Feature: Aftershock - Addressing secondary trauma in a setting mindful of both clients and service providers

Published August 2009 Vol. 13 Issue 7

by Mandy Walker
photos by Adrian DiUbaldo

Barbara molfese sits in her small office at the Boulder Valley Women’s Health Center and remembers a client she counseled about an unintended pregnancy. The young woman, dressed in boys clothing, told Molfese about the incest and sexual assaults she’d experienced beginning when she was just five-years-old.

“You could just feel the pain sitting in a room with her,” said Molfese. “I felt heartbroken for her for the next couple of weeks. Sad, depressed. I just kept seeing her, picturing her in my mind.” Molfese, counseling supervisor and chaplain at the center, knew she was suffering from secondary trauma.

Like Molfese, Rene Brodeur, program director at the Boulder Shelter for the Homeless, can recall traumatic events, like attempted suicides or violence and the impact they’ve had on him. He also knows there are times when he can’t identify a single specific incident and yet has found himself experiencing secondary trauma.

Rene Brodeur, left, and Janet Walker of the Boulder Shelter for the homeless have a meeting along the trails west of the shelter.

“I can point to times when every night I’d go to bed and I’d be dreaming of the shelter,” Brodeur said. “I’d go to the grocery store and have a really hard time making any decision at all on what type of beans to bring home. Standing there, not being able to make a decision.”

Brodeur believes the indirect trauma might be more dangerous as it slowly permeates through the resiliency
you’ve developed; he believes you don’t realize just how it’s affecting you until those around you start asking you questions about your behavior.

Whether the trauma is a single incident, like a car accident, prolonged like natural disasters or homelessness, or vicarious exposure, the ways in which we respond are the same. And, those responses can be triggered again, without the trauma being present, by reminders in the environment, such as the threat of rain, by seeing a client, by a new client with similar issues to a previous client or by sights and sounds. Those triggers can produce a sense of hyper-arousal that makes the threat of trauma seem every bit as real as the trauma itself. Without addressing it or seeking support, secondary trauma can lead to problems for clients and workers alike.

Even though almost everyone who works in the health and human services field will experience secondary trauma at some point, Jean McAllister argues that employee training is not as widespread as it needs to be, nor has it been widely incorporated into professional trainings and college courses. McAllister is the program director for HealthBridge Alliance, a nonprofit that provides support to organizations and individuals experiencing secondary trauma.

Certainly, the days of McAllister’s early career when coping skills meant getting to the bar as quickly as possible after work and drinking way too much, way too often, are gone; and research now recognizes that such behavior does not make for long-term resiliency. Natural disasters like hurricanes Katrina and Rita, and terrorist attacks like 9/11 have helped to increase awareness of the impact of trauma on responders.

HealthBridge specializes in offering secondary trauma training programs and McAllister is encouraged by the
number of organizations that are now conducting such training.

Not all the training is hitting the mark, though. A Denver outreach worker who wished to remain anonymous because he was not authorized to speak on behalf of his employer, attended secondary trauma training last year and recalls an exercise where participants were given crayons and asked to create a picture of what secondary trauma looked like. “There’s a presumption that secondary trauma reifies itself as being depressed, sad or unmotivated and I think that’s not necessarily true because there’s a lot of people in this work who I would say are experiencing secondary trauma whose primary feeling is rage and anger at the situation. Those feelings are tabooed in this professional environment, and there’s no safe place to really work through those feelings.” He sees the exercise as more humiliating than beneficial.

Brodeur acknowledges that it’s hard to differentiate between burn out and vicarious trauma, but he has found that helping employees deal with the symptoms without being stigmatized helps to reduce staff turnover, and that in turn helps the organization and clients. “With people staying here longer, you get a wiser, more reliable person working. The more experienced staff who aren’t burnt out treat clients with dignity, compassion, respect.”

Rene Brodeur, Director of Programs at the Boulder Shelter for the Homeless

One of the factors that does help build resiliency is limiting direct client contact. But, McAllister stresses that it’s a fine balance, because for most workers client contact is the reason they do the work, and it’s what brings them the most reward. The Denver outreach worker helps young people on the streets. “Their lives are often the most colorful or rejuvenating celebratory things of my work. I feel so very privileged to have access to their lives.”

