EMPATHY, VICARIOUS TRAUMA, AND CHILD WELFARE SERVICES SOCIAL
WORKERS
A Project
Presented to the faculty of the Division of Social Work
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SOCIAL WORK
by
Samantha Hamilton
Robin Miller
SPRING
2012
© 2012
Samantha Hamilton
Robin Miller
ALL RIGHTS RESERVED
ii
EMPATHY, VICARIOUS TRAUMA, AND CHILD WELFARE SERVICES SOCIAL
WORKERS
A Project
by
Samantha Hamilton
Robin Miller
Approved by:
_______________________, Committee Chair
Dr. Kisun Nam
________________
Date
iii
Student: Samantha Hamilton
Robin Miller
I certify that these students have met the requirements for format contained in the
University format manual, and that this project is suitable for shelving in the Library
and credit is to be awarded for the project.
_______________________, Graduate Coordinator
Dale Russell, Ed.D., LCSW
Division of Social Work
iv
________________
Date
Abstract
of
EMPATHY, VICARIOUS TRAUMA, AND CHILD WELFARE SERVICES SOCIAL
WORKERS
by
Samantha Hamilton
Robin Miller
The relationship between Child Welfare Services (CWS) social workers’ use of
empathy and their risk of exposure to vicarious trauma (VT) during the course of their
work was studied. It was hypothesized that CWS social workers that consistently and
effectively use empathy in their interactions with clients also expose themselves to
greater levels of VT. The study sample consisted of 28 social workers employed by a
county CWS agency in northern California. The participants completed a survey
focused on empathy and VT, and they also answered demographic questions. This
study tested 11 hypotheses regarding the relationship between empathy and the level of
VT, and nine hypotheses were confirmed. Implications, limitations, and future
direction are also discussed.
_______________________, Committee Chair
Dr. Kisun Nam
_______________________
Date
v
ACKNOWLEDGEMENTS
I would like to acknowledge the support of my family, Jesus Sabala and Jesus
Isaac Sabala, during the writing of this project. Over the last three years, their love and
support have been critical to my academic success. I would like to thank my parents,
Lysa and Samuel Sr., for their ongoing encouragement. I would like to dedicate this
project to my late brother, Samuel Jr., as well as to social workers around the world for
all of their hard work and many sacrifices.
Samantha Hamilton
vi
ACKNOWLEDGEMENTS
First and foremost I would like to thank my son, Lanier, for his understanding
and support while his mommy undertook this 3-year commitment. I want to give a huge
Thank You to Sharice Ford for watching Lanier on any given day with any given notice
which enabled me to attend class knowing my son was being watched after safely. I
would also like to thank numerous friends to include Richard Livingston Jr. who
provided me with the initial encouragement to enroll in graduate school and to Cynthia
Shockency, Carl Fuller Jr., Charlotte Richardson, and Akbar Bibb for their ongoing
support and praise. I want to give a huge applause to CWS social workers for the
genuine support, advocacy, and empathy they possess for their clients which serves as
the seed planted while knowing they will not be there when it blooms.
Robin Miller
vii
TABLE OF CONTENTS
Page
Acknowledgments .....................................................................................................
vi
List of Tables .............................................................................................................
xi
Chapter
1. INTRODUCTION ...............................................................................................
1
Background....................................................................................................
4
Problem Statement.........................................................................................
7
Theoretical Framework .................................................................................
9
Definition of Variables ..................................................................................
13
Justification....................................................................................................
14
Limitations .....................................................................................................
15
2. LITERATURE REVIEW ....................................................................................
16
Introduction ...................................................................................................
16
Historical Background of VT ........................................................................
17
Empathy .........................................................................................................
19
Vicarious Trauma ..........................................................................................
25
Empathy and Vicarious Trauma ....................................................................
30
Gaps in Literature ..........................................................................................
37
Summary........................................................................................................
39
viii
3. METHODOLOGY ..............................................................................................
41
Introduction ...................................................................................................
41
Research Question .........................................................................................
41
Study Design .................................................................................................
41
Variables ........................................................................................................
42
Sampling ........................................................................................................
42
Measurement Instruments .............................................................................
43
Data Collection Procedures ...........................................................................
43
Statistical Analysis Plan ................................................................................
44
Human Subjects .............................................................................................
44
4. DATA ANALYSIS .............................................................................................
46
Demographic Data .........................................................................................
46
Level of VT and Empathy by Sample’s Demographic Characteristics .........
46
Hypotheses Testing .......................................................................................
49
5. CONCLUSIONS AND RECOMMENDATIONS ..............................................
60
Implications ...................................................................................................
62
Limitations and Future Direction ..................................................................
63
Appendix A. SPSS T-Test Tables ............................................................................
64
Appendix B. SPSS Crosstab Tables .........................................................................
71
Appendix C. Consent Form E-mailed to Social Workers ........................................
79
ix
Appendix D. CWS Social Workers’ Use of Empathy and Trauma Reaction
Survey .................................................................................................
81
References .................................................................................................................
87
x
LIST OF TABLES
Page
1. Outcome of Demographic Data ...........................................................................
47
2. Vicarious Trauma by Characteristics ..................................................................
48
3. Empathy by Characteristics .................................................................................
48
4. Relationship between Spending More Time with Clients than is Expected
and Hyper-vigilance ......................................................................................
51
5. Relationship between Protective Attitude Toward Clients and
Hyper-vigilance .............................................................................................
51
6. Relationship between Practicing Self-care and Reacting as Clients Might ........
52
7. Relationship between Spending More Time with Clients than is Expected
and VT Experience ........................................................................................
53
8. Relationship between Being Emotionally Affected and VT Experience ............
53
9. Relationship between Spending More Time with Clients than is Expected
and Difficulty with Images ............................................................................
54
10. Relationship between Imagine Being in Clients’ Shoes and Feeling
Emotionally Drained .....................................................................................
55
11. Relationship between Spending More Time with Clients than is Expected
and Thinking About Clients Outside Working Hours ...................................
xi
56
12. Relationship between Being Emotionally Affected and Thinking About
Clients Outside Working Hours ....................................................................
56
13. Relationship between Urge to Solve Clients’ Problems and Thinking About
Clients Outside Working Hours ....................................................................
57
14. Relationship between Thought of Clients as Heroic and Extending Concerns
for Clients Beyond the Work Setting ............................................................
58
15. Summary of Results of Chi-square Tests ............................................................
58
xii
1
Chapter 1
Introduction
As the authors of this project have each been working as front line Child
Welfare Services (CWS) case-carrying social workers for a period of approximately 12
years, they have become increasingly interested in determining the relationship between
social workers’ use of empathy and their risk of exposure to vicarious trauma (VT)
during the course of their work. In these authors’ experiences, CWS social workers that
consistently and effectively use empathy in their interactions with clients also expose
themselves to the greatest levels of VT. When CWS social workers delve into their
clients’ traumatic pasts and experience their pain, the social workers are then making
themselves vulnerable to experiencing varying forms of stress. Frequently, these authors
have heard their coworkers discuss their worries about their respective clients and have
also heard some of their coworkers complain about sleeping difficulties and physical
ailments due to the nature of the job. In addition, these authors have witnessed some of
their coworkers in a state of physical distress after meeting with clients. This research
will empirically examine the relationship between empathy and VT as well as possible
factors associated with the outcome of this relationship.
In 1957, Carl Rogers, a psychotherapist, provided his own definition of empathy
as the entering of the internal sphere of another person and accurately participating in
that person’s experience along with the meanings of the experience to the person
(Marcia, 1987). However, empathizing has its consequences. According to Badger,
Royse, and Craig (2008), in using empathy, social workers perceive and respond to their
2
clients’ suffering, which then creates risk for exposure to VT. Empirical studies have
shown that the negative consequences of using empathy include professionals
developing post- traumatic stress symptoms and other symptoms, which include
depression, cognitive difficulty, feelings of inadequacy and insecurity, unintentional
intrusive thoughts, sleeping problems, emotional numbing, and so forth.
In social work practice, empathy is critical in developing a helping relationship
in which a client feels understood by the social worker (Hepworth, Rooney, Rooney,
Strom-Gottfried, & Larsen, 2006; Shulman, 2006). When social workers receive cases,
they must have the ability to empathize with the client in order to assist them
appropriately. Social workers conduct assessments, which entail gathering information
on a client’s current situation and past experiences and may include sexual abuse,
domestic violence, physical abuse, poverty, and so forth. Having empathy helps guide
the professional in understanding the client’s unfortunate circumstances and the choices
the client has made in order for the professional to assist the client in overcoming these
barriers. The social worker can then determine which services are most appropriate for
the client given the strengths and weaknesses in the client’s life.
Empirical studies have shown that empathy is closely connected to effective
outcomes in social work (Freedberg, 2007). Throughout social work education, students
are taught to use empathy in their interactions with clients. Despite being taught how to
use empathy, educators have not effectively taught these students about the hazards that
are associated with using empathy in working with trauma-exposed clients (NelsonGardell & Harris, 2003). In the authors’ experiences, CWS agencies consistently
3
encourage social workers to use empathy with their clients; however, these agencies do
not place an emphasis on continued education in this particular area. According to
Freedberg (2007), empathic practice requires agency and organizational support. Social
services agencies could offer their employees peer consultation, consensus based
decision-making, and policies that focus on both personal and professional growth
(Straussner & Phillips, 2005).
Vicarious trauma impacts both the professional and the client. Relieving the
emotional suffering of clients includes taking in information that is focused on the
suffering itself (Figley, 1995). The negative personal impacts upon social work
professionals can include depression, despair, and cynicism. Other impacts can include
alienation from friends, family, and work associates as well as particular places and
social activities. When a professional becomes impaired in these capacities,
psychological and physical symptoms are experienced if the trauma is untreated (Figley,
1995). Unfortunately, there is limited research in the areas of empathy and VT relating
to social workers in the CWS field. There are limited epidemiological studies relating to
compassion fatigue (CF) or secondary traumatic stress (STS) in regards to helping
professionals that are exposed to trauma during the course of their daily work (Sprang,
Clark, & Whitt-Woosley, 2007). It has been suggested that child protection work carries
a high risk for transmission of traumatic stress signs and symptoms. This suggestion is
based on research in STS with child protection services (CPS) workers (Dane, 2000;
Pryce, Shackelford, & Pryce, 2007). Clinically significant distress related to CPS work
was exhibited by 37% of study participants (Cornille & Meyers, 1999).
4
It is evident that more focus needs to be placed on the risk factors associated
with CF and self-care (Gilroy, Carroll, & Murra, 2002; Schwebel & Coster, 1998;
Skovholt, 2001). According to Dearing, Maddux, and Tangney (2005), it is the
responsibility of supervisors, faculty, and mentors to provide education in regards to
self-care. Self-care has been regarded in various research to implicate how one copes
with stress or self-protects from the emotional and physical strains of one’s job. This
could take the form of implementing stress management strategies, including the
following: (a) changing one’s behavior such as getting organized or venting emotions,
(b) changing one’s lifestyle such as exercising or pursuing leisure activities, (c)
changing one’s thinking such as challenging the “should” and avoiding “all or nothing”
thinking, or (d) creating social support systems where one identifies his or her social
support needs and helpful or non-helpful behavior (C. Rivera, personal communication,
June 10, 2011). Training programs are ethically mandated to develop ways in which to
help students deal with job related stress, prevent burnout, and emphasize self-care
(Corey, Corey, & Callanan, 2007). It is the hope of the authors that CWS agencies will
begin to realize the importance of prevention efforts and subsequently create a specific
and ongoing training curriculum focusing on empathy, VT, and self-care for social
workers.
Background
VT symptoms can develop when social workers are confronted with an event or
series of events that cannot be managed, either emotionally or practically, and in which
there is an element of danger. Social workers are increasingly being called on to assist
5
survivors of childhood abuse, domestic violence, violent crime, disasters, war, and
terrorism (Bride, 2007). As a result, social workers can be negatively impacted by
exposure to high levels of traumatic events experienced by the subpopulations to which
social workers are likely to provide services. According to Figley (1995), there is a cost
to caring. The cost of listening to clients’ stories of pain and suffering may result in the
professional experiencing similar pain and suffering. The professional may experience
increased fatigue or illness, emotional numbing, social withdrawal, reduced
productivity, and feelings of hopelessness and despair (Nelson-Gardell & Harris, 2003).
