Documenti di Didattica
Documenti di Professioni
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School
of
Social
Work
University
of
Minnesota,
Twin
Cities,
USA
SW
8602
Direct
Practice
Evaluation
Jane
F.
Gilgun,
Ph.D.,
LICSW
December
2009
Direct Practice Evaluation:
Secondary Trauma and Practice Effectiveness
Secondary trauma is an occupational hazard for social service professionals.
Unattended secondary trauma affects practitioner effectiveness. Because of its implications
for practice effectiveness, secondary trauma is an issue in direct practice evaluation.
Direct practice evaluation is a set of procedures that social work professionals use
to figure out what is going on for clients. They also keep track of what is going on for
themselves because what they do influences clients. Evaluation is an on‐going process
where service providers continually modify their own actions and words in response to
clients’ actions, words, issues, and circumstances. The goal of direct practice evaluation is
to increase effectiveness.
The four cornerstones of evidence‐based practice can help organize ideas about
practice effectiveness. The four cornerstones are best research evidence, professional
expertise, client concerns, values, and wants, and the personal experience and personal and
professional values of the practitioner. I abbreviate the fourth cornerstone by calling it the
person of the practitioner.
In this brief essay, I discuss secondary trauma of professionals as an issue for
practice
effectiveness.
This
topic
falls
within
the
fourth
cornerstone.
Gilgun secondary trauma
Page 2 of 2
Secondary
Trauma
&
the
Person
of
the
Practitioner
Secondary trauma interferes with social workers’ capacities for empathy and for
thinking clearly about client issues. By definition, when we experience secondary trauma,
we are at risk to be emotionally upset and irritable, to avoid reminders of the trauma, and
to have intrusive thoughts and images. This interferes with our effectiveness. To be
effective, we have to know when we have experienced secondary trauma and what to do
about it.
Secondary trauma is an occupational hazard in social services because professionals
routinely work with clients who have experienced trauma. In our efforts to understand
others and to be responsive to them, we are open to what others say and how they present
themselves. We want to be empathic while not losing our analytic stance. By being open
and empathic, we are exposing ourselves vicariously to trauma. If we experience trauma
vicariously, we may lose our analytic stance and become less effective in our work.
Social Services as a Balancing Act
Social workers, therefore, are engaged in an on‐going balancing act. On the one
hand, we want to be open and empathic. On the other hand, we want to be able to think
clearly, plan effectively, and get an idea of the full range of influences on client functioning.
To maintain this balance, we require a high degree of self‐awareness and help from co‐
workers and supervisors. Friends and family can be helpful, too, but many social workers
believe that problems related to work are best dealt with at work. We do not want to bring
trauma into the lives of family and friends. We also want to keep work and personal life
separate.
Gilgun secondary trauma
Page 3 of 3
Detecting
Secondary
Trauma
By its nature, secondary trauma may be difficult to detect. We may think we are all
right until we start talking about a case with co‐workers, when we wake up in the middle of
the night thinking about a case, or when we are behind the wheel of a car and scream at
another driver for a rude action such as not using a turn signal.
Therefore, it makes sense for social workers to check in with themselves
immediately after meeting with clients. A few simple questions can be helpful to detect
secondary trauma. These questions include
• What went well?
• What could have gone better?
• What could I have done better?
• What will I do the next time I’m with this client?
• Am I relaxed? Happy? Upset? Agitated? Angry?
• Can I picture a client’s story in my mind? Does this story bother me?
• Am I looking forward to seeing this client again?
• Am I looking forward to my upcoming meeting with another client?
A simple mental check‐in such as this can be helpful in detecting secondary trauma. If there
is trauma, then social workers have to decide what to do about it. Social workers can also
use this checklist in supervision and consultations.
Secondary Trauma Requires Attention
Any responses that suggest secondary trauma require attention. Some social
workers like to journal, and they will therefore write about their responses to clients,
reflect
upon
them,
and
plan
for
the
next
steps.
Self‐expression
about
distressing
subjects
Gilgun secondary trauma
Page 4 of 4
can
help
social
workers
feel
better
and
clear
their
heads.
They
are
more
able
to
meet
the
demands of work and their personal lives and find satisfaction in doing so.
Talking with supervisors and co‐workers about cases and responses to them also is
helpful in dealing with the effects of secondary trauma. Talking and feeling understood not
only bring relief and help social workers to manage their thoughts, emotions, and intrusive
images, but doing so also clears their minds so they can do constructive thinking and
problem‐solving. They also can go home at night prepared to be emotionally and
psychologically relaxed and available to family and friends.
Some work situations are unsafe for the discussion of secondary trauma. Under
these conditions, it is important to find someone else, or a group of people, who are
trustworthy and who understand secondary trauma. In group situations, social workers
can learn a great deal about secondary trauma and how to handle it effectively by listening
and responding to others.
Some practitioners talk out loud to a tape recorder. This can be beneficial. By
talking, we not only feel better, but we also express ideas and emotions we didn’t know we
had. Playing back the recording can be reassuring that our responses not only are
understandable but manageable, too.
Learning as much as we can about a practice area that is troubling can also help
service professionals deal with secondary trauma. Talking to knowledgeable others, going
to workshops, and reading about the topic all help. There is a great deal of reliable
information on the internet from a variety of professional organizations.
