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Psychological and Physiological Trauma Research
Seize Your Journeys
_______________________ Traumatic stress is found in many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences. Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences. Having symptoms after a traumatic event is NOT a sign of personal weakness. Given exposure to a trauma that is bad enough, probably all people would develop PTSD. By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment. _______________________
PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com __________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373
Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373 Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. ________________ DID-PTSD-EMDR Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com
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sychological Trauma
Vicarious Traumatization
Title: The role of empathy in vicarious traumatization. Author(s)/Editor(s): Friedman, Tatiana Ryk Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 62(8-B) Mar 2002, US: Univ Microfilms International; 2002, 3799Abstract/Review/Citation: In recent years, the secondary effects of treating traumatized people on helping professionals have been established in the literature. However, the psychological processes involved in vicarious traumatization have remained poorly understood. The present study was designed to examine the role of empathic processes in empathic distress, a less extreme form of vicarious traumatization, within the context of a simulated psychotherapy situation. The present study used a 2 (type of trauma exposed to: high or low) x 2 (type of empathizer: high or low) factorial design. Participants' physiological, affective, and cognitive responses to a target-patient's traumatic situation were assessed using various measures, as a function of individual differences in empathy and exposure to traumatic material. Eighty-eight female participants were preselected for this study in terms of their dispositional empathic abilities and were randomly assigned to observe a target-patient discussing a high or low trauma situation. In addition, participants reported on their use of problem- and emotion-focused coping as ways to manage stressful situations. Overall, participants who were exposed to highly traumatic material were indeed more likely to experience affective distress, as well as increased physiological reactivity. High empathizers exhibited greater empathically based physiological reactivity as a result of exposure to trauma, while they did not generally self-report more affective distress. Instead, evidence was found for an alternative trend in that low empathizers self-reported more affective distress, but not physiological reactivity, as a result of experimental exposure. In addition, cognitive processes, such as the adoption of a self- or other-focused orientation and the transmission of traumatic material, were related to individual differences in empathy and exposure to trauma. Moreover, two different forms of problem-focused coping, planful problem-solving and confrontive coping, were influenced by both individual differences in empathy and exposure to trauma; whereas, emotion-focused coping was affected only by individual differences in empathy. Results from this research have suggested possible implications about empathy's contribution to the development of vicarious traumatization within the therapeutic context. ========================================
Title: The lost soldier: A phenomenological study of trauma in noncombat soldiers in the Vietnam war. Author(s)/Editor(s): Pasternak, Alan Gary Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 62(9-B) Apr 2002, US: Univ Microfilms International; 2002, 4230Abstract/Review/Citation: Combat soldiers of the Vietnam War have made great gains in their search for wholeness through numerous programs that help them deal with the psychological effects of war. Noncombat soldiers have been left behind, because conventional wisdom affirms that they did not suffer the same trauma as combat soldiers. The present phenomenological study found that noncombat soldiers have also suffered from war, and in similar ways. Through vicarious trauma, the men in this study have lived with different but no less painful memories of the war. Some suffered by having to treat the injured soldiers who returned from Vietnam, and others by hearing stories of atrocities committed by their brother soldiers. Guilt played a large part in the stress and trauma that many suffered during their time in the military: the guilt of not going to war when others did; the guilt resulting from anger toward the government for allowing so many of their comrades to die in a country that few had ever heard of. The loss of fellow soldiers, family members, and friends to this war weighs heavily on each participant. The fear of death from nuclear attack during the Cold War, or even from conventional weapons in sensitive regions, has added to the effect on these individuals. Some were traumatized by the American people's hatred of the war and were inadvertently targeted when in uniform by protesters. Others were ridiculed by World War II veterans, because Vietnam was not fought like their war. All eight men who were interviewed for this study discussed some type of negative effect from serving in the military during Vietnam, and several broke down and cried when they remembered the stresses and losses they felt. This remembrance comes more than 30 years after they left the military, and it still deeply affects them today. ========================================
Title: What does this work do to us? Author(s)/Editor(s): Lansen, Johan Source/Citation: At the side of torture survivors: Treating a terrible assault on human dignity., Baltimore, MD, US: Johns Hopkins University Press; 2001, (xxv, 241), 198-211 Source editor(s): Graessner, Sepp (Ed) Abstract/Review/Citation: Describes some of the results for therapists of the difficult work of treating clients who suffer from the effects of persecution and torture, including burnout and symptoms of posttraumatic stress disorder. Some data from 300 therapists in treatment centers treating traumatized as well as other kinds of clients are presented, indicating that the phenomenon of vicarious traumatization is empirically verifiable. Three explanatory models for vicarious traumatization are discussed, and some recommendations for preventing burnout, entanglements, or the danger of too much distance are given. ========================================
Title: Counselor reactions to clients traumatized by violence. Author(s)/Editor(s): Jones, Karyn Dayle Source/Citation: Faces of violence: Psychological correlates, concepts, and intervention strategies., Huntington, NY, US: Nova Science Publishers, Inc; 2001, (xxviii, 470), 379-388 Source editor(s): Sandhu, Daya Singh (Ed) Abstract/Review/Citation: The trauma of violence effects those who experienced the trauma and many more. Counselors are among the many caregivers who may be impacted by their work with trauma survivors. Whether identified as vicarious traumatization, secondary traumatic stress, compassion fatigue, countertransference or empathic strain, it is clear that professional counselors may experience a variety of reactions associated with counseling survivors. Counselor reactions may include symptoms similar to posttraumatic stress disorder in addition to overidentification, avoidance, and the effects of vicarious traumatization. These reactions greatly impact counselors and their ability to effectively treat survivors. Personal counseling, balancing work and leisure, spirituality, and supervision are ways counselors can become aware of, work through, and cope with a normal reactions associated with trauma work. ========================================
Title: Trauma exposure and PTSD symptoms in international relief and development personnel. Author(s)/Editor(s): Eriksson, Cynthia B.; Vande Kemp, Hendrika; Gorsuch, Richard; Hoke, Stephen; Foy, David W. Source/Citation: Journal of Traumatic Stress: Special Issue: Vol 14(1) Jan 2001, US: Kluwer Academic/Plenum Publishers; 2001, 205-219 Abstract/Review/Citation: Investigated whether international relief and development personnel are directly or indirectly exposed to traumatic events, and whether they are at risk for developing symptoms of posttraumatic stress disorder (PTSD). Surveys were administered to 113 recently returned staff (mean age 39 yrs) from 5 humanitarian aid agencies. Results show that respondents reported high rates of direct and indirect exposure to life-threatening events. Approximately 30% of those surveyed reported significant symptoms of PTSD. Multiple regression analysis reveal that personal and vicarious exposure to life-threatening events and an interaction between social support and exposure to life threat accounted for a significant amount of variance in PTSD severity. The results suggest the need for personnel programs; predeployment training, risk assessment, and contingency planning may better prepare personnel for service. ========================================
Title: The Traumatic Stress Institute Belief Scale as a measure of vicarious trauma in a national sample of clinical social workers. Author(s)/Editor(s): Adams, Kathryn Betts; Matto, Holly C.; Harrington, Donna Source/Citation: Families in Society: Special Issue: Vol 82(4) Jul-Aug 2001, US: Families International Inc; 2001, 363-371 Abstract/Review/Citation: Reports on a study of the validity of the Traumatic Stress Institute Belief Scale (TSI)-Revision L, as a measure of vicarious trauma in masters' level clinical social workers. The scale purports to measure disturbed beliefs that may be caused by direct trauma, or by repeated exposure to clients' traumatic stories. A random sample of 185 social workers (27-74 yrs old) was surveyed. Results of correlational analyses of the TSI score with study variables, and exploratory multiple regression analysis on the TSI score indicate its association with younger age, more reported somatic symptoms, lower annual salaries, lower perceived social support from friends, and greater burnout. Results show that TSI scores were not associated with social workers' personal trauma, amount of face-to-face client contact, or a self-report of the intrusiveness of client material into the social workers' lives. TSI scores appear to be measuring perceptions about self and work that, like burnout, may relate to social workers' general outlook, not necessarily to traumatic stress, vicarious or otherwise. Significant overlap of the TSI with burnout scores suggests a lack of clear distinction between burnout and vicarious trauma. ========================================
Title: Traumatic symptomatology in children who witness marital violence. Author(s)/Editor(s): Finkelstein, James; Yates, Jennifer K. Source/Citation: International Journal of Emergency Mental Health: Special Issue: Vol 3(2) Spr 2001, US: Chevron Publishing Corp; 2001, 107-114 Abstract/Review/Citation: For many years, research has demonstrated the devastating effects of violence upon children, particularly in the form of direct physical and sexual abuse. What has only recently come to into focus are the potential effects of witnessing violence upon children. This area of vicarious victimization seems of particular import given the fact that so many youngsters are known to witness violent acts within their own households. This paper shall review the psychological effects which may be effected upon children as a result of witnessing marital violence. Relevant research issues concerning the potential roles of moderating and mediating variables will also be discussed. ========================================
Title: Vicarious traumatization: The relationship of absorption, emotional ; empathy and exposure to traumatized clients to ptsd symptom-like behavior in therapists. Author(s)/Editor(s): Wertz, Christina Ann Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 61(9-B) Apr 2001, US: Univ Microfilms International; 2001, 5013 Abstract/Review/Citation: Some psychotherapists who work with clients with a history of severe trauma have reported intrusive images, thoughts, nightmares, avoidance and other PTSD symptom-like behaviors related to their clients' traumas. The goals of the current investigation were to determine which therapists would experience PTSD symptom-like behaviors, reveal how common it is for therapist to report such behaviors, and specify which of these behaviors are most frequently reported. The main hypothesis was that therapists who are most prone to or capable of vicariously sharing the feelings and experiences of their clients would be more likely to manifest PTSD symptom-like behaviors. Two measures of these dispositional tendencies were hypothesized to be related to PTSD symptom-like behaviors in response to work with trauma clients: the Absorption Inventory of the Multidimensional Personality Questionnaire (TAS) (Tellegen, 1978/1982), and the Questionnaire Measure of Emotional Empathy (QMEE) (Mehrabian & Epstein, 1972) The contributions of several other therapist variables (personal history of PTSD, gender, and cumulative and recent exposure to trauma clients) to the occurrence of PTSD symptom-like behaviors were also assessed. One hundred and fifteen psychotherapists (83 females, 32 males) who had worked with trauma clients completed a set of self-report questionnaires. These questionnaires were used to measure levels of absorption and emotional empathy, and to obtain pertinent background information as well as information about PTSD symptom-like experiences related to trauma clients. Survey results indicate that it is common for trauma therapists to experience PTSD symptom-like behaviors related to their work. These behaviors do not constitute diagnosable PTSD reactions. As hypothesized, multiple regression analyses revealed that both therapist level of absorption (as measured by the TAS) and emotional empathy (as measured by the QMEE) predicted the extent to which the PTSD symptom-like behaviors reported by therapists resembled PTSD reactions. Absorption predicted the number of reexperiencing (intrusion) PTSD symptom-like behaviors reported and the total number of PTSD symptom-like behaviors reported. Personal trauma history predicted reexperiencing behaviors and the extent to which the PTSD symptom-like behaviors reported resembled PTSD reactions. Neither cumulative exposure nor recent exposure were related to reports of these behaviors. ========================================