The extreme exposure to trauma and the minimal support provided by agencies
contributes to difficulties with recruitment and retention as well as the morale and
burnout of social workers in the field of CWS. In fact, the United States Department of
Health and Human Services (USDHHS; 2004) reports that STS is a major reason for the
high turnover rate among social workers in CWS. In addition, the USDHHS also reports
that other causes of high turnover include low pay, high caseloads, and inadequate
supervision. Cyphers (2001) states that according to the Child Welfare Workforce
Survey: State and county data and findings, it was determined that there was a 22%
median yearly turnover rate for child protection social workers throughout 43 states
(Cyphers, 2001). Ultimately, social service agencies are destabilized, the workforce is
no longer cohesive, and the costs of providing services are increased when staff
turnover rates are high (Conrad & Kellar-Guenther, 2006). Unfortunately, there have
been minimal efforts made in determining the predominance of CF amongst child
protection social workers (Meyers & Cornille, 2002). In addition, there has also been
6
little effort made to understand how child protection social workers are impacted by CF
(Anderson, 2000). When social workers and management are aware of the effects of
STS, diligent efforts can be made to put policies and resources in place to help support
workers who begin to experience symptoms of STS. This study will provide awareness
of the need to take STS seriously in the field of social work.
Hodgkinson and Shepherd (1994) focused on the impact of disaster support on
73 British social workers who provided support to victims. Results indicated that 60%
of the social workers experienced significant levels of traumatic stress symptoms during
their first year of experience in providing disaster support. They reported symptoms of
depression, cognitive difficulty, and feelings of inadequacy and insecurity. In 1989,
Gersons conducted a study on 37 Amsterdam police officers. Results indicated that 46%
of his sample suffered from post-traumatic stress symptoms while another 46% fulfilled
Post Traumatic Stress Disorder (PTSD) diagnostic criteria. Durham, McCammon, and
Allison (1995) conducted a study on the psychological impact on rescue personnel who
responded to an apartment building explosion. Firefighters, police officers, and hospital
personnel were polled, and the results indicated that 80% of the rescue personnel
surveyed had at least one STS symptom.
Bride (2007) conducted a survey on 600 master’s level social workers in the
southern United States, and 40.5% of the survey respondents reported that they had
unintentional intrusive thoughts connected to their work with traumatized clients. In
addition, 24.4% reported sleeping problems, 25.9% reported emotional numbing, and
55% of the respondents met at least one of the three main diagnostic criteria for PTSD.
7
In a 2006 study by Conrad and Kellar-Guenther, 363 Colorado county child protection
caseworkers and supervisors attended secondary trauma training seminars over a period
of 10 months in several Colorado counties. The participants then completed the
Compassion Satisfaction and Fatigue Test. It was determined that nearly 50% of
Colorado county child protection caseworkers had a high or extremely high risk of CF.
Problem Statement
The purpose of this study is to determine the relationship between CWS social
workers’ use of empathy and their risk of exposure to VT during the course of their
careers. This study will focus on social workers within a county CWS agency in
northern California. Quantitative data will assist the authors in understanding and
bringing awareness of the complexities of VT on CWS social workers and whether
there is a heightened risk for VT on CWS social workers that effectively use empathy
when working with clients. This area of study is important to the social work field, as
STS can inhibit the ability of professionals in the helping field to effectively provide
services to their clients (Bride, 2007; Figley, 1999). When professionals suffer from
STS, they are at higher risk of making poor decisions and judgments in regards to a
client’s well-being in comparison to those professionals not experiencing the effects of
STS (Figley, 1999; Jones 2007).
Hypotheses for this study are:
1. The more time workers spend with their clients than what is expected,
the more hyper-vigilant the workers would be.
8
2. When workers experience higher levels of having a protective attitude
toward their clients, the more hyper-vigilant the workers would be.
3. When workers practice self-care more regularly, the less likely they
would be to react as their clients might.
4. The more time workers spend with their clients than what is expected,
the greater their risk of experiencing VT.
5. When social workers are more likely to be emotionally affected, they are
more likely to have reported experiencing VT in their professional work.
6. The more time workers spend with their clients than what is expected,
the more difficulty they would have in getting the images of their clients’
stories out of their minds.
7. When workers try to imagine being in their clients’ shoes after hearing
the clients’ experiences, they will experience high rates of feeling
emotionally drained.
8. The more time workers spend with their clients than what is expected,
the more workers would find themselves thinking about their clients’
experiences outside of working hours.
9. When workers are emotionally affected, they would find themselves
thinking about their clients’ experiences outside of working hours.
10. When a worker’s urge to solve clients’ problems increases, the worker
would find him or herself thinking about the clients’ experiences outside
of working hours.
9
11. When a worker views a client as heroic given the client’s traumatic
experiences, the worker would extend concerns for clients beyond the
work setting.
Because this county CWS agency does not have policies in regards to VT, and
this county is quite typical in CWS practice, the authors assume that CWS agencies in
general do not have policies in place to support social workers experiencing VT
symptoms in the workplace. Since upper management personnel have extremely limited
direct client contact, the authors also assume that management may not fully realize
what front line staff is experiencing in terms of VT.
Theoretical Framework
The theoretical framework for empathy can best be derived from the Caring
Theory and the conceptualization of STS is based in Constructivist Self Development
Theory (CSDT; Cara, no date). In Jean Watson’s Caring Theory, it states that caring,
which can be interchanged with empathy, endorses the professional identity within a
context in which humanistic values are constantly questioned and challenged (Cara).
According to Watson (2001), the major elements of the Caring Theory are: the carative
factors, the transpersonal caring relationship, and the caring occasion or caring moment.
Watson (2001) explained that the word “caritas,” based from Greek vocabulary,
means to cherish and to give special loving attention. Some of the carative factors
include the following: (a) practice of loving kindness and equanimity within context of
caring consciousness; (b) being authentically present and enabling and sustaining the
deep belief system and subjective life world of self and the one being cared for; (c)
10
developing and sustaining a helping-trusting, authentic caring relationship; (d) being
present to, and supportive of, the expression of positive and negative feelings as a
connection with deeper spirit of self and the one-being-cared-for; and (e) assisting with
basic needs, with an intentional caring consciousness, that is, administering “human
care essentials,” which potentiate alignment of mind-body-spirit, wholeness, and unity
of being in all aspects of care, tending to both the embodied spirit and evolving spiritual
emergence. This factor can be applied to social workers, as workers are required to be
present and supportive when interacting with clients on a daily basis. In addition, while
working with clients, an authentic, caring relationship develops where expressions of
positive and negative feelings surface for both the professional and the client. Lastly,
the role of the social worker is to assist the client with his or her basic needs so that the
client can provide a sufficient minimum level of care for the client’s children.
The transpersonal caring relationship factor characterizes a special kind of
human care relationship that depends on the following: (a) the social worker’s moral
commitment in protecting and enhancing human dignity as well as the deeper/higher
self; (b) the social worker’s caring consciousness communicated to preserve and honor
the embodied spirit, therefore, not reducing the person to the moral status of an object;
and (c) the social worker’s caring consciousness and connection having the potential to
heal, since experience, perception, and intentional connection are taking place. This
relationship describes how the social worker goes beyond an objective assessment,
showing concerns toward the client’s subjective and deeper meaning regarding his or
her own physical, mental, and emotional situation. The social worker’s empathy, or
11
caring consciousness, becomes essential for the connection and understanding of the
other person’s perspective. This approach highlights the uniqueness of both the client
and the social worker and also the mutuality between the two individuals, which is
fundamental to the relationship. As such, the one caring and the one being cared for, the
professional and the client, connect in a mutual search for meaning and wholeness, and
perhaps for the spiritual transcendence of suffering (Watson, 2001). The term
“transpersonal” means to go beyond one’s own ego and the here and now, as it allows
one to reach deeper spiritual connections in promoting the client’s comfort and healing.
Finally, the goal of a transpersonal caring relationship corresponds to protecting,
enhancing, and preserving the client’s dignity, humanity, wholeness, and inner
harmony.
The third and final element is the caring occasion or caring moment. A caring
occasion is the moment, focal point in space and time, when the social worker and
client come together in such a way that an occasion for human caring is created or
empathy is realized. Both persons, with their unique phenomenal fields, have the
possibility to come together in a human-to-human transaction. The Caring Theory also
insists that the social worker needs to be aware of his or her own consciousness and the
authentic presence of being in a caring or empathetic moment with the client. Moreover,
both the professional and client can be influenced by the caring, or empathetic, moment
through the choices and actions decided within the relationship, thereby, influencing
and becoming part of their own life histories. The caring occasion becomes
12
transpersonal as the event of the moment expands the limits of openness and has the
ability to expand human capabilities (Watson, 1999, pp. 116-117).
CSDT is a developmental, interpersonal theory explicating the effect of trauma
on an individual’s psychological development, adaptation, and identity (McCann &
Pearlman, 1990a). The theory is a unifying personality theory that integrates the clinical
and contextual emphasis of social learning and other developmental cognitive theories.
CSDT emphasizes integration, meaning, and adaptation. According to McCann and
Pearlman, the major assumption of CSDT is that adaptation to trauma is a result of a
complex interplay between life experiences (including personal history and specific
traumatic events) and the developing self (including psychological needs and cognitive
schemas about self and world). As individuals grow and develop psychologically, they
increase their capacity to adapt or modify their schemas. Exposure to trauma, however,
can disrupt an individual’s psychological growth cognitive schemas (McCann &
Pearlman). Five areas of the self can be affected by trauma within CSDT, and these
include frame of reference, self-capacities, ego resources, central psychological needs,
and perceptual/memory system (Saakvitne, Tennen, & Affleck, 1998). In effect, CSDT
can offer explanations for both negative changes in a person after trauma has occurred
as well as positive changes once an individual has adapted and made meaning of the
situation (Saakvitne, Tennen, & Affleck).
In looking at the relationship between CWS social workers’ use of empathy with
their clients and their risk of exposure to VT, cause and effects of trauma can be
understood when applying CDST. The life experience (specific traumatic events)
13
concept of CDST applies to CWS social workers, as the daily job responsibilities of
reading and listening to clients’ stories of pain and suffering which cause the
professional to feel similar pain and suffering, especially when social workers are more
empathetic, can be considered traumatic events for CWS social workers. CWS social
workers that use empathy most effectively with their clients absorb and internalize the
traumas that clients are describing or experiencing at greater rates, thereby placing them
at higher risk of experiencing VT. The developing self (psychological needs and
cognitive schemas) concept of CDST applies to CWS social workers, as the effects of
VT leaves the social worker to address his or her own psychological needs and negative
cognitive schemas result. The psychological effects of STS symptoms in social workers
include nightmares, emotional numbing, social withdrawal, and so forth. A social
worker’s cognitive schemas are impacted when feelings of inadequacy and insecurity
are present and when feelings of hopelessness set in. When these effects are left
untreated, the needs and negative cognitive schemas are exacerbated. If treated, which
would entail social workers understanding their symptoms and management providing
resources, social workers would be able to increase their capacity to adapt to the trauma
or modify their schemas positively.
Definition of Variables
Empathy is defined as a personality characteristic that gives people the ability to
effectively respond to other individuals in an objective manner (Badger, Royse, &
Craig, 2008). From the authors’ standpoint, the social work profession is identified by
empathy and considerable value and emphasis in placed on social workers’ use of
14
empathy when working with clients. Furthermore, effective use of empathy determines
the quality of a social worker’s practice.
VT, STS, and CF are all used interchangeably to describe the risk of negative
personal psychological consequences in people who provide assistance to others, such
as emergency workers, nurses, counselors, physicians, and police officers (NelsonGardell & Harris, 2003). Because the terms are identical, the authors will primarily
reference VT in this paper. VT is the “phenomena of the transmission of traumatic
stress by observation and/or bearing witness to the stories of traumatic events” (Gentry,
Baranowsky, & Dunning, 1997, p. 1).
Justification
Overall, this research topic will contribute to increased knowledge and best
practice in the field of social work. According to the Code of Ethics of the National
Association of Social Workers, social workers have specific ethical responsibilities
when it comes to their profession. For instance, “social workers should work to improve
employing agencies’ policies and procedures and the efficiency and effectiveness of
their services” (NASW, 2011). The authors hope that this study will encourage CWS
social workers to work on improving their agencies’ training policies and procedures on
the topics of empathy and VT. By suggesting and advocating for increased workplace
education in the aforementioned areas, CWS social workers will be making
management and administrators in their agencies aware that there is a dire need for
these types of training opportunities. As a result, agencies’ policies and procedures
15
could ultimately be improved in the areas of empathy and VT so that social workers
will be adequately supported.
Limitations
Because this research was confined to a small sample size of 28 CWS Social
Worker IIIs in a county CWS agency in northern California, generalizability to a larger
population of CWS social workers is limited. Also limiting generalizability is the fact
that men were not adequately represented amongst the participants. Approximately 93%
of the respondents were female. Another limitation of this study is that the survey
required self-reports from the participants. Self-reports may have been distorted or
inaccurate due to the participants’ memory limitations or possible feelings of distress
due to the nature of the survey itself. As a result, the data may have been skewed. If
participants had engaged in structured clinical interviews rather than completing
surveys, the results may have been different.
