Tuesday, December 9, 2008

Case Study: Trauma & Counselors Wellness by Tony Astro

Jennifer is an investigator for the child protection team. Her primary responsibility is to investigate reports of child abuse and neglect. She has been working in this position for about two years. Prior to this position, she was a case manager for the child protection team for about six months.

Jennifer is seeking counseling because, for the past two months, she has been experiencing extreme irritability and bouts of anger towards her husband. She is also having difficulty sleeping and reports very disturbing dreams. Jennifer describes several episodes in which she watches television and an hour passes by without her realizing anything that actually happened during that time period. She states that she just knows that she is “staring into space” and zones out. Jennifer also reports having some episodes of tearfulness and crying that occurs for no apparent reason.

When asked about the stress level at her job, she reports at that it is very high. She discusses a particular incident that occurred about 3 months ago in which a family was being investigated for child abuse. Before the case could be fully investigated, in a matter of a few days, the child died of sudden infant death syndrome (SIDS). Although this was not one of her cases, she says that it brings back thoughts of a previous case in which the child died of SIDS after he was reunited with his family. This occurred a year after her investigation, when the child was removed from the home. Jennifer states that she often feels overly responsible for the welfare of these children, yet has limited support and resources within the agency to completely protect them. She states that she receives no support from her employer or supervisor in debriefing from difficult cases.

Jennifer reports having no difficulty with her husband, finances, family, or any other area of her life. She states that her irritable behavior is completely out of character. She describes herself as a very positive, happy person.


Jennifer’s compassion fatigue shows the symptoms of a vicarious traumatization due to her previous related experience of child abuse, directly or indirectly. The a gradual lessening of compassion over time is common among victims of trauma and individuals that work directly with victims of trauma. It was first diagnosed in nurses in the 1950's (Barnes, 1997). Sufferers can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self doubt (Beaton, 1995).

Jennifer specific fatigue is reflected by her intrusive thoughts and self-doubt. Other empirical investigations have found vicarious traumatization to be associated with avoidance reactions (Weiss, Marmar, Metzler & Ronfeldt, 1995); increased social isolation, anger, anxiety, and sadness (Sexton, 1999); and intrusive thoughts and self-doubt (Pearlman & MacIan, 1995). (Meyer, 2006)

Jennifer being a female is more compassionate and more susceptible to compassion fatigue or vicarious traumatization. A recent University of Iowa study reveals a biological link between pain and fatigue and may help explain why more women than men are diagnosed with chronic pain and fatigue conditions like fibromyalgia and chronic fatigue syndrome (Newswise). Besides advising Jennifer to engage in healthy and healing activities, this learning will adapt Megan Bayliss, Director of Imaginif suggestions as follows (Imaginif website)
1. Understanding and responding to Jennifer’s own needs is the essence of an effective self-care strategy. Learning to balance work and play is an important place to begin. Those who work in stressful helping environments often find it difficult to leave work at the office when it is time to go home. This may include replaying situations or conversations over in their head or continuing to mentally work through issues even when the paperwork is left behind. Clearly setting boundaries of “their time” and “my time” is an important step to regaining control over your life. Creating time for rest and leisure is part of this. Finding activities that focus your mind and body elsewhere, such as reading, bush walking, sports, gardening, or playing with children, aid in clearly separating work time from leisure.
2. Maintain a positive view of the world: When working with clients who have experienced trauma, it may become easy to believe that the world is falling apart or that people are going mad. The world is not falling apart everywhere and not everyone is mad. Remember that, although bad things happen and people are affected, there is a lot of good that goes on as well. Work to look for the good in people and situations. Remember the good you are doing.
3. Use workplace supervision (or friend/peer debriefing) in a way that suits you. Talking about what you are feeling and how your work is affecting you not only provides an outlet for your feelings but may also allow your supervisor to understand your needs and likely your fellow caseworkers needs as well. Your supervisor/friend may be able to help you find ways of handling work related stress.

Overall, Jennifer needs to detach herself by using alternatives around her (peers, time, supervisors, meditation) and minimize the activities of direct involvement with the case.

Barnes, M. F (1997). "Understanding the secondary traumatic stress of parents". In C. R. Figley (Ed). Burnout in Families: The Systemic Costs of Caring, pp., 75-90. Boca Raton: CRC Press.

Imaginif website cited on 30 October, 2008 at http://www.imaginif.com.au/

Meyer, D., & Ponton, R. (2006). The healthy tree: A metaphorical perspective of counselor well-being. Journal of Mental Health Counseling, 28(3), 189–201.

Neswise website cited on 30 October, 2008 at http://www.newswise.com/articles/view/539520?sc=rsmn
Beaton, R. D. and Murphy, S. A. (1995). "Working with people in crisis: Research implications". In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized, 51-81. NY: Brunner/Mazel.
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