Honor's Thesis Excerpt (091713)
Dealing with Vicarious Trauma and Managing Emotions While Volunteering on a Crisis Hotline ----
Chapter 5 Excerpt from my Honor's Thesis (December 2007) Published to University of Colorado.
OVERCOMING SYMPTOMS OF VICARIOUS TRAUMA
AND STAYING COMMITTED
By: Leslie Allison Fischman
In this chapter, I will be discussing how feelings, thoughts, and emotions lead to vicarious trauma, and the transformation that occurs within the therapist’s and counselor’s sense of self once they learn how to successfully manage their emotions. Specifically, through the process of learning and applying emotion management strategies, individuals can overcome the obstacles necessary to maintain a long-term commitment to their role as a hotline counselor and/or trauma therapist. How personal motivations affect the individual’s ability to adapt to their role, how their interactions with their co-workers affects the degree to which they stay committed and feel a sense of belonging, eventually causes them to detach or fall victim to vicarious trauma.
EMOTIONAL INTELLIGENCE (EQ)
The ability for counselors and therapist to learn, adapt, and practice the skills they learn determines their level of success. Churchill (2000) argues that one’s “emotional intelligence [EQ]” determines not only how we interpret the emotions we feel and how we process them, but also our capacity to have control over them. Churchill argues that managing our emotions is something we can all learn to do, and that awareness and developing a better understanding of our own emotional triggers is key to empowering ourselves and our sense of control. What counselors and therapists feel and how they interpret their emotions to some extent determines how they can help others to manage their emotions. The degree to which we can identify and assess how our feelings and emotions affect us, helps us to recognize what causes us to feel that way and then assess what preventative measures we can take to keep our emotions from taking control over ourselves.
Churchill’s findings suggest that EQ indicates an individual’s ability to apply the skills they learn and accounts for 80% of our intelligence. According to Churchill, the difference between our IQ and our EQ, is that EQ encompasses the strategies we use to problem solve, whereas IQ is based strictly on our “cognitive skills.” In addition, intrapersonal intelligence or social intelligence can be classified under our overall emotional intelligence. Churchill defines the aforementioned terms as . . .
me dealing with others, how I deal with you, recognizing emotions in others (i.e. not just accepting face value, reading between the lines) and using this information as a guide for building and maintaining relationships.
In terms of hotline counseling and therapy, these findings suggest that we all have an internal capacity to control our emotions, and that by tapping into resources and support systems to help us cope can in turn provide us with, “constructive ways to use and harness [our] emotions” to prevent the experience of negative emotions.
According to Churchill (2000) . . . .
An emotionally intelligent person’s reasoning is often based on images; they can make connections between different domains and look at a problem from different perspectives. They can see the big picture, but can also focus on any relevant details and take them into account. If they encounter difficulties in finding a solution to the problem, they will translate the problem description and use other knowledge (very often from past experience of similar case scenarios) to find the appropriate answer.
OVERCOMING SYMPTOMS OF VICARIOUS TRAUMA
Another way counselors and therapists can learn to manage their emotions is by being mindful and aware of their feelings, which according to Bennett-Goleman (2001), requires an assessment of two factors, one being cognitive and the other mental. Therapists are better able to help others if they can help themselves pinpoint those “hidden emotional patterns, bringing them into light of awareness,” (4) and by finding positive outlets to express themselves to help balance their emotions. It is through this process of transformation that individuals learn to activate a belief within themselves and the power their mind has over the emotions they feel.
Everly and Mitchell (2000) provide research on what they call “the debriefing controversy” and a shift in focus within crisis intervention research. Their study investigates the “effectiveness of crisis intervention” and the need to now focus upon ‘who’ does crisis intervention, to ‘whom’ and in ‘what specific situations’ underlying the foundation of the field of crisis intervention (211). Reading this study made me curious to see how different levels of training, engagement, and educational backgrounds factored into one’s interpretation and perception of their experiences and themselves. Do paid professionals have a greater capacity to cope with feelings arising from interactions with clients who are sexual assault survivors, than 40 hour trained volunteers? I found that therapists in comparison to hotline counselors, overall seemed more prepared for their role and had more knowledge about what to expect from the clients and were more prepared for how to approach and/or help the client. For example, Carol, a professional therapist describes her most memorable experiences throughout her career . . .
