 percent) and to try to keep a
realistic perspective on the situation (53 percent). 11 percent reported
seeking emotional support from others or looking to others for direction. [A] Everly, George S.
(1995)Familial psychotraumatology
and emergency service personnel. In Everly,
George S (ed.). Innovations in disaster
and trauma psychology, volume one: applications in emergency services and
disaster response, pp. 42-50. Ellicott City, Maryland: Chevron. Can the family of an emergency worker
be the victim of traumatic stress? In this chapter speculation is offered
into the biological and psychological roots of trauma-related familial
discord. [T, p.3] Hodgkinson, Peter E;
Shepherd, Melanie A. (1994). The
impact of disaster support work. Journal
of Traumatic Stress, v. 7, no.
4, pp. 587-600. Limited available evidence suggests
that disaster support work may have negative effects. 67 social workers were
surveyed, measures being taken of psychological symptomatology
and wellbeing, personality variables, social support, life events, and
various aspects of disaster support work. Comparison with normative data
suggested that subjects were experiencing significant levels of stress. Two
major sources of disaster-related stress were identified: role-related
difficulties and contact with clients' distress. Approximately one third of
the variance in helper response could be explained by variables reflecting
coping style, prior life events and the aforementioned aspects of disaster
support work. Follow-up data at 12 months demonstrated persisting high levels
of stress. [A] Hodgkinson, Peter E;
Shepherd, Melanie A. (1994). The
impact of disaster support work. Journal
of Traumatic Stress, v. 7, no.
4, pp. 587-600. Limited available evidence suggests
that disaster support work may have negative effects. 67 social workers were
surveyed, measures being taken of psychological symptomatology
and wellbeing, personality variables, social support, life events, and
various aspects of disaster support work. Comparison with normative data
suggested that subjects were experiencing significant levels of stress. Two
major sources of disaster-related stress were identified: role-related difficulties
and contact with clients' distress. Approximately one third of the variance
in helper response could be explained by variables reflecting coping style,
prior life events and the aforementioned aspects of disaster support work.
Follow-up data at 12 months demonstrated persisting high levels of
stress. [A] Marmar, Charles R;
Weiss, Daniel S; Metzler, Thomas J; Ronfeldt, Heidi
Marie; Foreman, Clay (1996).Stress
responses of emergency services personnel to the Loma Prieta
earthquake Interstate 880 freeway collapse and control traumatic incidents.
Journal of Traumatic Stress, v. 9,
no. 1, pp. 63-85. Contrasted the responses of rescue
workers to the 1989 Loma Prieta earthquake Interstate
880 freeway collapse (n = 198) with responses to critical incident exposure
of Bay Area Controls (n = 140) and San Diego Controls (n = 101). The 3 groups
were strikingly similar with respect to demographics and years of emergency
service. The I-880 group reported higher exposure, greater immediate threat
appraisal, and more sick days. The 3 groups did not differ on current
symptoms. For the sample as a whole EMT/Paramedics reported higher peritraumatic dissociation compared with Police.
EMT/Paramedics and California road workers reported higher symptoms compared
with Police and Fire personnel. 9 percent of the sample were characterized as
having symptom levels typical of psychiatric outpatients. Compared with lower
distress responders, those with greater distress reported greater exposure,
greater peritraumatic emotional distress, greater peritraumatic dissociation, greater perceived threat, and
less preparation for the critical incident. [A] McCammon, Susan Lynn;
Allison, E Jackson (1995). Debriefing
and treating emergency workers. In
Figley, Charles R (ed.). Compassion fatigue: coping with secondary traumatic stress disorder
in those who treat the traumatized, pp. 115-130. New York: Brunner/Mazel. Emphasizes the importance of promoting
trauma resolution and healthy coping strategies in emergency workers.