Title: Burnout, vicarious traumatization, coping styles, and empathy in long-term care nursing personnel. Author(s)/Editor(s): Glidewell, Reba Sue Ellis Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 61(9-B) Apr 2001, US: Univ Microfilms International; 2001, 4982 Abstract/Review/Citation: There have been many research studies on burnout since the inception of the construct but few have investigated burnout in long term care nursing staff. In addition, the study of vicarious traumatization has recently begun to include empirical investigations. To date, no study has been identified that incorporated both burnout and vicarious traumatization using nursing staff employed in nursing home settings. This exploratory study was an investigation into a proposed process model for the development of burnout using vicarious traumatization, coping styles, and empathy as predictor variables. Nursing staff from 10 long term care facilities (N = 160) completed questionnaires measuring burnout, vicarious traumatization, empathy, and coping styles. Pearson correlations were used to explore the relationships between individual variables. Structural equation modeling was employed to test the goodness of fit of the proposed process model of burnout. Additionally, a canonical correlation procedure was used to measure the amount of shared variance between burnout and vicarious traumatization. A statistically significant relationship was found between vicarious traumatization and burnout, which is contradictory to much of the present research findings. The proposed process model of burnout was not supported, although several predictive relationships were present. ========================================
Title: Body awareness: An aspect of countertransference management that moderates vicarious traumatization. Author(s)/Editor(s): Forester, Cress A. Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 61(10-B) May 2001, US: Univ Microfilms International; 2001, 5561 Abstract/Review/Citation: Specialists in trauma work have observed that the management of countertransference is associated with reduced susceptibility to vicarious traumatization (Pearlman and Saakvitne, 1995). This had not however been explicitly studied. Further, there is ample evidence from body centered psychotherapies, about the importance of clinician's body awareness in managing countertransference; this also had not previously been studied. This research tested hypotheses that the use of body awareness by clinicians would be inversely related to their vicarious traumatization when other moderating factors were taken into account. The three moderating factors included in the analysis were: years of ongoing supervision/consultation, hours per month of supervision/consultation, and years of own therapy. These factors all aid in countertransference management. The population studied was clinicians in community mental health in San Francisco, who spend at least 20% of their monthly clinical time with trauma clients. Since no measures existed to assess the use of body awareness as a way of managing countertransference, two new measures were designed and tested in a pilot study: the Body Awareness measure and the Frequency of Practice (of body awareness) measure. Both obtained good reliability and validation criterion in the pilot study, and so were accepted for use in the main study. Vicarious traumatization was assessed through two measures: the TSI Belief Scale - version L (Pearlman and Mac Ian, 1995), and the Impact of Events Scale Revised (Weiss and Marmar, 1997). Hierarchical multiple regressions were used to analyze the data. Fewer clinicians (96) than anticipated responded to questionnaires, hence unfortunately the power for this study was too low to be likely to find large effects or significant relationships. The effect sizes found were indeed quite small, and few results were statistically significant. The results were nevertheless consistent with all hypotheses. Frequency of Practice (of body awareness) accounted for more inverse variance in scores for vicarious traumatization than any of the other factors. The effect of that variable in the regression far exceeded those for the other moderating variables put together. This was a beginning study; far more research into these factors is needed. ========================================
Title: Vicarious traumatization in therapists: Contributing factors, PTSD symptomatology, and cognitive distortions. Author(s)/Editor(s): Lugris, Veronica Maria Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 61(10-B) May 2001, US: Univ Microfilms International; 2001, 5571 Abstract/Review/Citation: One hundred ninety-one licensed psychologists who work with traumatized clients completed a survey that examines the impact of personal and professional factors on vicarious traumatization. Quantitative results indicated that therapists' personal variables of sex, personal trauma history, and current stressfulness of personal trauma predict PTSD symptoms, while variables that include vicarious exposure to trauma and perceived social support predict hyperarousal symptoms and cognitive distortions above and beyond the effects of therapists' personal variables. Qualitative results revealed the importance of maintaining a balance between professional and personal support, a holistic attention to body and mind that includes physical exercise and self-care, spirituality and meditation, leisure activities, cognitive strategies, and personal growth activities. Implications and recommendations for future research are discussed. ======================================== Title: Migration stress and the vicarious acquisition of learned helplessness through media exposure in Vietnamese refugees. Author(s)/Editor(s): Duong, Christine Hang Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 61(11-B) Jun 2001, US: Univ Microfilms International; 2001, 6185 Abstract/Review/Citation: The central purpose of this study was to investigate whether watching another experience helplessness can serve to vicariously induce learned helplessness in a particularly vulnerable population that has had a long history of trauma due to war and migration: the Vietnamese. Because television news often depicts situations in which people have little or no control over their environment, it was hypothesized that helplessness deficits affecting cognition, motivation, and emotion would ensue when a person of Vietnamese descent viewed the helplessness experiences of another person of Vietnamese descent. Furthermore, it was predicted that individuals' level of stress before and after migration to the United States would exacerbate these helplessness deficits. Fifty-six Vietnamese men and women were randomly assigned to one of three conditions, in which news stories, containing varying degrees of helplessness, were shown. Prior to viewing their designated news stories, premigation and postmigration stress were assessed via the Harvard Trauma Questionnaire (HTQ) and Acculturation Stress Index - Revised (ASI-R), respectively. Participants were then exposed to 15.5 minutes of uninterrupted news broadcasts containing either high helplessness content, low helplessness content, or neutral content. An anagram task given after the induction measured participants' cognitive and motivational deficits, whereas, the Positive and Negative Affect Schedule (PANAS) was administered before and after the induction to assess for emotional deficits. The findings suggest that watching helplessness content as shown on television newscasts did not cause or predict cognitive or motivational deficits as measured by an anagram task. However, the exposure to high levels of helplessness content coupled with participants' high levels of acculturation stress predicted emotional deficits, as indicated by an increase in negative adjectives endorsed on the PANAS, post-videotape. The findings and limitations of this study should be interpreted in light of the complexities involved in crosscultural research. ======================================== Title: The relationship between empathy and attachment styles and vicarious traumatization in female trauma therapists. Author(s)/Editor(s): Marmaras, Elizabeth Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 62(1-B) Jul 2001, US: Univ Microfilms International; 2001, 556 Abstract/Review/Citation: The role of empathy and attachment styles in vicarious traumatization was investigated in a national sample of 375 female therapists who treated adult outpatient trauma survivors. It was asserted that empathy styles (perspective taking, empathic concern, personal distress) as measured by the Interpersonal Reactivity Index (Davis, 1983) and attachment styles (secure, fearful-avoidant, preoccupied and dismissive-avoidant) as measured by the Relationship Questionnaire (Bartholomew & Horowitz, 1991) may be related to vicarious traumatization as measured by the Traumatic Stress Institute Belief Scale (Pearlman & Saakvitne, 1995). It was also asserted that vicarious traumatization results in disruptions in cognitive schemas and in behavioral symptoms of hyper arousal, avoidance and intrusion. Multiple regression analyses (MRA) were used to examine the relationship between empathy styles, disruptions in cognitive schemas and behavioral symptoms. Results indicated a significant relationship between empathy styles and disruptions in cognitive schemas, F (3, 371, df = 7.89, p < .00); the best predictor was the personal distress empathy style (B = .21, p = .00). Results suggested no significant relationship between empathy styles and symptoms ofhyper arousal, intrusion and avoidance, F (3, 371, df = 2.30, p < .07). Multiple regression analyses (MRA) were also used to examine the relationship between attachment styles, disruptions in cognitive schemas and behavioral symptoms. Findings indicated a significant relationship between attachment styles and disruptions in cognitive schemas, F (4, 370, df = 36.66, p < .00); the best predictors were the fearful-avoidant (B = .30, p < .00) and the preoccupied (B = .27, p < .00) attachment styles. Findings also suggested a significant relationship between attachment styles and symptoms of hyper arousal, intrusion and avoidance, F (4, 370, df = 15.68, p < .00);the best predictors were the fearful-avoidant (B = .21, p = .00), preoccupied (B = .20, p = .00) and the dismissive-avoidant (B = .20, p < .00) attachment styles. Post hoc multiple regression analyses (MRA) revealed a significant relationship between age, degree, weekly hours with trauma cases, personal therapy, total years of professional trauma experience and disruptions in cognitive schemas, F (5, 369, df = 6.75, p < .00). Limitations of generalazibility of findings, use of self-report questionnaires, and residual distress were discussed. Recommendations included the importance of a multidimensional approach and the incorporation of training on vicarious traumatization in mental health settings and educational institutions. ======================================== Title: Predictors of vicarious traumatization: Female therapists for adult survivors versus female therapists for child survivors of sexual victimization. Author(s)/Editor(s): Trippany, Robyn Layton Source/Citation: Dissertation Abstracts International Section A: Humanities & Social Sciences; Vol 62(3-A) Sep 2001, US: University Microfilms International; 2001, 926 Abstract/Review/Citation: The purpose of the present study was to explore individual and occupational variables that contribute to the experience of vicarious traumatization (VT). More specifically, this research examined the relationship of VT with personal and professional characteristics of sexual trauma therapists. Furthermore, this research investigated differences in the occurrence of VT between female therapists for adult survivors of sexual trauma and female therapists for child survivors of sexual trauma. No significant predictor relationship was found for the experience of VT with