I started out 20 years ago. One of my jobs was working at a hospice. I was working with individuals dealing with death and dying, while doing an internship for my Masters on insight oriented therapy. I found my experiences to be tremendously helpful. Learning how to help understand why its affecting me, in relation to myself and my clients. In my 30’s I did my doctoral work and that gave me an opportunity to focus on my psychological development. That’s when you learn how to read yourself. So that your able to think about it [your feelings and emotions that come up doing this kind of work] and recognize and still be able to control it and deal with it outside of the session.
The most difficult part of the hotline counselor’s role is the unexpected aspect of it, and what they have yet to learn through their academic, work, and life experiences. Whereas professional therapists, upon entering their role, are more prepared due to the experiences they have acquired throughout their extensive academic achievements and work experience prior to engaging with clients one-on-one.
One factor that can be predictive of the length of service of volunteers on a crisis hotline is their individual motivations they had prior to volunteering. When an individual’s motivations for volunteering are constructed by an expectation for personal gain and or guided by assumptions about what they think it will be like, they may have already set themselves up for failure. When their actual experiences differ from their preconceived notions of what therapy work will be like, minor triggers and the beginning stages of acquiring their role may pose significant challenges to their self concept which may lead them to drop out and/or easily become burnt-out. Cohen 1973 (in Lois 2002: 67) refers to this newcomer’s experience as “entry shock . . .(when) the reality of the group’s norms abruptly disconfirmed their initial expectations.”
Increasing individual awareness of the potential to experience negative emotions is one step toward preventing vicarious trauma and burnout, however, individuals cannot support themselves alone. More importantly, organizations provide the structure in which counselors and therapists learn to manage their emotions and are aware of the kinds of support they need to cope with negative emotions. Therefore, how well individuals function is based on not only what resources are made available to them (i.e. individual therapy and counseling services for rape crisis hotline counselors), but also the kinds of peer-support systems built within the organization. Organizations face the responsibility to raise awareness about vicarious trauma so that counselors and therapists will be less apprehensive about sharing those negative feelings associated with the work they do with other group members.
Counselors find reassurance knowing that they are not alone and that everyone else has felt similarly at one point or another during their time at SASA. Newcomers are particularly vulnerable because they may not know that a problem exists until someone else can help them identify what it is they are feeling and then how to cope with those feelings. Counselors have a tendency to lose touch with their emotions when they do not allow feelings which would conflict with others into awareness and say only what they anticipate would be most pleasing to the other group members (O’Leary 1997: 140). For example, Laura shared with me, what she found to be the most effective aspects of group meetings:
Everyone gets a lot of time to themselves to get to talk about what they want to talk about. Getting to know a group of people, who are going through some of the same things . . . you get close. Have fun. Have intense talks about terrible things. You learn that you don’t have to serious all the time, and that its okay to get down on yourself, because they help you get over the stuff that bothers us most.
This explains why it would be most difficult for those struggling to perform their role to admit any feelings that would suggest any personal weaknesses they may have, because they may see other counselors like Laura who are better at coping than they feel they are able to. However, what they fail to see by not sharing, is how similar they are rather than different. For example, Sophie describes her experiences before coming to SASA . . .
As a counselor you have this status as being among the “good people” so people tell you things they wouldn’t normally tell you if you weren’t a hotline counselor, its hard telling them, um I can’t really help you with this or I can’t handle this emotionally right now can we talk later . . .
Counselors begin to question whether or not this is the right role for them in life by creating self-sabotaging beliefs of themselves. Individuals who create perceived differences between themselves and the other more experienced counselors, see themselves as not fitting in because they learn to doubt themselves when they do not get the reassurance they need. As a result, counselors may end up feeling that they are less than capable of meeting group expectations. On the other hand, it may be difficult for those who want to help others to admit to themselves that they are not as good at helping others as they think they are, while coming to the realization that the one they should be helping is themselves.