Strategies that can be implemented before, during, and after a traumatic
event are summarized. Pretrauma interventions
include the use of a stress audit, training regarding stress and its management,
and policy development. During a traumatic event, interventions include
orientation to the trauma site, on-scene support, demobilization, and
debriefing. Common elements among the several debriefing models described
include the structuring of opportunities to review the events of the
traumatic situation and to ventilate feelings, the learning of skills for
integrating and mastering the event, and obtaining assistance in identifying,
enlisting, and accepting help from one's support system. Post-trauma
activities include individual follow-up sessions, the use of experimental
procedures such as eye movement desensitization and reprocessing, and
attention to anniversaries of traumatic events. Anecdotal reports testify to
the effectiveness of debriefing and provide helpful insights into working
with emergency responders. [T, p. xix] McCarroll, James E; Ursano, Robert Joseph; Wright, Kathleen M; Fullerton,
Carol S. (1993). Handling bodies after
violent death: strategies for coping. American
Journal of Orthopsychiatry (ISSN: 0002-9432), v. 63 no. 2, pp. 209-214. Interviews with and observations of
experienced and inexperienced personnel were conducted to determine their
coping strategies before, during, and after their work with the bodies of
people who had died violently. Avoidance, denial, and social support from the
work group and spouse appeared to facilitate coping. The implications of
these findings for therapeutic intervention are discussed. [A] Miller, Laurence (1998). Helping the helpers: psychotherapeutic
strategies with law enforcement and emegency
services personnel. In Miller, Laurence. Shocks to the system: psychotherapy of traumatic disability
syndromes, pp. 215-248. New York: Norton. This chapter describes the types of
stresses and problems experienced by police officers, firefighters,
paramedics, and other crisis workers and outlines the psychotherapeutic
strategies that may prove most effective in helping these emergency
responders. [T, p. 216] Mitchell, Jeffrey T; Everly, George S. (1995).Critical incident stress debriefing (CISD) and the prevention of
work-related traumatic stress among high risk occupational groups. In Everly, George S; Lating,
Jeffrey M (ed.). Psychotraumatology: key papers and
core concepts in post-traumatic stress, pp. 267-280. New York: Plenum Press. In this chapter, Mitchell and Everly introduce the critical-incident stress debriefing
(CISD) technology, an intervention technology used in response to accidents,
homicides, suicides, community disruptions, and disasters in much of the
world. CISD may be the most widely used formal group intervention for the
prevention of post-traumatic stress within high-risk groups. [T, p. 265] Myers, Diane Garaventa.
(1995). Worker stress during long term
disaster recovery efforts: who are these people and what are they doing here?
In Everly, George S (ed.). Innovations in disaster
and trauma psychology, volume one: applications in emergency services and
disaster response, pp. 158-191. Ellicott City, Maryland: Chevron. Topics treated include: Are disaster
workers affected by their mission?; disaster response and disaster recovery:
differences in worker tasks; roles and tasks of long-term recovery workers;
key organizations in long-term recovery; review of the literature about these
workers; sources of stress for long-term disaster workers; effects of stress
on workers; stress mitigators for workers; a
comprehensive stress management program for workers; recommendations for the
future; innovations in intervention Nocera, Antony. (2000). Prior
planning to avoid responders becoming "victims" during disasters.
Prehospital and Disaster Medicine, v. 15, no. 1,
pp. 46-48. Prior planning to meet the physical
and mental needs of medical and emergency services responders is a practical
measure to reduce staff stress. This has the potential to improve both the
operational efficiency of a disaster response and reduce the incidence of
PTSD in responders. Research is needed to define which interventions provide
the greatest benefits to local responders. [A] North, C. S., Tivis,
L., McMillen, J.C., Pfefferbaum,
B., Cox, J., Spitznagel, E.L., Bunch, K., Schorr, J., & Smith, E.M. (2002). Coping, functioning, and adjustment of
rescue workers after the Oklahoma City bombing. Journal of Traumatic Stress, 15, pp. 171-175. Firefighters who served as rescue and
recovery workers were assessed. They had relatively low rates of PTSD and
described little functional impairment, positive social adjustment, and high
job satisfaction. PTSD was associated with reduced job satisfaction and
functional impairment. Post disaster alcohol use and drinking to cope were
associated with indicators of poorer functioning. Surveillance for problem
drinking after disaster exposure may help identify those in need of
intervention. (from authors’ abstract) Pieper, Georg;
Maercker, Andreas. (1999). Mannlichkeit und Verleugnung
von Hilfbedurftigkeit nach
berufsbedingten Traumata (Polizei,
Feuerwehr, Rettungspersonal) [Masculinity and avoidance of help-seeking
after job-related trauma (police, firefighters, rescue teams)]. Verhaltenstherapie, v. 9, no. 4, pp. 222-229. Persons in the predominately male
domains of high-risk occupational groups (police, fire department, rescue
teams, prison guards) often show difficulties in accepting psychological help
after traumatization. The paper presents case reports and conceptual
discussion of the relationship between masculinity and treatment motivation.
