HONORS THESIS - FINAL DRAFT (EMAIL) (2013) -RECOVERED - BY: LESLIE ALLISON FISCHMAN
By: Leslie Allison Fischman
One Saturday afternoon in the fall of my junior year, while I was on call for the Sexual Assault Survivor Advocate’s (SASA) rape crisis hotline, I received a call from a local detective reporting that a sexual assault had occurred the previous night. He asked me to go to the emergency room at the local hospital to provide advocacy for a survivor undergoing a rape kit exam. I felt a sudden rush of adrenaline, and quickly flipped through my manual to make sure I had packed all the things I needed to bring with me to the hospital, including a list of questions to remind me what I needed to ask the police and nurses on site. I took a few deep breaths on the drive over, reminding myself that the most important thing I could do would be to show up and be a support system. When I arrived to the emergency room’s waiting area, Officer Jones of the local police department was already there, pacing around and taking notes in a small notebook. He gave me a little background information about the “survivor,” Carly, and information about the assault, including a description of where it took place, and what the perpetrator looked liked.
After speaking with the officer, I waited anxiously for Carly to finish her examination. I was still nervous and occupied myself by taking notes, filling out paper work, and reviewing a section in my manual on how to handle a “hot call” (which is a sexual assault that has occurred within the past 24hrs). About 30 minutes later, a nurse emerged from the emergency room to greet me, saying, “You must be the victim advocate from SASA—follow me.” As we walked towards the emergency room, she gave me a little background information about Carly and told me to take as much time as I needed to be alone with her. I would be the first person to speak with her after her rape kit examination—not the police officer, and not even her friend in the waiting room.
When I entered the room, I saw a young woman: anxious, nervous, and uneasy. Carly didn’t have to tell me how she was feeling—I could already sense the emotional and physical trauma she had endured. I could see she felt safe with me, because she immediately gave me details about the evening: where she was and what she remembered from the night before. She paused and asked me, “Did you get what you needed—is this for school or something?” I told her that I was there for her, not for information: “I’m here to check in with you, to talk to you about how you’re feeling, and to make sure you get all of the help and support you need.” Carly started to tear up, and I became a human sponge, absorbing all the emotions she was expressing. She was only a year older than me, and a college student as well, so I tried to put myself in her shoes and relate to her experience. I was just as shocked as she was, and I understood the concerns she was having about family and friends and their reactions. The more closely I felt I could relate to the trauma of her experience, the more difficult it became for me to separate myself emotionally.
Part of my role as victim advocate requires me to maintain a balance between being emphatic while at the same time avoiding any personal attachments to the client. When an emotional closeness develops during the sharing of their experience and feelings, working as a victim’s advocate can be personally draining and emotionally overwhelming. But the most rewarding aspect of this work is helping others, giving them the support and resources they need in order to begin to cope. However, I always feel as though I could do more, and this is where my interest in writing an honors thesis came from. I know how to talk to people in crisis, and the skills I have learned through working with victims has made me more sensitive to their needs and concerns. I find it immensely satisfying when I can help guide them through the process of healing and recovery from the trauma they experienced.
With each and every new experience, I am learning both how to better assess my own emotional triggers and reactions, and how to be more effective in working with and helping others. And in doing so, I have increased my awareness about the lack of support and funding needed to accommodate the victims of sex and hate crimes-- crimes that are often unacknowledged and ignored. There is a dire need for adequate services provided by both clinicians and first respondents to crisis situations, such as SASA hotline counselors.
One of the key aspects of being a rape crisis hotline counselor and trauma therapist is learning to help oneself manage their emotions before helping those in crisis manage theirs’. These volunteers are frequently among those who are first to respond to survivors of sexual assault, therefore the care they provide early on can have a critical influence on the survivor’s capacity to cope. The volunteer’s level of experience and training in comparison to professionally certified therapists, can be a significant hurdle they must overcome in learning to be more effective in their role. The counselor relies mostly on the skills learned in school and supervised training which are strengthened primarily through the experience of providing support and simultaneously managing their emotions on a continual basis. However, many counselors and therapist often find difficulty learning to manage their emotions and maintaining emotional boundaries between themselves and the client.