16
Chapter 2
Literature Review
Introduction
In essence, CWS social workers’ experiences with VT can be examined by
their use of empathy when working with their respective clients. When CWS social
workers effectively use empathy in their interactions with clients, they are likely to be
more vulnerable to VT exposure. Empirical studies indicate a correlation between social
workers’ use of empathy and their exposure to VT. However, not much effort has been
made to determine the prevalence of VT among CWS social workers or to understand
how VT impacts social workers on a professional and personal level (Conrad & KellarGuenther, 2006). CWS social workers can suffer from negative psychological impacts
as a result of exposure to VT. Furthermore, CWS agencies are not providing adequate
training opportunities in the areas of empathy and VT for their staff. This current study
attempts to show a correlation between CWS social workers’ use of empathy and their
exposure to VT. The authors hypothesize that a number of factors contribute to CWS
social workers’ exposure to VT. These factors include variables that are related to CWS
agencies, factors related to traumatic events, as well as factors that are connected to
individual CWS social workers. Within this study, the historical background of VT will
be addressed, empathy and VT will be discussed both individually and in combination
with each another, and gaps in the literature will be discussed.
17
Historical Background of VT
According to Figley (1985), the word trauma can be linked to the Greek
meaning of “wound” (p. xviii). In addition, the study of human reactions to traumatic
events originated in the medical writings of Kunus Pyprus that were published in Egypt
in 1900 B.C. (Figley, 1995). Interest in the field of traumatic stress studies, which is
also known as traumatology, became prominent in the mental health fields in the mid1980s due to a greater awareness of the consequences of shocking events. These
consequences include depression, medical problems connected to emotional stress, and
dysfunctional behaviors (Figley, 1995). In 1980, the American Psychiatric
Association’s third edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-III) became a significant milestone in the field of traumatology. The DSM-III
included the diagnosis of PTSD, and this allowed for accurate diagnosis and treatment
of traumatized people. However, subsequent traumatology literature excluded those
individuals who were traumatized indirectly or secondarily (Figley, 1995). Figley
(1995) stated that CF is the same as STS disorder and is equivalent to PTSD. The
authors do not believe that VT is synonymous with PTSD. In 1994, the DSM-IV noted
that PTSD can occur when an individual is traumatized either directly or indirectly. This
indirect traumatization is also known as STS/CF (Figley, 2002). In 2002, Figley also
noted that there were few reports of the prevalence of STS/CF. However, based on
secondary data and theory analysis, issues such as burnout, countertransference, and
worker dissatisfaction may have been the focal point thus masking the possible issue of
VT (Figley, 2002).
18
Before the twentieth century, the main concept was that professionals working
with clients who have or are experiencing trauma were immune to traumatic stress
reactions and symptoms because of their specialized education and training. It was not
until 1978 that attention was brought to STS with the work of Charles Figley. Figley
suggested that friends, family, and professionals are indeed susceptible to developing
traumatic stress symptoms from being empathetically involved with victims of
traumatic events (Cornille & Meyers, 1999). However, Carl R. Rogers, the founder of
the person-centered counseling approach, believed that those in the helping profession
should display empathy, unconditional positive regard, and congruence when working
with clients (Rosenthal, 2003). These are the three core attributes of effective helping,
and Rogers felt that helpers had to display them in order for clients to experience
purposeful changes in their lives (Rosenthal).
Over the years, there have been numerous studies that have documented the
effects of CF on emergency room nurses, hotline workers, police officers, and other
mental health professionals who work with traumatized individuals (Conrad & KellarGuenther, 2006). Until recently, studies did not focus on the effects of VT on social
workers. In 2003, Nelson-Gardell and Harris noted that social work professionals had
just begun to acknowledge that STS was relevant to their work. In 2004, Bride noted
that VT literature was based on anecdotes or conceptual ideas and that researchers had
just started to investigate how trauma exposure impacted professional helpers. Social
workers are subject to emotional and psychological risks in connection with their work
with vulnerable clients; however, these risks have been often overlooked in social work
19
educational curriculums and in agency training programs (Cunningham, 2004; Courtois,
2002). Over the last 20 years, the social services community has begun to acknowledge
these emotional and psychological risks and that they may pose occupational hazards
for social workers (Pryce, Shakleford, & Pryce, 2007). Despite some recent research in
this specific area, studies continue to remain limited for CWS social work professionals.
Empathy
The explanation of not only how people experience inanimate objects, but also
how they understand the mental states of other people derived from German
psychologist Theodore Lipps in the late 1800s (Montag, Gallinat, & Heinz, 2008).
Lipps used the term Einfuhlung to explain this notion, although the term had earlier
been coined by Robert Vischer in 1873. Einfuhlung was used to denote the idea that in
order to appreciate an object, one must protect the self by way of sympathetic
absorption into the form of being observed (Wispe, 1987). Lipps later expanded this
concept to include the experience of losing one’s self in an object being observed. This
mode of perception included the idea of “feeling into” an object (Wispe). Einfuhlung
was later translated into English as “empathy” by Edward Tichener, a British
psychologist, in 1909 (Montag, et al., 2008). Tichener used the term to explain optical
illusions where one could “feel into” the lines of a figure. What is of more significance
is that Tichener proposed that a person could reach another at an emotional level
through empathy. In 1915, Tichener wrote, “We are told of a shocking accident and we
gasp and shrink and feel nauseated as we imagine it; we are told of some new delightful
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fruit and our mouths water as if we are about to taste it. This tendency to feel oneself
into a situation is called empathy” (Tichener, 1915, as cited in Wispe, p.25).
Freud was one of those at the frontier among social scientists in exploring the
meaning and function of empathy. Freud believed that empathy was used to
comprehend what may be foreign to ourselves in an effort to understand another person.
For Freud, empathy was a way of knowing and feeling into another person’s conscious
experience (Wispe, 1987).
With the development of personality theory, influential theorists such as Gordon
Allport, Gardner Murphy, Heinz Kohut, and Martin Hoffman placed empathy as one of
their focal points (Wispe, 1987; Kohn, 1990). These theorists defined empathy as a
blend of intuition, imagination and inference, having roots in both the emotive and
cognitive domains. The leading theoretician to approach the concept of empathy was
psychotherapist Carl Rogers. In the 1950s, Rogers’ influence was massive with his
person-centered and client-centered theories during the World War II era (Hall &
Lindzey, 1978). Rogers’ concept placed a strong emphasis on the perceptions of the
individual: each person’s values, feelings, and experiences are seen as valid and
worthwhile. With professional relationships, this requires professionals to have the
ability to view their exchange as “a person to a person” in an “intensely personal and
subjective relationship” (Rogers, 1961, p. 185).
In 1957, Rogers defined empathy as entering the internal sphere of another
person and accurately participating in that person’s experience along with the meanings
of the experience to the person. In 1975, Rogers expanded his definition of empathy as
21
a process whereby the therapist enters the “private perceptual world of the client” (p. 4).
Rogers, along with his students and associates, conducted vast research and also
attempted to develop the first scales to measure empathy. As a result of their extensive
work surrounding the notion of empathy, empathy is now considered central not only to
client-centered theory but to any effective interpersonal communication (Marcia, 1987).
Empathy, as noted by Kohut (1971), is a means of knowing what it is like to be
the subject, rather than the object, of inquiry. Empathy, as a psychobiological capacity,
is a means of entering the phenomenal reality of the trauma victim to understand the
internal working schema of the trauma experience and its effects on intrapsychic
processes. Kohut believes that empathy is the only appropriate means to gather
psychological data concerning another. Kohut states “the replacement of empathy…by
other modes of observation leads to a mechanistic and lifeless conception of
psychological reality” (p. 301). Kohut stressed that the inability to use empathy to
understand another represents a “perceptual defect” (p. 301) that is to be overcome to
achieve psychological health, both for the analyst as well as for the patient. In addition,
he states that empathy is also a means of knowledge acquisition and a tool of discovery
of the trauma patient’s inner world. It is a process of discovering the nature of the
trauma landscape, which characterizes altered states of well-being. Kohut’s (1984)
emphasis in using empathy is to understand the subjective experience of the client. In a
professional atmosphere, the professional must be empathetic with the client’s inner
experience of herself or himself and truly grasp the client’s perception of his or her
psychic reality and accept it as valid.
22
Hoffman (1980) proposed that the development of empathy and its
transformation during cognitive development is the fundamental basis in terms of moral
development. As a result of one’s cognitive development, a person begins to
conceptualize others not only as distinct, but to project the self into another’s
experiences beyond the immediate concrete situation and, therefore, to respond with
empathic distress and a more reciprocal feeling of concern for the victim. Moreover,
this empathic distress can also be transformed into feelings of guilt if the victim’s
distress leads to self-blame with respect to one’s action or inaction (Hoffman).
Empathy has been described as the notion of being there emotionally for clients,
“feeling their pain.” The ability to empathize helps a worker better understand what the
person has experienced and therefore provide better care. Bailey (2006, p. 300)
describes empathy as “the self-knowledge that comes from being able to ‘hold’ the
perceptions and the emotions of another.” Being empathic requires a mindfulness
“unfolding” and constant awareness when professionals remain grounded and true to
themselves, continuously growing personally and professionally, while at the same time
opening their minds and hearts to learn and know others more deeply (Kabat-Zinn,
2005).
A more refined definition for empathy has arisen from the intersubjective school
of psychoanalysis, informed by infant and neurological studies (Arnd-Caddigan &
Pozzuto, 2008). Within the intersubjective school, Benjamin (2004) has formulated a
definition of empathy that she references as thirdness. Thirdness is the phenomenon that
two people in interaction mutually regulate each other so that they share a subjective
23
experience that is co-created by them both, and that could not exist in isolation from one
another (Arnd-Caddigan & Pozzuto). The relational school of intersubjective
psychoanalysis operates under the notion that people are not separate, but inherently
and necessarily connected. Intersubjectivity also supports the idea that empathy is not
simply the understanding of the client’s experience, but the sharing of that experience.
In other words, not only does the social worker co-create the client’s experience, but to
some degree the social worker shares it. The imagined aspect of empathy is replaced by
actual participation in a mutual experience (Arnd-Caddigan).
Scientifically, it has been recently demonstrated through social neuroscience that
human beings possess mirror neurons which recreate in one person’s brain the neural
activity that is occurring in the other person’s brain during focused social exchanges
(Goleman, 2006; Arnd-Caddigan & Pozzuto, 2008). It appears that there are specific
neurons that are activated when one person watches another person. These neurons fire
in the same way as if the observer were actually performing the activity (Beebe,
Knoblauch, Rustin, & Sorter, 2005). The activation of these mirror neurons allows the
observer to understand the intentions and experience, or the subjectivity, of the
observed. Both participants in this interaction respond to the psychophysiological
changes in the other, prompting changes in both the self and other, until a mutual state
is achieved. Empathy is thus not simply one person understanding what another is
experiencing, but it is awareness of a shared experience” (Arnd-Caddigan & Pozzuto, p.
324). Society for Neuroscience (2007) reports that some scientists speculate that a
mirror system in people forms the basis for social behavior, for our ability to imitate,
24
acquire language, and show empathy and understanding. Therefore, these neurons
actually assist in establishing an empathetic rapport between people that strengthens
interactions and relationships.
Therapeutically, according to MacRitchie and Leibowitz (2010), empathy is a
significant resource for counseling others and entering their lives. Furthermore,
empathy is a crucial component of therapeutic relationships (Badger, et al., 2008).
Rubin and Roessler (1995) report that regardless of how beneficial rehabilitation
professionals may appear, when there is a lack of empathy, the counselor’s ability and
obligation to act in a manner that promotes the well-being of others will be greatly
diminished. Rogers (1980) states that “the ideal therapist is, first of all, empathic”
(p.146). Empathy as a “way of being” is the foundation for establishing and building the
working alliance within client-center models of counseling and is necessary for working
with the psychosocial aspects of adjustment and adaptation to disability (Stebnicki,
2000). Empathy is integral to social work, as it is seen as a basic social work skill
implicit in practice and communication with clients (Bennett, Leoon, & Zilberfein,
1989). Raines (1990) states that empathy holds a prominent place in social work
practice.
Within studies conducted, Arnd-Caddigan & Pozzuto (2008) report that one of
them had conducted a study on empathy. After polling Master’s level social work
students concerning those character traits that are most important to social work
practice, empathy was the most frequently cited response. In 2008, Badger, Royse, and
Craig conducted a study using a stepwise regression analysis to examine the predictive
25
ability of emotional separation, social support, occupational stress, and empathy on
STS. Their control variable was the number of years worked in the field of social work.