Clinical experiences on male-specific complications of PTSD and a high risk profile
of male work-related trauma victims ('alpha-man') are discussed. Theoretical
discussion furthermore includes social cognitive theories of masculinity and
of development of PTSD. The paper concludes with suggestions for
interventions relevant to the outlined problems. [A] Raphael, Beverley; Meldrum,
Lenore; O'Toole, Brian I. (1991).Rescuers'
psychological responses to disasters. British
Medical Journal, v. 303, no. 6814, pp. 1346-1347. Discusses the fact that valuable
research has been done to clarify the impact of disasters (including PTSD) on
rescue workers and suggests ways of preventing long term morbidity. Raphael, Beverley; Wilson, John P (1994). When disaster strikes: managing emotional
reactions in rescue workers. In Wilson, John P; Lindy,
Jacob D (ed.). Countertransference in the treatment
of PTSD, pp. 333-350. New York: Guilford Press. The authors discuss nine dynamic themes common to
rescue work: (1) force and destruction, (2) confrontation with death, (3) helplessness,
(4) anger, (5) loss, (6) attachments, (7) elation, (8) survivor guilt, and
(9) voyeurism. Disaster and rescue workers are not immune from developing
psychiatric disorders; empirical studies that show that between 20 to over 80
percent of rescue workers show symptoms of prolonged stress response. This
has implications for job performance as well as for the nature of clinical
interventions necessary to provide care and an opportunity to work through
the emotionally troublesome aspects of rescue work. [T, Introduction]. Rosser, Rachel M (1997). Effects of disasters on helpers. In Black, Dora; Newman, Martin C;
Harris-Hendriks, Jean M; Mezey,
Gillian C (ed.). Psychological trauma:
a developmental approach, pp. 326-338. London: Gaskell. The characteristics of traumatic
reactions which are general to any helper and experiences more characteristic
of helpers in specific roles are discussed. These include people involved in
the physical act of rescue as professionals or as volunteers, such as fire officers,
ambulance staff, police and those involved in the immediate aftermath,
including religious leaders, those identifying the dead, accident and
emergency staff, cleaners and mortuary attendants. Those with particular
occupational hazards, especially transport workers, are also considered.
Therapists' experiences and the timing of their interventions are explored.
Role confusions, reversals and misunderstandings are desribed
in relation to all helpers, victims, expert witnesses and professionals in
senior positions. This leads into two new notions of the 'wounded healer' and
the multigenerational transmission of trauma. [A] Stuhlmiller, Cynthia M.
(1996). Studying the rescuers Reflections, v. 22, no. 1, pp. 18-19. Argues that nurses can play a beneficial
role in dealing with rescuers after a disaster, and warns that debriefings
that focus on the potential for PTSD symptom formation may be
counter-productive. Summey, Jimmy Ray (2001).
The prevention, treatment and
mitigation of secondary traumatic stress in emergency personnel dealing with
disasters. Annals of the American Psychotherapy Assn.,
18-21 Discusses pre-disaster, on-site and
post-disaster interventions that have been successfully used to prevent or
minimize the psychological and physical effects of the exposure of the
disaster relief worker to a disaster or other traumatic event. III.
Resources on Burnout and Vicarious Traumatic Stress Among Therapists, Counselors, and
Other Mental Health Workers Books Pearlman, L.A., & Saakvitne, K. (1995). Trauma and the Therapist: Countertransference
and vicarious traumatization in psychotherapy with incest survivors. New York: Norton. ISBN
No.0393701832. Stamm, B.H. (Ed.)
(1995). Secondary traumatic stress: self-care
issues for clinicians, researchers, and educators Lutherville, Maryland: Sidran Press. ISBN
No.1886968071. The articles in this book attempt to
raise the question of stressful experiences in an ecological perspective so
that we might learn to use what we know to prevent the pathology of PTSD and
to enhance the possibility of positive developmental growth in the face of
trauma. They address the psychological cost of doing trauma work, offer
suggestions for ways in which therapists can create safe environments in
which to work, and address ethical issues related to self care and vicarious
traumatization. Articles Arvay, Marla Jean
(2001). Shattered beliefs:
reconstituting the self of the trauma counselor. In Neimeyer, Robert
A (ed.). Meaning reconstruction and the
experience of loss, 1st ed., pp. 213-230. Washington: American
Psychological Association. First escribesthe
various definitions of secondary traumatic stress in order to locate it
within the discourse on trauma; second, provides a discussion of the
theoretical nexus between constructivism as an epistemology and narrative as
a form of inquiry; and third, explains how the self is narratively
configured and provide a brief description of the reflexive narrative method
used in this study. After this theoretical prologue, the narrative accounts
of two trauma counselors are presented followed by a discussion on how the
self is reconstituted through traumatic loss. [T, p.214] Berah EF, Jones HJ,
Valent P. (1984).The experience of a mental health team involved in the early phase of
a disaster. The Australian and New
Zealand Journal of Psychiatry, vol.18(4), 354-358. Reports on the reactions of a volunteer mental health team which
convened in the aftermath of the 1983 Ash Wednesday bushfires. Sources of
stress are discussed as are recommendations for their alleviation. [A] Blair, D Thomas; Ramones,
Valerie A. (1996). Understanding
vicarious traumatization. Journal
of Psychosocial Nursing and Mental Health Service,. 34, no. 11, pp. 24-30. Close and prolonged work with victims
of trauma and abuse can have serious psychological consequences for
professionals, including development of anxiety, depression, intrusive
thoughts, alienation, dissociative episodes,
feeling of helplessness, paranoia, hypervigilance,
and disrupted personal relationships. The concepts of cognitive processing
models and investigation into memory dynamics can offer understanding of
vicarious traumatization, and may help define preventive measures and
treatment options for this condition. [A] Blanchard, Ellen Arledge;
Jones, Mirta (1997). Care of clinicians doing trauma work. In Harris, Maxine; Landis,
Christine L (ed.). Sexual abuse in the
lives of women diagnosed with serious mental illness, pp. 303-319.