The roles and dynamics of group work, emotion management skills, and personal motivations, have a significant impact on the choices that individuals make to become a counselor or therapist, as well as the changes they experience within themselves while protecting their sense of self and psychological well being. Specific skills acquired during training play a fundamental role in the counselors capacity to cope with their own emotions, as well as the emotions of the caller. My research focuses on examining the individual’s development into their role, the challenges they faced as a newcomer, and how they have become more effective in their role.
Counselors and therapists learn how to gain control over their emotions and feelings by practicing what Hochschild (1979) refers to as emotion work. Hochschild’s study of flight attendants and the “feeling rules” associated with providing services to strangers, mirrors the techniques used by hotline counselors and therapist to maintain a balanced emotional self while interacting with clients over the phone and in person. Hochschild refers to the process of managing ones emotions as performing a type of emotional labor, during uneven exchanges of emotions in public service work. Through practice and experience counselors and therapists become more skilled at managing their emotions by maintaining constant awareness of themselves, their triggers, and their reactions when exposed to trauma. Once counselors and therapist achieve a level of control and emotional awareness of themselves they can help guide others to do the same. In some ways the counselor and therapist’s sense of self and feeling wholly competent is strengthened through their experiences while working with more experienced members in their field.
Jones (1997), found that one of the greatest challenges victim advocates face is finding a balance between their ability to maintain an emotional distance and at the same time develop an emotional closeness with the client. Victim advocates working with survivors in crisis situations express the difficulty they experience learning to show empathy, concern, and understanding, while at the same time not internalizing the trauma of the client. In addition, Jones describes the relationship between survivors and volunteers and potential transference of emotions resulting from frequent exposure to trauma. When the emotional boundaries become blurred between the counselor and the client, both become vulnerable and at risk for internalizing negative emotions and feelings associated with sharing the experience of trauma.
Similarly, van der Kolk (2001), in a study on the assessment and treatment of complex post traumatic stress disorder (PTSD), argues that “people’s core sense of self, is, to a substantial degree, defined by their capacity to regulate internal states and by how well they can predict and regulate their responses to stress” (7). He believes that the longer we allow symptoms of the trauma to persist, the greater the likelihood of developing more serious psychological problems later on. He focuses on the treatment of traumatized patients and the complexity of factors associated to their experience and importance of careful assessment while providing care to clients.
According to Hellman and House (2006), using a small sample of advocates in the southern plains of the United States, rape crisis volunteers providing “direct-care service to victims of sexual assault are a much-understudied group” (117). The authors argue while many studies have encompassed Hochschild theories of emotion work and emotion management in routinized service workers, there is still a “limited understanding of attitudes and behaviors associated with volunteerism in high-stress situations, such as those of sexual assault” (117). While there are many studies focusing on the volunteer role and experience, there are few that focus on negative factors affecting volunteers’ level of commitment. Which is why I’ve chosen to study volunteers working on a rape crisis hotline, for SASA (Sexual Assault Survivor Advocacy) and trauma therapists working as victim advocates, in order to better understand their role and the methods they use to avoid being triggered by the emotional trauma experienced by the survivor.
McCann and Pearlman (1990) were the first to use the term vicarious trauma to describe the negative factors affecting therapists and the secondary trauma experienced by them. The term originated in an article by Terr (1985), addressing children’s vulnerability to the trauma of others, however current research uses the term vicarious trauma to refer specifically to the experiences of therapists and counselors providing advocacy to survivors of sexual assault. In the past researchers have used the following terms interchangeably, secondary traumatization (Rosenheck and Nathan 1985), compassion fatigue (Figley 1995), and burnout, as well as vicarious trauma in studies discussing the trauma experienced by the therapists interacting with traumatized individuals. However current research has attempted to differentiate the meaning behind each term, which by themselves do not encompass all the factors contributing to the experience of vicarious trauma.
Group Support and Commitment
Building in-group support systems within non-profit organizations is essential to sustain volunteer commitment and prevent negative feelings from snowballing into burn-out, vicarious trauma, compassion fatigue, and secondary traumatic stress. For example, Supergroup meetings (mini-groups comprised of 4-6 volunteers and their supervisors that meet monthly) conducted by SASA provide a safe and confidential space for counselors to debrief and share their experiences with one another. Organizations centered on building peer-support networks such as SASA, reinforce the value of ongoing training, addressed by Hellman and House 2006, for volunteers working under high stress conditions (122).