The authors’ cross-sectional study utilized a sample of 121 trauma center social
workers. Most of the participants had Master’s degrees and had approximately 15.8
years of experience. In this study, empathy did not perform well, thus raising concern
that the instrument used to collect the data could have lacked sensitivity in detecting
empathy. In the regression analysis, empathy and social support were not significant.
Vicarious Trauma
VT, STS, and CF are essentially the same when referring to professionals’
indirect traumatic experiences caused by the clients’ traumatic experiences. Figley
became an expert on trauma and with assistance from his colleagues examined specific
symptoms related to STS (Bride, 2007; Perron & Hiltz, 2006; Stoesen, 2007). Figley
introduced the term “Secondary Traumatic Stress (STS)” and defined it as “the natural,
consequent behaviors and emotions resulting from knowledge about a traumatizing
event experienced by a significant other. It is the stress resulting from helping or
wanting to help a traumatized or suffering person” (Cornille & Meyers, 1999, p.3). STS
had previously been classified under burnout or countertransference. It wasn’t until the
1990s that STS was recognized as having its own distinct classification where it was
defined as a syndrome of symptoms that include avoidance, arousal, and intrusion
(Bride; Stoesen). STS symptoms are manifested as a direct result of listening to clients’
traumatic experiences (Nelson-Gardell & Harris, 2003). STS is considered an
occupational hazard when providing direct services to traumatized people (Bride).
26
McCann and Pearlman (1990a) state that people “who work with victims may
experience profound psychological effects, effects that can be disruptive and painful for
the helper and can persist for months or years after work with traumatized persons” (p.
133). McCann and Pearlman termed this process “vicarious traumatization.” In
addition, they state that professionals must take steps to avoid pathologizing the
response of their clients. Just as PTSD is viewed as a normal reaction to an abnormal
event, McCann and Pearlman view VT as a normal reaction to the stressful and
sometimes traumatizing work with victims.
Social workers with ongoing exposure to traumatized clients are at risk for
developing trauma-related responses. Among these are CF, a consequence of
continuous work with traumatized clients that leaves workers drained emotionally and
susceptible to depression and exhaustion; secondary trauma, resulting from an indirect
exposure to a traumatic event that produces symptoms in the helper similar to the
clients’; and shared trauma, which can occur when the client and social worker have
experienced the same traumatic event (Cunningham, 2003; Tosone & Bialkin, 2004).
When the client and the helping professional have experienced exposure to the same
trauma, problems may occur. Studies of helping professionals have found issues with
blurred boundaries, the need to rescue, and inappropriate disclosure of feelings
surrounding guilt and anger (Danieli, 1985). In addition, the higher the social worker’s
caseload, the greater the level of exposure to traumatic material. Ultimately, this results
in increased personal experiences with VT (MacRitchie & Leibowitz, 2010).
27
Furthermore, it is thought that STS contributes to social workers leaving the field
prematurely (Bride, 2007).
Along with witnessing and hearing about abuse, social workers must deal with
limited resources, which can lead to secondary trauma (Bride, 2007; Jones, 2007).
Through their job responsibilities, CWS social workers expose themselves to the sordid
details of the traumas that some adults impose on their children. The responsibilities of
interviewing children, adults, and families regarding abuse and neglect; reading through
case files and notes that provide descriptive accounts of physical and sexual abuse;
viewing pictures of children after they have fallen victim to physical abuse; having to
remove children from their homes or being placed in the position to make
recommendations for children to not return to their homes and instead be adopted by
strangers all expose social workers to trauma which can lead to extensive emotional
stress. This exposure to trauma forces the CWS social worker to acknowledge parental
cruelty and leaves the social worker vulnerable to physical and emotional stressors. In
addition, unrealistic caseload sizes, staffing shortages, and unsupportive management
can exacerbate STS for CWS social workers as these issues can cause workers to feel
more vulnerable and powerless.
Dane (2000) states that the general signs and symptoms of VT among social
workers include the following: decreased sense of energy; no time for one’s self;
increased disconnection from loved ones; social withdrawal; increased sensitivity to
violence, threat, or fear; or the opposite, decreased sensitivity, cynicism, and
generalized despair and hopelessness. These are considered the endpoints of a gradual
28
erosion of one’s beliefs and frame of reference. In other words, changes occur in one’s
identity, worldview, and spirituality (McCann & Pearlman, 1990b). In addition, other
indicators may include: losing one’s sense of humor; exhaustion; feeling angry and
overwhelmed; lack of patience; outbursts; alcohol or substance abuse; sleep difficulties,
and physical ailments that include headaches, gastrointestinal tract problems, and skin
rashes (Figley 1995, 2002, 2007; Huggard 2003; Mathieu, 2007). Figley (2007) states
that sufferers of CF often do not obtain or even know how to get help for themselves.
In regards to mental health professionals, VT has been described as having
“profound changes in the core aspects of the therapists’ self” (Pearlman & Saakvitne,
1995b, p.152). According to Trippany, White Kress, and Wilcoxon (2004), VT involves
disruptions in the cognitive schemas of counselors’ identity, memory system, and belief
system. Paivio (1986) also believes that therapists who work with victims may find their
cognitive schemas and imagery system of memory altered or disrupted by long-term
exposure to their victim clients. The imagery system of memory is most likely to be
altered in VT. Like the trauma victim, therapists may experience their clients’ traumatic
imagery returning as fragments, without context or meaning (Paivio, 1986). Horowitz
(1976) reports that these fragments may take the form of flashbacks, dreams, or
intrusive thoughts. These images may be triggered by previously neutral stimuli that
have become associated with the clients’ traumatic memories. Disruption in the imagery
system of memory is also frequently associated with vigorous affective states. Emotions
such as sadness, anger, or anxiety may be experienced by therapists as a result of
working with client victims. These feeling states may surface consciously to the
29
therapist or subconsciously. McCann and Pearlman (1990a) state that some therapists
may experience denial and emotional numbing, especially with those who are unable to
process their emotional reactions. Therapists are at a heightened risk of becoming
emotionally numbed when they are exposed to traumatic imagery that is too
overwhelming to integrate, emotionally or cognitively.
Nelson-Gardell and Harris (2003) initially used multivariate analysis and then
stepwise regression and forced entry regression analyses to study the link between
personal history of trauma, child abuse or neglect, and the increased risk for STS in
CWS social workers. The authors used a convenience sample of 166 CWS social
workers. Based on this study, experiencing personal childhood trauma in the form of
child abuse and neglect increases the risk of STS in CWS social workers. Dane (2000)
conducted a study in which she examined the nature of secondary trauma and its impact
on child welfare workers. The purpose of the study was to collect data and develop a
training model based on the perceptions of child welfare workers. The method used was
two focus groups where each session lasted three and a half hours and was conducted in
the fall of 1997. Dane completed informal consultations with agency supervisors and
other child welfare workers prior to the focus groups to learn about what issues they felt
needed to be addressed. A sample of 10 child welfare workers who had worked for at
least three years was drawn from the five borough offices of a child welfare agency in a
diverse metropolitan area. Dane found that all the participants reported behavioral
changes over time as coping resources and to avoid further stress. These behavioral
changes included: detachment, staying busy, accepting ones limitations, setting limits,
30
and “cutting off.” As a result of this study, Dane developed a two-day, 14-hour training
model. The model was designed to prepare child welfare workers with the necessary
knowledge, skills, and self-awareness needed to face the stress and trauma that occurs
during daily witnessing of child maltreatment.
In 1995, Pearlman and Mac Ian conducted a study on 188 trauma therapists. The
therapists completed questionnaires, and they were also asked about their personal
trauma histories. The results indicated that the therapists with the least amount of
trauma work experience experienced the most substantial psychological issues. In
addition, the therapists that disclosed personal trauma histories displayed more negative
effects from their work than those who did not report personal trauma histories.
Therefore, factors associated with VT, as identified by empirical research, include
personal history of trauma, coping skills, and duration of trauma work experience in
addition to empathy.
Empathy and Vicarious Trauma
Having empathy makes the professional vulnerable to internalizing some of the
clients’ trauma-related stress. Figley (1995) believes empathy makes individuals more
prone to STS. To understand a client’s state of traumatization requires empathy with
and knowledge of the nature of the wounds and injuries inflicted by the forces of nature
or by humankind. Figley (1995) also notes that “the process of empathizing with a
traumatized person helps us to understand the person’s experience of being traumatized,
but, in the process, we may be traumatized as well” (p.15). Thus, social workers who
feel high levels of empathy while helping others who have experienced chronic pain,
31
suffering, abuse, neglect, or trauma may experience the secondary stressors or parallel
feelings of the individuals they serve. Figley (1995, 2007) conducted research in the
field of stress related to the use of compassion and empathy and noted that a stress
response can develop quickly and without any forewarning. The identifying
characteristics of the emerging stress response are described as feelings of confusion
and helplessness, isolation, and symptoms that are not connected to their actual cause.
In addition, Figley notes that there seems to be a quicker recovery rate from this stress
response as compared to burnout. He describes this particular process as CF.
Furthermore, Figley discusses how trauma workers’ use of empathy is one of the
predominant reasons why they are highly vulnerable to CF.
Wilson and Thomas (2004) state that the concepts of CF, VT, and STS disorder
have been developed to explain the formation of stress-related symptoms, reactions, and
behaviors that have similarity to PTSD symptoms. However, a careful study of the
definitions of these concepts (Figley, 1999; Pearlman & Saakvitne, 1995a) would show
that they all emanate through the process of empathic identification with the client.
Wilson and Thomas define empathic identification as the processes of identifying with
the internal psychological state of another person. It is suggested that empathic
identification leads to empathic strain, involving states of affect dysregulation in the
professional. Therefore, with repeated exposure to traumatized clients, the stress-evoked
states in the helping professional may be associated with the transformation of selfcapacities; that is, VT, feelings of CF (i.e., mental fatigue and costs of caring), and STS
reactions (i.e., traumatoid states akin to PTSD symptoms; Wilson & Thomas, 2004).
32
VT has been conceptualized as being exacerbated by, and perhaps even rooted
in, the open engagement of empathy, or the connection with the client that is inherent in
counseling relationships (Pearlman & Saakvitne, 1995b). Pearlman and Saakvitne
(1995a) state that a valuable tool is the capacity to enter empathically into the
experience of our clients. The professional’s empathy is essential to the creation of a
therapeutic relationship and thus recovery; however, empathy also puts the professional
at risk for VT, in particular, a specific type of empathic connection with our clients can
heighten VT. The many potential sources of empathic strain in work with PTSD clients
include the following: (a) affective dysregulation in the professional while listening to
powerful and emotionally intense trauma histories; (b) cognitive disillusionment
induced in the professional by confronting the realities of human cruelty, malevolence,
capacity for aggression, emotional indifference and unbridled and ruthless egoism; (c)
the constancy of dysfunctional states in the trauma patient which tax the professional’s
coping strengths, which leads to fatigue; (d) the power of trauma stories to reactivate
areas of personal vulnerability in the professional, including unresolved issues of
childhood development; (e) the lack of education and training in traumatic stress,
PTSD, and stress disorders (Wilson, 2004); and (f) a rigid, ideological adherence to a
specific school of psychotherapy and intellectual dogmatism with respect to PTSD as a
fixed entity, as an anxiety disorder rather than a dynamic, fluctuating state of prolonged
stress with an array of variations which influence symptom production, selfpresentations, and somatic processes at any given time (McEwen, 1998; Wilson;
Wilson, Friedman, & Lindy, 2001). McCann and Pearlman (1990a) state that when
33
professionals begin to experience emotional numbing or begin to emotionally distance
themselves, they are then unable to maintain a warm, empathetic, and responsive stance
with clients.
In working with victims of trauma and PTSD, empathy takes center stage.
Empathy is subject to the forces of stress, time pressures, and external factors that
impinge on its quality. Empathic strains involve factors that limit empathy and the
processes of empathic attunement in which there is a loss of resonance, synchrony, and
congruence in communication. Wilson and Thomas (2004) define empathic attunement
as the psychobiological capacity to experience, understand, and communicate
knowledge of the internal psychological state of being of another person. Empathic
attunement is characterized by accurate emotional resonance, synchrony, the ability to
decode multichanneled signal transmissions (e.g., nonverbal, emotional,
physical/somatic states, cognitive processes, ego-defenses, ego-states, etc.) from
another person and manifest matching responses which are experienced by the
recipients as being understood and “on target” with what they were sending as
communications of information about their psychological processes (Wilson, 2004).