Individuals who constantly question themselves, the value of the work they do, and are dependent on the need to have their feelings normalized by others and receive other positive reinforcements are most likely to question their own self-concepts when their feelings are not validated by other members on the staff. Individuals are motivated to engage with others in a way that reinforces a positive self-concept. Therefore, support from the more experienced members is needed to reinforce feelings of competence among new counselors and their sense of belonging. Organizational support and attention must be paid to the newcomers who are most likely to see minor setbacks as indicative of future hardships, rather than see their potential to overcome those negative feelings with experience. For example, Jenna explains that . . .
Support groups are one of my biggest challenges. Not feeling like its okay and getting checked in on, that your okay and that your doing everything you’re supposed to do. What I really need and look for is someone like Cathy [the client services coordinator] and say something to her like, “I need you to normalize me.” Its not just because of the people in the group but its that dynamic that just doesn’t work for me, and make me feel better at the end of the day.
However, when one’s experiences and interactions with others yield negative feelings about one’s competency in their role, those feelings can cause one to question how important it is for them to stay committed. When feelings are not validated by others, it sends a message to that individual that the amount of emotion work they put into performing their role has been undermined by those whose support and reassurance has not been granted. Feelings that are not normalized by peer-support networks have the potential to spiral into “emotional crises [which] may threaten individual’s ‘inner sense of self’ and, to different degrees, threaten to disrupt and disorient the person depending” on how emotionally fragile they are emotionally at that time (Lois 2001: 169). Therefore, when counselor’s and therapist’s experiences with others yield negative feelings about oneself, it makes it difficult for them to feel comfortable being themselves and expressing feelings to those they feel do not understand them and feel judged by. As a result, counselors become defensive and highly sensitized by the opinions of others, not only among their peers but among those on the outside, resulting from the perceived threat, posed by those within the organization, to their sense of self. In order to recover from this cognitive distortion precipitated by those closest to them, counselor’s find strength in challenging the beliefs that they perceive others to hold of them, by “becom[ing] highly self-aware and . . . redefin[ing] their selves during crises” (169). Internalizing and overcoming the lack of acceptance of others, occurs when counselors and therapists no longer allow others to dictate the feelings they hold of their selves, and gain confidence when they are able to maintain a sense of emotional stability on their own and stop being needy of others for reassurance and validation.
Interfering Personal Motivations
Individuals whose motivations for becoming a hotline counselor or therapist, are to help others thinking it will bring them personal reward and gratification are in it for the wrong reasons. Lois (2003) claims that tension between the self and the group is alleviated once rescuers “sacrifice[d] their own interests in order to help [others],” by accepting organizational goals in place of their own and conforming to norms and values shared by existing members (64) . The path toward social change lies within those who genuinely strive to better themselves, and at the same time, work constructively with other team members to help guide others to do the same. In the field of counseling and professional therapy, there lies a fine line between helping others and trying to change others. When counselors become fixated on changing others, they may find themselves powerless before the reactions they receive and which differ from the outcomes they had anticipated. Therefore, trying to change callers can yield negative consequences when the focus on the needs of others surpasses one’s need to take care of themselves. Being an advocate and being empathetic does not mean sacrificing one’s needs for another in order to stabilize another emotionally while losing one’s sense of emotional stability. When one loses control over their senses, we become desensitized, and when we feel that we cannot control ourselves our awareness for perceived threats heightens as a result. Our view of reality becomes distorted when we are challenged by what we have yet to understand and process completely. This is why support groups and peers within organizations play a critical role helping counselors to identify the potential pitfalls of working with victims. At the same time, support groups help them to be aware of the symptoms of vicarious trauma and notice any changes in behavior they see in the newcomer as they arise and provide help to those who are unknowingly being affected by weakly practicing self-care and emotion management skills learned in training.
Personal fulfillment is reached when individuals no longer measure their growth in relation to the growth they see in those around them, and the acceptance of others. It occurs when counselors are able to find a deeper meaning to the work they do while helping others, meaning that will motivate them to continue working despite minor setbacks and obstacles they encounter while improving their own skills at managing their emotions. Measuring ourselves based on the acceptance of others, especially in non-profit work, is a means to an end, because as soon as we do not get the validation we had hoped for, and when we feel others do not acknowledge our progress, we may begin to question ourselves and our purpose within the organization. Individuals seeking group-acceptance have become fully entangled within organizations when a failure to reach group goals is accepted as a personal weakness. In the event this occurs, individuals may choose to disassociate from those whose acceptance has not been granted, in an effort to save face or by expressing a form of unwillingness to accept group goals and expectations of themselves. Therefore, level of commitment may not only be affected by the therapists and counselors direct interaction with the client, but influenced by the expectations and demands of the organizations to which they are apart of. Not only do individuals need to make a better assessment of themselves prior to engaging in this type of work, but organizations, while recruiting newcomers, should be well aware of the individual’s weaknesses and willingness to meet its requirements by making their expectations of their volunteers clear before they begin participating.
