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 A Self-paced guide and workbook for identifying

           And treating the secondary trauma

           Of First Responders, Emergency Personnel,

           Firefighters, Police, Counselors, Pastors,

           Medical teams, By-standers and Witnesses,

           Military, Spouses, Parents, Children,

           Family and Friends of Trauma Survivors

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Based on a workshop originally presented for

The National Organization of Victim Advocates

National Conference August 17, 2014

By Susan Rau Stocker, LPC, IMFT

 

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As usual, a client helped me see the need for this material to become public and accessible. Let me tell you about her. She presented with anxiety. I asked her if she could remember the first time she was aware of her anxiety. “Absolutely,” she answered. “It may not have been the first time I was ever anxious, but it was the first time I was unable to handle the anxiety I felt.” I asked her when that was. “September 11, 2001.”

She was on her way from her apartment in New Jersey to her job in downtown New York City that morning. As the bus she was riding entered a tunnel, she noticed dark, billowing smoke over the city. When the bus re-emerged from the tunnel, there was a hole in the cityscape she knew so well. A building was missing. One of the Twin Towers had disappeared. The sky was an ominous black with smoke, dust and debris everywhere.

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She continued on to work. The receptionist told her to turn around and go home, but she had no idea how to do that. She was trapped in the terror that was New York City on that September morning. Everything was shutting down. No buses, subways or trains were running. The city came to a standstill.Now, she wasn’t in the Twin Towers or on her way to them, not did one of her friends or relatives perish that morning. She believed based on those facts that she wasn’t a trauma survivor. She found a bus still running, and her dad met her in New Jersey and took her to her apartment. She says two things remain stuck in her head. She was about fifteen blocks from ground zero when she watched things fall from the second tower. She said, “We knew it wasn’t paper. It was falling too fast.” And, she said, the smell was overwhelming. It smelled like the biggest electrical fire imaginable – or unimaginable, to be more precise.

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Then, “safe” in her apartment by herself, she gave in to the fear of what the terrorists had done and would do next. Where were they? She felt people watching her and waiting for her. That morning when she left for work, she was a gutsy, independent young woman who worked in the Big Apple and knew how to keep herself protected. Her world had changed in that evil twenty minutes, and then changed even more when the news streamed in from the formerly impenetrable Pentagon and the previously serene hills of Pennsylvania. She intuitively knew the truth: Her world would never be safe again. She would never be safe again.

She had suffered a vicarious trauma, as had so many others who were in the second wave, or watching the nightmares unfold on television. Until she came to see me, fourteen years later, she had cut herself no slack. She had done what countless trauma and vicarious trauma survivors had done for centuries: she had compared her trauma to “really bad” trauma and told herself she was lucky. She needed to count her blessings instead of being upset and traumatized. After all, what she went through was really “nothing.”

Vicarious trauma is discounted as having no merit. We “should not” be traumatized by working with trauma victims or observing others being traumatized. If it does not happen directly to us, we should not be harmed or touched by the trauma, should we?

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I recently counseled a young man who was working beside a man who was hit and killed while part of a road survey crew. He didn’t see the accident happen. He was          faced the other way. But he heard the whoosh of the car as it careened past and the thud of the impact of his co-worker and the two tons of steel. He, like our young New    Yorker, will never be safe again.

Trauma which results in Posttraumatic Stress Disorder (PTSD) usually comes quickly in one fell swoop – the gun is shot, the tornado roars through, or the car crashes.      Usually there is one definitive action. Vicarious trauma is frequently more a build up of repeated actions which might, one by one, be less severe and devastating, but in the relentless build up over time, these repetitive poundings become as heavy and difficult to bear as any one discrete traumatic event.