Lofland (2006) illustrates the ways in which “emotions generated within some support groups are used as resources to sustain commitment to the group” (138). Support from group members provide constant affirmation to counselors of their importance through positive reinforcement which inspires them to keep doing the work that they do, gain a better understanding of themselves, and become more confident in their ability to help others. Moreover, new counselors and therapists rely heavily on the feedback they get from their support networks, both within the organization and in their personal lives to help them maintain a healthy balance between their private and public selves.
Leslie Irvine, in “Codependency Forevermore” (1999) studies the individuals and members of a 12-Step support group for those with codependency. Group support systems existing within volunteer organizations, and ones like CoDA, function in similar ways. They both provide a safe, open, and confidential space for its members to share their feelings with a group of people experiencing similar issues. Like a self-help group, support groups and team meetings provide a space for counselors and therapists to identify and explore their feelings in a place where their feelings can be normalized by those most similar to them. Support groups and debriefings enable counselors to make sense of their experiences, identify their progress, learn more about themselves, and pinpoint what they need to work on to improve the efficacy of care they provide to their clients.
Factors affecting the Transition from Low to High-Level Commitment
Hellman and House’s (2006) findings indicate that volunteers “serving victims of sexual assault report a psychologically stressful environment and often experience vicarious reactions to the trauma of victims” (117). Volunteer recruitment, training, and management practice play a key role in the hotline counselor’s development and subsequent level of commitment to the organization (Hellman & House 2006). Other factors have also been addressed as essential to an advocate’s level of commitment, “such as a helping personality, the motivation to serve, and social support as influencing satisfaction” according to Omoto and Snyder 1995, 2002 (in Hellman & House 2006:118). Not to mention, the “subjective experiences . . .related to satisfaction” as found in one study completed by David et al. (2003 in Hellman and House, 2006:118).
Sewell (2001), defines the relationship between teamwork and empowerment as the basis of an organizations foundation. Sewell argues that factors affecting an individual’s sense of belonging is in part determined by the feedback and affirmation they get from other group members. He argues that organizations who weakly provide positive reinforcement to its members affect the individual’s sense of belonging and thus negatively affect their level of commitment to the organization as a whole. He states that, “ways of organizing that do not pay attention to workers’ desires to form into teams run the risk of being badly received and ineffective in operation” (71), therefore his research focuses on how and why “we have always organized work around something that resembles . . .teams” (71).
Poor boundary maintenance and ineffective use of emotion management strategies, according to Hochschild (1979), is one reason that may lead individuals (counselor) to create an “illusion of boundary maintenance,” that can impede their personal growth and development. One way counselor’s may create this illusion is by using humor to disassociate or desensitize themselves, creating a separation from themselves, their feelings, and the work that they do (135). Hochschild argues that this occurs when an individual’s sense of self is challenged by performing emotional labor. She calls this “emotive dissonance,” when individuals become so separate from themselves and their feelings that, overtime, it causes them strain and may lead them to stop feeling altogether.
Who Volunteers? And How They Benefit
Naomi Abrahams (1996) “explores work in the community as a venue for women to stretch across class-based interests and race-ethnic identities even while both influence women’s community involvements” (768). Abrahams suggests that one reason women may become involved in “service work (is) for the betterment of themselves, their families, and their communities” (768). From a feminist perspective, Abrahams addresses the connection between community service work and similar forms of “invisible work” that women do in order to meet the “unmet needs of community members and (by) redefining those needs as public responsibilities rather than private matters” (769).
Throughout history violence against women has been viewed as a women’s issue and therefore a woman’s problem. However, this is not the case, and sexual assault affects more than just women, it affects our entire community, including men, children, and members of the GLBT community. Defining sexual assault as a woman’s issue not only marginalizes the experiences of those who do not fit the mold but silences many who fear that because they do not fit the mold of the stereotypical victim that they will not be believed. Sexual Assault Survivor Advocates serve as prime examples of community volunteers who have made an extended effort to challenge social stigmas and beliefs about rape, by making the community and public effort to address the needs of survivors who have been silenced. Counselors engage in an unconscious battle “struggling for self-definition” in a society that reinforces the stigmas associated with sexual assault, thus forcing counselors to reassess “the boundaries between self, family, and [their] community” while fulfilling their roles (770).