Amsterdam: Harwood Academic Publishers. Topics treated include vicarious
traumatization; countertransference; the clinician
survivor; self-care. Catherall, Donald R
(1995). Coping with secondary traumatic
stress: the importance of the therapist's professional peer group. In Stamm, Beth Hudnall (ed.). Secondary traumatic stress: self-care
issues for clinicians, researchers, and educators, pp. 80-92.
Lutherville, Maryland: Sidran Press. Suggests ways
that trauma therapists can create safe environments in which to work. Argues
that a carefully tended peer environment affords therapists the necessary
objectivity to do the highly subjective work with trauma clients. Peer groups
of trauma therapists set norms, provide support, help correct distortions,
and generally offer opportunities to reframe the traumas. These peer-rich
environments can be ripe for facilitating the ongoing work of self-care of
healing secondary trauma. [T, Introduction] Cerney, Mary S
(1995). Treating the "heroic treaters". In
Figley, Charles R (ed.). Compassion fatigue: coping with secondary traumatic stress disorder
in those who treat the traumatized, pp. 131-149. New York: Brunner/Mazel. This book chapter focuses on treaters who work with psychologically and physically
traumatized patients. Cerney notes that these
therapists are especially vulnerable to secondary traumatic stress (STS) and
secondary traumatic stress disorder (STSD), as the assault on their sense of
personal integrity and belief in humanity can be so shattering that it places
them in a special group of traumatized individuals who are similar in many
ways to the individuals they treat, although each trauma victim, whether
patient or therapist, is different. The author assesses the reactions of
therapists who experience compassion stress and compassion fatigue, including
issues of transference, countertransference,
projective identification, and identification. She also describes factors
that influence the experience and consequences of compassion stress/fatigue,
preventive measures to minimize or prevent its occurrence, and ways to help
the therapist who has suffered compassion fatigue. [T, p. xix] Lahad, Mooli Darkness
over the abyss: supervising crisis intervention teams following disaster.
(2000). Traumatology, v. 6, no. 4, pp. 273-293. This article suggests another way of
understanding the experience of the victim and the helper and the fantasy of
omnipotence related to the "magic touch" of parenting evoked by the
interrelationship of helper - parent; victim - child. Understanding the
experience of the encounter with the "darkness in the face of
abyss" may help to explain the powerful psychological effect on the
helper, once they get in contact with the abyss and the dark. This in turn
may be a partial explanation of compassion fatigue. [A] Lansen, Johan
(1993). Vicarious traumatization in
therapists treating victims of torture and persecution. Torture, v. 3, no. 4, pp. 138-140. It has become clear during recent
years that therapists exposed to traumatic "material" run the risk
of becoming traumatized themselves: vicarious traumatization. It is not yet
known what risks are involved in this respect for therapists treating victims
of torture and persecution. In order to get an impression of the extent of
this phenomenon, a questionnaire was sent to many centers in the world
involved with this work. An inventory was made of the casualties involved and
the measures that are taken to prevent this phenomenon. About 10 percent of
the therapists seem to be affected. Supervision by an experienced senior
staff member, peer group supervision, and monitoring case-load are considered
to be important preventive measures. [A] Lesaca, Timothy
(1996). Symptoms of stress disorder
and depression among trauma counselors after an airline disaster. Psychiatric Services, v. 47, no. 4, pp. 424-426 Psychological symptoms of 21
therapists who provided counseling to individuals affected by the crash of a
commercial airliner were compared with those of 20 therapists from the same
mental health center who did not participate in the disaster relief efforts.
At 4 and 8 weeks, the trauma counselors experienced significantly more
symptoms of PTSD and depression than the therapists in the control group. At
12 weeks the only significantly increased symptom among the trauma counselors
was avoidance behavior. [A] Meichenbaum, Donald Helping the helpers. In Scott,
Michael J; Palmer, Stephen (ed.). Trauma
and post-traumatic stress disorder, pp. 117-121. New York: Cassell. Counselors working with traumatized
clients are particularly walking a tightrope between a lack of empathy, in
order to protect themselves, and over involvement. This chapter flags the
warning signs and steps that can be taken to ensure that the counselor does
not fall off the 'rope'. [T, Introduction] Munroe, James Franklin; Shay,
Jonathan; Fisher, Lisa M; Makary, Christine; Rapperport, Kathryn; Zimering,
Rose Theresa (1995). Preventing compassion
fatigue: a team treatment model. In Figley,
Charles R (ed.). Compassion fatigue:
coping with secondary traumatic stress disorder in those who treat the
traumatized, pp. 209-231. New York: Brunner/Mazel.