the variables of personal trauma history, career longevity, client caseload, spirituality, and participation in formal peer supervision. Additionally, no significant differences for the experience of VT were found between therapists for adult survivors versus therapists for child survivors of sexual victimization. ======================================== Title: Secondary traumatic stress and Texas social workers. Author(s)/Editor(s): Dalton, Lisa Ellen Source/Citation: Dissertation Abstracts International Section A: Humanities & Social Sciences; Vol 62(3-A) Sep 2001, US: University Microfilms International; 2001, 1209 Abstract/Review/Citation: The concept of Secondary Traumatic Stress has only been in the literature since 1995. The growing body of research indicates that individuals in helping professions are at risk not only of experiencing stress, but also of developing pathological responses to learning of another's traumatic experiences. Secondary Traumatic Stress is of particular interest to the profession of social work. Social workers are the largest providers of mental health services in the country and work extensively with individuals that have experienced traumatic events. This associational study investigates the relationship between secondary traumatic stress and social workers in Texas. ======================================== Title: Women's trauma and healing in Japanese culture. Author(s)/Editor(s): Muramoto, Kuniko Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 62(3-B) Sep 2001, US: Univ Microfilms International; 2001, 1591 Abstract/Review/Citation: This dissertation explores the reality of women's trauma and the effective treatment for traumatized women in Japanese culture. Current research on Post Traumatic Stress Disorder supports the universality of many of the biologically determined components of PTSD experiences, while the importance of considering the cultural aspect of trauma is also stressed. Key research questions were: Can PTSD and trauma-related disorders be diagnosed in Japanese women? To what degree are the trauma theory and treatment methods from the West applicable to Japanese women? The primary research method was a literature review supplemented by interviews with Japanese clinicians and reflections on the author's experience as a psychotherapist. In Japan, the interest in trauma has been rapidly growing in the 1990s, particularly after the year 1995 when the Great Hanshin (Kobe) Earthquake happened. The developing statistics of women's trauma in Japan signify a serious problem to women's mental health, as is found in United States. Although the literature is limited yet, the research indicated that Japanese women suffer almost the same symptoms of PTSD and other trauma-related symptoms as women in the U.S. One distinctive characteristic is that Japanese people tend to complain of physical pain rather than psychological symptoms. The assessment and treatment procedures for traumatized women were not studied enough in Japan. The author illustrated the effective assessment and treatment plan for Japanese women as an example. The Western trauma theories and treatment methods are applicable to Japanese women, requiring some additional devices. Supportive psychotherapy and EMDR seem to be prevalent approaches at present. Creative art therapy and body-centered approaches have the potential to be effective in Japanese culture. Vicarious traumatization in mental health professionals is becoming a serious problem in Japan, too. The author also paid attention to multigenerational trauma in Japanese society. The trauma caused by World War II is reviewed in an effort to suggest the enormity of the task we have in dealing with trauma. It is time for Japanese people to resolve multigenerational trauma so as to stop continuous trauma and to take care of traumatized people. ======================================== Title: Treating sexually abused children versus adults: An exploration of secondary traumatic stress and vicarious traumatization among therapists. Author(s)/Editor(s): Dickes, Sara Jean Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 62(3-B) Sep 2001, US: Univ Microfilms International; 2001, 1571 Abstract/Review/Citation: This study explored secondary traumatic stress and vicarious traumatization among therapists treating sexually abused clients. Two hundred nineteen psychologists from two subdirectories of the American Psychological Association (Clinical Psychology and Clinical Child Psychology Directory) completed a questionnaire containing three measures: (1) Therapist Information Questionnaire, (2) Traumatic Stress Institute (TSI) Belief Scale - Revision L, and (3) Impact of Event Scale. Results revealed that therapists' history of childhood physical abuse, childhood sexual abuse, and domestic violence was significantly related to higher vicarious trauma (as measured by the TSI). A significant relationship emerged between caseload percentage of sexually abused children and vicarious traumatization, although the direction was opposite of what was expected. In other words, as the percentage of sexually abused children in one's caseload increased, vicarious trauma symptoms decreased. Finally, higher perceived quality of supervision was related to lower levels of vicarious trauma. Implications for training and further research are discussed. ======================================== Title: A relational perspective on PTSD in early childhood. Author(s)/Editor(s): Scheeringa, Michael S; Zeanah, Charles H. Source/Citation: Journal of Traumatic Stress; Vol 14(4) Oct 2001, US: Kluwer Academic/Plenum Publishers; 2001, 799-815 Abstract/Review/Citation: This paper describes the clinical and research evidence for the importance of the relational context of posttraumatic stress disorder in young children. The authors review 17 studies that simultaneously assessed parental and child functioning following trauma. In many studies, despite limitations, an association between undesirable parental/family variables and maladaptive child outcomes has been consistently found. A model of the parental/family variables as moderators and vicarious traumatic agents for symptoms in young children is presented. Also, a Compound Model is proposed, with three distinctive patterns of the parent-child relationship that impact on posttraumatic symptomatology in young children. Implications for clinical practice and research directions are discussed. ======================================== Title: Overcoming traumatic stress: A self-help guide using cognitive behavioral techniques. Author(s)/Editor(s): Herbert, Claudia; Wetmore, Ann Author Affiliation: Private Practice, Halifax, NS, Canada Source/Citation: New York, NY, US: New York University Press; 2001, (xvi, 206) Abstract/Review/Citation: Applies proven techniques of cognitive behavioral therapy to help sufferers, their families and those who work with them to overcome the physical, mental, and emotional reactions of traumatic stress. It is stated that cognitive behavior therapy helps traumatic stress by changing negative patterns of thought. Notes/Comments: Acknowledgements Introduction Part one: Understanding traumatic stress When trauma strikes Understanding your reactions Understanding the reactions of families and loved ones Issues for professionals and carers: Vicarious traumatization Part two: Managing traumatic stress Moving towards your path of recovery On the path to recovery Managing your intrusive, re-experiencing reactions Managing your arousal reactions Managing your avoidance and numbing reactions Your life before the trauma Guilt, self-blame and self-respect Grief, loss, sadness and emotional pain Changes in the body, physical pain Healing, letting go and moving on A final note References Useful books and addresses Index Appendix traumatic stress; cognitive behavioral therapy ======================================== Title: Exploring the counselor's experience of working with perpetrators and survivors of domestic violence. Author(s)/Editor(s): Iliffe, Gillian; Steed, Lyndall G. Source/Citation: Journal of Interpersonal Violence; Vol 15(4) Apr 2000, US: Sage Publications Inc; 2000, 393-412 Abstract/Review/Citation: Examined the professional and personal impact on counselors from working with domestic violence (DV) clients. Semi-structured interviews with 18 counselors (mean age 45.8 yrs) having case loads of more than 50% DV clients yielded themes including initial impact of DV counseling, personal impact of hearing traumatic material, changes to cognitive schema, challenging issues for DV counselors, burnout, and coping strategies. Ss described classic symptoms of vicarious trauma, and reported changes in cognitive schema, particularly in regard to safety, world view, and gender power issues. Challenging aspects of DV counseling included changes in counseling practice to meet the unique needs of DV clients, difficulties with confidentiality, and feelings of isolation and powerlessness. 12 Ss reported feelings of burnout. Reported adaptive strategies included monitoring client caseloads, debriefing, peer support, self-care and political involvement for social change. ======================================== Title: Risking connection: A training curriculum for working with survivors of childhood abuse. Author(s)/Editor(s): Saakvitne, Karen W.; Gamble, Sarah; Pearlman, Laurie Anne; Lev, Beth Tabor Source/Citation: Lutherville, MD, US: The Sidran Press; 2000, (xvii, 275) Abstract/Review/Citation: Provides a comprehensive training curriculum for working with survivors of childhood abuse specially designed for staff in all mental health settings, including public systems. Emphasizing the concepts of empowerment and collaboration, 3 major goals serve as the main focus: (1) a theoretical framework to guide work with survivors of traumatic abuse, (2)specific intervention techniques to use with survivor clients, and (3) attention to the internal needs of trauma workers as well as clients. In addition, common concerns and skepticism about trauma treatment are addressed. Interspersed in this curriculum are client/treater worksheets as well as assessment, self-reflection, group discussion, and clinical practice exercises. An annotated bibliography, report and recommendations from a state mental health department, and a policy statement from a national mental health association are also included. This curriculum was written for personnel working in the following settings: community mental health centers; community hospitals; partial hospitalization programs; state psychiatric hospitals; substance abuse, addiction, and recovery programs; domestic violence agencies; sexual assault centers; crisis services; and any treatment setting serving adults who were abused as children. Notes/Comments: Editorial board Preface Acknowledgments Introduction Note to the reader Module one: Understanding trauma is the first step A trauma framework The effects of traumatic abuse Introduction to vicarious traumatization: How this work will change you Module two: Using connections to develop treatment goals with survivor clients--The RICH guideline Being an ally: Forming a therapeutic alliance Safety and respect: Frame and boundaries in work with survivors Working toward change: Using connection to help clients manage their feelings and memories Module three: Keeping a trauma framework when responding to crises and life-threatening behaviors General principles of crisis management with survivor clients How to apply the general principles to specific crises and behaviors VT: The impact of crisis interventions on the helping professional Module four: Working with dissociation and staying grounded--Self-awareness as a tool for clients and helpers Using the basic principles of crisis work to respond to dissociative episodes and flashbacks Self-awareness for the helper: Notice your experience Why do we all have strong reactions to work with survivors? Module five: Vicarious traumatization and integration: Putting it all together How trauma work can change you: Vicarious traumatization What to do about it: Protecting yourself, addressing and transforming VT Overview and summary of curriculum Appendices Massachusetts Department of Mental Health Task Force on the restraint and seclusion of persons who have been physically or sexually abused National Association of State Mental Health Program Directors policy statement of services and supports to trauma survivors References Annotated bibliography Index Forms and self-awareness worksheets training curriculum for working with survivors of childhood abuse, implications for mental health personnel ======================================== Title: Heritability and prevalence of specific fears and phobias in childhood. Author(s)/Editor(s): Lichtenstein, Paul; Annas, Peter Source/Citation: Journal of Child Psychology & Psychiatry & Allied Disciplines; Vol 41(7) Oct 2000, US: Cambridge Univ Press; 2000, 927-937 Abstract/Review/Citation: Investigated the relative importance of genetic and environmental influences on specific phobias and fears using parental reports of animal, situational, and mutilation fears and phobias for 1106 pairs of 8-9-yr old Swedish twins. The prevalence of specific phobias was 7.3% for boys and 10.0% for girls. Genetic, shared environmental, and nonshared environmental