Many of those who choose to volunteer do so because they want to make a difference. Volunteering is seen as a way of “giving back to the community, gaining personal awards, and creating social change” (Abrahams 1996:772), for rape crisis hotline counselors and victim advocates. SASA volunteers are mostly female, but there are also males and members of the GLBT community, who volunteer as well. Some volunteers and counselors who are primary survivors of sexual assault have found helping others as a way to help themselves heal from their own experiences. Survivors helping survivors is “one avenue for exploring careers and/or developing identities centered on empowerment” (Abrahams 1996:775) and developing a more positive projection of themselves, by enhancing their sense of self and at the same time help others to do the same.
Counselors expressed how their individual experiences have had an impact on the future choices they made and have had an influence on their direction and course in life. According to Goffman “the self is seen as a product of the various means by which it is produced and maintained” (in Friedson 1983: 359). Volunteering helps individuals to reinforce a positive projection of themselves within society, through the support they get from their peers and the validation they receive for “one’s efforts to do so” (359). In addition, Taylor and Pancer (2007) studied the association between the volunteers’ amount of support from both outside members and the organization in relationship to the number of positive outcomes they felt in their community service setting. In addition, Eccles and Barber (1999 in Taylor and Pancer, 2007) discuss how volunteer work has had the most positive effect on young students whose lives they say have changed as result of their involvement in community service work (321).
Contrary to Goffman (in Friedson 1983) and Abrahams, Lois (2003), in a study on search and rescue volunteers, describes the volunteers relationship to their work as arising from group interests and not motivated by the individual’s need for personal reward and validation. She describes the process of socializing volunteers and individuals into heroes, and the challenges they face while proving their dedication to the group. Lois argues that, unlike American society’s growing sense of individualism and decreasing dedication to the community (64), before becoming heroes the volunteer must put the interests of the community and others before their own. Volunteers within non-profit organizations similarly prove their dedication by adopting group norms and values and putting others before themselves.
Multidisciplinary Approaches to Studies on Vicarious Trauma
Rothschild (2006) was the first to integrate a multidisciplinary approach to the concept of vicarious trauma and the experience of individuals in helping professions, including sexual assault hotline counselors and trauma therapist in her book Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma. Rothschild offers some common sense answers to healing from vicarious trauma and learning to cope with symptoms of it when they arise. She discusses how whether feelings arise unconsciously or consciously during the victim advocates interaction with the clients, the impact over time can threaten their own sense of self. Rothschild in her discussion on countertransference declares that “even the best-trained and most experienced psychotherapist is vulnerable to being touched or stirred by [their] clients” (16). She also makes note of the positive and negative aspects of being empathetic. She calls “conscious empathy [as] a desirable capacity, [that makes] it possible for us to relate to the experiences of others” and which is a necessary part of the role of the hotline counselor (29). However, she also makes note of the potential “downside, particularly when it is not conscious and is therefore beyond one’s ability to moderate” and have control over” (29).
Rothschild (2006) argues that counselors and therapist who are better able to help themselves are the ones most successful at helping others. However, she also claims that those who unsuccessful at managing their emotions, are the ones most susceptible to the experience of burn-out, compassion fatigue, vicarious trauma, and secondary traumatic stress, which account for the difficulty they experience coping with the negative emotions that arise while helping others (Figley 1995; McCann and Pearlman 1990; Rosenheck and Nathan 1985 in Rothschild 2006:12-13).
More recently, researchers have begun to address the short-comings of working with victims of trauma and sexual assault. As well as, the responsibility for organizations to monitor the affect that working with victims of sexual assault has on the caretaker (Bell, Kulkarni, and Dalton 2003). Bell et al. argue that vicarious trauma can significantly alter “important beliefs, called cognitive schemas, that individuals hold about themselves, other people, and the world” as a direct result of working with victims of sexual assault (464).
To a large extent becoming a hotline counselor requires individuals to conform to a set of group norms and adopt the collective values of the organization. Volunteers become hotline counselors by learning scripts and developing new schemas, perspectives, and judgments about themselves in relation to the world around them. The personal changes that volunteers and therapist undergo are all part of the transition from a newcomer status to becoming a complete member. Therefore how well individuals manage their emotions, and how they are socialized into their role during training, determines how well they are able to cope.
Leslie A. Fischman