Wilson and Thomas (2004) state that excessive, continuous, or repeated exposure to the
client’s state of traumatization, where the levels of intensity, severity, and potential are
high enough evokes fear, helplessness, affect dysregulation, and pose challenges to
systems of meaning, belief and ideology.
The process of working with trauma clients is directly related to empathic
identification in which the helping professional identifies with the pain and suffering of
34
clients and their efforts to recover from the traumatic events they have endured.
Through the process of empathic identification arises the potential for CF, STS, and VT,
which are distinct but interrelated psychological processes. Respectively, CF concerns
the fatigue of caring; STS refers to the acquisition of traumatoid states; and VT
specifies cumulative and permanent transformations in self-capacities (Wilson &
Thomas, 2004). These three forms of response to trauma work each have their own
unique characteristics, which impact areas of coping and adaptation. The professional
outcomes include (a) counter transference processes; (b) somatization, fatigue,
exhaustion; (c) impacts to self-capacities, including identity, beliefs, values, ideology,
worldview; (d) the quality of interpersonal and affiliative patterns; (e) a search for
meaning about trauma related issues of morality, justice, fairness, authority, power,
religion, salvation/redemption, atonement; and (f) spirituality and understanding the
numinous experience (Wilson & Thomas).
Empathic strains emanate from empathic identification and are a precondition
for traumatoid states such as CF and STS reactions. Wilson and Thomas (2004) believe
that empathy is the key to understanding the phenomena described as CF, STS, and VT.
Empathic attunement and empathic identification with the trauma client are indigenous
to trauma work and post-traumatic therapy. Empathic strains challenge professionals’
capacity to stay empathically attuned and to maintain their own psychological
equilibrium during the course of treatment. Wilson and Thomas’ research has shown
that therapists experience dysregulated affective states associated with exposure to the
trauma narratives of their patients. They freely report PTSD-like symptoms associated
35
with three factors: (a) the patient’s accounts of trauma; (b) the patient as a person who
presents pain, suffering, confusion, discouragement, loss of trust and hope, feelings of
being “damaged goods” and, in many cases, a diminished sense of self-worth and
human dignity; and (c) reactions to the historical and situational context in which abuse
and traumatization occurred (e.g., warfare, family, political oppression, terrorist attack,
genocide, marriage, natural disaster, in the line of duty, etc.). As a result of these three
factors and the multitude of inherent stressors, the therapist experiences empathic
strains which may then be manifest in the form of CF, STS reactions, and VT.
James Marcia, a contemporary psychotherapist, refers to empathy as the
“psychological toll” for professionals who engage in empathic responding as part as
their duties. “To empathize consistently with a number of different people, most of
whom are in some kind of psychological pain, is to live, vicariously, as many painful
lives as the number of patients one sees” (Marcia, 1987, p.100). Through the actions
and process of empathy, suffering becomes a shared experience between the
professional and client. The professional is then given the task of alleviating the client’s
suffering. For social workers and other similar professionals, methods of reducing
psychic distress frequently are imperfect, which can result in draining and frustrating
experiences (Morse, Bottorff, Anderson, O’Brien, & Solberg, 1992).
According to Badger, Royse, and Craig (2008), emotional separation may result
in reduced STS symptoms and that emotional separation may help in maintaining a
balance. The authors also state, “teaching social workers how to differentiate from their
patients and maintain the balance of emotional distance and empathy at the onset of
36
their work may help with the provision of caring interventions . . .” (p. 69). It is
important that social workers establish professional boundaries, create self-awareness,
and develop objective therapeutic connections (Badger, et al.). Nelson-Gardell and
Harris (2003) state that CWS agencies and their social workers should take a shared
preventative approach in handling STS. STS training and ongoing programs such as
support groups, caseload rotations, and changes in job responsibilities should also be
utilized in CWS agencies (Nelson-Gardell & Harris). Social workers need to focus on
their own self-care and well-being, and they should also inform their administrators,
who are removed from the front line social work experience, about STS so that they are
aware of the impacts relating to decisions and policies (Badger, et al.).
Studies have been conducted with rehabilitation counselors which found that the
younger, less experienced rehabilitation counselors who have a “save the world”
outlook or those who have an enormous capacity for feeling and expressing empathy
tend to be more at risk of the emotional and physical exhaustion associated with
empathy or CF (Stebnicki, 2000). The studies suggest that younger, less experienced
rehabilitation counselors are prone to higher levels of emotional exhaustion than older,
more experienced rehabilitation professionals (Cranswick, 1997; Corrigan &
McCracken, 1997). Stebnicki states that many rehabilitation professionals who are just
beginning their careers have little preparation for dealing with the complexities of
having to be empathically available during intensive counseling interactions with
persons who have chronic mental and physical disabilities. Corey and Corey (1993)
state that many beginning-level counselors reported that they were frustrated and
37
disappointed about their new job’s unexpected stressors and demands. Super (1994)
believes that most people in their early 20’s have insufficient experience to make a
career commitment. A willingness to work with people who frequently experience a
great deal of distress requires a deep dedication and commitment. Stebnicki states that
counselors at varying levels of experience will likely encounter a parallel process of
emotional exhaustion due to the grief, loss, or chronic physical and mental impairments.
Gaps in Literature
Research studies regarding VT have been primarily focused on crisis workers,
therapists, and emergency service personnel. There is little research in the area of VT
focusing specifically on social workers, particularly CWS social workers (NelsonGardell & Harris, 2003). There is a significant gap in the literature relating to pragmatic
methods of preventing and treating VT, STS, and CF (Newell & MacNeil, 2010).
According to Badger, Royse, and Craig (2008), “more research is necessary to further
our understanding of variables contributing to the development of STS . . .” (p. 64).
Further research is needed in regards to the relationship between the amount of
exposure to traumatic information and STS experiences (MacRitchie & Leibowitz,
2010). In Nelson-Gardell and Harris’ study completed in 2003, the convenience sample
affected generalizability to CWS social workers. In addition, data was not collected on
variables such as caseload types, personal therapy histories, and job responsibilities.
Data collection in these areas could have affected the findings in the study.
Furthermore, some of the participants were from a state CWS agency, and some were
from a professional conference. The CWS sample mailed their questionnaires back to
38
the researchers, and those at the conference submitted their questionnaires on the same
day they completed them. Ultimately, this affected participation rates, as the researchers
had difficulty with the return rates of the mailed questionnaires.
Although Dane’s research conducted in 2000 was focused solely on child
welfare workers, there were several limitations to the study. Methodological factors
limit the interpretation of data which affects the generalizability of the findings to this
population. The pilot study used a small, nonrandom, convenience sample of 10
participants. In addition, participants could have been affected by social desirability
bias, in that participants may have distorted their responses to make themselves appear
in the best light. Furthermore, the study did not have a control group, making it
impossible to compare findings. Lastly, the author may have been biased to achieve
desired results. This could have been done by asking leading questions or by nonverbal
responses to the participants’ comments during focus groups.
As for empathy and STS, there has been little, if any, empirical research
focusing on the connection between the two (Badger, et al., 2008; MacRitchie &
Leibowitz, 2010). According to Jenkins and Baird (2002), there is very limited research
in regards to how and if empathy serves as the gateway of vulnerability to STS. In the
research that has been completed, gaps have been identified. In Badger, Royse, and
Craig’s research, the study limited generalizability and causality could not be assumed.
In addition, selection bias was possibly an issue as the authors used a self-selection
sampling method. Furthermore, the instruments used to collect data were self-report,
and this could be an issue due to the misrepresentation of information by the
39
participants. Lastly, the authors stated that the data collection instrument may have not
been sensitive enough.
Without question, there is a great deal of research that is yet to be completed in
the areas of empathy, VT, and CWS social workers. The authors’ current research will
assist in filling this gap, as the research will bring awareness to the field of social work
by exploring CWS social workers’ use of empathy and whether it heightens their risk of
exposure to VT. This research will also encourage ongoing training and education
within CWS agencies in order to ensure that social workers have opportunities to
properly address VT as well as to learn ways to handle it appropriately.
Summary
In essence, the nature of CWS social work brings social workers in daily contact
with clients that have experienced tragedy and trauma. By using their empathic skills,
social workers place themselves at risk of experiencing VT. Ultimately, VT can have
negative impacts on social worker practice; therefore, training and support within CWS
agencies is a necessity. Pearlman and Saakvitne (1995b) discuss a specific process for
the management and treatment of CF. Their process includes personal, professional, and
organizational interventions. On a personal level, the authors suggest that professionals
seek out a reasonable work-life balance, utilize healing activities, and engage in
personal therapy. In the workplace, Pearlman and Saakvitne suggest engaging in
consistent supervision, developing professional networks, and practicing regular selfcare activities. Within organizations, the authors suggest that employers create a
comfortable environment, foster support, and ensure respect in the workplace. Newell
40
and MacNeil (2010) suggest that information on VT, STS, and CF should be included in
training programs at social work agencies. In addition, social workers should be their
own advocates for resources relating to VT, STS, and CF (Newell & MacNeil).
Due to the negative symptoms associated with VT for professionals in the social
work field, it is crucial to raise awareness in order for social workers to understand VT
so that such symptoms are not exacerbated. Research has shown that when
professionals use empathy, they are at a higher risk in developing VT. Based on the
nature of the social work field, it is inevitable that a high percentage of workers will
experience VT at some point during their careers. Therefore, these authors would like to
determine the specific relationship between social workers use of empathy and their
heightened risk of developing VT. In doing so, the research will provide insight into the
different levels of empathy and how each level correlates with VT symptoms, which
can then assist in formulating more effective training, self-care, and support programs
for social workers.
41
Chapter 3
Methodology
Introduction
In this section, the authors will address the specific research question, discuss
the study design, and define the dependent and independent variables. In addition, the
study population, sampling method, and measurement instruments will be discussed.
Furthermore, the authors’ data collection procedures, statistical analysis plan, and
human subjects information will be outlined in this particular section.
Research Question
This research will empirically examine the relationship between empathy and
VT as well as possible factors associated with the outcome of this relationship.
Study Design
These authors utilized the quantitative design by using survey methods.
Specifically, SurveyMonkey was utilized, which allowed for the use of an online
survey. One advantage of the online survey design includes cost savings, as there is no
need for postage or interviewers. Other advantages include ease of data analysis, quick
turnaround time, and higher response rates. In contrast, some of the weaknesses of the
online survey design include greater confidentiality issues due to potential network
security problems, as well as technical difficulties with computer hardware and software
(Colorado State University, 2011).
42
Variables
The independent variable was identified as empathy. The authors conceptualized
the term empathy as feeling the pain and emotions of others. The dependent variable
was identified as VT. The authors conceptualized the term vicarious trauma as the
resulting behaviors of being exposed to the traumatic experiences of others.
These authors operationalized both empathy and VT by utilizing a survey with a
Likert Scale consisting of responses that included never, rarely, sometimes, often, and
always. As to empathy, these authors explored whether CWS social workers reported
imagining being in their clients’ shoes, reported spending more time than expected with
their clients, or reported if they have been emotionally affected after hearing their
clients’ stories. As to VT, these authors explored whether CWS social workers reported
experiencing VT, reported thinking about their clients’ experiences outside of their
working hours, or reported having difficulties getting the images of their clients’ stories
out of their minds.
Sampling
The study population consisted of social workers employed by a county CWS
agency in northern California. Specifically, social workers in the Social Worker III
classification were included in this study. Although 54 social workers were currently
employed by the agency at time of data collection, five employees were on leave for
various reasons, so the authors did not have access to these employees. In addition, the
authors are both employees of the agency, which then resulted in the availability of 47
social workers for the study population. These authors utilized nonprobability-sampling
43
methods through purposive/judgmental sampling. The sample size consisted of 28
Social Worker IIIs for a response rate of 60%.
Measurement Instruments
These authors developed nine survey questions focused on VT and 10 questions
focused on empathy. In addition, demographic questions were included in the survey
that related to the following topics: (a) gender, (b) age, (c) ethnic/cultural heritage, (d)
years of experience, (e) educational level, and (f) current caseload size.
Many of the survey questions were taken from an already existing survey about
vicarious trauma: Clinicians’ Trauma Reaction Survey (Wilson & Thomas, 2004). In
addition, these authors reviewed the Professional Quality of Life Scale (Stamm, 2009)
and adapted some of their survey questions from that tool. These authors felt that the
questions needed to be personalized, as they were trying to capture CWS social
workers’ specific feelings about their work. Therefore, the questions in the
aforementioned survey and scale were not fully adopted, and all of the questions in
these authors’ survey were altered. The authors of this project allowed the county CWS
Director and three CWS program managers to review their survey, and these four
individuals approved the survey before it was released via SurveyMonkey’s website.
