Why Is Self-Care So Hard?

I was talking to another advocate the other day about the importance of self-care and came to a few realizations.    Those of us working in domestic violence and sexual assault field are impacted every day by the stories that we hear and we need to have downtime in order to recover from the effects of vicarious trauma.  But many of us seldom take the time.  When asked “why not?” many will just shrug their shoulders and say “I don’t have the time.”  I think that for many people it really goes deeper than that.  I think that if a person asks herself why she can’t find the time, the answer reflects more about the person’s regard for herself than it does time constraints. 

1.        “I am not important enough.”  This reflects an attitude that the advocate feels that the problems of others are more important than her own and that she just needs to buck up and not impose on others in order to take care of herself.  She doesn’t see herself as having any value.  The important thing to remember is that if you don’t take care of yourself, you can’t take care of anyone else. 

2.       Imposter syndrome – This has been written about in different places.  It basically is the innate belief a person has that she is hiding her basic unworthiness from the world and that it is only time before every one finds out what a fraud she is.  Staying busy and refraining from self-care is a way of proving one’s value to the world and/or keeping people from finding out the secret.

3.       The depression that comes from vicarious trauma makes it difficult to do any more than what is asked for and taking the extra steps for self-care seem overwhelming.  Depression also makes a person lose touch with the things she used to love to do.  It always amazes me when an advocate can list the contents of a whole tool box of self-care items for a survivor but fails to open that box for herself. 

4.       Trying to stay ahead of the effects of trauma – Many advocates have their own trauma history and are regularly triggered by the stories they hear.  Staying busy is a way to keep from facing one’s own past, but it can often lead to complete burn out and collapse.  It also contributes to being ineffective as an advocate. 

It may take a few tries to find  activities to alleviate the effects of vicarious trauma.  It may be helpful to think about what you used to do that lifted your spirits and find new ways to enjoy them.  Did you enjoy singing – how about joining an acapella group?  Have you always wanted to play music?  Then take lessons or join a drumming group.  Sports?  I know advocates who have joined roller derby teams and love it.  Outdoors?  Check out www.meetup.com to find out what activities are going on in your area or just grab a friend for a hike in the woods.

If you find you are hesitating or it is difficult to engage in activities that you enjoy or you refrain from spending time with family and friends, then the effects of the vicarious trauma may be deeper.  Seriously consider looking for a good therapist in your area to talk to about what you are experiencing.  It could be the best thing you could do for yourself and for the people with whom you come in contact.

Vicarious Trauma and Advocate Responsibility

Vicarious trauma is real and can lead to poor morale and health in advocates who are regularly exposed to the trauma of others.  The effects of vicarious trauma can mirror the reactions that we see in victims of domestic violence and sexual assault – depression, difficulty planning and making decision, and problems following through with a course of action.  An advocate may become hyper-vigilant and have difficulty sleeping. 

In order to keep on providing good advocacy services, there is a high level of responsibility on the part of the advocate to manage her/his own trauma effects.  Hopefully, an advocate is working as a part of an organization that promotes good self-care but the mission of domestic violence or sexual assault organization cannot be fulfilled if it is spending all of its time managing the trauma of its advocates.  Advocates need to consider self-care a responsibility to themselves, their organizations, and to the victim/survivors who are seeking services.  Given that an advocate is expected to perform his/her duties and provide support as a part of employment, it is imperative that self-care be done pro-actively rather than be used as an excuse not to be available to a victim/survivor.

This is becoming increasingly important as agencies are expected to do more with less.  It is not fair to the agency, co-workers, and victims if an advocate decides that the effects of vicarious trauma are so bad that she cannot provide advocacy for an afternoon or a day.  In the same way that first responders and emergency personnel are expected to work through the stress, advocates may need to find a way to continue to provide support and perform work tasks even while dealing with the effects of trauma.  Yes, we expect our agencies to be trauma informed/responsive and have an understanding of the trauma that advocates experience. However, it is the advocate’s responsibility to create a plan to manage the effects of trauma during both work and off-work hours. 

Supervision can be used to discuss the effects of vicarious trauma and can also be used to determine whether or not an advocate is truly dealing with the effects of VT or is experiencing burnout or compassion fatigue.  It may be a time to explore boundary issues, grapple with organizational skills and managing workload, or re-define success or expectations.