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Let’s take the example of an emergency room doctor. The pace in most emergency rooms is frantic, and the stakes are life and death. Whom do I attend first, the person slipping into a diabetic coma, the person having a heart attack, or the person whose blood pressure is dropping rapidly for no apparent reason? This kind of decision-making requires constant hyper-vigilance and attention to detail. It is the same with the air traffic controller and so many others. This morning I saw a police officer making a traffic stop, and my heart stopped along with the incident. It was a sunny, Sunday morning but people in cars being stopped by police have guns on sunny, Sunday mornings, too, and beautiful weather doesn’t negate bad outcomes of every day police work like catching speeders.

Witnessing traumas, like our New Yorker and our road worker, and working in constant states of hyper-arousal, like the emergency room physician and the police officer, are two common ways people end up with vicarious trauma. There are, of course, many other ways we become survivors of secondary trauma.

Certain professions are certainly more susceptible to vicarious trauma. Professions which deal with man’s inhumanity to man are breeding grounds for vicarious trauma, as are professions which clean up natural and man-made disasters. I include counseling in the list of dangerous professions, because even though counselors sit in comfy rockers in cozy offices, they spend their days listening to stories of terror and horror. The American Counseling Association agrees and posts a Fact Sheet (#9 on the website) which discusses vicarious trauma and the occupational hazard it poses to counselors.

Certain temperaments are also more susceptible to secondary trauma. People who are more sensitive and feel more deeply are more likely to feel the effects. However, people who are uncomfortable with their emotions and feel they have to act “tough” and “unfazed” are also particularly susceptible. One of my favorite phrases is, “What doesn’t come out straight comes out crooked.” People who do not allow themselves to feel their emotions may well end up getting bitten in the butt by them. Left neglected inside us for too long, emotions turn toxic and deeply affect our health, both physical and mental.

Read on to see if you are suffering from vicarious trauma. Fill out the questions and complete the exercises. Read the case studies and take time honestly to access your life, both past and present. Then read the characteristics of vicarious trauma, look at the list of predictors, and check out what makes people particularly vulnerable to secondary trauma.

image437 of vicarious trauma are those who have taken the time to know and understand what they might be experiencing and why they might be experiencing it. Vicarious trauma,   like  almost everything else in life, can be dealt with and minimized. This requires honestly admitting that we have been traumatized, and that we consciously choose to control the aftermath instead of allowing it to control us. 

This is serious stuff. Please, take this material and yourself seriously. No statistics exist on the number of tragedies that result from unrecognized and untreated vicarious trauma. I know that untold cases of anxiety and depression are directly related to vicarious trauma. Unimaginable numbers of people suffer physical illnesses because they have driven their trauma reactions underground and forced them to “come out crooked,” as physical ailments instead of emotional reactions. I know that hundreds of thousands of suicides are committed by people who know there is something wrong with them but have no idea what. If we can name it, we can tame it. Does vicarious trauma have a grip on your life? If so, let’s do some work together here and see if we can walk out of the fog of the unknown and into the clarity of identifying and then surviving Vicarious Trauma.

And please always remember that one of the names given vicarious trauma is “The Cost of Caring.” Only people who care deeply about other people (or animals or           image439      forests – any living thing) will develop vicarious trauma. It is a possible consequence of being a truly good person. We can’t say that about any other emotional response       that I’m aware of. This is the disease of the nice girls and guys. We can at least feel good about our humanism and concern for others if ours is one of The Many Faces of       Vicarious Trauma.

 

 

 

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PTSD Symptoms, Observations, Participant Responses

Vicarious Trauma Symptoms, Observations, Participant Responses

 

Working with Case Studies of Possible Vicarious Trauma

Seeing It, Naming It, Helping Colleagues

Specific Ways We Could Help and/or Harm Each Other

Personal Vulnerabilities

 

Preventative Self-Care Choices

Self-knowledge and Self-observation

Techniques for Self-Preservation

Characteristics of those Most Vulnerable to Vicarious Trauma

 

Preparing a Personal Evacuation Plan (PEP)

Knowing When to Step Back

Self-Loyal Stances That Promote Balance and Integrity

What to Take with You As You Finish This Study

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A traumatic event is something outside the realm of normal human life. An example I frequently use is the difference between the death of your ninety year old grandfather who has been ill and failing and the death of your nine year old child who was sitting in his third grade class when a deranged gunman entered the school and killed a number of children. Granddad’s death was in the normal rhythm of life. He will be missed and grieved. The death of a nine year old is traumatic. Such an occurrence is totally outside the normal range of life events. Those close to the death of a child, the parents and siblings and maybe other relatives, will be likely to have a set of predictable reactions to the child’s death. This set of predictable reactions we call PTSD.

