【代替性创伤】因素 vicarious trauma

Risk factors for vicarious trauma Risk factors are realities that make you more vulnerable to experiencing vicarious trauma, or experiencing more severe vicarious trauma. Understanding what your personal risk factors are will make it easier to identify what might help you prevent or address vicarious trauma. So before we look in more detail at signs and symptoms of vicarious trauma, or how to cope with it, we are going to explore some issues that may be putting you at risk. Vicarious trauma arises from an interaction between you and your living and working situation, all in a cultural context (see the box below). Anything that gets in the way of you fulfilling your commitment to help those in need can put you at risk of vicarious trauma. The following can all play an important role in this process:   The humanitarian worker: Personality and coping style Personal history Current life circumstances Social support Spiritual resources Work style  The situation: Professional role, work setting, and exposure Agency support Affected population’s responses and reactions The cultural context: Cultures of intolerance Cultural styles of expressing distress and extending and receiving assistance The culture of humanitarian work   Below, we briefly discuss each of the personal, professional, and situational risk factors that we have listed above. There is a lot of information in this section, so take your time. As you read, think about how each of these applies to your situation. Remember: Everyone is different, so what contributes to your experience of vicarious trauma may not affect someone else in the same way; and Vicarious trauma is a dynamic process – the factors that are most problematic for you today may be different from what will affect you most tomorrow. Anything that gets in the way of fulfilling your responsibility or commitment to help those affected by disaster or violence can contribute to your vicarious trauma.   The humanitarian worker Personality and coping styles How you experience and process your feelings about the pain and suffering of those affected by violence and disaster will significantly influence your experience of vicarious trauma. You might think that the solution to being hurt by empathizing with other people’s pain is to try to avoid paying attention to others’ pain (or your own) altogether. Yet this is problematic. While cutting themselves off from their emotions may be a useful survival strategy for some people in times of crisis, it is not effective as a long-term coping strategy. Emotions that are not acknowledged (even if only to oneself) and experienced tend to build up over time. Follow this link to read a story: What happens when emotions come knocking at your door? If you either shut down completely to protect yourself from others’ suffering, or you take home all of their pain and let it build inside like a smoldering volcano, you can have big problems in the long run. Research on stress and coping suggests that VT will be more problematic for people who tend to avoid problems or difficult feelings, blame others for their difficulties, or withdraw from others when things get hard. On the other hand, people who are able to ask for support, who try to understand themselves and others, and who actively try to solve their problems may be less susceptible to severe vicarious trauma. VT may be more problematic for people who tend to avoid problems or difficult feelings, blame others for their difficulties, or withdraw from others when things get hard.   Personal history   “Everyone reacts according to their background and experience. You see a refugee who looks like your grandmother, then you are worse off than the man next to you who doesn’t. You need to be open to that. Our experiences sometimes help us through, sometimes they hit us from a strange angle we didn’t expect or understand.“ Christen Halle (Quoted in Danieli, 2002, p.17)   Research has produced mixed findings on the question of whether people who have experienced personal trauma themselves are more susceptible to vicarious trauma. It seems possible that people who (because of their own histories) identify more closely with a particular type of pain or loss others have experienced will more readily imagine, or even remember, such losses happening to themselves. As a result they may be more vulnerable to experiencing more problematic vicarious trauma and distress related to their own personal trauma histories. This risk factor may be especially relevant for national staff, as national staff have often survived the same events and suffered similar losses as those they are assisting. In addition, those with a personal trauma history who are (consciously or unconsciously) using humanitarian work primarily to seek their own recovery instead of engaging in personal healing processes, may have a harder time with VT. (Follow this link to read Velma’s story.) Those who have experienced trauma themselves may identify more closely with particular types of pain or loss others have experienced, and may be more vulnerable to experiencing vicarious trauma.  Current life circumstances Added stress in other areas of your life can make you more vulnerable to VT. If, for example, someone you love is ill, your partner has just lost his job, you are experiencing lots of changes you can’t control, and you are worried about money, then you will be less able to perform your best at work. Stress and competing needs in your life accumulate and can make it more challenging to take care of yourself while also working effectively and compassionately with those you are helping. Added stress in other areas of your life can make you more vulnerable to vicarious trauma.   Social support Everyone who works with people or communities that have been harmed or traumatized, whether at home or abroad, will at times find it difficult to describe to friends or family the nature and challenges of this sort of work. Not having people to talk to who know you and care about your welfare can be an especial problem for humanitarian workers who are living and working far from home. However, even if your friends and family are nearby, it’s easy to feel (and it may be true) that they simply won’t understand, and it can be tempting not to reach out to them. And some elements of the work may be confidential, so it can be challenging to discuss it even with close friends and family. However, research strongly suggests that social isolation puts you at increased risk for developing VT. Lack of good social support puts you at increased risk for vicarious trauma.   