Working with victims of crime: A manual applying research to clinical practice (Second Edition)
1.0 The Importance of Self-Care
A farmer was using a well-used, dull, rusted axe to cut a huge oak tree on his property. His neighbour was passing by and saw that the farmer was making no progress at all. “At this rate,” the neighbour thought to himself, “it will take him years to chop that gigantic tree down.” So he said to his friend, "Why don't you sharpen your axe?" The farmer replied, breathless: "I can't (chop)…take the time (chop)…Must cut down (chop)…this tree (chop)…by tomorrow."
Based on a Sufi teaching tale
Like the farmer chopping down the tree, we, as victim service workers, can get caught up in trying to reach our goals. We do not think about how we are doing our work or how we can do it better, because we are so busy. As workers we want to help; this is the reason we do this work. However, we can lose sight of our own needs because of all the work we see around us. We say,
“What are my problems/ stress/ exhaustion in comparison to what this person is dealing with!?!” This single-minded focus is also quite seductive, because others working with victims will support these “selfless” and “self-sacrificing” acts as dedication and empathy. I disagree with this view. As we stop taking care of ourselves, we wear down the major tool of our work. Like the farmer chopping the oak with a dull axe, there is activity – but how useful is it? We also need to have empathy for ourselves, as the tool with which we work. The bottom line is that if we are trying to help clients build skills, then we need to take care of ourselves. We need to act as models of self-care. For this reason, the manual begins with a discussion on the importance of workers looking after themselves.
It goes without saying that working with victims can be stressful, but some researchers have looked at this issue more closely. Brown and O'Brien (1998) found that 65% of workers in battered women’s shelters are moderately to highly stressed due to anger and frustration related to the behaviour of both victims and perpetrators. Added challenges of the job include stress related to time pressures, red tape, physical demands and lack of general achievement in their job (Brown and O'Brien 1998). Thus, these researchers found that job stress is related not only to the clients but also to dealing with the system. This is likely not very surprising to workers. However, it is important to emphasize this point to administrators and supervisors, who should monitor themselves and their staff for signs of burnout and job stress.
In a study looking at different types of clinicians, Holmqvist and Andersen (2003) interviewed experienced therapists who worked on a special project with victims of war-related trauma. They compared this group with therapists from general therapy settings and group homes. They found that the therapists who worked with trauma victims reported being less objective and less “motherly,” and feeling less enthusiastic than those working in general therapy. In comparison to those working in group homes, trauma therapists reported being more anxious and embarrassed. Further, as these therapists worked with trauma victims they became more detached and more bored, and reported less anxiety and reservation (Holmqvist and Andersen 2003). Perhaps as the therapists become more detached they are better able to deal with the anxiety related to their work. However, this does not serve our clients: Holmqvist and Andersen (2003) emphasized the importance of therapist self-care, and noted the danger that distancing could interfere with good clinical work. Cloitre et al. (2007) found that child abuse survivors in treatment for post-traumatic stress disorder did better in treatment if they had a positive relationship with the therapist. Workers must engage in self-care to be able to build strong, professional relationships with the victims with whom they work.
Self-care is important; our self-care activities, however, can have positiveor negative effects depending on what activities we choose. Passive methods suchas avoidance, ignoring the source of stress, or using alcohol or drugs are notthe best ways of dealing with the stress, because they do nothing to addressthe underlying problem (Pines and Aronson 1988). If the problem is left unchecked,stressed-out workers can end up quitting, becoming ill, or basically just becomingless and less effective in their daily work. Thus, it makes sense to move towardsmore active ways of coping such as talking about our sources of stress, gettinginvolved with other activities, or changing the source of our stress (Pines andAronson 1988). These researchers also found that workers who have a positiveattitude show less career burnout as well.