effects contributed to individual differences in fears and phobias in young children, but the magnitude of the effects differed between sexes. Shared environmental effects contributed to a general susceptibility for fearfulness. Genetic and nonshared environmental effects, on the other hand, contributed both to the general susceptibility and specific fearfulness, even though these effects primarily were fear specific. It is concluded that these results indicate that both heritable factors as well as environmental factors such as trauma, vicarious learning, and/or negative information are important for differences in fearfulness and phobias--at least in children. ======================================== Title: Stress on the job: Self-care resources for counselors. Author(s)/Editor(s): O'Halloran, Theresa M.; Linton, Jeremy M. Source/Citation: Journal of Mental Health Counseling; Vol 22(4) Oct 2000, US: American Mental Health Counselors Assn; 2000, 354-364 Abstract/Review/Citation: Counselors in all work settings are likely to encounter clients who have experienced some form of trauma. Working with these traumatized clients may have negative consequences for counselor work and well-being. As a result of working with traumatized clients, counselors may experience symptoms of secondary traumatic stress or secondary traumatic stress disorder due to vicarious traumatization. This article offers numerous resources for counselor self-care that may be helpful in maintaining wellness. ======================================== Title: The Oklahoma City bombing: The relationship among modality of trauma exposure, gender, and posttraumatic stress symptoms in adolescents. Author(s)/Editor(s): Pesci, Marianne Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(9-B) Apr 2000, US: Univ Microfilms International; 2000, 4902 Abstract/Review/Citation: This study examined the relationship of direct and vicarious bomb exposure and gender with posttraumatic stress symptoms among adolescents in the Oklahoma City School District seven weeks after the April 19, 1995, bombing of the Alfred P. Murrah Federal Building. The sample of 1,313 adolescents was assessed for the degree of reported posttraumatic stress symptoms. As hypothesized, adolescents with higher levels of vicarious exposure to the bombing reported higher levels of distress. In addition, direct exposure to the bombing was associated with higher levels of reported symptoms. Females were more likely than males to report distress. They were also more likely to report experiencing both internalizing and externalizing symptoms of posttraumatic stress. This study's findings are consistent with previous studies suggesting that different modalities of trauma exposure are associated with the occurrence of posttraumatic stress symptoms. It helps illuminate the types of experiences that have been shown to be related to the etiology and maintenance of posttraumatic stress experiences. ======================================== Title: Vicarious traumatization in psychotherapists who work with physically or sexually abused children. Author(s)/Editor(s): Young, Carolyn Merchant Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(9-B) Apr 2000, US: Univ Microfilms International; 2000, 4918 Abstract/Review/Citation: This research sought to clarify the significant variables that contribute to vicarious traumatization (that is, disruption to schemata due to exposure to victims of trauma) in psychotherapists who work with children who have been physically or sexually abused. Participants in this study were practicing psychotherapists registered with the APA with either a primary or secondary specialty in clinical child psychology. One thousand surveys were mailed to a random sample of psychotherapists across the United States. Three hundred and two useable surveys were returned. The survey included demographic questions and measures assessing personal child abuse, caseload size, job-related stress, general life stress, coping abilities, and level of vicarious traumatization. Correlational analyses were performed to compare each independent variable to the dependent variable, vicarious traumatization. Significant relationships were identified between vicarious traumatization and coping abilities, personal child abuse, and job-related stress. A multiple regression analysis was performed to assess the overall and unique contribution of the independent variables to vicarious traumatization. Forty-eight percent of the variance of the dependent variable was accounted for by the five independent variables. Only three of the independent variables identified unique variance at significant levels. These were coping abilities, job-related stress, and personal child abuse. Coping ability was by far the most significant contributor to level of vicarious traumatization experienced. This finding indicated that it was not the presence of risk factors, but the relative absence of protective factors that increased levels of vicarious traumatization in psychotherapists who work with physically or sexually abused children. These results stress the importance of the development of good coping skills and the need for coping skills training for psychotherapists who work with trauma victims in order to minimize vicarious traumatization. ======================================== Title: Vicarious traumatization: The impact of therapists of treating trauma clients. Author(s)/Editor(s): Kim, Sung Eun Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(9-B) Apr 2000, US: Univ Microfilms International; 2000, 4892 Abstract/Review/Citation: Vicarious traumatization (VT) of mental health professionals who provide services for survivors of traumatic victimization has received increased attention in recent years, though there is still little empirical research examining this phenomenon. The present study examined several factors thought to be significant contributors in the development and maintenance of VT. Specifically, this study examined the effects of vicarious exposure to traumatic material via working with trauma clients, therapists' past personal trauma histories, amount of trauma work experience, quality and satisfaction with supervision/consultation, and colleague context. Overall, there was relatively little vicarious trauma or distress in the present sample of therapists, who on average tended to be older, more experienced therapists. Results indicate that vicarious exposure to traumatic material may indeed significantly contribute to therapist distress, though its impact may be confounded by other related factors. More direct trauma and stress associated with therapists' own past personal trauma histories, consultation, and colleague context seemed to have a greater impact than vicarious exposure to traumatic material on therapists' general distress level. There was no support for the moderating effects of past personal trauma, years of trauma work experience, consultation, or colleague context. Considerations for future VT research are discussed. Recommendations include using a variety of measures to assess both symptomatic and cognitive aspects of VT, and more careful sampling procedures to obtain therapists yet relatively less experienced in providing trauma therapy. It may be that those who are quite clinically experienced may have already found appropriate strategies for coping effectively with the impact of vicarious exposure to trauma, and that the impact of vicarious exposure is most likely to be evident in younger, less experienced clinicians or those still in training. ======================================== Title: Effects of treating trauma survivors: Vicarious traumatization and style of coping. Author(s)/Editor(s): Weaks, Kimberly Albin Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(9-B) Apr 2000, US: Univ Microfilms International; 2000, 4915 Abstract/Review/Citation: The purpose of this study was to examine vicarious trauma and coping in psychotherapists as they are related to a reduction in posttraumatic stress disorder (PTSD) and disruptions in cognitive schemas. Ninety-five therapists completed the Ways of Coping Questionnaire (WCQ: Folkman & Lazarus, 1988), the Impact of Event Scale (IES: Horowitz, Wilner, & Alvarez, 1979), the Traumatic Stress Institute Belief Scale (TSI: Pearlman, 1994), and a demographic questionnaire. Seventy-one percent of therapists experienced PTSD symptomatology that was clinically significant. There was no support for the hypothesis that therapists with doctoral degrees and more than 10 years of professional experience would experience less PTSD symptomatology and fewer disruptions in cognitive schemas than therapists in all other conditions. There was no support for the hypothesis that therapists with a trauma history experience more symptomatology when treating adults who were traumatized recently than when treating adults who were traumatized long ago. Therapists with a personal history of trauma were also expected to experience greater PTSD symptomatology and more cognitive disruptions when they treated children traumatized recently than when they treated adults recently traumatized. There was a main effect for personal trauma history. Traumatize therapists experienced more intrusive symptomatology but no more avoidance or cognitive disruptions than therapists with no trauma history. Prediction models were tested for individual and professional factors that buffer a therapist from vicarious trauma. Individual factors that were expected to mediate the effects of vicarious trauma included lower levels of education, fewer years of professional experience, female gender, lower levels of income, coping style and younger age. Professional factors that were expected to mediate the effects of vicarious trauma include having fewer hours of trauma-specific training and having a low percentage of survivors in one's current and cumulative caseload. The results of these analyses were presented and discussed. Therapists who employed emotion-focused coping strategies had significantly higher levels of PTSD symptomatology but no more disruptions in cognitive schemas than therapists who employed emotion-focused coping styles. Implications for theory, research, training, and practice were discussed, as well as limitations to the current research and directions for the future. ======================================== Title: Working models of self and other in adult attachment and vicarious traumatization. Author(s)/Editor(s): Brandon, Jonathan Henry Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(10-B) May 2000, US: Univ Microfilms International; 2000, 5219 Abstract/Review/Citation: In recent years, there has been a considerable increase in research on adult attachment and on the negative reactions of mental health professionals as a result of working with trauma survivors. These negative reactions are known as vicarious traumatization (Pearlman and Saakvitne, 1995). A four-category model of adult attachment proposed by Bartholomew and Horowitz (1991) and vicarious traumatization theory share a common conceptual framework. Both sets of researchers assess their constructs based on the distinction between working models of self and other. However, no research to date has examined the relationship between these constructs. This study examined (a) the relationship between attachment style and vicarious traumatization on the dimensions of self and other, (b) the attachment styles of mental health professionals when compared to psychology graduate students to determine if professionals' attachment styles may be disrupted by their clients' traumatic material, and (c) the relationship between work experience, personal trauma history, and vicarious traumatization among mental health professionals. A group of 46 psychology graduate students filled out a measure of adult attachment and a demographics questionnaire to serve as a comparison group for mental health professionals. A group of 140 mental health professionals returned a demographics questionnaire, a modified measure of adult attachment style, and a measure of vicarious traumatization. Professionals who reported that greater than 50% of their clients were trauma survivors were classified as trauma workers (n = 89), and the other professionals were classified as counselors (n = 51). Results indicated that a majority of the trauma workers were trauma survivors. There was not a significant relationship between overall level of vicarious traumatization and time spent as a trauma worker or history of personal trauma. Also, there was not a significant interaction between vicarious traumatization and attachment on the dimensions of self and other. There were significant differences in the overall level of vicarious traumatization for the adult attachment styles, with securely attached professionals indicating fewer disruptions than those in the other styles. Finally, when the attachment styles of the three groups were examined, results indicated that overall, these participants did not endorse a significantly different pattern of attachment styles. Limitations of the study and practical and research implications are discussed. ======================================== Title: The experience of Bosnian refugees living in the United States. Author(s)/Editor(s): Keyes, Emily