Spiritual resources You are more likely to find vicarious trauma problematic if you don’t have a connection with a source of meaning, purpose, and hope. Without this, humanitarian workers do not have a context for comprehending the terrible events they encounter in their work. Even with such a context, many face an ongoing struggle to make sense of the violence, disasters, and cruelty they witness. A lack of connection with a source of meaning, purpose, and hope is a risk factor for developing more problematic vicarious trauma.   Work style The way you work and the ways you think about your work contribute to your experiences of vicarious trauma. For example, not managing boundaries appropriately and holding unrealistic expectations of yourself and those you are helping or working with may contribute to vicarious trauma. Working protectively, a topic we address later in the module, is essential. Unsustainable professional and work-life boundaries and unrealistic ideals and expectations about work can contribute to more problematic vicarious trauma.     Think about What are three “individual risk factors” that may be placing you at risk of experiencing vicarious trauma at present? What are three things in your life related to you as an individual that you feel help protect you from vicarious trauma? We can call these “individual protective factors.”   The situation Professional role, work setting, and exposure People in different jobs experience different demands, constraints, and priorities. Each situation has its challenges. All of these factors can compromise your ability to do your job well, and may contribute to vicarious trauma. For example: Field staff often work in very difficult conditions, sometimes without basic sanitation or other resources. They may be quartered in locations where their physical safety depends on living in compounds, which can severely restrict socializing, exercise, and other opportunities for relaxation after hours. They may feel isolated from their friends and family and face frustrations with communications and inadequate resources for their work. They are frequently exposed to the aftermath of violence and disaster and overwhelming levels of direct need, with little time and few opportunities to process their responses. Staff based in headquarters offices, particularly in the West, may experience chronic stress related to balancing the competing demands of budgets, donors, staff, and dividing inadequate resources among desperate beneficiaries. They may also struggle to balance the demands of their work with those of their family and other commitments. National staff may have been directly impacted by the disaster or violence, and daily have to return to the work of rebuilding their own lives. They may also be supporting their extended family and friends in the face of limited job security. Those who work for international NGOs may also face discrimination and other risks because of their association with the NGO. Expatriate staff are frequently working in cultures quite different from their own, and far from the comforts and routines of home as well as family and friends. Isolation, long working hours, frequent travel, and working in cultures and with teams that are unfamiliar to them can compromise their ability to function at their best. In general, however, research suggests that humanitarian workers who have more exposure to trauma survivors are likely to experience more problematic vicarious trauma.  This means that the following job-related factors are probably all significant risk factors for VT: Working directly with more people in need (beneficiaries) Hearing more distressing stories and/or witnessing more distressing scenes or events; Being in a position of responsibility and/or feeling responsible for more people, while also feeling as if you do not have the control or resources you need to do your job well; and Working longer engagements or moving from one challenging assignment to the next without adequate rest and processing in between. Different situations present different challenges. However, research suggests that humanitarian workers who have more exposure to trauma survivors are likely to experience more problematic vicarious trauma. Agency support Humanitarian workers who work with organizations that don’t support their staff well enough may also be at greater risk for more problematic vicarious trauma. The following are some agency-related risk factors for worker vicarious trauma:  Agencies that work as top-down hierarchies (with little opportunity for those at lower levels to communicate their concerns, get the latest accurate information on the agency’s priorities and policies, or influence important decisions); Agencies that ignore the demanding nature of this work and do not work to create a supportive organizational culture; and Agencies that don’t provide adequate time off and/or that overwork staff chronically. Humanitarian organizations that don’t foster an organizational culture of effective management, open communication, and good staff care, increase their staffs’ risk of vicarious trauma. Affected population’s responses and reactions Many people whom humanitarian workers work with have been directly or indirectly affected by disasters, emergencies, violence, or chronic conditions of deprivation or injustice. When these events occur, especially when they are severe or chronic, people must adapt. This is natural — when things change, your mind, body, and behavior adjust over time to cope with the new reality. Sometimes these adjustments are healthy (e.g., when you talk to a friend when you feel lonely and isolated). Sometimes the adjustments are not as healthy (e.g., when you use alcohol and drugs to numb your anxiety or to help you sleep). In response to experiencing violence or loss people can develop unhealthy styles of relating that can be challenging for those around them. Traumatic events are traumatic partly because they are often unexpected, and the people affected feel like they have