Each worker is different. We each need to identify what healthy self-care behaviours will help us reduce stress and fatigue. This will help us both in our work with victims and in our ability to build a balanced life. The following are possible ways in which workers can seek balance. Doing so may also help ensure that we increase our success with clients and still meet our personal needs in the rest of our lives.
To understand our stress levels, we should continually assess and examine our feelings, thoughts, and behaviour (Grosch and Olsen 1994). We need to understand the difference between normal fatigue and the exhaustion that is related to burnout. This is different for each person. Often, burnout fatigue appears as not feeling rested after sleep, losing energy quickly, feeling frustrated, or feeling empty and “wrung-out” (Grosch and Olsen 1994; Pines and Aronson 1988). Needless to say, these feelings can also result from physical illness, so consulting a doctor is important if one suspects a medical problem. However, consulting with peers and supervisors can also help us to understand where we are and how we can cope better. As workers we need to listen closely to our bodies, feelings and thoughts, but also to feedback from others. Listening to co-workers, friends and family can be a good way to keep track of stress levels. Thus, advice and insight from any source needs to be examined to decide what works for each of us. Interested workers are referred to Richardson (2001), who included a self-awareness exercise in the appendix of her publication on vicarious trauma.
Use of effective supervision/peer support
As mentioned in the Self-Assessment section, workers must rely on others to give them feedback on their stress level (Gorman 2001; Grosch and Olsen 1994; Kottler 1999). Researchers have found that workers who feel supported by their supervisors, friends and family showed less emotional exhaustion and felt more connected to other people and their own feelings (Brown and O'Brien 1998). Other researchers see supervision and consultation as one of the most important factors in preventing burnout (Salston and Figley 2003). In consultation and supervision we also need to take time to focus on our successes and the positives of our work – no one wants meetings that focus solely on what has gone wrong.
As workers, we need to build a network that helps support us and from which we can receive clear, direct feedback. Building a network of support that tiptoes around us, or treats us like delicate glass figurines, will not help if we need clear feedback. Remember: this may include feedback from friends and family, because they may notice small changes that could grow into big problems. They also can help support us in making sure that we do not focus only on our work (Kottler 1999). In building this system, we could include “burnout checks,” checking on stress and exhaustion levels, as part of normal supervision or team discussions.
Workers need to learn to set clear boundaries (Grosch and Olsen 1994; Kottler 1999). Anyone working in a helping profession knows this pearl of wisdom, but many ignore these boundaries when overworked or stressed. Boundaries are basically the limits that we set on ourselves to ensure quality care. Daniels, Bradley and Hays (2007) note that workers might choose to limit caseloads, which may mean limiting numbers but should also mean balancing our caseloads among teammates so that no one worker is dealing with all the challenging cases.
Remember – setting strong boundaries does not mean that we cannot be adaptable. Workers simply need to be aware of boundaries and how to apply them in a way that benefits both themselves and their clients. One worker might decide that she never works past 6 pm, another doesn’t give out his home number, and a third will not talk to her clients about her personal life. Team discussions and supervision meetings are excellent times to explore boundaries. Different people and different professions draw boundary lines differently – the key question to ask is: “Do my boundaries help me build and keep resources for the benefit of myself and my clients?” By always putting our needs last, we risk becoming less effective as a worker and as a person.
Building a balanced life
Another important issue in self-care is balancing home and work life: We do not exist only at work. We can have stress in our home life. Money worries, relationship problems, medical stresses do not disappear just because we walk through our office door. Remember – stress at home can affect work just as easily as stress from work can affect home. The activities and skills described below can help us deal with stress in all parts of our lives, not just the challenges of work.
Balancing your life includes setting limits (Grosch and Olsen 1994); boundaries are often one of the first things we give up as we start to ignore our needs. Thus, working over a couple of lunches because that’s when the client can meet us is seen as no big deal. Certain offices and supervisors may even see this as dedication. However, this behaviour is the first step to ignoring our own needs and, potentially, to burnout. There is a fine line between being the “hero” of the clinic and needing to go on stress leave!