Suggests that isomorphic
characteristics of compassion fatigue and PTSD, and the intensity and
duration of exposure by clients, is predictive of responses. The authors
assert that no therapists are immune to these effects. The chapter deals with
the thorny ethical questions in traumatology: the duty
to inform, educate, and act in connection with compassion fatigue among
colleague therapists. This team of authors suggests that therapists working
alone may be unable to identify their own responses. A team approach is
described that prevents secondary trauma and enhances client treatment by
actively modeling appropriate coping strategies. Recognizing the effects of
secondary trauma, the authors argue, gives therapists not only a means of
prevention for themselves, but also a window of understanding and an
opportunity to intervene actively with their clients. They offer several
examples of client patterns and team responses, and outline several specific
practices for therapists. The ideas presented here are derived primarily from
work with the Veterans Improvement Program which provides treatment for
Vietnam combat veterans diagnosed with PTSD. [T, p. xx, 209] Ortlepp, K., &
Friedman, M. (2002). Prevalence and
correlates of secondary traumatic stress in workplace lay counselors. Journal of Traumatic Stress, 15, pp.
213-222. Data were collected to explore the
experiences of nonprofessional trauma counselors in the workplace. Most of
the counselors did not experience symptoms of secondary traumatic stress
requiring clinical intervention. Changes to cognitive schemata regarding
counselors’ world views were found. Program coordination, self-efficacy,
stakeholder commitment, sense of coherence, and perceived social support were
significantly related to counselor’s experience of secondary traumatic stress
and role satisfaction. (from author’s abstract) Ostodic, Edita (1999).Some
pitfalls for effective caregiving in a war region
Women and Therapy, v. 22, no. 1,
pp. 161-165. This article presents an overview of
issues and concerns which can negatively impact the effectiveness of caregiving in a war zone by traumatization of caregivers,
and conflicting agendas and prejudice of foreign mental health organizers and
trainers. [A] Pearlman, Laurie Anne; Saakvitne, Karen W. (1995). What contributes to vicarious traumatization? In Pearlman, Laurie
Anne & Saakvitne, Karen W. Trauma and the therapist: countertransference
and vicarious traumatization in psychotherapy with incest survivors, pp.
295-316. New York: Norton. Each therapist brings his own personal
history, current circumstances, and empathy to the therapy relationship. In
addition, the trauma material and the nature of the clientele contribute to
the possibility of vicarious traumatization. This chapter discusses these
aspects of psychotherapy. Pearlman, Laurie Anne; Saakvitne, Karen W. (1995). Supervision and consultation for trauma therapies. In Pearlman, Laurie Anne & Saakvitne, Karen W. Trauma and the therapist: countertransference and vicarious traumatization in
psychotherapy with incest survivors, pp. 359-381. New York: Norton. This chapter will address the
techniques and practice of supervision and consultation for trauma therapies,
identify essential components for a trauma therapy supervision, and discuss
some broader training and educational needs.
[T, p 360] Pearlman Laurie Anne (1995). Self-care for trauma therapists:
ameliorating vicarious traumatization. In
Stamm, Beth Hudnall
(ed.). Secondary traumatic stress:
self-care issues for clinicians, researchers, and educators, pp. 51-64.
Lutherville, Maryland: Sidran Press. This chapter outlines the areas
impacted by vicarious traumatication and suggests
self-care strategies that apply to each area of disruption. Ratliff, Nancy (1988). Stress
and burnout in the helping professions.
Social Casework, Vol 69(3), 147-154 Reviews the literature on stress and
burnout in human services professionals. Most of the literature consists of
common sense advice, personal anecdotes, and case studies; empirical evidence
for what actually prevents stress is scant. Empirical studies are difficult
to evaluate because of differing definitions of stress and burnout, weak
controls, and failure to use a control group. Rosenbloom, Dena J;
Pratt, Anne C; Pearlman, Laurie Anne (1995).
Helpers' responses to trauma
work: understanding and intervening in an organization. In Stamm, Beth Hudnall (ed.). Secondary
traumatic stress: self-care issues for clinicians, researchers, and educators,
pp. 65-79. Lutherville, Maryland: Sidran Press. Describes policies and programs
employed by the Traumatic Stress Institute to prevent and alleviate vicarious
traumatization among members of its professional staff. Smith, A J M; Kleijn,
Wim Chr; Stevens, J A.