Social systems that develop within organizations, and among volunteers and professionals associated with SASA, are primarily constructed by “affective connections among members of the system (in Callahan 2002:284). For example, Hochschild’s (1983) study on emotion work illustrates the degree to which “society drives an individual to cognitively shape and control feelings in order to fit within that society, in order to achieve goals within that society. Therefore, learning how to use and apply emotion management skills can be considered as one type of instrumental action that motivates the newcomer to blend in and achieve what is expected of them while performing their role, and why they may display themselves in ways that enable them to fit in with the other counselors (284). Callahan argues that instead of seeing emotions as an “individual phenomenon,” we should look at the potential for emotions “to be seen as an external or social phenomena that becomes embedded in the environment itself” (291). She argues that, in order to recognize these patterns of emotional structuration we must address a “need for change at the larger organizational level” (292) in order to start making changes at the individual level.
Part of a therapist’s personal growth comes from accepting the fact that she can never expect change to come from someone else, and learn to accept the fact that she is powerless over another’s feelings. Counselors learn to accept that they have no control over others through their experiences and interpretations, in addition to their level of training or educational background. Shainberg (1983) illustrates the key transformation that therapists undergo when working with clients in this way. She claims that when counselors learn to let go of their thoughts, and stop trying to fix, they become better listeners. By making a conscious effort to be aware of one’s thoughts and judgments, counselors and therapist can better prepare themselves to be active listeners by identifying the caller’s feelings, instead of focusing on feelings within themselves the caller is triggering. In this way, counselors can best help others by letting the client make sense of their experiences themselves without the counselor telling them how or what they should feel. For example, Sophie expresses . . .
I didn’t always listen as well to what people were feeling, its something I would automatically do. I realized that it doesn’t always help to tell others what to do and see how I affect people like my mom. In order to see things better myself I had to learn to see how listening, advice, and guidance is a better way to help others see things on their own, including myself.
The role of the hotline counselor is to help others make sense of their experiences, and as an added bonus to helping others, counselors and therapists may learn from the experiences that lead them to a better understanding of themselves.
Trungpa (1983) argues that the basic role of therapists “is to become full human beings and to inspire full human-beingness in other people.” Similarly, counselors are best able to help others when they fully understand the importance of being open and come to understand the meaningfulness of the work they do for survivors of sexual assault. When counselors and therapist are unsuccessful at being true to themselves then “working with others is a question of being genuine and projecting that genuiness to others” (Trungpa 1983). The role of the therapist is not try to figure out people based on their past but rather for him or her to develop a sense of fearlessness in the face of the unknown which is necessary to work patiently with others.
Part of accepting the unknown aspects of being a first respondent to individuals in crisis situations requires learning to let go of our past failures while on the job and avoid using the past as a indicator for future failure. This is especially true for hotline counselors whose role requires them to put themselves in unfamiliar territory, and forces them to interact with others on a very deep and personal level. Once counselors become more accepting of what they cannot change, they become more skilled at dealing with present circumstances in constructive ways. Bennett-Goleman (2001) suggest that in order to have “empathy [for] our distorted thoughts . . . means understanding how we perceive and how our perceptions are colored and swayed by hidden meanings” (25). Counselors and therapist in the field can accomplish this by learning to be more accepting of one’s past inadequacies and not allow past mistakes to deter them from reaching their potential for future successes.
