BY JENNIFER GAZDA, LCSW, CMC, CDP
The field of case management is considered to be a helping profession. A helping profession is any field of practice that provides support and services for human beings. While other professions are working with products or various services, our “product” is people, and what we do or do not do can potentially have a great impact on the life of another individual. Due to the nature of our work, we are exposed to a variety of traumatic experiences and stories that over time can have an impact on our own well-being. The frightening part is often we are oblivious to the changes that are happening within ourselves as we try to navigate through our day-to-day experiences. Secondary trauma, also described as compassion fatigue or burnout, needs to be at the forefront of minds as we go about our daily work as well as when we train and mentor our next generation of case managers.
Common Symptoms
How do you know if you are experiencing secondary trauma? Secondary trauma can present in various ways impacting you physically, cognitively, behaviorally and emotionally. Symptoms such as difficulty sleeping and irritability/moodiness are examples, but it can also be attributed to other conditions or issues. Laura van Dernoot Lipsky and Connie Burk (2009) detail sixteen warning signs of trauma response in their book Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. Some of these warning signs will be shared here to help you identify them in your own experiences and include hypervigilance, minimizing, exhaustion and numbing or lack of empathy (van Dernoot Lipsky and Burk, 2009).
Hypervigilance
During the course of your day, do you take a lunch break? Are you able to step away long enough to not be interrupted, enjoy a meal either alone or with colleagues and not discuss work? Many individuals experiencing secondary trauma are unable to turn off. They are constantly on the go, always working or thinking about work and maybe at the end of the day cycling through what they could have done differently or remembering a task they did not get to that may be urgent. The ability to work from home and advances in technology further create a barrier to being able to break away from work responsibilities. You may be constantly available or feel the need to respond to things as they are coming through on apps on your phone. Have you ever taken a vacation and set your out of office message to something such as you will have limited access to email? The purpose of vacation is to step away, reset, regroup and not check in at work. The personal pull to always be on, available and vigilant for work in one sign that you may be having a trauma response.
Minimizing
Have you ever experienced a time when you are sitting with a patient and they share something traumatic for them and you find yourself thinking, “this is hardly worthy of being called traumatic” or “I really need to get to my next patient so I can make it home on time”? For example, maybe how they are struggling with the loss of their child who died of cancer (or some other condition) after a long battle with the disease and you begin to think of another patient who lost their child from a violent crime. This is an example of minimizing behavior, which is essentially trivializing an experience because it is not as bad as something else you may have heard or been through. It is a sign of a lack of empathy and compassion. While you still are able to empathize and be compassionate to the needs of others, your trauma response blocks this ability in this moment because you have nothing left to give of yourself in an emotional sense.
Exhaustion
Exhaustion is a self-explanatory sign, but it goes beyond simply being tired. You are exhausted physically, mentally and emotionally. You may experience physical difficulties such as lack of ability to fall or stay asleep, stomach upset, headaches or elevated blood pressure. You may begin to experience cognitive strain and have difficulty with your memory and paying attention. Your overall performance may falter. Depression or anxiety can be experienced during times of exhaustion.
Numbing/Lack of Empathy
Think back to when you were a new graduate, starting your first job and how excited and passionate you were about starting to work in your field. Over time and with exposure to the traumatic experiences of others, you may find you view things differently and maybe you have started to respond to things in ways that you never have before. After experiencing the death of patients for over 10 years and that at one point took an emotional toll on you, now you move on to the next patient without a second thought. While some of this could be attributed to time and experience, the lack of a response to a traumatic experience is not typical of professional and personal growth. As part of a secondary trauma response, you may find yourself not showing that empathy to your patients or colleagues that you once held so true to your heart. You also may turn to numbing the experience and be at risk of an addiction if that numbing takes the form of substance use.
Risk Factors and Employer Contributions to Secondary Trauma
While anyone in a helping profession is at risk of developing secondary trauma or compassion fatigue, there are certain risk factors that increase the likelihood of this experience. Individuals who have experienced their own traumatic past, have personal problems at home, lack social support and lack positive coping strategies are at a greater risk of being impacted by secondary trauma (Ravi, Gorelick and Pal, 2021). It is important to be self-aware and reflective on what is going on in your own life when you are in a helping profession.
Our organizations and healthcare systems have a role in contributing to the increased risk of helping professionals experiencing secondary trauma. The manner in which organizations make decisions related to staffing and policies can have a great impact on burnout and job satisfaction of its employees. Kreitzer, Brintnell and Austin (2020) identified several institutional barriers that contribute to poor working conditions including but not limited to instituting cost-effective strategies (which can lead to higher work volumes and management turnover), lack of communication and lack of relationship building among teammates. It is important for people working in helping professions to have a solid and supportive team and environment to help through the challenges faced daily.
Strategies to Alleviate Secondary Trauma Symptoms
Self-care practices and strategies have been largely identified as being the best method to help be a protective factor against developing secondary trauma as well as alleviate the symptoms associated with the condition. That being said, it is easier to write about than to actually put in practice. In our busy day-to-day lives, finding time to step away or take time for ourselves can prove challenging. Self-care can be categorized as physical, emotional, social, cognitive, financial and spiritual (Johnson, 2020). Ideally, we should set aside time in our schedules each day for a self-care activity similar to how we schedule our workday, medical appointments, our children’s sporting events, etc. Self-care can be practicing mindfulness, exercising, taking a walk, sitting in a nature or wooded environment or reading a book. It can be whatever brings you peace and rests your mind and allows you to reset. It is also helpful to work toward setting boundaries, personally and professionally, so you are not always “on” and needing to produce an outcome or support someone. Setting boundaries not only can help you but can help your colleagues as a model of best practices.
References
Johnson, M.M. (2020). Self-Care: The Antidote to Compassion Fatigue. Educational Leadership, 46-51.
Kreitzer, L., Brintnell, S.E., and Austin, W. (2020). Institutional Barriers to Health Workplace Environments: From the Voices of Social Workers Experiencing Compassion Fatigue. British Journal of Social Work, 50, 1942-1960.
Ravi, A., Gorelick, J., and Pal, H. (2021). Curbside Consultation: Identifying and Addressing Vicarious Trauma. American Family Physician, 103(9), 570-572.
van Dernoot Lipsky, L. (2009). Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. Berett-Koehler.
Jennifer Gazda, LCSW, CMC, CDP, holds a Doctorate of Social Work from Aurora University and has dedicated the majority of her career to helping the geriatric population and their families. Jennifer has held the role of case manager in a variety of settings including child welfare, skilled nursing, and hospitals. Jennifer currently serves as Regional Director-Midwest for Arosa, provider of private care management and home care services across the country.
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