(2001). De posttraumatische
stress-stoornis: bedrijfsrisico
voor behandlehaars?: een onderzoek naar werkstress bij traumtherapeuten=
(Posttraumatic stress disorder: an occupational risk for therapists?:
research findings of workstress in trauma
therapists). Tijdschrift voor Psychiatrie, v. 43 no. 1, pp. 7-19. Research questions were, how burdening
are trauma therapies for the therapists, and, does the emotional burden
relate to the characteristics of the patients' The contribution of
organizational factors was also analysed. A
questionnaire was distributed among 129 employees of a trauma institute. A
high level of experienced emotional burden was related to the treatment of
traumatized patients. Emotional burden was related to therapist-anxiety and
acuteness and severity of the PTSD-symptoms. Role clarity (tasks and responsibility)
was a stress-reducing factor. Other factors seemed to play a part in burnout:
here the relationship of the therapist with the organization as a whole
emerged as an important factor. [A] Van der
Veer, Guus. (1992). The consequences of working with refugees for the helping
professional. In Van der Veer, Guus. Counselling and
therapy with refugees: psychological problems of victims of war, torture and
repression, pp. 241-248. Chichester, England:
Wiley. This chapter advises therapists on how
to avoid negative consequences of counseling victims of civil warfare and
rape. Vicary, Dave;
Searle, Grey; Andrews, Henry (2000). Assessment
and intervention with Kosovar
refugees: Design and management of a therapeutic team. Australasian Journal of Disaster and Trauma Studies. Vol 4(2).. The Western Australian Department for
Family and Children's Services (FCS) were invited to assist in providing
services to the Kosovar refugees relocated to
Australia in 1999. The department's involvement centered on needs assessment
of the Kosovar and the provision of family and
individual support and advocacy. Family and Children's Services made an early
decision to develop support infrastructure for staff prior to commencing work
with the Kosovar. The management of staff was
designed to reduce levels of tension related to the counsellors'
work, build a strong and supportive team, reduce the possibility of worker
burnout, and facilitate re-entry into the workplace upon completion of the
Team's work. This article reviews the assessment methodology and subsequent
interventions undertaken with the Kosovar by FCS
team members. It also examines the management strategies utilized to maintain
the health and functionality of the Team so that they in turn could provide
quality services to the refugees. White GD. (1998). Trauma treatment training for Bosnian and Croatian mental health
workers. American Journal of
Orthopsychiatry, Vol. 68(1), 58-62. Williams, Mary Beth; Sommer, John F. (1995). Self-care and the vulnerable therapist. In Stamm,
Beth Hudnall (ed.). Secondary traumatic stress: self-care issues for clinicians,
researchers, and educators, pp. 230-246. Lutherville, Maryland: Sidran Press. Discusses the vulnerabilities
experienced by therapists within a framework of ethics and standards of
practice, and examines the importance of addressing these issues on both an
individual and collective basis. [T, p. 131] Yassen, Janet (1995)
Preventing secondary traumatic stress
disorder. In Figley,
Charles R (ed.). Compassion fatigue: coping with secondary traumatic stress
disorder in those who treat the traumatized, pp. 178-208. New York: Brunner/Mazel. This chapter presents an understanding
of the concept of prevention and offers an ecological model as a framework
for planning for the impact of secondary traumatic stress (STS). It is based
on the premise that STS in itself cannot be prevented since it is a normal
and universal response to abnormal (violence induced) or unusual events
(disasters). The enduring or negative effects of this response, however, can be
prevented from developing into a disorder, secondary traumatic stress
disorder (STSD). This chapter emphasizes the various components of a
comprehensive prevention program including the individual and environmental
aspects of self-care. It assumes that unless we prepare, plan, or attend to
the effects of STS, we can cause harm to ourselves, to those who are close to
us, or to those who are in our professional care. The second section of this
chapter discusses implementation of a prevention plan. It identifies factors
that influence successful prevention planning and makes suggestions for
combating resistance to prevention planning. [T, p. 178] Resources on
Burnout and Vicarious Traumatic Stress: Miscellaneous Books Figley, Charles R
(ed.) (1995). Compassion fatigue:
coping with secondary traumatic stress disorder in those who treat the
traumatized. New York: Brunner/Mazel. ISBN
No.0876307594. Discusses the vulnerability of
caregivers to “compassion fatigue,” distinctions between compassion fatigue,
burnout, countertransference,and PTSD. Raphael, Beverley; Wilson, John P (Eds.) (2000). Psychological debriefing: theory, practice and evidence. Cambridge: Cambridge University Press. ISBN No.0521647002. This book discusses the current state of the vigorous debate over the effectiveness of debriefing, explores circumstances in which debriefing may or may not be useful, and suggests directions for future research. Articles Catherall, Donald R.
(1995). Preventing institutional
secondary traumatic stress disorder. In Figley,
Charles R (ed.). Compassion fatigue:
coping with secondary traumatic stress disorder in those who treat the
traumatized, pp. 232-247. New York: Brunner/Mazel.