Brodeur agrees. “We try to promote the relationships that staff can get with homeless folks because, I think it’s good for the homeless folks, it’s good for the staff, it’s good for the safety of the building but we also know it comes with risks.”

To help minimize those risks, most staff at the Shelter are part-time. Brodeur sees the optimum number of hours per week with direct client contact as around 20 or less. “The best staff have other jobs or have a lot of outside interests and this is a small part,” Brodeur said. “As soon as this work becomes your whole work life then you’re going to have challenging times.” He walks his talk. Brodeur himself is part-time and in his other job as Executive Director for Windhorse Guild, a non-profit in the mental health field in Boulder, he has no direct client contact.

Brodeur says that when staff first starts working at the shelter he sees a naïveté about helping the clients. Once they’ve been there a while they learn to take care of themselves first.

Exercise is important for Brodeur, and the shelter encourages its staff to exercise with running groups and biking groups. The exercise philosophy even applies to managing staff. “A lot of supervisions are walking supervisions so you’re getting outside in nature,” Brodeur says. The shelter, located in north Boulder, is nestled in the foothills of the Front Range with easy access to lots of hiking trails. “Even just getting out of the building and going to a coffee shop and having your supervision there helps with perspective.”

Brodeur appreciates the supervisory structure of his organization where even part-time shelter workers have supervisors and meet with them on a weekly basis. He says that level of staffing is unusual for non-profits. During those weekly meetings, staff are encouraged to talk about their client contacts and their work. Supervisors are trained to spot signs of secondary trauma and to start asking the questions, like are you exercising, how’s your diet, are you drinking too much, are you starting to use drugs?

By broadening such supervisory discussions to include how staff members are feeling in addition to work-related items, McAllister says the organization is helping to normalize secondary trauma. Staff learns that feelings of isolation, anger, lower energy or wanting to spend more time at work are normal responses to exposure to the traumatic situations.

McAllister also says it can be very effective for workers if for case review meetings they prepare a positive outcome case or a small positive step forward case as well as a problem case. “Even though many times we can’t fix things, we need to experience the interventions that we can [make] as successful responses in some fashion,” says McAllister.

Brodeur agrees but says it’s easier said than done. “If you’re on the frontlines, it is very difficult to because, yeah, the 160 people have beds. But I know 10 people who came to the door that don’t have beds and they’re staying outside. I know one person I talked to tonight who told me about his family who all died in a car accident and he lost everything. Those bigger stories, those bigger events are what your mind is going to focus on. It is really hard to train yourself to think about the 160 inside.”

“I know one person I talked to tonight who told me about his family who all died in a car accident and he lost everything. Those bigger stories, those bigger events are what your mind is going to focus on.”
—Rene Brodeur

Making it even harder for an organization is that the secondary trauma may not come from the clients or their situation. The Denver outreach worker said in his experience it isn’t necessarily the lives of individual clients that’s traumatizing. “It’s bearing witness to the inefficiencies of social service provision as a system or as an industry, when those systems come up short time and time again. The stakes are high in the sense that people go to jail because of mistakes in the system, or people become despondent to the point of suicide because of mistakes in the system, or people become overall depressed or it accentuates mental health conditions they already have. You bear witness to all of that and you tend to take on this burden—that need to be responsible for making those systems work.”

Andie Lyons, program manager at Rainbow Alley, a GLBTQ drop-in center in Denver, believes the often-substantial pay disparity that is typical for direct service jobs compared to administrative jobs is a contributing factor. To illustrate the point, the Denver outreach worker says the direct care staff at his organization make between $11 and $13 an hour. “You could go to El Centro and do day labor and get paid with no taxes for $10 an hour. Instead, you’re in charge of feeding 60 people, monitoring 60 people through the night and maintaining the safety of the site. Those issues are incredible for what they are making.”

Secondary trauma and the associated burn out may be inevitable but what troubles Lyons is what she seesas a culture in the non-profit world of accepting it as the status quo. “I think there are ways if we’re creative enough in our thinking to make jobs more sustainable, whether it’s providing unique opportunities for community feedback or support, or looking at how jobs can be shared among people so there’s less burn out on one person. It doesn’t make any sense if we are in organizations trying to make the world a better place for people that we would inflict harm on the people trying to do that work.”•