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5. Helping the helpers
( See The good helper and The good helper revisited in Part II, pages 34-35 and 74-75.)
When working with severely traumatised people, close attention should be paid to helpers’ reactions. Helpers too are at risk.
• Secondary traumatisation. Helpers sometimes develop the same symptoms as those they help. They may experience hyper arousal, avoidance or distancing, and commonly experience intrusive images and nightmares after hearing or witnessing the traumatic suffering of survivors. Even a single story can create intrusive images.
• Vicarious traumatisation. As they accumulate experience of human suffering, helpers’ attitudes may evolve. They may become cynical or pessimistic about the world. This can cause them to undervalue themselves and others, or lose their belief in the possibility of change; they become indifferent. Over time, some helpers may feel that their personality has changed.
• Compassion fatigue. This state resembles vicarious traumatisation but may also affect professionals in caring positions who are highly exposed to, but do not work only with trauma. It describes a form of‘ burn-out’ that, in addition to changing cognitive attitudes, causes people to feel exhausted and demotivated, demoralised, bored and hopeless, leading to sleeping problems and sometimes to somatic difficulties and substance abuse.
PART III: THEORY
In all the above states, the helper feels that her problems, needs and well-being, and her private networks, do not merit attention; and that her own risks and hazards are insignificant. Such an attitude has severe consequences. The person is no longer available as an emotional resource to others; the quality of her work may decline; her family and other relationships may suffer; and she herself is likely to be unhappy and may become psychologically destabilised.
Advice
When symptoms of secondary traumatisation occur, the techniques used to help victims( such as stabilisation exercises, sleeping advice, etc.) can often be helpful to the helpers themselves. Helpers need to understand that it is important to recognise their own needs and reactions, and understand what triggers and modifies them.
In cases of vicarious traumatisation and compassion fatigue, additional factors may be relevant.
• Those most at risk tend to be individuals who set extremely high standards, find it difficult to set limits, and impose unrealistic demands on themselves. They need to be helped to recognise that they cannot do everything, are not indispensable, and cannot be responsible for all that happens. They need to learn how to: share or vary their workload; take holidays and schedule time for rest and relaxation; confide in friends and give themselves permission to plan time with them and with family; eat well; exercise regularly; and organise proper support and supervision for themselves at work.
• Vicarious traumatisation and compassion fatigue are likely to be more frequent in organisations that impose heavy demands on their staff and do not adequately regulate and manage their workflow, and where staff work in isolation without feedback from colleagues. The working environment should provide feedback and support, sound supervision, and opportunities to train and learn.
If you employ an interpreter, take care of her welfare too. Even an experienced interpreter may be emotionally overwhelmed by the stories she hears. Though it does not happen often, interpreters may be unable to hide their emotions. Helpers can try to look after the survivor and interpreter by acknowledging that it is painful for both to hear the horrible, unjust experiences that survivors report.
( For more information see page 21.)