In this book chapter, institutions are
the central point of interest, especially those that are vulnerable to acts
of violence or other sources of traumatic stress. The author argues that
well-prepared institutions establish ongoing mechanisms to deal with PTSD and
compassion fatigue among their workers, including therapists. He maintains
that the first step is to evaluate the degree of exposure and assign
responsibility for prevention activities before incidents actually occur. The
institution must then work to establish an atmosphere that acknowledges the normality
of reactions to compassion stress and facilitates the processing of exposure
to secondary stressors. This healthy atmosphere, according to Catherall, is similar to that in families that cope
functionally with primary trauma (i.e., they identify the stressor as a
problem for the entire group, and not just the affected individual) and that
approach the problem in an open, supportive, nonblaming
fashion. In addition, Catherall notes that
institutions must attend to aspects of the institutional environment that
affect the workers' abilities to function as a closely knit group. These
elements include the hierarchical structure of most institutions, the
impersonal and disempowering atmosphere of many bureaucracies, and the
influence of the institutional mission. Finally, Catherall
points out that institutions must attend to the dynamics of the group and
ensure that affected workers are not viewed as having something wrong with
them, but, rather, as having had something happen to them. [T, p. xxi] Figley, Charles R.
(1995) Compassion fatigue: toward a
new understanding of the costs of caring. In Stamm,
Beth Hudnall (ed.). Secondary traumatic stress: self-care issues for clinicians,
researchers, and educators, pp. 3-28. Lutherville, Maryland: Sidran Press. Topics treated include: conceptual
clarity; identification of trauma; why are there so few reports of secondary
trauma?; why STSD?; definition of secondary traumatic stress and stress
disorder; contrasts between STS and other concepts; countertransference
and secondary stress; burnout and secondary stress; why compassion stress and
compassion fatigue?; implications for training and educating the next
generation of professionals. Figley, Charles R; Kleber, Rolf J. (1995).
Beyond the "victim":
secondary traumatic stress. In Kleber, Rolf J; Figley, Charles R; Gersons, Berthold P R (ed.). Beyond
trauma: cultural and societal dynamics, pp. 75-98. New York: Plenum
Press. This chapter focuses on these
secondary victims: the victim's spouse and/or children, friends and
neighbors, colleagues at work, and helping professionals such as rescue
workers, emergency personnel and psychotherapists. These people are in some
way close to the victim or survivor. Secondary traumatic stress refers to the
stress symptoms resulting from hearing about an extreme event experienced by
a friend or loved one or from attempting to help the traumatized or suffering
person. This exposure may be a confrontation with powerlessness and
disruption as well. The authors review the scientific literature associated
with secondary effects of traumatic stress and describe the various groups of
people indirectly influenced and touched by trauma. [T, p.15] Figley, Charles R.
(1995). Compassion fatigue as
secondary traumatic stress disorder: an overview. In Figley,
Charles R (ed.). Compassion fatigue:
coping with secondary traumatic stress disorder in those who treat the
traumatized, pp. 1-20. New York: Brunner/Maze. The purpose of this chapter is
fivefold: (a) to introduce the designation compassion fatigue to describe the
result of working with traumatized people; (b) to provide a rationale for the
stress-producing potential of these secondary traumatic stressors, which is
equal to or greater than that of more conventional, direct traumatic stressors;
(c) to discuss the advantages of separating out secondary stress reactions
(compassion stress) and stress disorders (compassion fatigue) in the DSM from
direct stress reactions and stress disorders; (d) to describe a theoretical
model that accounts for and predicts the emergence of compassion stress and
compassion fatigue among professionals working with traumatized people; and
(e) to explicate the principles associated with accurate diagnosis,
assessment, research, treatment, and prevention of compassion fatigue. [T, p.
xvi] Maslach, Christina; Leiter, Michael P. (1997). The truth about burnout: How organizations cause personal stress and
what to do about it. San
Francisco, CA, US: Jossey-Bass/Pfeiffer xi, 186 pp.
This book focuses on the organizational
sources of job burnout. Guidelines for eliminating the underlying problems
that cause burnout are discussed. Urquiza, Anthony J;
Wyatt, Gail Elizabeth; Goodlin-Jones, Beth L.