The authors’ measurement of VT and empathy shows a higher rate of reliability where
the alpha coefficient is .732 for VT and .807 for empathy.
Data Collection Procedures
The authors received permission from the Deputy Director of the county CWS
agency to distribute surveys to all Social Worker IIIs employed by the agency. The
44
authors sent an email briefly describing the research and provided a hyperlink to
SurveyMonkey so that the social workers could access the survey online. By
distributing the hyperlink via e-mail and emphasizing that the survey was voluntary and
anonymous, any potential conflicts of interest may have been reduced. In addition,
neither of these authors occupies a management position, which may have aided the
social workers in not feeling pressured or mandated to complete the survey. No
inducements were offered. These authors provided their contact information should the
social workers experience difficulties accessing the survey. The survey was open to
participants for a total of one month. The authors provided a two-week deadline for the
completion of the survey and then extended the deadline an additional two weeks in
order to collect more data.
Statistical Analysis Plan
These authors utilized a quantitative design by using survey methods with both
univariate and bivariate analysis in order to statistically analyze their research. The
authors inputted data retrieved from SurveyMonkey into Statistical Package for the
Social Sciences (SPSS) so that it could be effectively analyzed. Chi-square tests and ttests were completed in order to determine if there were any significant statistical
relationships between the selected independent and dependent variables. Results were
then fully detailed within the project.
Human Subjects
The subjects’ rights to privacy were protected by their anonymity, as no
identifying characteristics were asked of the subjects. According to SurveyMonkey’s
45
website, the survey authors are permitted to disable the storage of email addresses
and disable IP address collection so that anonymous survey responses could be
collected. In addition, the safety of the data was maintained through SurveyMonkey’s
physical, network, storage, and organizational security measures. These authors also
ensured that the participants understood that they were participating in the survey on a
voluntary basis, as implied consent was obtained from the subjects through the survey,
as accessed by the SurveyMonkey hyperlink, in an encrypted format.
This research has been reviewed according to California State University,
Sacramento’s Institutional Review Board procedures for research involving human
subjects. The Protocol for the Protection of Human Subjects was submitted and
approved by the Division of Social Work as minimal risk. Some participants may have
found that completing the survey stimulated awareness and provoked emotion about the
nature of their work. As a result, these subjects may then have experienced some
emotional discomfort during or after the completion of the survey. In the Consent to
Participate in Research document that all of the participants received via
SurveyMonkey, the authors provided the contact numbers for the Employee Assistance
Program as well as mental health services in the event that individuals experienced
emotional discomfort after completing the survey.
46
Chapter 4
Data Analysis
Demographic Data
As part of the demographic data, the authors collected information from the 28
survey participants in regards to gender, age, race/ethnicity, years of social work
experience, education, and current caseload size. The majority of the sample is female
(93%), aged 26-45 years (79%), Caucasian (43%), with 10 years or less of CWS
experience (89%), a Master’s degree education (86%), and carries a workload of 11-15
cases (21%). See Table 1 for outcomes.
Level of VT and Empathy by Sample’s Demographic Characteristics
The authors conducted T-Tests using SPSS to analyze the correlation between
each variable [Independent Variable (IV)=empathy, and Dependent Variable (DV)=VT]
with each demographic question. Tables 2 and 3 are derived from the SPSS T-Test
tables that are provided in Appendix A.
When looking at the relationship between the DV (VT) and each demographic
question, gender is significantly associated with VT. Females are more likely to report
experiences of VT than males (p<0.10). No other demographic characteristics are
significantly associated with the level of VT.
When looking at the relationship between the IV (Empathy) and each
demographic question, age is significantly associated with empathy. Social workers that
are 35 years of age or younger are more likely to report experiences of empathy than
47
Table 1
Outcome of Demographic Data
Sample Characteristics
Gender
Female
Male
Age
25 or less
26-35
36-45
46-55
56-65
Race/Ethnicity
Asian
African American
Hispanic
Caucasian
Biracial
Other
Years of Experience
1-5 years
6-10 years
11-15 years
Education
Bachelors
Masters
Current Caseload
1-5
6-10
11-15
16-20
21-25
26 or more
Sample size (N)
%
92.9
7.1
7.1
39.3
39.3
10.7
3.6
10.7
10.7
17.9
42.9
10.7
7.1
46.4
42.9
10.7
14.3
85.7
10.7
14.3
21.4
25
17.9
10.7
28
48
Table 2
Vicarious Trauma by Characteristics
VT by Characteristics
Gender*
Female
Male
Age
35 or younger
36 or older
Ethnic/Cultural Heritage
Non-White
White
Years of Experience
1-5 years
6 or more years
Education Level
Bachelors
Masters
Note: *: p<0.10 **: p<0.05 ***: p<0.01
Means of VT
18.1154
12.5
17.9231
17.5333
17.0625
18.5833
17.6923
17.7333
17
17.8333
Table 3
Empathy by Characteristics
Empathy by Characteristics
Gender
Female
Male
Age**
35 or younger
36 or older
Ethnic/Cultural Heritage
Non-White
White
Years of Experience
1-5 years
6 or more years
Education Level
Bachelors
Masters
Note: *: p<0.10 **: p<0.05 ***: p<0.01
Means of Empathy
20.9615
26
23.5385
19.4
20.25
22.75
22.9231
19.9333
18.25
21.8333
those social workers that are 36 years of age or older (p<0.05). No other demographic
characteristics are significantly associated with the level of empathy.
49
Hypotheses Testing
These authors conducted all possible Chi-Square tests using cross tabulations in
SPSS between the 10 IV (Empathy) and the nine DV (VT) survey questions. The
relationships that had statistical significance, p<0.05, were analyzed. Tables 4 through
14, the dummy tables showing the relationship between the row and column variables
(Weinbach & Grinnell, 2010), are derived from the SPSS crosstab tables that are
provided in Appendix B.
Eleven hypotheses were tested as follows:
1. The more time workers spend with their clients than what is expected, the more
hyper-vigilant the workers would be.
2. When workers experience higher levels of having a protective attitude toward
their clients, the more hyper-vigilant the workers would be.
3. When workers practice self-care more regularly, the less likely they would be to
react as their clients might.
4. The more time workers spend with their clients than what is expected, the
greater their risk of experiencing VT.
5. When social workers are more likely to be emotionally affected, they are more
likely to have reported experiencing VT in their professional work.
6. The more time workers spend with their clients than what is expected, the more
difficulty they would have in getting the images of their clients’ stories out of
their minds.
50
7. When workers try to imagine being in their clients’ shoes after hearing the
clients’ experiences, they will experience high rates of feeling emotionally
drained.
8. The more time workers spend with their clients than what is expected, the more
workers would find themselves thinking about their clients’ experiences outside
of working hours.
9. When workers are emotionally affected, they would find themselves thinking
about their clients’ experiences outside of working hours.
10. When a worker’s urge to solve clients’ problems increases, the worker would
find him or herself thinking about the clients’ experiences outside of working
hours.
11. When a worker views a client as heroic given the client’s traumatic experiences,
the worker would extend concerns for the client beyond the work setting.
The first hypothesis of this study is that the more time workers spend with their
clients than what is expected, the more hyper-vigilant the workers would be. In Table 4,
empathy is measured by spending time1 and the VT is measured by hyper-vigilance.2
Table 4 shows the statistically significant relationship (χ²=6.283;df=1;p=.012) that,
when social workers are more likely to spend more time than is expected of them with
their clients, they are more likely to have higher levels of hyper-vigilance. Thus, the
findings in Table 4 confirm the first hypothesis.
Spending time as empathy is measured by the following question: “I find myself spending more
time than is expected of me with my clients.”
2 Hyper-vigilance as the VT is measured by the following question: “In working with my clients, I
have found myself to be hyper-vigilant as to what is happening around me.”
1
51
Table 4
Relationship between Spending More Time with Clients than is Expected and Hypervigilance
Hyper-vigilance
Level
Low Level
High Level
Note: χ²=6.283;df=1;p=.012
Level of Spending More Time with Clients
Low Level
High Level
X
X
The second hypothesis of this study is that when workers experience higher
levels of having a protective attitude toward their clients, the more hyper-vigilant the
workers would be. In Table 5, empathy is measured by protective attitude3 and the VT
is measured by hyper-vigilance.4 Table 5 shows the statistically significant relationship
(χ²=5.305;df=1;p=.021) that, when social workers are more likely to have a protective
attitude toward their clients, they are likely to have lower levels of hyper-vigilance.
Thus, the findings in Table 5 did not confirm the second hypothesis.
Table 5
Relationship between Protective Attitude toward Clients and Hyper-vigilance
Hyper-vigilance Level
Low Level
High Level
Note: χ²=5.305;df=1;p=.021
Level of Protective Attitude
Low Level
High Level
X
X
The third hypothesis of this study is that when workers practice self-care more
regularly, they are less likely to react as their clients might. In Table 6, empathy is
Protective attitude as empathy is measured by the following question: “I have experienced a
protective attitude toward my clients.”
4 Refer to footnote #2 for the question wording.
3
52
measured by self-care5 and the VT is measured by reacting as clients might.6 Table 6
shows the statistically significant relationship (χ²=5.535;df=1;p=.019) that, when social
workers are more likely to practice self-care, they are less likely to react as their clients
might. Thus, the findings in Table 6 confirm the third hypothesis.
Table 6
Relationship between Practicing Self-care and Reacting as Clients Might
Reacting as Clients Might Level
Low Level
High Level
Note: χ²=5.535;df=1;p=.019
Level of Self-Care
Low Level
High Level
X
X
The fourth hypothesis of this study is that the more time workers spend with
their clients that what is expected, the greater their risk of experiencing VT. In Table 7,
empathy is measured by spending time7 and the VT is measured by VT experience8.
Table 7 shows the statistically significant relationship (χ²=4.173;df=1;p=.041) that,
when social workers are more likely to spend more time than is expected of them with
their clients, they are more likely to have reported experiencing VT in their professional
work. Thus, the findings in Table 7 confirm the fourth hypothesis.
Self-care as empathy is measured by the following question: “I practice self-care (i.e., doing things
for yourself like getting a massage, exercising, etc.) to minimize the effects of stress that I experience in
the workplace.”
6 Reacting as clients might as VT is measured by the following question: “I find that I react as my
clients might (e.g., exaggerated responses, on edge around government officials, not trusting of
“systems”…).”
7 Refer to footnote #1 for the question wording.
8 VT experience as VT is measured by the following question: “In my professional work with CWS, I
have experienced vicarious trauma. (Vicarious trauma is defined as the phenomena of the transmission of
traumatic stress by observation and/or bearing witness to the stories of traumatic events, or the natural,
consequent behaviors and emotions resulting from knowledge about a traumatizing event experienced by
another person. It is the stress resulting from helping or wanting to help a traumatized or suffering
person.)”
5
53
Table 7
Relationship between Spending More Time with Clients than is Expected and VT
Experience
VT Experience Level
Low Level
High Level
Note: χ²=4.173;df=1;p=.041
Level of Spending More Time with Clients
Low Level
High Level
X
X
The fifth hypothesis of this study is that when social workers are more likely to
be emotionally affected, they are more likely to have reported experiencing VT in their
professional work. In Table 8, empathy is measured by emotionally affected9 and the
VT is measured by VT experience.10 Table 8 shows the statistically significant
relationship (χ²=11.221;df=1;p=.001) that, when social workers are more likely to be
emotionally affected, they are more likely to have reported experiencing VT in their
professional work. Thus, the findings in Table 8 confirm the fifth hypothesis.
Table 8
Relationship between Being Emotionally Affected and VT Experience
VT Experience Level
Low Level
High Level
Note: χ²=11.221;df=1;p=.001
Level of Being Emotionally Affected
Low Level
High Level
X
X
The sixth hypothesis of this study is that the more time workers spend with their
clients than what is expected, the more difficulty they would have in getting the images
of their clients’ stories out of their mind. In Table 9, empathy is measured by spending
Emotionally affected as empathy is measured by the following question: “I have found myself
emotionally affected after hearing the stories of my clients (i.e. have cried, had tears).”
10 Refer to footnote #8 for the question wording.
9
54
time11 and the VT is measured by difficulty with images.12 Table 9 shows the
statistically significant relationship (χ²=4.732;df=1;p=.030) that, when social workers
are more likely to spend more time than is expected of them with their clients, they are
more likely to have difficulty with getting the images of their clients’ stories out of their
mind. Thus, the findings in Table 9 confirm the sixth hypothesis.