Fay Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(12-B) 2000, US: Univ Microfilms International; 2000, 6022 Abstract/Review/Citation: The purpose of this study was to elucidate the experience of Bosnian refugees currently living in the United States. Seven adult female, Bosnian refugees each participated in an audio recorded interview lasting from one to two hours. The method used was the phenomenological praxis operationalized by Amedeo Giorgi (1979/1985), in which four steps are employed to arrive at the intersubjective constitution of the phenomenon being studied. In this study, the results constituted the phenomenon of 'living elsewhere.' Results of the study showed the presence of six main categories and two major themes. The categories were: mixing blood, which in a state of ethnic warfare was dangerous and even lethal; deracination, where human disturbances caused by being uprooted manifested themselves as numbness, illusions of invulnerability, dreaming, timelessness of sleep, and the search for lost objects; nostalgia, in which a state of perpetual mourning caused a time warp where past, present, and future collapsed into one frame; transgenerational and vicarious lives, wherein children and grandchildren became custodians for an ethnic group's past; reciprocity, which served as a measure of genuineness and well-being in human relations; and, language and belonging, where linguistic ability became a carrier of the sense of devastation caused by one's sense of not belonging. The two major themes were: belonging, in which the refugees lost their sense of belonging in their old homes, and were searching for a sense of belonging in their new homes; and adapting, wherein the refugees changed their environment and themselves in their new environment. In addition, they used specific coping mechanisms to survive, such as sleeping, dreaming, changing their cognitive frameworks, tolerating psychic ambiguity, and working very long hours. The process of belonging and adapting found in this sample of Bosnian refugees living in the United States represents a part of the human response to having survived war trauma and to being resettled. ======================================== Title: " . . . en wij proberen te luisteren . . ." Reacties van therapeuten op traumatische ervaringen van hun patienten./ " . . . and we will try to listen . . .": Reactions of therapists to the traumatic experiences of their patients. Author(s)/Editor(s): Smith, Annemarie J. M.; Kleijn, Wim Chr.; Stevens, Johan A. Source/Citation: Tijdschrift voor Psychotherapie; Vol 26(5) Sep 2000, Netherlands: Bohn Stafleu Van Loghum BV; 2000, 289-307 Abstract/Review/Citation: Studied the occurrence of traumatic countertransference, secondary traumatization, and vicarious traumatization in psychotherapists in response to the treatment of trauma victims. These effects and their relation with emotional burden and burnout in trauma therapists were assessed in a qualitative and quantitative study in the Netherlands at an institute for the treatment of victims of organized violence. Therapists were interviewed and were administered the Maslach Burnout Inventory and items from the Nighttime Intrusions after Traumatic Experiences (J. N. Schreuder et al, 1998). Principal component factor analysis with varimax rotation was performed. The results indicate that trauma therapists experience the effects of confrontation with the interpersonal violence that their patients experienced. The data suggest that these effects are normal assimilative and accommodative reactions rather than destructive processes. ======================================== Title: Education and debriefing: Strategies for preventing crises in crisis-line volunteers. Author(s)/Editor(s): Kinzel, Audrey; Nanson, Jo Source/Citation: Crisis: Special Issue: ; Vol 21(3) 2000, US: Hogrefe & Huber Publishers; 2000, 126-134 Abstract/Review/Citation: Telephone crisis lines offer an important service to individuals in crisis. The accessibility as well as a lack of other means of support leads many individuals to call the line. The role of the volunteer is to listen and support the caller as well as provide information and referrals to other agencies. Agencies are presented with a high turnover of volunteers and are then faced with the task of recruiting and training replacements. Volunteers are often exposed to horrific accounts of human pain and suffering which may affect their personal thoughts, feelings, beliefs and actions and influence the decision to quit. Compassion fatigue is one term used for this inherent "cost of caring." Many factors contribute to this cost, including the nature of crisis calls, the repeat caller, and personal coping mechanisms. Educating and debriefing the volunteer are two strategies that may prevent the onset of compassion fatigue and volunteer resignation. Debriefing is viewed as an effective strategy for volunteers as it has been found to be successful in assisting other helpers in many different contexts to cope and deal with the traumatic events that they experience or hear about. ======================================== Title: Secondary trauma from working with Vietnam veterans. Author(s)/Editor(s): Pierce, Roger Clarke Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 61(2-B) Aug 2000, US: Univ Microfilms International; 2000, 1093 Abstract/Review/Citation: This paper presents a study exploring how therapists describe their experience of coping with the impact of providing treatment to individuals who have experienced severe trauma. Research suggests that those who work with severe trauma are vulnerable to becoming traumatized themselves (Kluft, 1989; Talbot, 1990, Genest, Levine, Ramsden & Swanson, 1990, McCann & Pearlman, 1990, Pearlman & Saakvitne, 1995, Figley, 1995, Briere, 1997). Therapists who continue to work effectively with traumatized populations must find ways to reduce the impact of the traumatic material on themselves. This study explored therapists' narratives about their encounters with vicarious traumatization from working with Vietnam veterans and how thesetherapist can continue to provide treatment for this population. ======================================== Title: Bearing witness: An investigation of vicarious traumatization in therapists who treat adult survivors of rape and incest. Author(s)/Editor(s): Pinsley, Olivia Simons Source/Citation: Dissertation Abstracts International Section A: Humanities & Social Sciences; Vol 61(4-A) Oct 2000, US: Univ Microfilms International; 2000, 1616 Abstract/Review/Citation: This study was designed to explore vicarious traumatization in therapists who treat adult survivors of rape and incest. One-hundred and sixty three therapists from the New York City and Long Island area participated. Participants completed a trauma questionnaire, which included the TSI Belief Scale, the Impact of Event Scale, and the Maslach Burnout Inventory. Therapists with a caseload of rape and incest survivors greater than 50% in the last year reported more intrusive and avoidance symptoms associated with trauma distress than therapists with a caseload less than 50% of rape and incest survivors. A therapist's history of sexual trauma was not found to be a predictor of vicarious traumatization. Those therapists who reported to have experienced personal life stress events in the last year experienced disruptions in cognitive schemas and reported avoidance symptoms. Therapists who reported disruptions in cognitive schemas also reported to have experienced burnout symptoms. ======================================== Title: A qualitative study of the effect of a history of childhood sexual abuse on therapists who treat survivors of sexual abuse. Author(s)/Editor(s): Benatar, May Source/Citation: Journal of Trauma & Dissociation; Vol 1(3) 2000, US: Haworth Medical Press; 2000, 9-28 Abstract/Review/Citation: This qualitative study explored the effect of a history of sexual abuse on therapists who work with survivors of childhood sexual abuse. A comparison was made between experienced therapists (aged 24-57yrs old) who reported such a history and those who did not. Themes relating to vicarious traumatization (VT) were examined as well as data relating to positive self-transformation (PST), a category relating to enduring change in therapists of a positive nature. No notable differences were evident between groups with regard to VT or PST. Overall similarities were more striking than differences in the two groups examined in this study. This result is consistent with some empirical literature but contradicts some other studies. Therapists' experience with trauma work, and similarities between patients' and therapists' trauma histories, appear to be important factors in evaluating the impact on therapists in their work with sexual abuse survivors. Experienced therapists with a childhood sexual abuse history do not appear to be more vulnerable to VT than their counterparts without such a history. ======================================== Title: Supervising counsellors who work with survivors of childhood sexual abuse. Author(s)/Editor(s): Etherington, Kim Source/Citation: Counselling Psychology Quarterly: Special Issue: Vol 13(4) Dec 2000, United Kingdom: Carfax Publishing Ltd; 2000, 377-389 Abstract/Review/Citation: This paper draws attention to issues for supervisors who support counsellors working with adult survivors of childhood sexual abuse from the perspective of trauma theory. The author describes the effects of vicarious traumatization and the unconscious dynamics that contribute to this experience. A narrative approach is included as another way of supervisors listening to distressing stories, both those of clients and of their counsellors, and reflects on the value of bearing witness to those stories in supervision and of recognizing them as a source of healing. ======================================== Title: Relacion entre fuentes de exposicion al estres post traumatco, severidad del sintoma y percepcion de autoeficacia./ Relation between sources of exposition to post-traumatic stress, symptom severity, and perception of self-efficacy. Author(s)/Editor(s): Contreras, Sandra Juliana P.; Trujillo Moncada, Maria Victoria; Uribe Valdivieso, Cecilia; Rodriguez Diaz, Maria Clara Source/Citation: Revista Argentina de Clinica Psicologia: Special Issue: Vol 9(2) Aug 2000, Argentina: AIGLE; 2000, 137-148 Abstract/Review/Citation: Studied the influence of sources of exposition to traumatic events (direct experience, vicarious experience, or verbal information) on the severity of psychological symptoms of posttraumatic stress disorder (PTSD) and levels of general and social self-efficacy in 557 army officers and sub-officers in the Colombian National Army (aged 20-41 yrs). The PTSD Diagnostic Scale (E. Foa, 1995) and the Self-Efficacy Scale (M. Sherer et al, 1982) were used. Data were obtained using correlation analysis and other statistical tests. Mild to severe PTSD was diagnosed in 46 Ss, 36 as a result of direct experience, 7 as a result of vicarious experience, and 3 as a result of verbal information to combat, assault, explosions, torture, violent death, and kidnapping. The results do not show any significant correlation among source of exposition, symptom severity, nor scores for general and social self-efficacy. Implications for further investigation of PTSD and development of intervention programs are discussed. ======================================== Title: The effectiveness of psychological debriefing with vicarious trauma: A meta-analysis. Author(s)/Editor(s): Everly, George S.; Boyle, Stephen H.; Lating, Jeffrey M. Source/Citation: Stress Medicine; Vol 15(4) Oct 1999, US: John Wiley & Sons Inc; 1999, 229-233 Abstract/Review/Citation: Post-traumatic psychiatric reactions to physical trauma are readily acknowledged and accepted. However, there is a relatively new phenomenon of developing similar reactions after providing emergency care to such patients. The purpose of this study was to examine the effectiveness of a crisis intervention technique known as group psychological debriefing, which is designed to mitigate the impact of post-traumatic morbidity in individuals exposed to vicarious traumatization. Using adequately controlled, peer-reviewed journal articles and clinical proceedings as the database, 698 adolescent & adult Ss from 10 investigations were submitted to a meta-analysis. The results support the effectiveness of group psychological debriefings in alleviating the effects of vicarious psychological distress in emergency care providers. ======================================== Title: Essential papers on posttraumatic stress disorder. Author(s)/Editor(s): Horowitz, Mardi J. Source/Citation: New York, NY, US: New York University Press; 1999, (vii, 548) Essential papers in psychoanalysis. Abstract/Review/Citation: This book, divided into 3 parts (diagnosis, explanation, and treatment), provides the reader with an overview of agreements and controversies concerning posttraumatic stress disorder (PTSD). The individual papers provide detailed elaborations about these issues. The contemporary era finds a high degree of agreement on diagnosis. There is also an encouraging level of agreement on explanation. Even in the area of treatment, where one may expect controversy, there is growing agreement on