Another type of PTSD results from childhood abuse and neglect. Again, it is within the normal expectations of life for children to be cared for and well treated.   When instead of coming into a loving, caring family a child enters a family where he or she is not nurtured in the myriad of ways children need for growth, that child is likely to grow up with a predictable set of reactions to the abuse and neglect. We call these predictable reactions PTSD, also.

Crime victims, victims of man-made and natural disasters, and others who experience cruelty and horror, are also likely to exhibit expected behaviors as a result of the horrific experiences they endured.

While there are many different causes of PTSD, many of the results are similar. The results are so similar, in fact, that we can look at a list of symptoms of PTSD, and, whether the PTSD resulted from childhood or adverse adult experiences, we will see patterns.

The following is a long list of combined symptoms of PTSD from many different causes and events. Read the list slowly and carefully a number of times. Think about yourself and people you know. In the following pages you will be asked to create some observations based on your own personal reactions and responses.

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Do you shoot yourself in the foot?

Are you hyper-vigilant and always aware of your surroundings?

Do you feel anxiety out of nowhere?

Panic when nothing is wrong?

Mind never settles down and is always “zooming”?

Eating disorder? Overeat?  Binge? Purge?

Diarrhea? IBS? Crohn’s?

Fibromyalgia or Chronic Fatigue Syndrome?

Feel different?  Don’t fit in?

Feel like you never belong?

Smoke to calm down?

Drink to forget?

Take drugs to numb?

Trouble trusting anyone?

Forget large segments of your childhood?

Was your mother critical and impossible to please?

Did you have an abusive or abandoning father?

Alcoholic parent?

Suicides in family?

Denied medical or dental care as a child?

Control issues as an adult?

Perfectionist?

Anal retentive? Obsessive/compulsive?

Wish you were dead?

Find life meaningless?

Don’t like to play and let your hair down or be silly?

Distrust your friends?

Have no friends?

Fractured family?  People don’t talk to others in the family?

Intimacy Issues, Emotional and Physical: No sex? Can’t get enough sex?

Dress to hide your body?

Dress to flaunt your body?

Hate your life?

Hate God?

Believe you’re a loser?

Behave in passive/aggressive ways frequently?

Say “I don’t know” a lot? (Safer not to know what’s going on?)

Experience gender confusion or sexual preference confusion?

Can’t say “no”?

Can’t make decisions?

Prefer animals to people?

 

This is my list.  It is based on twenty-six years of observation and experience.  It is neither comprehensive nor conclusive. But, if I heard you mention a number of these, I’d be aware of the possibilities of PTSD.  These are the most common descriptors I hear.

 

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For a fuller list, go to the American Counseling Association website and look at Fact Sheet #9. The list is compiled specifically for counselors, but is a thorough overview of the ways in which vicarious trauma changes us.

Changes in behavior: tardiness, missing a lot of work, frequent job changes, exhaustion, talking to oneself, becoming either over- or under- responsible, anger and irritability which are free-floating and have no apparent cause, dropping out of activities, rejecting physical and emotional closeness, becoming reclusive, or going out to avoid being alone. Changes in the fundamentals of eating and sleeping are big signs of trouble – too much or too little of either should be taken seriously, as should repeated vague but debilitating illnesses.

Changes in interpersonal relationships: conflicts, blaming others, shunning of responsibility, refusing to be a team player, poor communication, withdrawal from previous activities, impatience, hostility, or an inability to be satisfied or pleased.

