I read a book* recently about how community helpers are susceptible to vicarious (meaning, indirect) trauma due to being in close proximity to others trauma and mental health needs for an extended period of time. Completely rocked my way of thinking about my job as a therapist and the importance of a helper receiving adequate support.
My ACE (Adverse Childhood Experience) score is 2 (Find out more about this scale at https://www.cdc.gov/violenceprevention/acestudy/index.html). Other than grief/loss through divorce and familial death and growing up in a culture of racial microaggressions and systemic racism, I consider myself one of the lucky ones when it comes to Trauma.
So, what does it mean when I find myself wanting to avoid my clients, when I battle anxiety and irritability on a daily basis, or experience a steady decline in passion and purpose connected with my role as a therapist/healer…especially since there are no other personal traumas to correlate to my symptoms? It could mean that I’m experiencing compassion fatigue, better known as vicarious trauma or secondary traumatization.
I completed an informal poll on social media recently, asking those who consider themselves “helpers”, what they needed most. The answers varied, but I did notice a pattern: the themes of “rest”, “support”, and “increased resources to do my job effectively” tended to show up more often. Research I’ve found correlated these deficits with the likelihood of helpers experiencing vicarious trauma.
Working in community mental health is especially draining/challenging. The expectations often focus on maximizing quantity of services provided, rather than providing adequate training and daily support to provide quality services. “How can we get the most out of our helpers?” rather than “How can we inspire the best within our helpers?” is often the agenda. We are encouraged to be more fiscally minded in order to strategize service to a maximum amount of people. But, what I’ve found is that this often does a disservice to clients in need, essentially, due to high employee turnover (overworked employees do not stay at the same agency and clients may have an average of 2-3 different people performing the same role), and high levels of absenteeism (because helpers are sick more often or use more mental health days due to burnout). The culture within these types of agencies cause a deep divide between helpers; a face-off occurs between those who value competitiveness and the bottom line and those who value balance and feeling purposeful over feeling useful. It’s possible that the former will thrive and the latter will silently suffer.
But, this isn’t just about my job. It’s a common occurrence across our entire country; stemming from a struggling system of mental health/human services that is called upon to constantly prove itself. Insurance companies and legal entities look for value in what we offer to people from the gate; often refusing to reimburse providers if persons having never met either therapist or client are not convinced that this treatment is worth the cost. Therapists at private practices are left to become like salesmen before insurance boards; “selling” themselves in order to be credentialed. This trickles down into how supervisors see value in their supervisees within agencies. Those who bill more are automatically seen as more valuable over the employee who bill below average. Again, quantity is preferred over quality.
Meanwhile, the people around us continue to struggle. We see after tragedies, such as school shootings and drug crises that helpers are essential to the thriving of our communities. We are the white blood cells of the community’s body, as it were. But imagine the priorities shifting every few years (or even within each fiscal year), where helpers are never sure if they are truly valued – both within their perspective agencies and from the viewpoints of local, state, and federal governments. We are now in a country where it is more feasible to spend money to arm teachers with weapons, rather than ensuring they have adequate financial support to purchase classroom materials. The priorities are indeed different, and the rate of this shift is unsettling.
So, that leaves me with an inner conundrum; how hard should I work to change the narrative? Where can I find a better sense of balance? And what, if anything, can I do to better assist the helpers that will arrive after me? The ones that desire, albeit naively, to change the world for the better? I believe my burden lies, not just in changing my own situation, but to alter the culture so that future helpers may not struggle so frequently. EAP support (that’s mental health support found with most benefited positions), though typically suggested for helpers with internal struggles, doesn’t seem to help employees shoulder the daily load of helping. There is a problem with work culture.
Then there are our immediate supervisors, who are more overloaded than we are, often provide little or inconsistent encouragement and are left to be our administrative monitors. Even the most well-meaning ones will have an “open door policy” that accepts questions and will give guidance to supervisees that ask, and yet fail to provide a balanced environment of noticing strengths and actively building weaknesses of their employees. We are supported by way of checking off boxes, compliance with paperwork requirements and are monitored so not to steal company time and resources. The term “gatekeeper” has taken on a different meaning, because what it means to supervise a mental health worker has differing priorities. For example, resident counselors are forced to have two different supervisors during residency – one is more administrative and required for your employment at your place of residency and another for guidance with clinical skills. You are lucky if they are one in the same.
I have had the supreme privilege of having amazing licensed/unlicensed therapists, professors, colleagues and peers that have guided me through this road to becoming a better therapist, and I can say without a doubt that it was their impartations that aided me developing my own theoretical orientation, uniqueness, and competencies. From my experience, it is clear where building quality helpers is a high priority and where it is secondary…or even nonexistent.
So, if you have accepted the call to be a helper (I wrote from the perspective of a mental health therapist, but you may be a caregiver for the elderly, a pediatric nurse, or run a community-based non-profit), I encourage you to examine the culture around you. Find resources, programs, and relationships that actively BUILD YOU UP. Ask yourself what/who replenishes you and find a way to make that a priority. Out of many others in our communities, YOU are needed most. And there is a mandate for helpers to be the first to seek health and wholeness. We are all works in progress, of course, but we can show our communities what it means to live out true resiliency.
* Trauma Stewardship by Laura van Dernoot Lipsky and Connie Burk