For some people who continue to grapple with the stress of providing advocacy to victims of abuse, it may be necessary to self-reflect on whether this particular choice of occupation is a good fit.  Sometimes it is important to admit that it is time to move on and make other choices rather than continue to work in a job that affects your health and well-being and makes it difficult for you to fulfill the expectations and mission of the organization and the victims who seek help.  This does not mean that one has failed. It just means that there was not a good fit.  There are many jobs which I have not applied for because it would not be a good fit and a few jobs in which I worked that I eventually left because it was not a good fit.  By learning what fit and what didn’t I was able to make better career decisions that fulfilled me and used my talents.  I also know, however, that I am responsible for my own self care.

The following information is from The Headington Institute.  It is an outline for managing vicarious trauma for advocates and managers. 

Make a vicarious action plan

You probably wouldn’t set out to help the people you serve without a plan. Why not give yourself the benefit of that same approach? This exercise can be completed in 15 minutes, or you can spend more time on it. We strongly recommend that you repeat it at least every couple of months.

As you complete the exercise, you might like to refer back to the text of this module. For each question we’ve included links back to the relevant section. You can also follow this link to download a list of all the “Think about” questions in this module. If you have been taking notes in response to these questions, those notes will help you complete this exercise. 

1.     List your important risk factors for vicarious trauma. These are things that get in the way of you helping others. They come from three main areas:

a.     From personal factors (e.g., past and current stress in your life)

b.     From your situation (e.g., work-related factors)

c.     From the cultural context (e.g., discrimination and attitudes of intolerance)

2.     List any signs or symptoms of vicarious trauma that you are experiencing. Think about the following areas:

 .      Physical

a.     Psychological

b.     Behavior and relationships

c.     Worldview or frame of reference (spirituality, identity, and beliefs)

3.     What are things that you can do to cope better with these symptoms? (Hint: Think about how you can counteract your risk factors, and remember that good coping strategies for vicarious trauma are things that help you take care of yourself – especially things that help you escape, rest, and play.) How can you take care of yourself in the following areas:

 .      Physical

a.     Mental and emotional

b.     Behavior and relationships

c.     At work

4.     What steps can you take that can help you transform your vicarious trauma on a deeper level? (Hint: remember that transforming vicarious trauma means identifying ways to nurture a sense of meaning and hope).

 .      Outside work

a.     During work

5.     Pick two things you have listed in response to questions 3 or 4, and think about how you will put those into practice this week. Set two specific, realistic, goals by completing the sentence below (Hint: think about how, when, and where you achieve these goals and put that in your answer too):

This week I will ______________________ to help prevent or manage vicarious trauma. 

6.     What obstacles might get in the way of you doing the two things you identified in item 5, above?

7.     What might you to do overcome the obstacles listed above? What will support you in accomplishing your goals (Hint: think about people who can support you and how they might encourage you.

What managers can do

Are you a manager? Managers can take many steps to help lessen the impact of vicarious trauma on staff they are supervising. Here are some of them.

1.     Understand the psychological and spiritual impact of humanitarian work:

a.     Be alert to how the cumulative exposure to stressful and traumatic situations may be affecting staff.

b.     Regularly check in with staff about how they’re coping – do not wait for them to approach you with a problem.

c.     Support staff in seeking counseling or coaching if and when needed.

2.     Set a good example in the way that you care for yourself, including:

 .      Work at a sustainable and reasonable pace over time, and encourage staff you supervise to do the same;

a.     Openly value things and people outside of work (e.g., time spent with your family);

b.     Take allocated leave time;

c.     Acknowledge that humanitarian work can be challenging and that healthy work/life balance takes practice and intentionality.

3.     Especially during times of increased pressure or crises, look for ways to help staff keep current challenges in perspective by:

 .      Reminding staff of the bigger picture of the organization’s mission and purpose, and how this assignment or disaster response fits into that bigger picture; and

a.     Reminding staff of the value the organization places upon them both as people and the organization’s most important resources. Encourage staff to work in sustainable ways. If that does not appear possible in the short-term, encourage them to take extra time after the immediate impact phase is over to rest and regain equilibrium.

4.     Express concern for the general well-being of your staff and not just the quality of the work they are doing.

5.     Make sure that staff suggestions and feedback about their jobs and the organization are heard and valued – even if you are fairly sure they will not result in tangible change in the near future.

6.     Do not say or do things that would stigmatize staff who are struggling with vicarious trauma or other stress or trauma-related issues.

7.     Strive to stay positive, and to praise and acknowledge effort and results whenever possible.

Vicarious Trauma: An Interview with Golie Jansen, Associate Professor, Department of Social Work, Eastern Washington University

From The Research & Advocacy Digest, A Publication of the Washington Coalition of Sexual Assault Programs, 2004

WCSAP: What originally led you to do this research project?