Changes in personality and emotional make-up: loss in interest, hopelessness, dissatisfaction, detachment, increased worry and withdrawal, lack of gratitude, blaming others, negativity, lowering of self-esteem, changes in motivation, lack of attention to detail or too much attention to detail, inflexibility, changes which reflect insecurity, feelings of not being safe, feelings of lack of trust. Lack of focus and loss of joy in every day activities are serious signs.

 

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What observations can you draw between the characteristics of PTSD and the characteristics of vicarious trauma? Write them down.

Most people find that the characteristics seem more similar than different and that they seem to be different in intensity more than anything else.

My personal observations of vicarious trauma are that people around a person suffering from vicarious trauma will notice the changes more quickly than will the one who is suffering. Also, many people who are experiencing secondary trauma will “fake good” for as long as they can, because, as I stated earlier, vicarious trauma is not regarded as “serious.” The one who is most likely to be aware of the changes in behavior and personality is a good friend. Spouses and close family members are likely to blame themselves and worry about their “relationship” with a person instead of noticing that these changes are happening “inside” a person. Because it often takes someone close enough to be aware of change but removed enough not to take the changes personally (as a rebuff or a relationship issue), a colleague may well be the one into whose hands it falls to recognize the symptoms of vicarious trauma and offer identification, help and support.
That said, here are some hypothetical case studies to help us see what vicarious trauma might look like in real life. Underline, circle, or make a list of symptoms you notice in each case study.

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image442You’ve worked with Amy for the last three years, and until a few months ago you would have described Amy as easy-going, fun to be around, and dedicated to her work. She’s a social worker in a program to find and protect victims of human trafficking. She also runs a community awareness program. You’ve watched her gain weight. She says she wakes up every night at three and can’t go back to sleep. She has nightmares about “stuff” from her childhood. She’s begun taking things personally and recently broke up with her long-time boyfriend. She’s complaining that her mother, who lives with her and has always been her best friend, is driving her nuts. She’s given up reading which used to be her favorite pastime – she says she usually can’t concentrate, and when she can, it gives her a headache. She talks a lot about people’s ignorance and apathy. “They’re stupid and self-centered.”

 

image449Bob works in a domestic violence shelter during the day and runs groups for perpetrators three nights a week. He’s been married five years and has three small children. His wife, a former social worker, has had to quit her job to stay home with the children. He talks about money incessantly. He says that when he complains to his wife, she says she’ll gladly trade places. He reports increasing dissatisfaction with the “useless” staff at the shelter and total disgust with the victims who return to their perpetrators when they leave the shelter. He has begun to feel the shelter provides nothing more than “babysitting” and a free month’s rent. The men in his evening groups are only there because they’re court-ordered, he’ll tell you. Maybe one in a hundred is actually interested in changing. Bob has started coming to work looking drugged. When confronted, he says he hurt his back, and the muscle-relaxers and pain meds are the only things which allow him to keep functioning. This man, who five years ago was a happy, dedicated social worker with a “calling,” is now a frustrated, financially strapped shadow of his former self who is increasingly isolating and impossible to please.

 

image479Sarah has been a victim advocate for fifteen years. As her colleague, you always admired her steadiness and optimism. Then, about eighteen months ago, she was assigned to go through court proceedings with a woman who had sustained a decade of brutal spousal abuse. Sarah worked with the victim for almost a year before the abused woman was strong enough to leave her husband and bring charges against him. They went to the prosecutor, and the husband was arrested and brought to trial. He’s a well-respected minister in the community. He was acquitted. He told the court his wife had mental problems and showed her history with psychologists, psychiatrists and prescription anti-depressants which he believed made her lie. Two weeks after the trial was over and the minister had taken his wife back, as he professed before his congregation God would want him to do – he also had her come before the entire church so they could all lay their hands on her and forgive her –she disappeared. Almost six months later, she still hasn’t been heard from or found. You have watched your friend, Sarah, become more depressed, suspicious, paranoid and anxious with every passing day.