Workers who become overly focused on work run the risk of meeting personal needs through providing help to clients (Kottler 1999). These personal needs may be to feel useful, have social contact, be valued, or address unresolved childhood or relationship issues. It is great to feel a sense of accomplishment in our work and even to grow because of what we do (Hernandez et al. 2007), but meeting our needs in our job does not necessarily mean we are meeting our client’s needs. If, on the other hand, we are meeting our needs in other areas (e.g. through home life, friendships, spirituality) then we may be less likely to try to seek this at work.
What does a balanced life look like?
We each find balance in different ways. Basically, we need to look at the different roles we play in life: spouse, worker, friend, parent, child, and so on. Which are the most important? Each worker should arrange his or her roles in order of importance and set aside time for the most important. Where do we recharge our batteries? For example, if self-care is important, we will set aside time in our week for activities that we view as soothing. These might include meeting friends for coffee, reading a “fun” book (not a work-related manual like this!), playing softball, meditating, golfing, or painting. It can be useful to write out a “Recharge List” of things that help you rebuild or unwind, and keep it handy so that when you feel tense or overwhelmed, you can quickly look at the list and do something on it that will help you take a breather. Bryant and Veroff (2007) describe this process as going on a formal “Daily Vacation” where you take 20 minutes to enjoy a pleasant, relaxing activity. During the activity you set aside all distractions and worries, paying attention to fully experiencing your enjoyment (including your thoughts and feelings) and ending the vacation by planning what you will do in tomorrow’s vacation. At the end of the week, you review all your daily vacations and notice how your week went – especially in contrast to weeks when you did not take daily vacations.
The key to understanding a balanced life is to realize that we each have limited resources that need to be rebuilt; we cannot do it all. Stress in any part of your life will affect your resources in other areas – stress at work affects your home life, financial stress affects your work and relationships. This is normal. Balancing your life is basically a process of deciding how many resources you have and then using those resources in areas that are important to you. Through planning ahead, you are more likely to feel in control and less likely to feel that stress runs your life. Remember – these activities will likely improve your overall quality of life, not just your work.
Education and professional development
Workers can always benefit from professional development and training. Salston and Figley (2003) see training in dealing with trauma as important to reducing burnout. These activities not only teach new skills, but also give time for workers to reflect on their performance. In other words, development sharpens our skills (like the axe) by taking time to review our approach (noticing the dullness) and adding or improving our skills (sharpening). Although developing skills around self-care and setting boundaries is important, the benefits associated with learning any new skill or looking at an issue from a new vantage point can help you recharge in providing services. In a sense, setting aside time to read this manual is self-care.
Services for workers
Workers also need to know when to seek out help. Possible treatment options include self-help (e.g. reading self-care books), support groups, psychotherapy, and outpatient or inpatient treatment (Grosch and Olsen 1994; Kottler 1999; Salston and Figley 2003). Basically, these direct methods of dealing with stress help us take care of our needs. This is the farmer taking the time to sharpen his axe. The choices we make depend on our goals. For example, if it is important to deal with past issues at a deep level, therapy may be the best approach. However, if we just need a place to unload our stress, a self-help group may be in order. Self-help resources are a great way to identify new ways to deal with stress around work and home. It all depends on our stressors and goals. We may also find that we use a mix of methods, using different approaches at different times. We are the best judge of what works for us, but we can all benefit from getting help and feedback from others.
It may seem odd to begin a manual on the psychological effects of crime victimization with a discussion on workers. This approach is taken for one key reason: working with people in distress is a highly stressful and highly rewarding activity (Grosch and Olsen 1994; Pines and Aronson 1988). Workers should not ignore the rewards of this work, but these benefits can only be felt if we feel healthy (Kottler 1999). In recognition of the rewards, researchers have recently started to investigate a phenomenon called vicarious resilience, which focuses on how those working with victims can learn and benefit from witnessing client growth and resilience (Hernandez et al. 2007). These researchers interviewed psychologists who work with victims of social violence, political violence and kidnapping. They found that the therapists were able to identify important benefits of this work, including increased hope for growth, belief in people’s strengths, improved clinical skills, social empowerment, appreciating blessings and enhanced meaning (Hernandez et al. 2007). It is good to be reminded of these benefits.