integrating biological, psychological, and social approaches. Unselected chapters are journal and chapter reprints that were covered by PsycINFO at the time of their original publication and can be found in the PsycLIT database. Notes/Comments: Introduction [by] Mardi J. Horowitz Part I: Introduction Signs and symptoms of posttraumatic stress disorder Mardi J. Horowitz, Nancy Wilner, Nancy Kaltreider and William Alvarez Conflict between current knowledge about posttraumatic stress disorder and its original conceptual basis Rachel Yehuda and Alexander C. McFarlane Childhood traumas: An outline and overview Lenore C. Terr Complex PTSD: A syndrome in survivors of prolonged and repeated trauma Judith Lewis Herman Introduction to Psycho-Analysis and the War Neuroses Sigmund Freud Organic and psychosomatic aftereffects of concentration camp imprisonment Leo Eitinger Pierre Janet and modern views of dissociation Frank W. Putnam Symptomatology and management of acute grief Erich Lindemann Psychiatric reactions to disaster: The Mount St. Helens experience James H. Shore, Ellie L. Tatum and William M. Vollmer A follow-up study of rape victims Carol C. Nadelson, Malkah T. Notman, Hannah Zackson and Janet Gornick Psychophysiologic responses to combat imagery of Vietnam veterans with posttraumatic stress disorder versus other anxiety disorders Roger K. Pitman, Scott P. Orr, Denis F. Forgue, Bruce Altman, Jacob B. de Jong and Lawrence R. Herz Part II: Introduction Functional disorders Michael R. Trimble The human meaning of total disaster: The Buffalo Creek experience Robert Jay Lifton and Eric Olson A behavioral formulation of posttraumatic stress disorder in Vietnam veterans Terence M. Keane, Rose T. Zimering and Juesta M. Caddell Dissociation and hypnotizability in posttraumatic stress disorder David Spiegel, Thurman Hunt and Harvey E. Dondershine A model of mourning: Change in schemas of self and other Mardi J. Horowitz Neurobiological aspects of PTSD: Review of clinical and preclinical studies John H Krystal, Thomas R. Kosten, Steven Southwick, John W. Mason, Bruce D. Perry and Earl L. Giller The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress Vessel A. van der Kolk Part III: Introduction Stress response syndromes: Character style and dynamic psychotherapy Mardi J. Horowitz Witness to violence: The child interview Robert S. Pynoos and Spencer Eth Imagery in therapy: An information processing analysis of fear Peter J. Lang Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling Edna B. Foa, Barbara Olasov Rothbaum, David S. Riggs and Tamera B. Murdock Efficacy of the Eye Movement Desensitization procedure in the treatment of traumatic memories Francine Shapiro Levels of functional impairment following a civilian disaster: The Beverly Hills Supper Club fire Bonnie L. Green, Mary C. Grace, Jacob D. Lindy, James L. Titchener and Joanne G. Lindy Pharmacotherapy for posttraumatic stress disorder Matthew J. Friedman An epidemiological study of psychic trauma and treatment effectiveness for children after a natural disaster Rosemarie Galante and Dario Foa Vicarious traumatization: A framework for understanding the psychological effects of working with victims I. Lisa McCann and Laurie Ann Pearlman Empathic strain and countertransference John P. Wilson and Jacob D. Lindy Index About the editor diagnosis & explanation & treatment of posttraumatic stress disorder ======================================== Title: Vicarious traumatization, spirituality, and the treatment of sexual abuse survivors: A national survey of women psychotherapists. Author(s)/Editor(s): Brady, Joan Laidig; Guy, James D.; Poelstra, Paul L.; Brokaw, Beth Fletcher Source/Citation: Professional Psychology: Research & Practice; Vol 30(4) Aug 1999, US: American Psychological Assn.; 1999, 386-393 Abstract/Review/Citation: Should psychotherapists limit their clinical work with trauma survivors to avoid being traumatized themselves? Vicarious traumatization (VT--the symptoms similar to posttraumatic stress disorder and the disruption in cognitive schemas reported in clinicians who are exposed to the trauma material of their clients--was assessed in a national survey of 1,000 women psychotherapists. Therapists with higher levels of exposure to sexual abuse material reported significantly more trauma symptoms but no significant disruption of cognitive schemas. Spiritual well-being, a key area thought to be damaged by VT, was found to be higher for those clinicians who saw more sexual abuse survivors. ======================================== Title: Therapists' collusion with the resistance of rape survivors. Author(s)/Editor(s): Fox, Raymond; Carey, Lois A. Source/Citation: Clinical Social Work Journal; Vol 27(2) Sum 1999, US: Kluwer Academic/Plenum Publishers; 1999, 185-201 Abstract/Review/Citation: Based mostly upon a qualitative study of nine rape survivors (aged 18-42 yrs), but also upon intensive review of the literature devoted to countertransference, vicarious traumatization, compassion fatigue, and burnout, this article examines collusive resistance, a process whereby therapists join clients to avoid confronting painful issues. It offers guidelines for the therapist to follow in the therapeutic dance to avert such collusion, and thereby to intervene more effectively especially with traumatized clients to facilitate their recovery actively, and, ultimately, to contribute to their true survivorship. The authors share 2 vignettes to highlight the personal and professional issues encountered by them. Also, the viewpoints of the rape survivors are given, including their perspectives on the therapeutic process of collusive resistance and their experienced rape trauma. ======================================== Title: Self-help for the helpers: Preventing vicarious traumatization. Author(s)/Editor(s): Ryan, Katherine Source/Citation: Play therapy with children in crisis: Individual, group, and family treatment (2nd ed.)., New York, NY, US: The Guilford Press; 1999, (xxi, 506), 471-491 Source editor(s): Webb, Nancy Boyd (Ed) Abstract/Review/Citation: Describes how therapists should care for themselves when working with severely traumatized children. The author believes that by identifying personal issues therapists can act in self-protective ways that preserve their professional identities and improve their work. Topics discussed include psychotherapists' reaction to trauma victims, models of responses to therapy with trauma survivors, vicarious traumatization, feelings specifically associated with child victims, tasks for novice therapists and therapists who are survivors themselves, trauma therapy supervision, and recommended strategies for therapists. The chapter also includes an example of a consultation group meeting. The group process in this example illustrates many of the points emphasized in the chapter related to the playing out of transference and countertransference in work with severely traumatized children. ======================================== Title: Vicarious traumatisation of counsellors and effects on their workplaces. Author(s)/Editor(s): Sexton, Leo Source/Citation: British Journal of Guidance & Counselling; Vol 27(3) Aug 1999, United Kingdom: Carfax Publishing Limited; 1999, 393-403 Abstract/Review/Citation: The literature on therapists' reactions to clients' traumatic material is critically reviewed. The various attempts within this relatively new literature to conceptualize this phenomenon include countertransference, compassion fatigue and vicarious traumatisation. The limited research evidence is evaluated and found to support anecdotal accounts by trauma therapists. Empathic engagement with trauma survivors is necessary for effective psychotherapeutic intervention. However, empathic engagement also makes therapists vulnerable to the detrimental effects of vicarious trauma, with consequent negative effects on individual counsellor effectiveness and organisational dynamics in the workplace. Given the apparently serious effects of secondary or vicarious exposure to traumatic material for trauma therapists, their clients, and the organisations that employ them, it is important that prevention and management of this phenomenon is taken seriously by all concerned. ======================================== Title: The impact of sexual abuse treatment on the social work clinician. Author(s)/Editor(s): Cunningham, Maddy Source/Citation: Child & Adolescent Social Work Journal; Vol 16(4) Aug 1999, US: Kluwer Academic Publishers; 1999, 277-290 Abstract/Review/Citation: A growing body of literature exists on the prevalence and psychological sequelae of sexual abuse and its treatment. However, less attention has been focused on the experience of clinicians who treat these clients. This article uses the concept of vicarious traumatization (I. L. McCann and L. A. Pearlman, 1990) to describe the impact this work may have on the social work clinician. The issues addressed include the impact of the work on the clinician's world-view and the possibility that there is a grief process as clinicians come to terms with their exposure to traumatic material. Feelings of denial, anger, sadness, and resolution are discussed as part of the grief process. Implications of this reaction and suggestions to alleviate the detrimental effects are addressed. ======================================== Title: Learning history in fear of blushing. Author(s)/Editor(s): Mulkens, Sandra; Boegels, Susan M. Source/Citation: Behaviour Research & Therapy; Vol 37(12) Dec 1999, England: Elsevier Science Ltd; 1999, 1159-1167 Abstract/Review/Citation: Investigated, in an analogous or treatment-seeking population, the learning history (i.e., traumatic conditioning experiences, vicarious learning, and informational learning) of participants with and without fear of blushing. In Exp 1, 61 college students (aged 18-40 yrs) with high fear of blushing and 59 college students (aged 18-39 yrs) with low fear of blushing completed the (revised) Phobic Origin Questionnaire (POQ; L. G. Oest and K. Hugdahl, 1981). In Exp 2, 31 14-49 yr olds who applied for treatment for fear of blushing and 31 15-47 yr old nonfearful controls were interviewed with the same instrument, taking into account only specific memories. Results show that high fearful Ss reported more negative learning experiences in connection with blushing than low fearful Ss, irrespective of the type of questioning. Exp 1 (written POQ) produced higher percentages of negative learning experiences for both high and low fearful Ss than Exp 2 (interview). Findings indicate that the POQ interview showed a more realistic picture than the written POQ. The possible role of learning history in the acquisition of fear of blushing is discussed. ======================================== Title: Therapists in distress: An integrative look at burnout, secondary traumatic stress and vicarious traumatization. Author(s)/Editor(s): Pickett, Gail Y. Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 59(7-B) Jan 1999, US: Univ. Microfilms International; 1999, 3708 Abstract/Review/Citation: Three constructs have been proposed to explain the effects of conducting therapy upon therapists: burnout, secondary traumatic stress and vicarious traumatization. Research within the trauma field has focused on differentiating vicarious trauma from burnout. This study was undertaken to investigate the underlying relationships between the three constructs. An integrative model was proposed that stated vicarious traumatization is the combination of burnout (consisting of Emotional Exhaustion, Depersonalization and Personal Accomplishment) and secondary traumatic stress. Four hundred questionnaires were distributed to mental health professionals attending a conference on traumatic stress; 94 (23.5%) were returned. The hypothesis that the three factors of burnout are not correlated with secondary traumatic stress was not supported; the bivariate correlation between Emotional Exhaustion and secondary traumatic stress was moderately high (r=.55). Logistic regression was used to test two models predicting job satisfaction, with similar results. Vicarious traumatization and Depersonalization (70.24%) predicted job satisfaction classification nearly as well as the model including Emotional Exhaustion, Personal Accomplishment (transformed) and secondary traumatic stress (72.62%). Multiple regression analyses were used to evaluate the predictive value of several variables, and all of the hypotheses were supported. Distortions in schemas about Others (Experience of Connection) contributed most significantly to the prediction of Depersonalization. Distortions in Self schemas (Experience of Autonomy) accounted for most of the explained variance in predicting Personal Accomplishment. The non-trauma specific variables of Emotional Exhaustion and hours conducting therapy predicted secondary traumatic stress. Finally, Personal Accomplishment (transformed), secondary traumatic stress and Depersonalization contributed most significantly to the prediction of vicarious traumatization. The integrative model was not tested fully because of the high intercorrelations among the variables. This research was successful in demonstrating that, rather than being distinct, burnout, secondary traumatic stress and vicarious traumatization are interrelated in