 

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Make a list of the symptoms from the three case studies. Circle the symptoms which you have experienced or can imagine yourself experiencing. Then look back at the list of vicarious trauma symptoms from the larger list. Which of those symptoms do you imagine you would exhibit if you had vicarious trauma? Perhaps a better way to ask this question is to ask you which of these symptoms you have experienced? Which of these symptoms are you presently experiencing? List them below.

 

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First, we are going to talk about helping someone else – our colleague, friend or family member. We are starting with “them” because it is easier to conceptualize what we might do and say for another than how we might actually help ourselves.

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When talking to another, here are some ideas: Be factual, objective and inclusive.
You’ve missed six days of work/ you’re late almost every day/you can’t wait to get home and start drinking/you no longer go to jazzercise/etc., etc.
I’m not your boss – I don’t care about your tardiness – I’m your friend/colleague and I care about what’s changed that you’re dragging your feet about getting here.
Any of us, in fact all of us, are susceptible to PTSD, you know that. We had a vow to watch each other. Anything left untreated only gets worse, you know that. Let’s do some pro-active things together – how about we form a meditation group, for starters?

Talk to the person alone.

Keep the focus on her/him: “Nope, we’re not talking about me right now. I’m concerned with you.”

Label It: Vicarious Trauma is an occupational hazard.

Keep in mind the Triangle of Negative Emotions:

 

                                                    FEAR                                                                       

 

 

 

SADNESS                                                                                                     ANGER

The triangle of negative emotions is essential here and at so many other junctures in life. What this triangle signifies is that there are three major groups of negative emotions. They can be drawn into categories of fear (usually comes out as anxiety), sadness (usually shows itself as depression) and anger (which is the dominant emotional reaction to trauma, since any and every trauma takes away our personal control, which ALWAYS makes us angry.)

Each of us has an emotional grouping which is our “go to” set of feelings. Mine are in the fear category. Do you know where you typically head? Are you more likely to get scared, sad or mad?

WHICHEVER grouping shows, as for example my fear would show, what supports that fear are the other two groupings of feelings. The fear is what I express and the sadness and anger are what I repress.

This is an absolute in psychology. One of the few absolutes. What shows is like the tip of an iceberg. MOST of the negative emotions inside our bodies are repressed. The repressed emotions are those which harm us. (What doesn’t come out straight comes out crooked.)

If I see an anxious (fearful) person in front of me, I am going to ask them what they’re sad about and what they’re angry about. We always need to chip away at the repressed emotions to clear the road for healing.

So, if, when you speak to a colleague or friend about the possibility of vicarious trauma, they get angry with you, you have just learned that they are fearful (probably partially because they don’t understand why they’re feeling so different and so badly) and sad (because they don’t want to be feeling so tired and miserable.) This is a lot like the kid who has undiagnosed dyslexia and throws the book across the room because he can’t read it. He is going to lash out in anger rather than admit he can’t read. Because he won’t admit he can’t read, we think we have a behavior problem and we isolate him in a class of behaviorally challenged kids – probably most of whom can’t read or focus – and that is that for their learning opportunities! ANGER is always the emotional response of someone whose control has been taken from them, by a trauma, or bad eyesight, or dyslexia, or fighting parents, or abusive caretakers. We humans don’t get angry for no reason. But if shame, guilt, embarrassment, sadness, or fear are our other choices . . . bring on the anger – it’s the shield we put on to try to protect ourselves from being vulnerable. Unfortunately, until we are willing to be vulnerable, no one can help us because no one knows we’re hurting. Our anger just pushes them away and leaves us alone in our misery.

 

Write down what you would want someone to say to you right now if they were to ask you if you are suffering from vicarious trauma. What would you want them to know, understand, share, give?

