Vicarious Traumatization in Treatment Providers and Law Enforcement Personnel: Recognition, Response and Prevention Dana P Neitlich, MSW Assistant Director of Clinical Programs Massachusetts Department of Correction MHM Services, Inc. July 12, 2011 Adapted from presentation developed by Maria Masotta, Psy.D. Workshop Outline • What is Trauma? • Trauma Exposure in Inmate Populations • Impact of Trauma in Law Enforcement • What is Vicarious Traumatization? • Risk and Protective Factors • Prevention and Intervention What is Trauma? • Direct personal experience or event involving: – Actual or threatened death – Serious injury – Other threat to one’s physical safety • Witnessing an event involving: – Death – Injury – Threat to physical integrity of another person What is Trauma? • Learning about – Unexpected or violent death – Serious harm – Threat experienced by family member or other close associate • Response must involve intense fear, horror or helplessness Traumatic Events... • Emotional abuse • Rape or assault • Sexual abuse • Mugging • Physical abuse • Domestic violence • Painful or frightening medical procedure • Burglary • Catastrophic injuries or illnesses • Witnessing murder/ assault • Natural disasters • Immigration • Combat Trauma History Among Inmates Physical Abuse: Males 43% - 66% Females 38% - 77% Threatened/Injured with a Weapon: Males 35% - 46% Females 29% - 52% Wolf & Shi, 2009 More Trauma Among Inmates… Choked or Experienced Attempt to Drown: Males 14% - 40% Females 17% - 41% Burned with Hot Object: Males Females 11% - 29% 7% - 29% Wolf & Shi, 2009 More Trauma Among Inmates… Sexual Abuse: Males Females 2% - 26% 19% - 65% Emotional Abuse: Males 34% - 53% Females 35% - 59% Wolf & Shi, 2009 Not So Fun Facts • Incarcerated males with a mental disorder compared to incarcerated males without a mental disorder: – 33% more likely to report being physically victimized in the past 6 months – Nearly twice as likely to report being sexually victimized • 20% of male inmates report sexual assault during prison incarceration Polych, 1992 What’s important to know? • Acknowledging trauma ≠ excusing antisocial behavior • Acknowledging trauma ≠ digging trauma memories up • Acknowledging trauma = proactive management • Acknowledging trauma = staff support and care Impact on the Workplace • Risk of re-victimization • Increased risk of: – prison paranoia – physical aggression – self-injury/suicide attempts – crisis calls – codes – uses of force – disciplinary reports Impact of Trauma on Culture: • Symptomatic inmates could result in: – Tension in the facility – Tension among inmates – Creates a stressful work environment • Development of Vicarious Traumatization What is Vicarious Traumatization? Developed by those that are exposed to a client’s trauma experiences… • Includes listening to graphic descriptions of horrific events • Bearing witness to people’s cruelty to one another and • Witnessing traumatic reenactments Pearlman & MacIan, 1995 Signs and Symptoms • Behavioral changes • Intrusion of inmate stories • Burn-out • Feeling overwhelmed • Withdrawal from inmates/colleagues • • • • • • • • Impaired self-care Numbing/flooding Denial PTSD symptoms Nausea Headaches Sleeplessness Difficulty trusting It is a Normal Experience… Vicarious traumatization is: – Neither a reflection of inadequacy on the part of the staff – Nor the toxicity or badness on the part of the inmate – Best conceptualized as an occupational hazard within corrections Pearlman, 1999, p. 52 It Can Happen to Anyone • • • • • • • Administrators Law Enforcement /Correctional officers Program staff Parole Medical staff Mental health staff Other inmates Basic Statistics About Clinicians • More than 50% of clinicians providing treatment to either a sex offender or victim experience symptoms in clinical range • 33% of clinicians providing sex offender treatment experience hyper-vigilance regarding safety – Generally mistrustful of others, particularly those who have regular contact with children Moulden & Firestone, 2007 Elevated Vicarious Traumatization in Secure Settings • Increased emotional exhaustion • Feeling like nothing is real • Decreased feelings of accomplishment • May be result of: – Hardened environment – Isolation – Dangerousness of inmate population Moulden & Firestone, 2007, p . 67 Staff Exposure to Trauma Direct Vicarious • Witnessing use of force • Hearing details of violent crimes • Witnessing or responding to selfinjurious or suicidal behaviors • Learning of inmates’ trauma in community and in prison • Being threatened or assaulted • Witnessing inmate relive trauma Protective Factors • Professional experience • Training • Social engagement/support system • Balanced lifestyle Risk Factors for LE/Custody Staff • Forced overtime • Responding to fights • Responding to emergencies • Use of force • Unable to take breaks • Limited support from peers, supervisors • Code of silence Risk Factors for Clinical Staff • Substantial involvement in direct treatment • High caseloads with trauma histories • High exposure to inmates with trauma • Female gender • Personal history of trauma Preventive Strategies • Avoid professional and personal isolation • Form/participate in a support group • Stress self-care • Training in vicarious traumatization • Make time to relax Prevention…. • Healthy personal life • Maintain a supportive work environment • Provide supervision • Seek supervision Healthy Coping Strategies • Balancing personal and professional lives • Maintaining personal boundaries • Maintaining realistic expectations for self in doing this work • Allow yourself to experience emotional reactions • Seek out non-victim related activities More Healthy Coping Strategies • Be aware of unresolved issues that may be impacted • Get plenty of rest • Use humor! • Exercise • Sports • Hobbies More Healthy Coping Strategies • Eat healthy foods • Remind yourself that you are having a natural reaction • Talk to friends/family • Spend time with others • Provide support to other co-workers who may feel similarly Not So Healthy Coping Strategies • Drugs • Alcohol • Denial • Isolating • Code of silence Systemic Responses (When Feasible) • Supportive work environment • Supervision • Training in vicarious traumatization • Support time away from work (breaks, PDO) • Support an EAP program Maintain Optimism and Hopefulness • Identify and talk about positive aspects of work • Recognize and cherish human resilience • Take pride in having an impact on the effects of violence – All of these increase social activism Questions? Dana P Neitlich, MSW dneitlich@mhm-services.com