(1997). Clinical interviewing with
trauma victims: managing interviewer risk. Journal of Interpersonal Violence, v. 12 no. 5, pp. 759-772. During the past decade, research
methodology in the area of child and adult violence has increasingly utilized
a clinical interview methodology. Although this methodology promises a more
reliable and clinically rich set of data, it also carries higher degree of
risk of emotional distress to the interview participants. Thus far, most of
the focus on risk has been directed toward the respondent or subject;
however, this article describes differing aspects of risk for the interviewer
and presents clinical examples. Approaches to minimizing and managing
emotional distress on the part of the interviewer are presented, with an
emphasis on recruitment of research personnel, initial and ongoing training,
and structuring regular interviewer team meetings. It is proposed that the
safety and emotional health of both the respondent and the interviewer should
always take priority over data collection. [A] Van der Velden, Peter G; Hazen, Koos H
M; Kleber, Rolf J. (1999). Traumazorg in organisaties (Trauma care within organizations). Gedrag en Organisatie,
v. 12, no. 6, pp. 397-412. Various organization and professions
are at risk for acute stress situations and traumatic events. Due to the nature
of their services and products they are confronted with aggression,
robberies, sudden deaths, traffic accidents, calamities and disasters. When
acute stress situations accumulate and occur frequently they become part of
chronic work stress. To prevent incident-related and persistent coping
disturbances, absentee's leave, and diminished work performance, three forms
of trauma care are described and discussed, which are based on a
social-cognitive approach to coping with (traumatic) stress. The central element
of these forms of trauma care is the structured provision of informative,
cognitive, social, and emotional support. First, an outline is given of a
structured short term cognitive oriented assistance program, designed for
single acute stress situations like a robbery and sudden death of a
colleague. Second, a structured supportive behavioral counseling program is
described for employees who in the aftermath of the event are confronted with
new stressors which negatively affect the coping process, such as
reorganizations, medical problems, and formal investigations. Third, a
structured work meeting program is described and discussed, which is designed
for organizations where acute stress situations accumulate. The advantage of
these forms of trauma care is that they can be realized within organizations.
[A] V.
Coping With Catastrophe:
Responding to the Psychosocial Effects of War, Natural Disasters, and other
Humanitarian Emergencies General Manuals Ehrenreich, J.H. (2001). Coping With Disaster: A Guidebook to Psychosocial Intervention
(Rev. Ed.). Old Westbury, NY: Center for Psychology and Society. (Also
available online, in English and Spanish, at http://www.mhwwb.org/disasters.htm).
Hodgkinson, P.E., & Stewart, M.
(1998). Coping with catastrophe: A handbook of post-disaster psychosocial
aftercare (2nd
Edition). London: Routledge. ISBN
No.0415168538. Raphael, B. (1986) When disaster strikes: How individuals and communities cope with catastrophe. New York: Basic Books. ISBN
No.0465091687. Roberts, A.R. (Editor). (1990). Crisis intervention
handbook. Belmont, CA:
Wadsworth. ISBN No.019513365A. World Health Organization, (1996). Mental Health of Refugees. Geneva: World Health Organization. ISBN
No.9241544864. Young, B.H., Ford, J.D., Ruzek,
J.I., Friedman, M.J., & Gusman, F.D. (1998). Disaster mental health services: A
guidebook for clinicians and administrators. White River Junction, VT: National Center for PTSD. (Also available
on-line at http://www.ncptsd.org).
Additional
Resources: Books Danieli, Y., Rodley,
N.S., & Weisaeth, L. (Editors). (1996). International responses to traumatic
stress. Amityville, NY: Baywood. ISBN
No.0895031329. Enarson, E., & Morrow, B.H.
(Editors) (1996). The gendered terrain
of disaster through women’s eyes. Westport, CT: Greenwood Publishing
Company. ISBN No.0275961109. Everly, G.S., & Lating, J.M. (Editors). (1995). Psychotraumatology: Key papers and core concepts on post
traumatic stress. New York and London: Routledge.
ISBN No. 0306447827. Ladrido-Ignacio, L., & Perlas, A.P. (1995). From
victims to survivors: Psychosocial intervention in disaster management in the
Philippines. International Journal
of Mental Health, 24, 3-51. Marsella, A.J., Friedman, M.J., Gerrity, E.T., & Scurfield,
R.M. (1996). Ethnocultural aspects of posttraumatic stress
disorder. Washington, D.C.:
American Psychological Association. ISBN No.1557989087. Walker, B. (Ed.) (1995). Women and Emergencies.
Oxford: Oxfam. Additional Resources: Internet David Baldwin’s Trauma Pages, http://www.trauma-pages.com.
A wide variety of articles and resources can be accessed at this site. Health and Human Rights Info: http://www.ishhr.org. “Health and Human Rights Info” is a project aimed at making practical information and materials on health and human rights more easily accessible to health workers in the field. The focus will be on psychosocial intervention and psychological care in areas affected by gross human rights violations and catastrophic events. For this purpose we will establish a website with selected texts and information. The website will be launched by the end of 2002. National Center for PTSD, http://www.ncptsd.org.
The PILOTS Database, a database on traumatic stress, is available at this
site. National Hazard Center, http://www.colorado.edu/hazard.
The Search-HazLit database, a database on disasters
of all kinds, is available at this site. Psychosocial Working
Group Inventory of Key Resources: http://earlybird.qeh.ox.ac.uk/psychosocial/.
This inventory is a collection of grey (unpublished) literature that
allows ready access to project-related documentation exemplifying key methods
and principles of psychosocial interventions. The Refugee Studies Centre, |