Remember this: If the person who is coming to you to ask you if you are suffering turns the conversation back to himself, you will most likely shut down. If the person who comes to you to ask if you are suffering takes personally the things you say and is offended by your honesty, you will most likely shut down. WHEN you go to someone to help them with vicarious trauma, LEAVE YOUR EGO HOME.

 

 

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Myers/Briggs Personality Inventory available free on-line

I like the test offered by HumanMetrics – it gives personality type letters and numbers indicating the strength of each preference. The Myers-Briggs helps us understand “how we’re wired.” Preferences (as they’re called) rarely change very much during a lifetime. From my observations as a mom, I can tell you that my oldest son, a “J,” has been lining up cars, glasses, baseball cards, etc. his whole life. My middle son, a “P,” is the one who’s impetuosity landed him in hot water from age two until his mid-thirties, when he learned to temper his “leap before you look” nature. This is fascinating stuff and a wealth of self-knowledge. Please Understand Me by David Kiersey is a great resource.

The Enneagram has a more spiritual component in addition to the psychological/emotional information. It comes from ancient traditions in many different cultures and is much more complex than the Myers/Briggs. It requires some serious study but is invaluable when you reach the level of self-observation where you are ready for shadow work and some serious refinement of the rough edges. Richard Rohr is the co-author of The Enneagram: A Christian Perspective.

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Thich Nhat Hanh and Pema Chodron lead the list of wonderful writers who help us take a half a step outside our own egos so we can start observing ourselves. They are both Buddhist writers.

Tom Shadyac (the famous comedy director): Life’s Operating Manual

Michael Singer: the untethered soul

Thomas Keating’s boat exercise – Trappist monk, Thomas Keating has many practical suggestions for centering prayer which is another avenue out of the confines of our egos and thoughts. Father Keating suggests we sit by an imaginary river and every time we have a thought, we put it in a little boat and send it off down stream. Don’t get angry for thinking. Don’t judge what you’re thinking. Just let the thoughts float away. In this manner we empty our minds and bring ourselves peace.

Learning to honestly see and observe ourselves is the way in which we self-edit in a healthy way. We all grow to adulthood with biases and filters. Once we become aware of them, we can control which we choose to keep and which we choose to leave behind. Until we can consciously control them, however, they unconsciously control us.

 

What do you know about yourself?

 

Who are you?

 

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Physical: Sit down and Get Moving

Sit Down: Rest, Breathe, Take Breaks

Get Moving: Exercise, Clean, Walk, Garden.  Dale’s suggestion: Reclaim a part of you that mattered or helped you feel alive BEFORE the trauma – for her it was going back to swimming which she had done in college. (“Innocence”)

Intellectual: Reading and Writing (not so much Arithmetic)

Read: Novels and Fiction for the escape

Non-fiction for the guidance and stimulation: The Biology of Belief (Bruce Lipton); Proof of Heaven (Eben Alexander); Women Who Run with the Wolves (Clarissa Pinkola Estes); books on feng shui and decorating! (BALANCE!)

Blogs for the support and perhaps guidance themanyfacesofptsd.wordpress.com

Write: Journal – see where you’ve been and where you’re going; keep your plate clean; journaling is an act of “self-emptying.”

Write prose (fiction and non-fiction) and/or poetry – incredible way to clarify your thinking.

Emotional: Therapy with a professional or an amateur (a trusted friend!)

Art work – from coloring to photography to collage

Music – play, listen, join a group, hum, sing

Spiritual: Observe the natural world – I use Animal Speak (Ted Andrews) to help me interpret the animal messages – Sit and study the clouds – Watch water flow or grass grow.

“Bible” Study – whatever your Bible is, study what you believe

Dream groups; guided imagery (Joan Borysenko) ; astrology (Rob Brezsny online); Angel Cards (Doreen Virtue); Meditation (Thich Nhat Hanh) or Centering Prayer (Thomas Keating).

 

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This list of characteristics is compiled from my twenty-six years as a therapist working with other therapists – even some time in the emergency room observing  crisis workers and some crisis intervention training. Like my list of PTSD predictors, I offer this list for discussion and educational purposes only.