Be Open to Others
We sometimes are unaware of how secondary trauma affects us. Therefore, we
have
to
prepare
ourselves
to
be
open
to
others,
such
as
family,
friends,
supervisors,
and
co‐
Gilgun secondary trauma
Page 5 of 5
workers,
when
they
ask
us
about
how
we
are
feeling,
how
we
are
doing,
or
when
they
question our judgment about a case. While we may be tempted to be defensive, we have to
train ourselves to think automatically, “You could be right. Let me listen to what you have
to say. I might learn something. I might become more effective as a social worker. If you
are wrong, no harm done.” Saying “You could be right” is a principle of assertiveness
training. Thinking or saying this cuts down on defensiveness and shows respect for others.
What Research Says about Secondary Trauma
Trauma is an event that is life‐threatening or psychologically devastating to the
point where individuals’ capacities to cope are overwhelmed. Intrusive thoughts and
images, avoidance of reminders of the trauma, and emotional arousal are three main
classes of responses to trauma (APA, 2000). The DSM‐IV‐TR has a diagnostic category
called post‐traumatic stress disorder (PTSD). Secondary trauma is characterized by these
same three classes of responses (Bride, 2007).
Most of the clients with whom service providers work have experienced traumas.
Examples include child abuse and neglect, physical assault, rape, child sexual abuse,
witnessing violence, family violence, violent crime, loss of loved ones through civil war,
natural disasters, torture, war, terrorism, and forced migration including refugee status.
There is little research on secondary trauma of social workers in the United States,
but there is a growing body of research in allied professions. This brief review will cover
only the readings for the course Direct Practice Evaluation.
In a survey of almost 300 social workers in a southern state, Bride (2007) found that
about 70% experienced one of the symptoms of PTSD in the previous week, more than half
met one diagnostic criteria, about 20% met the criteria for two, and 15% met all three
diagnostic
criteria.
He
also
found
that
about
45%
of
the
sample
reported
intrusive
Gilgun secondary trauma
Page 6 of 6
thoughts,
45%
reported
avoiding
reminders
of
the
traumatic
event,
and
about
25%
reported emotional and physiological arousal. These are high numbers. Left unattended
these responses can affect quality of services.
Pludio (2007) reported on her interviews with 50 social workers who provided
services to survivors of the 9/11 attack in New York City. She also drew upon the training
she did for service providers on secondary trauma. As in Bride’s (2007) study, Pludio
observed in her work that professionals experienced long‐lasting symptoms of PTSD
including emotional arousal, intrusive thoughts and images, and avoidance of reminders of
the trauma.
She found the rates of secondary trauma to be alarmingly high, a situation she
believed lack of supervision worsened. Social workers found processing their sessions with
clients to be highly stressful, and they often wept after being with clients. Their work with
children particularly filled them with anguish. They often felt as if they re‐lived the events
of 9/11 over and over again. They felt frustrated and helpless when they were unable to be
of help to survivors.
These professionals attempted to hold their responses in check for a year or two
after their work ended, only to experience intrusive thoughts and images, anger and
irritability, and avoidance of reminders, all symptoms of PTSD.
Supervision and debriefing were insufficient during their direct work and difficult to
come by once they had completed their work. Many took the initiative and found their own
sources of professional support and consultation to help them deal with their own trauma‐
related responses. Humor during supervision and consultation can relieve stress and open
up possibilities for problem‐solving and effective actions (Gilgun & Sharma, submitted for
publication).
Humor,
of
course,
has
to
be
well‐timed,
and
social
workers
must
perceive
Gilgun secondary trauma
Page 7 of 7
remarks
intended
to
be
amusing
to
be
amusing.
Both Bride (2007) and Pludio (2007) reflected upon their findings. Bride pointed
out that many people believe that secondary trauma is a reason why professionals leave
human services, that many service providers have short‐ and long‐term effects of
secondary trauma, that the effects can put strains on personal relationships, and that
secondary trauma can affect practice effectiveness. He recommended further research on
these areas. Pludio (2007) made many suggestions about how to provide resources and
support to professionals with secondary trauma. These include supervision, de‐briefings
after sessions, training, and peer support. At the agency level, she recommended that
supervisors and other administrators receive training on managing and preventing
secondary trauma, and change the organizational structure to provide support for
professionals, including providing for a varied caseload and not only clients with high
degrees of trauma. She noted that social workers wanted a repository of information on
secondary trauma, client responses to trauma, and referral sources. She also said that any
disaster response plan must include strategies for dealing with secondary trauma.
Discussion
Secondary trauma affects most service providers. Left unattended, such trauma can
affect quality of services and therefore practice effectiveness. This article discussed
strategies for identifying and dealing with secondary trauma. The benefits of doing so are
high for clients and for practitioners themselves, both professionally and personally. Social
workers who last and have satisfying work and personal lives have mastered many
different ways of managing secondary trauma.
References
American
Psychiatric
Association.
(2000).
Diagnostic
and
statistical
manual
of
mental
Gilgun secondary trauma
Page 8 of 8
disorders
(4th
ed.,
text
rev.).Washington,
DC:
Author.
Bride,
Brian
E.
(2007).
Prevalence
of
secondary
traumatic
stress
among
social
workers.
Social
Work,
52(1),
63‐70.
Gilgun,
Jane
F.,
&
Alankaar
Sharma
(submitted
for
publication).
Humor
in
social
services.
Pulido,
Mary
L.
(2007).
In
their
words:
Secondary
traumatic
stress
in
social
workers
responding
to
the
9/11
terrorist
attacks
in
New
York
City.
Social
Work,
57(3),
279‐281.
About the Author
Jane F. Gilgun, Ph.D., LICSW, is a professor, School of Social Work, University of Minnesota,
Twin Cities, USA. See Professor Gilgun’s other articles, children’s stories, and books on
Amazon Kindle, scribd.com/professorjane, and stores.lulu.com/jgilgun.