Table 9
Relationship between Spending More Time with Clients than is Expected and Difficulty
with Images
Difficulty with Images
Level
Low Level
High Level
Note: χ²=4.732;df=1;p=.030
Level of Spending More Time with Clients
Low Level
High Level
X
X
The seventh hypothesis of this study is that when workers try to imagine being
in their clients’ shoes after hearing the clients’ experiences, they will experience high
rates of feeling emotionally drained. In Table 10, empathy is measured by imagine
being in shoes13 and the VT is measured by emotionally drained.14 Table 10 shows the
statistically significant relationship (χ²=4.169;df=1;p=.041) that, when social workers
are more likely to imagine being in their clients shoes, they are less likely to feel
Refer to footnote #1 for the question wording.
Difficulty with images as VT is measured by the following question: “After meeting with clients, I
have difficulty getting the images of their stories out of my mind.”
13 Imagine being in shoes as empathy is measured by the following question: “After hearing stories of
CWS clients’ experiences, I have tried to imagine being in their shoes.”
14 Emotionally drained as VT is measured by the following question: “I feel emotionally drained due
to the nature of my work.”
11
12
55
emotionally drained. Thus, the findings in Table 10 do not confirm the seventh
hypothesis.
Table 10
Relationship between Imagine Being in Clients’ Shoes and Feeling Emotionally
Drained
Emotionally Drained Level
Low Level
High Level
Note: χ²=4.169;df=1;p=.041
Level of Imagine Being in Shoes
Low Level
High Level
X
X
The eighth hypothesis of this study is that the more time workers spend with
their clients than what is expected, the more workers would find themselves thinking
about their clients’ experiences outside of working hours. In Table 11, empathy is
measured by spending time15 and the VT is measured by thinking outside of work.16
Table 11 shows the statistically significant relationship (χ²=9.852;df=1;p=.002) that,
when social workers are more likely to spend more time than is expected of them with
their clients, they are more likely to think about their clients’ experiences outside of
working hours. Thus, the findings in Table 11 confirm the eighth hypothesis.
Refer to footnote #1 for the question wording.
Thinking outside of work as VT is measured by the following question: “I find myself thinking
about my clients’ experiences outside of working hours.”
15
16
56
Table 11
Relationship between Spending More Time with Clients than is Expected and Thinking
About Clients Outside Working Hours
Thinking Outside of Work Level
Low Level
High Level
Note: χ²=9.852;df=1;p=.002
Level of Spending More Time with Clients
Low Level
High Level
X
X
The ninth hypothesis of this study is that when workers are emotionally affected,
the workers would find themselves thinking about their clients’ experiences outside of
working hours. In Table 12, empathy is measured by emotionally affected17 and the VT
is measured by thinking outside of work.18 Table 12 shows the statistically significant
relationship (χ²=4.929;df=1;p=.026) that, when social workers are more likely to have
higher levels of being emotionally affected, they are more likely to think about their
clients’ experiences outside of working hours. Thus, the findings in Table 12 confirm
the ninth hypothesis.
Table 12
Relationship between Being Emotionally Affected and Thinking About Clients Outside
Working Hours
Thinking Outside of Work
Level
Low Level
High Level
Note: χ²=4.929;df=1;p=.026
17
18
Level of Being Emotionally Affected
Low Level
High Level
Refer to footnote #9 for the question wording.
Refer to footnote #16 for the question wording.
X
X
57
The tenth hypothesis of this study is that when a worker’s urge to solve clients’
problems increases, the worker would find him or herself thinking about the clients’
experiences outside of working hours. In Table 13, empathy is measured by solve
problems19 and the VT is measured by thinking outside of work.20 Table 13 shows the
statistically significant relationship (χ²=4.929;df=1;p=.026) that, when social workers
are more likely to have an urge to solve the problems of their clients, they are more
likely to think about their clients’ experiences outside of working hours. Thus, the
findings in Table 13 confirm the tenth hypothesis.
Table 13
Relationship between Urge to Solve Clients’ Problems and Thinking About Clients
Outside Working Hours
Thinking Outside of Work
Level
Low Level
High Level
Note: χ²=4.929;df=1;p=.026
Level of Urge to Solve Clients Problems
Low Level
High Level
X
X
The eleventh and final hypothesis of this study is that when a worker views the
client as heroic given the client’s traumatic experiences, the worker would endure
concerns for the clients beyond the work setting. In Table 14, empathy is measured by
clients as heroic21 and the VT is measured by concern for clients.22 Table 14 shows the
Solve problems as empathy is measured by the following question: “I have felt a strong urge to
solve the problems of my clients.”
20 Refer to footnote #16 for the question wording.
21 Clients as heroic as empathy is measured by the following question: “I have thought of my clients
as heroic for enduring the traumatic experiences.”
22 Concern for clients as VT is measured by the following question: “I have endured concerns for my
clients that extend beyond the work setting.”
19
58
statistically significant relationship (χ²=8.400;df=1;p=.004) that, when social workers
are more likely to think of their clients as heroic for enduring the traumatic experiences,
workers are more likely to endure concerns for their clients that extend beyond the work
setting. Thus, the findings in Table 14 confirm the eleventh hypothesis.
Table 14
Relationship between Thought of Clients as Heroic and Extending Concerns for Clients
Beyond the Work Setting
Concern for Clients
Level
Low Level
High Level
Note: χ²=8.400;df=1;p=.004
Level of Thought of Clients as Heroic
Low Level
High Level
X
X
Table 15 presents the eleven hypotheses and the results of each Chi-square test.
Table 15
Summary of Results of Chi-square Tests
Hypotheses
The more time workers spend with their clients than what is
expected, the more hyper-vigilant the workers would be.
When workers experience higher levels of having a
protective attitude toward their clients, the more hypervigilant the workers would be.
Findings
Confirmed
Rejected
When workers practice self-care more regularly, the less
likely they would be to react as their clients might.
Confirmed
The more time workers spend with their clients than what is
expected, the greater their risk of experiencing VT.
Confirmed
59
Table 15 (continued)
Hypotheses
When social workers are more likely to be emotionally
affected, they are more likely to have reported experiencing
VT in their professional work.
The more time workers spend with their clients than what is
expected, the more difficulty they would have in getting the
images of their clients’ stories out of their minds.
When workers try to imagine being in their clients’ shoes
after hearing the clients’ experiences, they will experience
high rates of feeling emotionally drained.
Findings
Confirmed
Confirmed
Rejected
The more time workers spend with their clients than what is
expected, the more workers would find themselves thinking
about their clients’ experiences outside of working hours.
Confirmed
When workers are emotionally affected, they would find
themselves thinking about their clients’ experiences outside
of working hours.
Confirmed
When a worker’s urge to solve clients’ problems increases,
the worker would find him or herself thinking about the
clients’ experiences outside of working hours.
Confirmed
When a worker views a client as heroic given the client’s
traumatic experiences, the worker would extend concerns
for their clients beyond the work setting.
Confirmed
60
Chapter 5
Conclusion and Recommendations
By surveying CWS social workers in a northern California county, these authors
were attempting to determine the relationship between use of empathy and risk of
exposure VT. Overall, the authors postulated that there would be a relationship
between CWS social workers’ use of empathy with their clients and their risk of
exposure to VT. After the data analysis was completed, it was determined that of the 11
cross-tabbed variables which showed statistical significance, 9 of the cross tabulations
validated these authors’ hypotheses. For these authors, the most significant validated
hypothesis was when social workers are emotionally affected, they find themselves
thinking about their clients’ experiences outside of working hours. This finding
coincides with Bride’s (2007) research in which he found 40.5% of the 600 Master’s
level social workers responded that they had unintentional intrusive thoughts connected
to their work with traumatized clients.
Interestingly, there were two hypotheses that did not support these authors’
research. These authors hypothesized when CWS social workers experience higher
levels of having a protective attitude with their clients, the more hyper-vigilant the
workers would be. In addition, the authors hypothesized that when social workers try to
imagine being in their clients’ shoes after hearing their clients’ experiences, the workers
would experience high rates of feeling emotionally drained. The subsequent research
results in regards to both of these hypotheses proved otherwise, which the authors found
unusual. These authors speculate that some of the respondents may have created
61
barriers for themselves in order to emotionally distance themselves from their
respective clients. As a result, some of the social workers are not as hyper-vigilant or as
emotionally drained as the authors hypothesized.
The authors expected there would be a significantly higher number of female
respondents in this study, as there are very few male social workers employed by the
CWS agency that participated in this research. As expected, 93% of the respondents
were female which may reflect the field of social work in general. As a result, it was
difficult to analyze gender due to having a higher rate of females.
When T-Tests were conducted between the dependent variable, VT, with each
demographic question, a statistically significant relationship was only found between
VT and gender. These authors’ research demonstrated that females are more likely to
report VT experiences as compared to males. These authors attributed this particular
finding to the disproportionate number of female respondents in this research. If more
males had participated in this study, the outcome could have been notably different.
When T-Tests were conducted between the independent variable, empathy, with
each demographic question, a statistically significant relationship was only found
between empathy and age. This research demonstrated that social workers who were 35
years of age or younger are more likely to have greater empathy than social workers
who were 36 years of age or older. The authors believe this finding to be accurate, as
younger social workers have probably been in the field for shorter periods of time than
older social workers and therefore are not as jaded. In addition, younger social workers
62
likely graduated more recently from postsecondary education and may have had some
recent, although limited, education in regards to empathy and VT.
Implications
The authors believe there is a relationship between empathy and VT but that
more exhaustive research is needed in order to solidify the findings even further.
Implications of this study include raising awareness of VT in CWS agencies and how
social workers’ use of empathy may heighten their risk of being exposed to VT. Social
workers’ cognizance of VT symptoms and their use of empathy may have a
preventative function regarding VT. An awareness of personal reactions to VT may
allow social workers to implement personal self-care strategies to ameliorate the effects
of VT. This study may encourage CWS agencies to provide ongoing training
opportunities and support services to social workers.
CWS social workers have jobs that elicit strong emotions, as they are regularly
exposed to unimaginable cases of child abuse and neglect. These authors believe most
CWS social workers are innately empathic individuals and that they care about their
clients. As a result, a majority of CWS social workers will experience the effects of VT
at some point in their careers. Those social workers who do not have agency support in
addressing their VT experiences will be negatively affected both personally and
professionally. There are emotional and psychological impacts associated with VT that
need to be addressed with CWS social workers at the agency level. It is the agency’s
responsibility to support their social workers through training and education; however,
social workers also need to be proactive in their workplaces and advocate for their own
63
needs. Perhaps CWS social workers could form small workgroups in their respective
agencies in order to discuss their VT experiences on a regular basis and to support each
other. Furthermore, this research may also encourage social workers to become directly
involved in developing policies and procedures in regards to how to handle VT at their
respective CWS agencies.
Limitations and Future Direction
The authors were unable to analyze data in regards to caseload size due to the
survey lacking the inclusion of the particular CWS units in which the respondents were
placed. This exclusion proved to be significant, as social workers within each unit at the
identified CWS agency have different responsibilities and varying workloads. In other
words, a workload of 25 cases in one unit may be considered average while a workload
of six cases in a different unit may be considered very high.
To increase generalizability, replicating the authors’ research design study
within other CWS agencies in different geographical locations will need to be
completed. Significantly more social workers need to be surveyed in future studies. The
sample size in this particular study was very small. In future research, data will need to
be collected on both the social workers’ caseload sizes and assigned units in order to
conduct data analysis to determine if there is a correlation between workload and social
workers’ use of empathy and their exposure to VT. It is clear that much more research
is needed in regards to empathy and VT in the CWS field.
64
Appendix A
SPSS T-Test Tables
Table 2
Group Statistics
Q21_n
VT
N
Female
Male
Mean
Std. Deviation
Std. Error Mean
26
18.1154
4.22684
.82895
2
12.5000
.70711
.50000
Independent Samples Test
Levene’s Test
for Equality of
Variances
t-test for Equality of Means
95% Confidence
Interval of the
F
VT
Equal variances
1.955
Sig.
t
.174
df
1.845
Sig. (2-
Mean
Std. Error
tailed)
Difference
Difference
3.04312
26
.076
5.61538
5.801 10.791
.000
5.61538
Difference
Lower
Upper
-.63984
11.87061
.96807 3.47964
7.75113
assumed
Equal variances
not assumed
Group Statistics
Age - grouped
VT
N
Mean
Std. Deviation
Std. Error Mean
35 or younger
13
17.9231
3.59308
.99654
36 or older
15
17.5333
4.99809
1.29050
65
Independent Samples Test
Levene’s Test for
Equality of
Variances
t-test for Equality of Means
95% Confidence
Interval of the
F
VT Equal
Sig.