G: During my conversations with therapists who worked with sexual assault survivors, I noticed that they made statements and discussed some behaviors that made me question how the work was affecting them. For instance, I heard about instances of therapists saying they were shopping during every lunch break, needed drinks to relax when they got home or just stated that they were not involved in much of anything. So, I started wondering if they were experiencing vicarious trauma because of their work. I also started to question whether the organization had a responsibility to address some of those negative aspects of sexual assault work with their workers. In reading the literature pertaining to vicarious trauma I wanted to determine whether organizational support made a difference in how it mitigates vicarious trauma. Although there is much literature pertaining to vicarious trauma, there is very little literature on the relationship between organizational support and vicarious trauma, so I set out to conduct a research project on the topic.

WCSAP: Can you describe how you designed your research project?

G: We used two standardized instruments: 1) the Traumatic Stress Institute’s (TSI) Belief Scale and 2) the Measure of Perceived Organizational Support, which measures how satisfied workers are with their organization and their perceptions of support they receive from them. These two measures give us a good idea about the relationship between perceptions of support and whether that support has any influence over how vicariously traumatized they are. We distributed the surveys at WCSAP’s annual conference to a variety of participants, including advocates, educational specialists, managers, community outreach specialists and therapists and had a 40% return rate, which is pretty high.

WCSAP: We know your study is still being analyzed and refined, and will be submitted for formal publication in the near future, but can you tell us what your preliminary findings are?

G: Preliminary findings indicate that participants were definitely experiencing vicarious trauma as a result of this work, but we also are finding that when people perceive their organizations to be supportive, they experience lower levels of vicarious trauma. At this point in the analysis, our hypothesis has been strongly confirmed; this study is leading us to believe in the relationship between organizational support and how much this support can mitigate the severity of vicarious trauma. This information is very much needed because it provides recommendations for organizations on how to manage their programs to mitigate or even prevent the effects of vicarious trauma.

WCSAP: Based on your preliminary findings, what are some recommendations that you would give to sexual assault organizations, their workers and management? What is crucial for them to understand?

G: My recommendations are as follows:

• It is important for organizations to understand their role as the managers of all this and to not place the burden of dealing with it on the individual therapists and advocates.

• Younger, less experienced workers may need more training since we’re finding that they tend to be more vicariously traumatized than more experienced workers.

• Organizations have an obligation to inform and a duty to warn those coming into the field of the potential occupational hazards of the work. This can be done as part of the hiring process so they can make informed choices about whether to continue. Organizations can also set this practice up in their personnel protocols. They should, however, not only stress the hazards, but ways advocates can protect themselves and discuss what the organization will do to help minimize the most negative effects.

• Provide more training on trauma in general to students and sexual assault workers so they are aware of its impact. Universities often don’t emphasize this, which ultimately does a great disservice to those going into the work. Consequently the workers have limited exposure regarding the nature of trauma but then find themselves dealing with extremely traumatized people. This also speaks to the need for more intensive staff development.

WCSAP: Those are great recommendations. Is there anything else you would like to add about this topic?

G: One of the ways that vicarious trauma impacts people is that is affects their worldview, spirituality and sense of identity. Someone may initially be an idealistic person who sees the world as a place where things are fair or where people are basically good. But by doing this work you only work with the atrocities that people tell you. Consequently, you may begin to shift the notion of what your worldview looks like and find yourself becoming more cynical, and the whole idea of hope becomes lost. The question then arises, if I as a therapist or sexual assault advocate lose hope, how can I instill it in people who are most vulnerable? How can I demonstrate that there are ways to address it; that there are antidotes? Also, if we don’t see great success in the work, we may think “I’m a bad therapist” or “I’m a bad advocate.” These are issues that agencies can help workers address. Staff meetings and consultation can help people begin to identify ways they are being affected and develop strategies to deal with them, like fostering self-care routines.

I also want to remind people that even though we hear and see atrocities, it is important to remember that people are doing incredible, beautiful and heroic things out there in the world, every day. You can embrace both the atrocities and the goodness. It’s important to keep a balanced perspective.

I have completed another research project by interviewing 15 sexual assault workers from all over the state. It was amazing to see how those workers who have stayed in this field for ten or more years talked about the joy and satisfaction this work gives them. Many of them said that spirituality now had a big place in their life as a result. In doing this work they gained a deeper understanding of what life is like, what relationships really are and how beautiful the world is. So we also need to begin to talk about post-traumatic growth and how resilient we are. This work can deepen our sense of connection in the world because we can overcome trauma and suffering. However, one won’t come to this place if they don’t address the harmful and hurtful aspects of the work, which ultimately can be damaging to our clients.