lost control of their lives and what is happening to them. After a traumatic event people often feel insecure and can have trouble trusting, feeling connected to, or respecting others. As a natural counterbalance to the sense of losing control, people who have been through traumatic events can also feel an increased need to try to control their surroundings, including the people around them. These types of adjustments that can happen after traumatic events can impact all of a person’s relationships. In the context of humanitarian work this means that when humanitarian workers show up, the people they want to help sometimes react with mistrust, a sense of distance, and a lack of gratitude or even cooperation that can be bewildering to the humanitarian workers. These dynamics can lead to frustration, annoyance, and anger in the workers, who are just trying to do their jobs. The humanitarian workers may end up feeling misunderstood, unacknowledged, unappreciated, or manipulated. Over time, after many encounters like this, the humanitarian worker may start to feel cynical, abused and hopeless. All of this can be part of the process of vicarious trauma. People who have experienced traumatic events can react and interact in ways that the humanitarian workers can find frustrating and bewildering. Over time this can contribute to humanitarian workers experiences of vicarious trauma.   Think about What are three situational risk factors that may currently be placing you at risk for vicarious trauma? What are three situational protective factors that may currently be helping protect you from experiencing vicarious trauma? Jot down any thoughts about new ways you may understand some of your past experiences as a result of what you have read. What was the situation? How did you respond?  How did others involved respond? What is your new understanding?   The cultural context Culture of intolerance There are many broader cultural factors that can influence your experience of vicarious trauma. Three important ones are: 1. Society’s attitudes about traumatic events and those involved; 2. Society’s attitudes about different groups within the society; 3. Society’s attitudes about humanitarian workers and assistance in general. Sexism, racism, injustice, intolerance, and ethnic hatred are part of the fabric of many societies. Working toward reclaiming dignity and hope is very difficult in a culture that devalues certain groups (e.g., rape victims). Humanitarian workers may feel that in environments like this, they will not be able to address or overcome some of these deep-seated attitudes present in the broader cultural context no matter what they do. At least in the short-term, this may be an accurate assessment, and it can cause humanitarian workers to deeply question their sense of meaning, purpose, and the effectiveness of their efforts. All of this can contribute to vicarious trauma. Societies also differ in how and whether they value humanitarian relief and development work. When humanitarian workers feel unwelcome or are generally perceived as part of the problem, their chances of experiencing more problematic vicarious trauma increase. Cultural attitudes of intolerance can increase a humanitarian workers’ risk of experiencing vicarious trauma in a variety of ways.   Cultural styles of expressing distress and extending and receiving assistance The ways in which we typically express distress and extend or ask for support are greatly influenced by the culture we grew up in. Humanitarian workers who are working in cultures that have very different communication styles than what they are used to will find extra challenges in their work. It may be difficult to understand what people need or expect, and equally difficult for you to convey how you can help. Each culture also has its own ways of showing appreciation. It may not be clear how or whether co-workers and beneficiaries are responding to you, and you may find yourself feeling frustrated, offended, or confused by daily interactions. Feeling offended can be a common cross-cultural experience, and one that can leave you (as well as those you are trying to help) feeling misunderstood or devalued. Not understanding cross-cultural differences in expressing distress and extending and receiving assistance can contribute to an increased risk of vicarious trauma. The culture of humanitarian work   “They go out as na?ve youngsters, into a mythological world that’s full of clichés and try to live up to those. That can destroy you, unless you catch on quickly.“ Paul McEnroe, Lecture at International Society for Traumatic Stress Studies, November 5, 2006   Just as societies, countries, and families have their own cultures, so too do professions. These professional cultures are identified by their language, norms, practices, traditions, and so forth. Humanitarian assistance has its own culture. All humanitarian workers know that they don’t completely fit the common stereotypes of “cowboy” and/or “saint” that are generally applied to humanitarian workers. However this profession is often characterized by self-neglect, toughing it out, risk-taking, and denial of personal needs. Such a culture is very different from one that suggests that helping promote staff wellness is the most effective and ethical way to help others. Humanitarian workers or agencies that cherish or promote the myths of self-reliance and machismo make it very challenging to name or address vicarious trauma. If staff feel they will be ignored, devalued, ridiculed, demoted, or fired, they will not openly seek the resources needed to understand and address their VT. Humanitarian work as a profession is often characterized by self-neglect, toughing it out, risk-taking, and denial of personal needs. All of these can contribute to more severe vicarious trauma.   Think About List three cultural risk factors that may currently be placing you at increased risk of experiencing vicarious trauma. List three cultural protective factors that may currently be helping protect you from vicarious trauma. How have you experienced the culture of humanitarian assistance and/or your organization? How do the values of your organization feel consistent with your own personal values? How do they feel inconsistent? How has this affected your own experience of vicarious trauma?