Workers best serve themselves and their clients by watching their stress andactively pursuing activities that build personal resources. There can sometimesbe an expectation – on our part or as part of the culture in the helpingagency – that we can handle everything. Such views are tempting becausethe work is very important. Some view working with victims as a “calling” whereinwe silently shoulder the stress, but this misses the point. Working with crimevictims is difficult; it is normal that we will sometimes feel drained. Workingwith victims is rewarding: it is normal that we will feel moved and inspired.As workers we must remember that we need to take care of ourselves first, beforewe can take care of others. If we ignore our own care we are like the farmerchopping the tree with a dull axe – we’re busy but we’re notgetting anywhere.
Self-care activities are important. This is a manual on crime victims, not workers, and so self-care activities are only briefly introduced in this section. Interested readers are directed to the following resources and Web sites to increase their knowledge in working with victims and self-care. Good self-care should help us to improve our job satisfaction and effectiveness in our work and daily life. Of particular note is:
The following resources can also be found on the Internet:
The International Society for Traumatic Stress Studies: Good links and resources:
Hope Morrow’s Trauma Central: Several articles on vicarious traumatization and burnout:
The National Center for Post Traumatic Stress Disorder, United States Department of Veterans Affairs:
Ontario Council of Agencies Serving Immigrants at Settlement.org:
National Family Violence Clearinghouse, Public Health Agency of Canada:
Self-care Guide from the Public Health Agency of Canada
- Self-care is key to better service delivery.
- Workers need to take care of themselves first, if they are to effectively help their clients.
- Workers can be models of good self-care.
- Workers can choose to apply effective coping strategies (dealing directly with the problem) rather than poor coping strategies (avoidance, ignoring, “working through the stress”).
- Self-care behaviours can include:
- Self-Assessment – watch for signs of stress (numbness, feeling or being disengaged, unmanageable emotions) and strength (resiliency, supports, spirituality) (Grosch and Olsen 1994; Kottler 1999; Maslach and Leiter, 1997; Pearlman, 1999);
- Using effective supervision from superiors and peer support from coworkers (Grosch and Olsen 1994; Kottler 1999);
- Focusing on the things that went well and areas of potential growth and development;
- Setting boundaries, both in your work and home life (Balanced life) (Grosch and Olsen 1994; Weiss, 2004);
- Taking a Daily Vacation (Bryant and Veroff 2007);
- Building a balanced life (Grosch and Olsen 1994);
- Using support groups, therapy, outpatient treatment, etc.; (Grosch and Olsen 1994);
- Pursuing educational and professional development activities.
- Note that your treatment model may blind you to paying attention to self-care issues (Dana 2000).
- Also make self-care a priority at the team or community level (Maslach and Leiter 1997).
- Being aware of the risks of vicarious trauma may help in preventing the problem (Daniels et al. 2007).
- Providers may find themselves trying to avoid certain clients or topics (Shubs, 2008).
- Providers may find that they overly identify with the victim and become overwhelmed (Shubs 2008).
- Providers can also look toward the strengths they gain from working with victims (vicarious resilience) (Hernandez et al. 2007).
Spend time reading on self-care and try some of the activities suggested. Ask your colleagues what they do that helps them keep their life balanced.
… Sharpen Your Axe.
 See the “Further Reading” section for this chapter.
 Please note: The links provided in this manual were active at the time of publication, but organizations commonly restructure Web sites and move material. If the link does not work you can search the organization’s site or use a general search engine to find the document or resource.
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