Normalizing the feelings of others requires the therapist in part to create an open space, let go of their own fears of failure and the embarrassment they may feel by saying the wrong thing. Trungpa (1983) explains that in order to cultivate basic healthiness in others requires the therapist to cure her own impatience and learn to be more accepting of others, regardless whether or not she may understand them. Trunpga (1983) alludes to the idea that whether or not therapists can personally identify with the experiences of another should not be a measure of how capable the therapist feels in helping that individual, but that being there and listening is just as effective. Trugpa (1983) specifically speaks to psychotherapists and their role as the helper to commit to their patients fully, in the sense that they pay attention and actively listen to patients, requiring them to be more sensitive to a patient’s emotional needs than any ordinary medical work position would require them to. She describes the relationship between the therapist and the client as more of a “long term commitment” that strengthens over time, with patience and the development of a certain trust that enables the client to freely express themselves and share their feelings.
Many of those whom I interviewed expressed being at either the beginning of a transition in their lives or coming to an end of a transition that marked a significant personal change or achievement. Changes included switching majors (as an undergraduate), attending their first year of graduate school, finishing up graduate school and beginning a new profession, applying for graduate school, or even changing professions and giving up a more profitable profession for a position at this particular organization. Witnessing changes at the individual level proved to have an affect on the organization as a whole. When individuals transition out of their older role required rebuilding and acquiring new staff members, it added stress to existing members who were forced to expand their role to make-up for her loss of participation. In addition, individuals within organizations have the potential to cause organizational strain, when they fail to follow-up with the commitments they have made, and force others to do more work than they had anticipated. For example, taking on too many shifts and cases, and over-extending oneself to ease the stress on others within the organization can eventually lead to feelings of being overwhelmed and cause burn-out among volunteers and therapists. For example, Jenna expresses . .
I go through cycles, sometimes I feel comedic, and sometimes too much is going on in my personal work. If I have my own issues to deal with how do I have the energy to help others. My work in graduate school challenges me to try and do school and work through my personal issues. Its hard finding a balance between my school work and being a hotline counselor on call, I can’t do everything I want to sometimes.
In fact, Frazier (in Zimering et al. 2003) found that “the greater the percentage of survivors in a provider’s caseload, the greater the number of secondary trauma symptoms reported.” Similarly, one of the trauma therapists I interviewed, Debra, mentioned balancing herself by dividing up the caseloads among her colleagues depending on each one’s individual capacity. Debra, who is also the executive director of an organization assisting sexual assault survivors, found it necessary to meet the individual needs of her co-workers in order to avoid overwhelming one another with more work or cases they could handle at once.
Individuals undergoing major transitions in their life, may see SASA as an organization to which they can form attachments to help themselves through their personal transitions. In fact, Bell et al. (2003) found that age mattered in terms of the counselors ability to cope with these symptoms, and found that “younger and less experienced counselors exhibit the highest levels of distress” (465). Although working with sexual assault survivors, and the knowledge they obtain through training may help them cope with their own experiences, the process may be emotionally draining and may require newcomers to cope with a great deal of stress on the job, in addition the stress related to their academic work and achievements. In many ways work stress can manifest itself in ways that “contribut[e] to personal relationship difficulties at home,” and in terms of students living away from home, it can have an affect on their ability to relate and develop relationships with the people they meet and interact with for the first time (465). It may be difficult for the younger hotline counselors, who while transitioning into adulthood, to overcome both the pressure they put on themselves to succeed as well as the pressure the perceive to exist while meeting organizational requirements. In fact, the pressure that counselors put on themselves much of the time exceeds the expectations that organizations have of them, and counselors, while attempting to live up to their own expectations of themselves as hotline counselors, may find that they are unable to manage both academic and personal pursuits in life to the extent they believe will determine their level of success in life.
On the other hand, volunteering can give its members a sense of purpose, and direction in life, by situating them in a place where they can learn to help others and focus less on themselves. While counselors learn to be more accepting of others, they learn to be more accepting of themselves. Learning to help others cope with their trauma may help to alleviate the distorted perceptions the counselor has of themselves and their capacity to have control over their lives. When hotline counselor Debbie was asked why she chose to volunteer, she expressed that is was a way for her to get more involved, describing herself . . .
doing something this important and valuable to the community and family as a whole. It changes the way you view the world and how you see things. People don’t realize that one person makes a difference. You know you do coming out of here.
