New Content Added: This course provides the therapist with tools for stress in treating your client who has experienced domestic violence. To update the content we have added Compassion Fatigue information found at the end of the Table of Contents
Introductory remarks: Across several studies, it appears that 21-67% of mental health workers may be experiencing high levels of burnout. In a study of 151 community mental health workers in Northern California, Webster and Hackett (1999) found that 54% had high emotional exhaustion and 38% reported high depersonalization rates, but most reported high levels of personal accomplishment as well. In Rohland’s (2000) sample of 29 directors of community mental health centers in Iowa, over two-thirds reported high emotional exhaustion and low personal accomplishment. Further, almost half reported high levels of depersonalization. Siebert (2005) surveyed a state chapter of social workers, and of the 751 respondents, 36% scored in the high range of emotional exhaustion. The investigators also used a single item burnout measure and 18% of the sample endorsed the statement: “I currently have problems with burnout.” Oddie and colleagues (2007) examined 71 forensic mental health workers in the UK, and 54% reported high rates of emotional exhaustion. Prior United Kingdom studies reviewed by Oddie and colleagues (2007) also reported a range of 21% to 48% of general mental health workers as having high emotional exhaustion.
On this track, we will focus on a therapist's
personal reactions to a battered woman's traumatic events. As you may know, these
reactions can quickly create burn-out for a therapist.
First, let's look
at a common reaction from therapists as they hear about a battered woman's trauma.
As you know, battered women experience traumatic and terrifying events, and these
events and fears are inevitably brought out in session. Have you found, like I,
that this can often result in a Secondary Traumatic Stress Disorder from the therapist?
As you know, STSD is the traumatic stress that the therapist takes on from the
As you may know, there are four key risk factors to
Secondary Traumatic Stress. As I read these, imagine how you felt at the end of
your last session with a battered client. Do any of these sound familiar?
4 Key Risk Factors for STSD
STSD Risk Factor 1. Empathy
As you know, empathy is a major resource
for therapists in assessing the problem and formulating a treatment approach because
the perspectives of the battered woman must be considered. However, research on
therapists' Secondary Traumatic Stress Disorder suggests that empathy is a key
factor in the transference of traumatic material from the primary to the secondary
victim. Thus, by empathizing with a traumatized battered woman, the therapist
may become traumatized as well. Think back to a session you just had with a battered woman and your level of empathy with her. Do you feel you took the appropriate
self-care measures to minimize residual effects of any Secondary Traumatic Stress
you may have experienced? Later tracks will cover self-care measures.
STSD Risk Factor 2. Intrusive Imagery
As you know, intrusive imagery
is a hallmark of PTSD and is of Secondary Traumatic Stress as well. Through working
with battered or the batterer, therapists may also experience intrusive imagery,
often images of the scenes that the battered woman has described vividly. Have
you found, like I, that certain images may hit very close to home and become nearly
impossible to shake? At the end of this track, we will discuss some measures I
have found to effectively decrease or rid myself of these images.
Risk Factor 3. Pessimistic Views
As I listen to the batterer's capacity
for cruelty, I can thereby begin to develop a more pessimistic view of others
and their motives. Excitement and energy to meet new people and be exposed to
new ideas may be replaced by a sense of cynicism, doubt, and self-protectiveness.
Think of those words for a minute: cynicism, doubt, and self-protectiveness. Think
back to your first days and weeks on the job. Have you become more cynical, doubting,
and self-protective than you were on your first days on the job as a therapist
treating battered women?
In addition to the risk factor of empathy, and
the reactions of intrusive imagery and pessimistic views, let's look at
STSD Risk Factor 4. Perceived Inadequacies
As you know, helpers may
experience difficulty maintaining a positive attitude in light of their perceived
inadequacies in their role as a helper. Questions may arise. At times you may
feel overwhelmed with a seemingly endless flow of stories of suffering and feel
unable to address the roots of the problem to prevent further pain. Take a second
to rate your perceived inadequacy on a scale of 1 - 10: 1 being totally inadequate,
and 10 being totally adequate. The next track will deal more with perceived inadequacies.
5 Steps to Alleviate STSD
Now that we have discussed four elements of Secondary Traumatic Stress, let's
discuss five steps you can take to alleviate some of these feelings.
1. Do you have a system within your agency for supportive sessions with
a co-worker who understands the dynamics of Secondary Traumatic Stress and has
had experience dealing with domestic violence?
2. Do you, or are
you able to... organize your case load in such a way as to balance your daily schedule
so you intersperse seeing battered clients with paper work? As you probably have
figured out, by scheduling your domestic violence clients back-to-back, you may
be creating added stress for yourself, rather than interspersing them with other
tasks or other kinds of clients. Obviously, this is a viable suggestion, only
if your case load permits.
3. Have you taken time to identify
your personal and social resources and supports? You do this all the time for
a client. But how about for yourself? Take a minute to think about who and what
your resources are that act as a pressure release valve for you. Do you need to
use these people or activities more often?
4. Do you know your
own limitations? When you know your domestic violence client's issues may be too
close to home for you, can you set your ego aside and consider referring your
client to a colleague? Is the atmosphere in your agency supportive of these types
of referrals? If it isn't as supportive as you'd like, are there any steps you
might consider taking to increase the encouragement of referrals to colleagues?
5. How comfortable are you admitting that you may have made a mistake
or used poor judgment in a session with a battered woman? I have found that my
own self-criticism and second guessing after a session with a battered woman can
trigger many of the reactions mentioned earlier on this track related to intrusive
imagery, pessimistic views, and my perceived inadequacies.
In this track we have discussed four risk factors to the development of Secondary Traumatic
Stress that may occur as a reaction to treating battered clients. These risk factors
are: empathy, intrusive imagery, pessimistic views, and perceived inadequacy.
We have also discussed five steps that can alleviate these feelings. These steps
are: supportive session, caseload organization, resources, knowing limitations,
and accepting mistakes. In the next track we will be discussing what I feel is
the biggest trigger for STSD and possible burn-out. This trigger is the perceived
inadequacies that result from a battered woman's cycle of leaving and returning,
only to leave and return again and again.
Online Continuing Education QUESTION
What are four risk factors to the development of Secondary Traumatic
Stress found in therapists treating battered women and batterers? To select and
enter your answer go to .