Trauma Victims (Viet Nam War research supports this  . . . See Ed Tick’s War and The Soul for a detailed description. I never saw an exception in my work.)

People who are uncomfortable with emotion.

People with no family or friend in their field of work who would therefore have no one to talk to who “understands.”

People who work “out in the field” facing unpredictable situations which require them to be “ON ALERT” at all times.

People who are either too idealistic or too cynical. (ONCE AGAIN THE WORD TOO IS VERY IMPORTANT.)

People who are on call or work nights.

People with too much or too little ego.

People who have difficulty with paradox. Black and white thinkers who are Sensing on the Myers/Briggs Personality Inventory.

People with an impetuous temperament – SP’s on the Myers/Briggs

People who are too young.

People who are too accomplished – who’ve always had straight A’s.

People who are control freaks.

People with no “faith” – no belief in something larger than themselves.

 

Which of these apply most to you? Forewarned is forearmed.

 

 

P.E.P.  (your) PERSONAL EVACUATION PLAN – how to get out of the swamps and off the slippery slopes of vicarious trauma.

 

Look back at the list of your personal vulnerabilities. Look at the list of general vulnerabilities of those most likely to suffer from vicarious trauma.

Combine the lists to form your own personal list of symptoms.

__________________                                        ____________________

__________________                                        ____________________

__________________                                        ____________________

__________________                                         ____________________

 

In addition: Where do you usually get out of balance: physically, emotionally, intellectually, or spiritually?       ____________________

With whom can you be most vulnerable?      ____________________

Who can you trust to tell you the truth?         ____________________

 

NOW: Let’s design your own personal solutions:

Who?

What?

When?

Where?

Why?

How?

 

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Am I being an observer? As long as I continue to be me, the participant, nothing will change. I must take a half a step back and become an observer of my own thoughts, feelings and behaviors. Einstein said, “No problem was ever solved by the same thought process that created it.”

Have I included ways of getting back into balance? I may have to schedule these at first. For example, if I recognize that I need to read more, I may have to schedule myself to go sit in a library or a coffee shop for an hour or two every Saturday afternoon. This must be treated as an appointment!!

Am I taking my personality into account? According to the Myers/Briggs am I an introvert or an extravert?  An exhausted introvert needs time alone in her own head. An exhausted extravert needs time with people. Shall I hike alone or with a hiking club?? Shall I read by myself or join a book group?

According to the Enneagram what can I add or subtract from my days which will help with my integrity and self-esteem? For example, TWOs, who are considered heart-type people and would be thought to have and understand their feelings, are really people who have no feelings of their own – they carry the feelings of everyone else in their lives. If I am a TWO, I need to carve out time in my life to see what I really feel. (Journaling? Art? If I shop, perhaps I should shop by myself and buy what I like.)

Have I included in my PEP some ways of keeping positive and optimistic?

Have I included opportunities for silence and reflection? Meditation?

Can I say the word, “NO?” Even though we want to be the kind of people who start with “Yes,” we need to be able to say “NO” when appropriate. Start somewhere you can succeed – telephone solicitors?  HUGE help here is Rule #1 of Assertiveness: Do NOT Explain, Justify or Defend. Another helpful hint: People over the age of two who ask you WHY? always put you on the defensive. Don’t answer. Never miss an opportunity to keep your mouth shut. When necessary, say: “Oh.”  St Francis of Assisi said, “Pray all the time and when absolutely necessary use words!”

To thine own self be true. Please, treat yourself with grace!!!!!!!!!!

I hope you have benefitted by working your way through this material on vicarious trauma. If you have questions or comments, please leave them on the pillaroflightfoundation.org website. Check out our other services and let us know if there is a way in which we can help you to walk the walk God has planned for you. It is specifically and individually yours. No one else can be you or fill your shoes. The world needs you and the gifts you bring to this shared earthly journey.

Blessings and peace from Tony Winston and Susan Stocker