.298
t
.590
df
Sig. (2-
Mean
Std. Error
tailed)
Difference
Difference
Difference
Lower
Upper
.233
26
.817
.38974
1.66945
-3.04186
3.82134
.239
25.21
.813
.38974
1.63049
-2.96686
3.74635
variances
assumed
Equal
variances not
5
assumed
Group Statistics
Race - 2 groups
VT
N
Mean
Std. Deviation
Std. Error Mean
Non-White
16
17.0625
5.17003
1.29251
White
12
18.5833
2.84312
.82074
Independent Samples Test
Levene’s Test
for Equality of
Variances
t-test for Equality of Means
95% Confidence
Interval of the
F
VT
Equal variances
2.888
Sig.
.101
t
-.918
df
Sig. (2-
Mean
Std. Error
tailed)
Difference
Difference
Difference
Lower
Upper
26
.367
-1.52083
1.65758
-4.92804
1.88638
-.993 24.176
.330
-1.52083
1.53107
-4.67960
1.63793
assumed
Equal variances
not assumed
66
Group Statistics
Experience - 2 group
VT
N
Mean
Std. Deviation
Std. Error Mean
1-5 years
13
17.6923
2.98286
.82730
6 or more years
15
17.7333
5.33809
1.37829
Independent Samples Test
Levene’s Test
for Equality of
Variances
F
VT Equal variances
t-test for Equality of Means
Sig.
2.923
.099
t
df
Std.
95% Confidence
Error
Interval of the
Difference
Sig. (2-
Mean
Differenc
tailed)
Difference
e
Lower
Upper
-.025
26
.981
-.04103
1.67118
-3.47618
3.39413
-.026
22.49
.980
-.04103
1.60751
-3.37053
3.28848
assumed
Equal variances
not assumed
8
Group Statistics
Q25_n
VT
N
Bachelors
Masters
Mean
Std. Deviation
Std. Error Mean
4
17.0000
2.82843
1.41421
24
17.8333
4.56515
.93186
Independent Samples Test
Levene’s Test
for Equality of
Variances
F
VT
Equal variances
1.037
Sig.
.318
t-test for Equality of Means
t
df
Std.
95% Confidence
Error
Interval of the
Difference
Sig. (2-
Mean
Differenc
tailed)
Difference
e
Lower
Upper
-.351
26
.729
-.83333
2.37621
-5.71770
4.05103
-.492
6.023
.640
-.83333
1.69362
-4.97372
3.30706
assumed
Equal variances
not assumed
67
Table 3
Group Statistics
Q21_n
Empathy
N
Female
Male
Mean
Std. Deviation
Std. Error Mean
26
20.9615
5.56044
1.09049
2
26.0000
2.82843
2.00000
Independent Samples Test
Levene’s
Test for
Equality of
Variances
t-test for Equality of Means
95% Confidence
Interval of the
Sig.
F
Empathy
Equal variances
.408
Sig.
t
.529
df
(2-
Mean
Std. Error
tailed)
Difference
Difference
Difference
Lower
Upper
-1.253
26
.221
-5.03846
4.02166
-13.30510
3.22818
-2.212
1.677
.181
-5.03846
2.27798
-16.89060
6.81368
assumed
Equal variances
not assumed
Group Statistics
Age - grouped
Empathy
N
Mean
Std. Deviation
Std. Error Mean
35 or younger
13
23.5385
2.25889
.62650
36 or older
15
19.4000
6.80126
1.75608
68
Independent Samples Test
Levene’s Test
for Equality of
Variances
t-test for Equality of Means
95% Confidence
Empathy Equal variances
df
Interval of the
Sig.
Mean
(2-
Differen
Std. Error
tailed)
ce
Difference
Difference
F
Sig.
t
Lower
Upper
6.621
.016
2.092
26
.046 4.13846
1.97855 .07150
8.20542
2.220
17.461
.040 4.13846
1.86449 .21263
8.06430
assumed
Equal variances
not assumed
Group Statistics
Race - 2 groups
Empathy
N
Mean
Std. Deviation
Std. Error Mean
Non-White
16
20.2500
7.13209
1.78302
White
12
22.7500
1.42223
.41056
Independent Samples Test
Levene’s Test
for Equality of
Variances
t-test for Equality of Means
95% Confidence
Interval of the
Mean
F
Empathy
Equal variances
11.538
Sig.
.002
t
df
Sig. (2-
Differenc
Std. Error
tailed)
e
Difference
Difference
Lower
Upper
-1.191
26
.244
-2.50000
2.09868
-6.81389
1.81389
-1.366
16.569
.190
-2.50000
1.82968
-6.36795
1.36795
assumed
Equal variances
not assumed
69
Group Statistics
Experience - 2 group
Empathy
N
Mean
Std. Deviation
Std. Error Mean
1-5 years
13
22.9231
2.17798
.60406
6 or more years
15
19.9333
7.11604
1.83735
Independent Samples Test
Levene’s Test
for Equality of
Variances
t-test for Equality of Means
95% Confidence
Interval of the
F
Empathy
Equal variances
Sig.
8.439
.007
t
df
Sig. (2-
Mean
Std. Error
tailed)
Difference
Difference
Difference
Lower
Upper
1.454
26
.158
2.98974
2.05659
-1.23765
7.21713
1.546
16.959
.141
2.98974
1.93411
-1.09162
7.07110
assumed
Equal variances
not assumed
Group Statistics
Q25_n
Empathy
Bachelors
Masters
N
Mean
Std. Deviation
Std. Error Mean
4
18.2500
5.50000
2.75000
24
21.8333
5.49044
1.12073
70
Independent Samples Test
Levene’s
Test for
Equality of
Variances
t-test for Equality of Means
95% Confidence
Interval of the
F
Empathy
Equal variances
.124
Sig.
.728
t
df
Sig. (2-
Mean
Std. Error
tailed)
Difference
Difference
Difference
Lower
Upper
-1.208
26
.238
-3.58333
2.96577
-9.67957
2.51290
-1.207
4.065
.293
-3.58333
2.96960
-11.77680
4.61014
assumed
Equal variances
not assumed
71
Appendix B
SPSS Crosstab Tables
Table 4
Table 5
72
Table 6
73
Table 7
Table 8
74
Table 9
75
Table 10
76
Table 11
Table 12
77
Table 13
78
Table 14
79
Appendix C
Consent Form E-mailed to Social Workers
Consent to Participate in Research
You are being asked to participate in a master-level research study through California State
University, Sacramento conducted by Samantha Hamilton and Robin Miller, graduate students,
under the supervision of Kisun Nam, Ph.D. The purpose of this study is to explore the
relationship between Child Welfare Services (CWS) social workers’ use of empathy and their
exposure to vicarious trauma during the course of their work. You are being invited to
participate in this research project because you are employed as a Social Worker III with the
Solano County Child Welfare Services Division, and your input will be valuable to this
research.
You will be provided with a hyperlink to complete a survey consisting of questions relating to
your use of empathy and your risk of exposure to vicarious trauma in your daily work. Most
persons typically complete the survey within 15 minutes. Some respondents may find
completing this survey stimulates awareness and provokes emotion about the nature of their
work. The results of this study will be used for scholarly purposes only.
All surveys are anonymous, and your responses will be kept confidential to the degree permitted
by the technology used. All data is stored in a password protected electronic format. However,
no absolute guarantees can be given for the confidentiality of electronic data. To further protect
your confidentiality, the surveys will not contain information that will personally identify you.
80
Your participation in this research study is voluntary, and you may choose not to participate
without penalty. If you decide to participate in this research survey, you may withdraw at any
time without penalty. However, the researchers will be unable to remove anonymous data from
the database in the event you complete and submit the survey and then choose to withdraw.
If you have any questions about this research study, please contact Samantha Hamilton at 707784-8666, Robin Miller at 707-784-8287, or Dr. Kisun Nam, Faculty Advisor, at 916-278-7069
or by e-mail at knam@saclink.csus.edu.
This research has been reviewed according to California State University, Sacramento’s
Institutional Review Board (IRB) procedures for research involving human subjects.
There is minimal risk of experiencing emotional discomfort due to the nature of some of
the survey questions. Should you desire to access confidential, professional, short-term
counseling services, you are encouraged to contact the Employee Assistance Program
(EAP) at 1-800-242-6220, or Solano County Mental Health Services at 1-800-547-0495.
It is highly encouraged that you print the above page, as it provides contact information as
well as resources should you have any questions/concerns and/or experience emotional
discomfort.
81
Appendix D
CWS Social Workers’ Use of Empathy and Trauma Reaction Survey
1. This survey is being conducted as a master-level research study through California
State University, Sacramento by Samantha Hamilton and Robin Miller, graduate
students, under the supervision of Kisun Nam, Ph.D. The goal of this study is to explore
the relationship between Child Welfare Services (CWS) social workers’ use of empathy
and their risk of exposure to vicarious trauma (VT) during the course of their work. For
research purposes, VT is defined as the phenomena of the transmission of traumatic
stress by observation and/or bearing witness to the stories of traumatic events, or the
natural, consequent behaviors and emotions resulting from knowledge about a
traumatizing event experienced by another person. It is the stress resulting from helping
or wanting to help a traumatized or suffering person. All surveys are anonymous and
confidential. Some respondents may find completing this survey stimulates awareness
and provokes emotion about the nature of their work. Most persons typically finish
within 15 minutes.
Instructions
Please read each statement and write the number on the space provided that best applies
to you in your work as a CWS social worker among the provided selections of:
(0) Never
(1) Rarely
(2) Sometimes
(3) Often
(4) Always
Electronic Consent:
By completing this survey, you are agreeing to participate in the research.
Yes, I agree to participate in the research.
No, I do not agree to participate in the research. Please do not proceed and exit the
survey. Thank you for your time.
82
(0) Never
(1) Rarely
(2) Sometimes
(3) Often
(4) Always
In working with my clients, I have found myself to be
2. _________
hyper-vigilant as to what is happening around me.
In working with my clients, I realize that I have become
3. _________
less trusting of strangers.
I find that I react as my clients might (e.g., exaggerated
4. _________
responses, on edge around government officials, not
trusting of “systems”…).
In my professional work with CWS, I have experienced
vicarious trauma. (Vicarious trauma is defined as the
phenomena of the transmission of traumatic stress by
observation and/or bearing witness to the stories of
5. _________
traumatic events, or the natural, consequent behaviors and
emotions resulting from knowledge about a traumatizing
event experienced by another person. It is the stress
resulting from helping or wanting to help a traumatized or
suffering person.)
After being exposed to stories of CWS clients, I have
6. _________
experienced more concern about the safety of those I hold
dear.
83
After hearing stories of CWS clients’ experiences, I have
7. __________
tried to imagine being in their shoes.
After meeting with clients, I have difficulty in getting the
8. _________
images of their story out of my mind.
I find myself spending more time than is expected of me
9. _________
with my clients.
Due to the impact of my clients, I have found myself
10. _________
reappraising my own beliefs and values.
I am touched by my clients and their stories.
11. _________
I feel emotionally drained due to the nature of my work.
12. _________
I have found myself emotionally affected after hearing the
13. _________
stories of my clients (i.e., have cried, had tears).
I find myself thinking about my clients’ experiences
14. _________
outside of working hours.
I have experienced a protective attitude toward my clients.
15. _________
I have felt a strong urge to solve the problems of my
16. _________
clients.
84
I have thought of my clients as heroic for enduring the
17. __________
traumatic experiences.
I have experienced a need to protect, rescue, or shelter my
18. __________
clients from the abuses they have suffered.
I have endured concerns for my clients that extend beyond
19. __________
the work setting.
I practice self-care (i.e. doing things for yourself like
20. __________
getting a massage, exercising, etc.) to minimize the effects
of stress that I experience in the workplace.
21. Your gender:
(a) Female
(b) Male
22. Your present age:
(a) 25 or less
(b) 26-35
(c) 36-45
(d) 46-55
(e) 56-65
(f) 66 or greater
85
23. Your ethnic/cultural heritage:
(a) Asian
(b) Black/African American
(c) Hispanic
(d) Native American/Alaskan Native
(e) White/European American
(f) Biracial
(g) Other (please specify) _________
24. Total years of experience as a CWS social worker (Include internship):
(a) 1-5 years
(b) 6-10 years
(c) 11-15 years
(d) 16-20 years
(e) 21 years or more
25. What is your current education level?
(a) Bachelor’s Degree
(b) Graduate Degree
(c) Ph.D.
(d) Other _____________________
86
26. What is your current caseload size?
(a) 1-5
(b) 6-10
(a) 11-15
(d) 16-20
(e) 21-25
(f) More than 25
Thank you for your time and the attention you gave in completing this survey. Your
input will be valuable in exploring the relationship between social workers’ use of
empathy and their heightened risk of developing vicarious trauma (VT). Thank you
once again for participating.
Robin & Samantha
87
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