How smoothly these transitions occur at the individual level can shape how the organization operates and determines how effectively it can help its clients. For example, during particular periods of the year, such as summer, SASA expects many of their volunteers will be on leave so they are prepared to cover shifts with the few hotline counselors available. However, when there is a significant loss in participation during a period of year that comes unexpectedly, it may add strain that forces SASA to take action, such as recruiting and training new volunteers in response to their current deficit. For example, during the summer season many counselors, who are students go on vacation or go home for a couple months, leaving many shifts to cover for those remaining during the summer months.
Organizational transitions occur, partially as a result of individuals coming and going, but is also related to changes occurring within society and among outside members. As society evolves and the individuals within them change, so does the role of the therapist and hotline counselor in responding to victims of trauma. From a sociological perspective, changes occurring within society can have a tremendous effect on the individual sense of self, depending on the mechanisms of which they have to successfully cope with these changes. As culture changes, people change, and new problems associated with those changes arise. In lieu of the major catastrophes that have struck our nation in recent years, researchers have begun to question the effectiveness of the care provided by first respondents and those in the mental health care professions and the level of preparation they have in the event of an emergency. Researchers have only begun to assess what adjustments need to be made to current training requirements among mental health care professionals and first respondents (i.e. hotline counselors) and how to deal with these newly arising social problems to help others address and cope with their present circumstances (Zimering, Rose, Munroe, James and Gulliver, and Bird 2003).
Debbie states that the biggest stress administrative members face, occurs when there is a lack of social support from outside as well as within. For instance over the past year SASA lost a huge portion of funding from the government, which forced them to make additional efforts to cover for their losses. Which is why Debbie expresses that, “It’s important for volunteers to help us raise money, but sometimes I’m hesitant to ask volunteers about it because they already do so much.” In addition to the help provided by volunteers, monies donated and provided by government grants is what helps sustain organizations like SASA. SASA has made it clear that funding is needed to accommodate their efforts to acquire new volunteers, conduct training sessions, research more effective strategies of helping survivors, and to support administrative members efforts to conduct prevention education training programs to help put an end to sexual assault.
According to Zimering (1997), the factors most predictive of secondary trauma “include insufficient training, identification with victims, insufficient supporting in the workplace and insufficient social and familial support.” Hotline counselors can gain control over the way they feel by adopting the strategies they learned to manage their emotions, practicing those strategies on a continual basis, and by utilizing in-group support systems to decrease the emotional strain that leads to vicarious trauma. In addition, those most vulnerable to experiencing symptoms of VT are also the most likely to seek immediate gratification and positive reinforcement from alternative modes of therapy that may prove to be less effective than the more traditional methods they learn to reject. Therefore, organizations play an important part in preparing individuals for their role, and teaching them early on how to “disengage from the emotional habits” that can ultimately undermine their livelihood of their future relationships (Bennett-Goleman 2001: 4).
The culture of an organization, and the people in charge of its structure, dictates how individuals work together and the level of support they receive from one another. The general goals of the organization are to provide support to victims, however, it must be weary of undermining the significance of the support they give to their providers. The “Parsons’ General Theory of Action provides a framework for linking emotions to organizational action” (Callahan 2002:282). Callahan applies this theory of action and its four functions: adaptation, goal attainment, integration, and latent maintenance. According to Callahan, Parsons’ General Theory of Action helps one to understand the complex social systems that make-up organizations and their ability to achieve their greatest potential for change.
Essentially, vicarious trauma is like a panic attack, if you ignore the signals leading up to it, it hits you, but if you are mindful of the cycle that leads up to it you leave room for the potential to prevent the experience from ever arising. Seeing emotions as a social phenomena can help us to better understand the processes through which emotions arise, how hotline counselors are socialized within organizations, and learn to deal with negative emotions. Organizations can help by increasing their awareness and understanding of how to help individuals manage their emotions, which in turn helps increase the counselors’ capacity to control their own emotions even when sufficient support is not available to them. In order to the prevent vicarious trauma and help sustain the volunteer’s level of commitment, individuals as well as the organization as a whole need to be aware and address the emotion management strategies and self care strategies that specifically help one to cope with symptoms of vicarious trauma as they arise. Therefore, negative emotions triggered through interaction with sexual assault survivors can be avoided if counselors and therapists are properly trained and prepared. If successfully used, the emotion management techniques learned during training, in many ways, will prevent volunteers from experiencing vicarious trauma.
Leslie A. Fischman