"Feeling heavy"

Vicarious trauma and other issues facing those who work in the sexual assault field
ACSSA Wrap No. 4 – September 2007

Organisational support to prevent and address vicarious trauma

Organisational support can be key to helping employees vent, process, or debrief about traumatic material (Wasco & Campbell, 2002). Conversely, unsupportive administration, low salaries and difficulties encountered in providing services are all predictive of higher burnout rates (Bell, Kulkarni, & Dalton, 2003). So what are ways in which organisations can create a supportive environment for professionals working in the sexual assault field?

Ensuring appropriate and diverse caseloads

Given that the level of exposure to trauma is a predictor of vicarious traumatisation levels, the number of cases workers see within a given time period needs to be appropriate. It is also important that workers do not feel pressure to see more than this because of 'waiting lists' (if waiting lists are a problem, more workers need to be funded). In relation to professions where caseloads are not applicable, exposure to traumatic material or traumatised clients/participants needs to be recognised as difficult and challenging work, with appropriate supports put in place.

More diverse caseloads are associated with decreased vicarious traumatisation (Crestman, 1995, cited in Bell et al., 2003, p. 463). Diverse caseloads can be achieved for some workers through ensuring they see a diversity of clients rather than only traumatised clients. For those working in a specialist field (for example, sexual assault counsellor advocates), more diverse caseloads can be achieved through seeing a diversity of client types: children as well as adults (if the service sees both children and adults), adult survivors of child abuse as well as adults recently abused, and both female and male survivors. Another strategy for diversifying caseloads is for a sexual assault specialist to work at multiple levels in sexual assault recovery and prevention (e.g., engaging in individual counselling, group work, training, research, communication, advocacy and community education/social change work).

Providing effective supervision for all

Effective supervision is said to be an essential component of the prevention and healing of vicarious traumatisation (Bell et al., 2003). Responsible supervision creates a relationship in which a worker feels safe to express their fears, concerns and feelings of inadequacy. Sometimes staff supervision will be combined with ensuring organisational accountability and staff evaluation. This can create a tension: a worker's concern about the evaluation of their work may make her or him reluctant to bring up something relevant to vicarious traumatisation. Because of this, some recommend supervision and evaluation remain separate functions (Bell et al., 2003). In agencies where this is not possible, the use of external clinicians for trauma-specific supervision is recommended. Certainly, all supervisory relationships need to be characterised by trust and transparency, set by a supportive workplace culture (discussed below). It is also worth noting that supervisors themselves need to be able to access effective supervisory support.

Access to debriefing

Debriefing and peer support were identified in a study of domestic violence counsellors as the most important strategy for dealing with the after-effects of a difficult counselling session (Iliffe & Steed, 2000). Workers dealing with trauma need to have access to regular debriefing. 'Critical incident debriefing' is a formalised method for processing specific traumatic events, and is an important component of organisational support. However, it is different from managing repetitive or chronic traumatic material,and ongoing support for this also needs to be available.

Indeed, it has been suggested that talking in a semi-structured setting may be an integral part of dealing with rape crisis work. Rape victim advocates may be bound to silence outside of the work setting, either by legal confidentiality mandates or social pressures not to bring up the topic of rape. Therefore, a key way in which organisations can support workers is by providing opportunities to verbalise 'rape-related pain' and be in the company of supportive listeners, which may be difficult for them to arrange in other areas of their lives. This also relates to staff and peer support (see below).

Staff and peer support

The literature on both vicarious traumatisation and burnout emphasises the importance of social support within the organisation. As Bell et al. (2003) state, staff opportunities to debrief informally and process traumatic material with supervisors and peers are helpful. Group support can be formal or informal, take a variety of forms, and can be peer or professionally led. It may involve case conferences, clinical seminars or even reading groups. Time for social interaction between co-workers (for example, celebrating birthdays and specific achievements, team-building activities, staff retreats) can increase workers' feelings of support. Staff support also relates to workplace culture (see below).

Safety and comfort in the work environment

Some work places are so dangerous that workers experience primary trauma, including physical and sexual violence, abuse, stalking and threats of violence, rather than only vicarious trauma. They may also experience bullying and harassment. Research has found that being threatened by a client or other person at work is strongly correlated with compassion fatigue. Obviously, protecting workers' physical and psychological safety must be of primary concern when creating a supportive work environment. Workplace measures must exist that clearly and urgently prioritise a sexual assault professional's physical and psychological safety. Such measures must prevent the occurrence of any direct physical and psychological harm, and respond swiftly and effectively to any safety violations that occur.

As well as safety issues, workers' comfort is also important. Research has suggested workers need to have personally meaningful items in their workplace (Pearlman & Saakvitne, 1995), and 'inspiring posters or pictures' can 'model the importance of the personal in the professional' (Bell et al., 2004, p. 467). A comfortable break room (separate from clients, if relevant) is also important, perhaps with provisions for comfort (hot drinks, music, etc.).

Workplace culture

The values and culture of an organisation set the expectations about the work. When the work includes contact with trauma, they also set the expectations about how workers will experience trauma and deal with it, both professionally and personally. (Bell et al., 2003, p. 466)

I feel very supported doing the work that I'm doing. (Rape victim advocate and research respondent, Wasco & Campbell, 2002)

An organisational culture that normalises the effects of working with trauma can be a start to providing a supportive environment for workers to address those effects in their work and wider lives. It may also give 'permission' or encouragement for workers to take care of themselves. Part of acknowledging the impact of vicarious traumatisation will include providing education about vicarious traumatisation. Ideally, this education will start at the beginning of a professional's career and will be ongoing.

Apart from the above points, additional aspects of a supportive organisation might include:

  • allowing for holidays, flexible working hours, taking time off for illness and participating in continuing education, and not explicitly or implicitly expecting or encouraging staff to work overtime. Ideally, people working in this field would have additional leave to deal with vicarious trauma issues or to simply take a break when necessary;
  • creating opportunities for varying caseload and work activities;
  • making staff care and self-care part of a mission statement;
  • making time, resources and funds available for workers' self-care activities. Ideally, staff salaries would be commensurate with the difficult nature of this work, like other work that places professionals in 'danger';
  • addressing self-care issues in staff meetings;
  • being understanding and supportive of sexual assault issues, and effectively dealing with rape supportive beliefs in the organisation;
  • accepting that workers will sometimes make mistakes and creating an environment free from shaming behaviours;
  • actively soliciting staff views on what would create a more supportive organisation;
  • actively soliciting staff views on decisions affecting staff and the organisation;
  • warning applicants of the potential 'risks' of trauma work (Pearlman & Saakvitne, 1995), while balancing this with a discussion of the positives (see below); and
  • discussing the positive aspects of sexual assault work, including emphasising and celebrating good news and achievements.