many complex ways. ======================================== Title: Narratives of secondary traumatic stress: Stories of struggle and hope. Author(s)/Editor(s): Arvay, Marla Jean Source/Citation: Dissertation Abstracts International Section A: Humanities & Social Sciences; Vol 59(12-A) Jun 1999, US: University Microfilms International; 1999, 4365 Abstract/Review/Citation: Even though posttraumatic stress theory has been extensively developed in the psychological and medical literature, development of secondary traumatic stress theory is still in its infancy. The traumatology literature reveals a focus on traumatized victims and, with few exceptions, excludes those who are secondarily traumatized (Figley, 1995). Secondary, or vicarious, trauma has become more topical over the past 7 years. Claims have recently been made that counselors working in the field of trauma are vulnerable and at risk for developing trauma symptoms similar to those experienced by their traumatized clients. Descriptors such as compassion fatigue (Figley, 1995), traumatic countertransference (Herman, 1992), and contact victimization (Courtois, 1988) are used in the trauma literature to capture the essence of this phenomenon, which is thought to be a natural consequence of knowing about a traumatizing event experienced by a significant other. For a trauma counselor, this significant other is the client with whom a caring and often long-term relationship has been established. The American Psychiatric Association's (1994) fourth edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) refers to a secondary traumatic stress reaction, but omits discussion of the implications. Empirical research on secondary traumatic stress is minimal: Most focuses on survey data that report incidence levels and correlate demographic variables and symptoms. Qualitative research into the lived experience of counselors working in the field of trauma is absent from the literature. This research study is an investigation into the meanings of experiences of struggling with secondary traumatic stress. The researcher sought to answer the question, "What meanings do trauma counselors make of their struggles with secondary traumatic stress?" Four counselors working in the field of trauma co-constructed narratives on their struggles with secondary traumatic stress. Three conversations were held with each participant. A reflexive narrative method was designed for data collection and narrative analyses were conducted at three levels of interpretation: (a) textual interpretation of the research conversations, (b) interpretation of the research interactions, and (c) four collaborative interpretive readings of the narrative accounts. Narrative analyses generated the following salient aspects of the participants' struggles with secondary traumatic stress: (a) struggling with changing beliefs, (b) intrapsychic struggles, (c) struggling with the therapeutic relationship, (d) work-related struggles, (e) struggling with social support, (f) struggling with power issues, and (g) struggling with physical illness. Implications for professional practice, research, and education were addressed. ======================================== Title: The resilient psychotherapist: An heuristic inquiry into vicarious traumatization. Author(s)/Editor(s): Bennett-Baker, Alethea Anne Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(1-B) Jul 1999, US: Univ. Microfilms International; 1999, 0357 Abstract/Review/Citation: This study evolved from a desire to understand the experience of vicarious traumatization, the transformation experienced in the self of the therapist as a result of empathic engagement with clients' trauma material. The study was conducted utilizing the heuristic design and methodology. The findings of this study were based on data analyzed from interviews with 13 psychotherapists, including licensed psychologists, social workers, and counselors, between the ages of 36 and 58. The composite depiction of psychotherapists' experience supports the data that vicarious traumatization is characterized by the following: PTSD-like symptoms, based on clients' material; feelings of self-doubt; a tendency to pull away from primary relationships; and a cathartic release after talking with colleagues who understand vicarious traumatization as a normal reaction to doing trauma therapy. The findings offered information to psychotherapists, mental health supervisors, and consultants, extending their knowledge. Finally, implications of the data included: the need for more graduate education about trauma, trauma therapy, and vicarious traumatization; the importance of effective supervision in ameliorating the adverse effects of vicarious traumatization; the most effective ways of coping with vicarious traumatization; and how some therapists transform this experience into an opportunity for personal and professional growth. Five themes permeated the experience of these psychotherapists: (1) Vicarious traumatization is a normal reaction to doing trauma therapy; (2) Vicarious traumatization will change you, as a person and as a therapist; (3) Therapists gained a new awareness of the preciousness of relationships; (4) Therapists learned to transform vicarious traumatization in the midst of the session; that is, they developed the ability to change the painful experience of listening to trauma material into an experience of healing for their clients and themselves; and (5) Spirituality is the bridge to healing. In the final chapter, a discussion, summary, implications, and recommendations for further research are provided. ======================================== Title: Social worker trauma: An empirical study of negative workplace events and workplace trauma effects reported by child protection professionals. Author(s)/Editor(s): Horwitz, Mark Jay Source/Citation: Dissertation Abstracts International Section A: Humanities & Social Sciences; Vol 60(3-A) Sep 1999, US: University Microfilms International; 1999, 0887 Abstract/Review/Citation: Child protection professionals are exposed to a variety of workplace events that could overwhelm them. Some of these events stem from proximity to the distressing life circumstances of their clients and others involve verbal abuse, violence and threats of violence directed at workers by clients. This study analyzed the association between negative workplace events and workplace trauma effects amongst 273 child protection professionals and examined the moderating role of job support and job satisfaction on this relationship. Vicarious events, those that stem from proximity to clients' lives, were more highly associated with trauma effects (r =.54, p=.000) than were events stemming from verbal abuse and a worker's safety being threatened by a client (r =.28, p=.000). Vicarious events had a similar impact on caseworkers (r =.57, p=.000) and supervisors (r =.59, p=.000) despite caseworkers' direct contact with clients. More experienced workers reported levels of events and those reported by less experienced workers. Neither job support nor job satisfaction moderated the relationship between negative workplace events and workplace trauma effects. Methods are proposed for decreasing child protection professionals' exposure both to events related to verbal abuse and threats to personal safety and to vicarious events given the strong associations between these events and workplace trauma effects. Finally, a new research model is proposed that would test the role of job support, job satisfaction and other variables on the frequency, severity and duration of workplace trauma effects, and on worker attributions regarding the effects. ======================================== Title: Partner agreement regarding the adult sequelae of childhood sexual abuse for female survivors and their relationship partners. Author(s)/Editor(s): Wiersma, Noelle Susanna Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(3-B) Sep 1999, US: Univ. Microfilms International; 1999, 1353 Abstract/Review/Citation: Recently, increasing attention has been directed toward the concerns of adult female survivors of childhood sexual abuse. Nonetheless, the relationship partners of these individuals have been largely overlooked in the traumatization literature. It has been suggested that partners represent 'secondary survivors' (Remer & Elliott, 1988b, p. 389), experiencing significant distress as a result of their vicarious encounter with the trauma previously sustained by the primary victim. These observations, however, are based almost exclusively on informal clinical observations of males as adjunct participants in the therapy of female partners who have been raped. By virtue of its collateral effects, several authors have suggested that child sexual abuse might best be viewed as a 'shared trauma' (Silverman, 1978, p. 166) for couples. There is, however, no study investigating couples' reciprocal awareness of each others' responses in the wake of sexual abuse previously experienced by one member. It is unknown whether the sequelae of sexual abuse do in fact represent shared experiences, as partners may not be cognizant of the mutual impact of prior sexual trauma. Given these deficits, the present study investigated the extent of partner agreement regarding the impact of child sexual abuse for self and partner. Six couples were identified using purposive sampling procedures. Members of each couple participated in individual interviews of approximately 2 hours duration. They were asked to share perceptions of the effects of the sexual abuse on self and partner, as well as perceptions regarding the extent of awareness by each member of these effects. Transcribed data were analyzed using the open and axial coding procedures of Strauss and Corbin's (1990) grounded theory method. Results highlight areas of agreement and disagreement within and across couples concerning the affective, cognitive, self-perceptual, somatic, sexual, academic/career, and social sequelae of abuse for primary and secondary survivors. Emphasis is given to the expressive and receptive motivations and capacities of each partner that may serve as potential barriers to and facilitators of agreement. ======================================== Title: Secondary traumatization and related variables in mental health professionals. Author(s)/Editor(s): Schalow, Pamela Anne Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(4-B) Oct 1999, US: Univ. Microfilms International; 1999, 1871 Abstract/Review/Citation: This study utilized a national mail survey with licensed psychologists to explore therapist variables related to secondary traumatization. A 27% participation rate resulted in 255 partially or totally completed questionnaires (61.2% male; 38.4% female). The survey assessed for demographic information, a personal history of trauma, a vicarious history of trauma in personal relationships, vicarious exposure to trauma at work, years of experience, current trauma symptoms, and the belief in a just world. Vicarious experiences of trauma in both personal and professional relationships and a history of personal trauma were expected to be positively related to trauma symptoms. An inverse relationship between trauma symptoms and years of experience was predicted. Interaction effects between a personal history of trauma and experiences with traumatized clients in predicting both trauma symptoms and the belief in a just world were hypothesized. Similar interaction effects involving a vicarious history of trauma in personal relationships were proposed. Multiple analyses of variance, regression analyses, and correlational analyses were utilized to investigate hypotheses. Group differences as a function of a personal history of trauma were not identified. There was some evidence that the experience of greater numbers of personally traumatic events was related to increased trauma symptoms, and the impact of trauma varied as a function of participants' gender, the age in which the trauma was experienced, and the specific type of trauma experienced. Perhaps one of the key findings in this study, a greater number of vicariously traumatic experiences in personal relationships was related to increased trauma symptoms, but vicarious exposure to trauma in professional relationships was not. The only interaction effect detected was between a vicarious history of trauma and years of experience in the prediction of trauma symptoms. Specifically, as years of experience and amount of vicarious trauma increase, trauma symptoms decrease at a progressively stronger rate. Finally, the current study failed to replicate previous research findings on relationships between trauma symptoms and the variables of vicarious exposure to trauma at work and years of experience. Findings were integrated with results from other research studies in this area and interpreted within the framework of information-processing theories. ======================================== Title: A qualitative study of the effect of a history of childhood sexual abuse on therapists who treat survivors of sexual abuse. (countertransference). Author(s)/Editor(s): Benatar, May Source/Citation: Dissertation Abstracts International Section A: Humanities & Social Sciences; Vol 60(5-A) Dec 1999, US: University Microfilms International; 1999, 1765 Abstract/Review/Citation: This study explored the effect of a history of sexual abuse on therapists who work with survivors of sexual abuse. A comparison was made between experienced therapists reporting such a history and those who did not. Themes relating to countertransference and vicarious traumatization (VT) were examined as well as data relating to 'PST' or positive self transformation, an unanticipated category relating to enduring change in therapists of a positive nature. Few differences were evident in relation to countertransference themes, VT or PST. Overall, similarities were more striking than differences in the two groups considered in this study. This result corresponds with some empirical literature and contradicts other studies. The role of experience in regard to trauma work as well as the importance of the specific nature of the trauma under consideration and how it matches up with the trauma of the clientele, appears to be an important mediating factor in evaluating the impact on therapists of their work with sexual abuse survivors. ======================================== Title: Countertransference and theoretical perspective. (vicarious traumatization, therapist response, posttraumatic stress disorder, trauma therapy). Author(s)/Editor(s): Long, Janet Anne Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(6-B) Jan 1999, US: Univ. Microfilms International; 1999, 2951 Abstract/Review/Citation: Freud initially conceptualized countertransference as the influence of the patient on the unconscious feelings of the analyst. The concept has evolved to include the entire realm of responses to a patient by the primary therapist and other professionals involved in the care of the individual. Drawing at times on different theoretical assumptions, the traumatic stress literature also addresses the importance of the role of countertransference. The treatment of PTSD can evoke particularly strong and often specific types of countertransference reactions which can enhance empathy and facilitate the therapy, or impede, derail or even disrupt the therapeutic process. Furthermore, it can pose emotional risks to the therapist, a phenomenon referred to as 'vicarious traumatization'. It has been suggested that one's theoretical stance influences how one defines countertransference and consequently how one perceives, experiences, and thus manages it. The goal of the present study was to investigate how countertransference may be influenced by theoretical perspective. It was hypothesized that countertransference responses will vary significantly between therapists employing different theoretical orientations. Subjects were 101 psychotherapists, 48 psychoanalytically oriented therapists and 53 trauma oriented therapists. Scores for the two groups were compared on two measures which assesses attributes considered to be important to the management of countertransference and the notion of vicarious traumatization. The findings suggests that trauma therapists' cognitive schemas about the world, or basic assumptions, are significantly different from psychoanalytic therapists on two measures that have been demonstrated to assess aspects of the construction of the meaning of the impersonal and personal world. Rather than reflecting a direct, linear relationship to the notion of vicarious traumatization, the data suggests that the countertransference responses to persons with PTSD are far more complex. This investigation also determined an interaction effect between the assessment of the importance of anxiety management as a factor in the management of countertransference and level of experience. Both types of therapists assessed anxiety management more highly with increasing experience. This was particularly true for the psychoanalytic therapists. The trauma therapists, however, rated it higher at every level of experience than did the psychoanalytic therapists. ======================================== Title: Distinguishing traumatic, vicarious and routine operational stressor exposure and attendant adverse consequences in a sample of police officers. Author(s)/Editor(s): Brown, Jennifer; Fielding, Jane; Grover, Jennifer Source/Citation: Work & Stress; Vol 13(4) Oct-Dec 1999, US: Taylor & Francis; 1999, 312-325 Abstract/Review/Citation: Problems in studying occupational stress within the police service are identified and the paucity of work on operational duties as potential stressors are discussed. The present study reports the results of a factor analysis of operational stressors (N = 601 serving British police officers) that revealed three factors: exposure to death and disaster; violence and injury; sexual crime. These were demonstrated to be reliable scales and were included in logistic regression models together with a range of demographic and psychological variables. Models were applied to men and women separately, which showed there to be different predictors of the likelihood of suffering distress (measured by the General Health Questionnaire) in terms of the officer's gender and operational role. Overall the model for women officers was better at predicting psychological distress than that for men. These findings are related to aspects of the police occupational culture. Further discussion is offered that conceptualizes police operational stressors as traumatic, routine and vicarious. Finally, some implications are drawn for the provision of stress intervention in the light of this differentiation. ======================================== Title: Responding to self-injurious behavior. Author(s)/Editor(s): Deiter, Pamela J.; Pearlman, Laurie Anne Source/Citation: Emergencies in mental health practice: Evaluation and management., New York, NY, US: The Guilford Press; 1998, (xiii, 450), 235-257 Source editor(s): Kleespies, Phillip M. (Ed) Abstract/Review/Citation: In this chapter, we review some of the psychological literature on self-injury, then provide a theoretical framework for understanding and addressing self-injury in emergency settings. In this chapter the focus is on the client's best interest and the optimal emergency treatment experience. We address the impact on the treatment provider through a brief discussion of countertransference and vicarious traumatization and suggest some resources for helping professionals and their clients. ======================================== Title: The ecstasy and the agony: The impact of disaster and trauma work on the self of the clinician. Author(s)/Editor(s): Charney, Amy Ehrlich; Pearlman, Laurie Anne Source/Citation: Emergencies in mental health practice: Evaluation and management., New York, NY, US: The Guilford Press; 1998, (xiii, 450), 418-435 Source editor(s): Kleespies, Phillip M. (Ed) Abstract/Review/Citation: In this chapter, we focus on the impact and unique challenges that disaster and trauma work impose on the self of the helping professional who works in the area of disaster/crisis intervention and offer a theoretical framework for understanding how these effects, what we term "vicarious traumatization," can be transformed. Although our primary focus is on the aftermath of traumatic events such as disasters that have community impact, the concepts associated with vicarious traumatization are also applicable to clinicians who work with individual victims of violence (e.g., the victims of assault, rape, or other terrorizing behavior). ======================================== Title: A restraint on restraints: The need to reconsider the use of restrictive interventions. Author(s)/Editor(s): Mohr, Wanda K.; Mahon, Margaret M.; Noone, Megan J. Source/Citation: Archives of Psychiatric Nursing; Vol 12(2) Apr 1998, US: WB Saunders Co; 1998, 95-106 Abstract/Review/Citation: Children with behavior problems are put in units with milieu therapy for the support and guidance of a specialized health care team, supposedly experts in the care of children with these unique and urgent needs. The reality of such units, however, is that those with the most contact with the children are often inadequately prepared, both in terms of knowledge and skills, to manage disruptive behaviors. As a result, the milieu that is supposed to provide support and structure can actually exacerbate the trauma for the vulnerable child. Preliminary data are presented from an ongoing study that is investigating the experiences and memories of 19 formerly hospitalized children (aged 8-24 yrs). Three types of traumatic experiences are described: vicarious trauma, alienation from staff, and direct trauma. Many of the traumatic events endured by child patients are the result of an inappropriate use by staff of power and force. There was a marked lack of understanding by the children of why given interventions were used. Although coercive interventions are sometimes necessary, ethical, legal, and other professional considerations make it clear that more work is needed. ======================================== Title: The effects of suicide on the private practitioner: A professional and personal perspective. Author(s)/Editor(s): Fox, Raymond; Cooper, Marlene Source/Citation: Clinical Social Work Journal; Vol 26(2) Sum 1998, US: Kluwer Academic/Plenum Publishers; 1998, 143-157 Abstract/Review/Citation: A patient's suicide has a profound effect on the therapist and psychotherapy with a chronically suicidal patient is particularly troubling. Guilt over one's failure to recognize the warning signs, fear of one's incompetence or irresponsibility, shame that one has failed, and fear of being blamed by the patient's loved ones and by colleagues are feelings that frequently surface and that can result in isolating a practitioner from the very sources of peer support that are necessary to resolve the trauma. This article explores the effects of suicide on the private practitioner. It discusses how burnout and vicarious traumatization impact upon the therapist who treats the chronically suicidal patient. Two clinical examples illustrate the impact of working with imminent suicide and the aftermath of a patient's death from a personal perspective. Recommendations are made to help private practitioners maintain equilibrium when working with these overwhelming case situations. ======================================== Title: An interactional view of traumatic stress among First Nations counselors. Author(s)/Editor(s): Morrissette, Patrick J.; Naden, Michelle Source/Citation: Journal of Family Psychotherapy; Vol 9(3) 1998, US: Haworth Press Inc; 1998, 43-60 Abstract/Review/Citation: This purpose of this article is to discuss systemic intervention with vicariously traumatized First Nations (Native) counselors who listen to stories of abuse that are shared by former students of residential schools. For many victims of the residential school era, a sense of shame has effectively quelled their ability to share their painful, and, at times, debilitating narratives. The systemic effect upon counselors who are privy to the eventual disclosure of such stories is examined, along with a solution-focused approach designed to assist the recipients of such disturbing narratives. ======================================== Title: PTSD transmission: A review of secondary traumatization in Holocaust survivor families. Author(s)/Editor(s): Baranowsky, Anna B.; Young, Marta; Johnson-Douglas, Sue; Williams-Keeler, Lyn; McCarrey, Michael Source/Citation: Canadian Psychology; Vol 39(4) Nov 1998, Canada: Canadian Psychological Assn; 1998, 247-256 Abstract/Review/Citation: Posttraumatic Stress Disorder (PTSD) provides a common language for diagnoses and assessment of trauma victims, including Holocaust survivors. Many of these survivors established post-war families and it is here that we began to witness the possibility of trauma transmission. Parental communication regarding the Holocaust, often characterized by obsessive re-telling or all-consuming silence, and strong family ties are implicated in the theoretical literature on trauma transmission. Terms such as vicarious, empathic, and secondary traumatization have been used to describe intergenerational trauma transmission. The crucial emergent question is whether a secondary PTSD syndrome, reflected in the current PTSD symptomology, is being transmitted from one generation to the next. There is evidence in the literature to support this hypothesis and a call is made for rigorous empirical studies as the test. ======================================== Title: The effects of repeated exposure to trauma on volunteer victim advocates. Author(s)/Editor(s): Slover, Charlene Ann Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 58(8-B) Feb 1998, US: Univ. Microfilms International; 1998, 4473 Abstract/Review/Citation: Although there have been studies investigating the effects of trauma on direct victims and limited investigations into the effects of trauma exposure on certain helping professionals, there has been no research on the effects on victim advocates. The purpose of this study was to investigate the effects of repeated vicarious exposure to trauma on volunteer victim advocates. Participants were 32 victim advocates from police jurisdictions in the Denver metropolitan area. The participants completed the TSI Belief Scale, the Maslach Burnout Inventory and the Impact of Event Scale prior to the start of their training and then again after a minimum of six months on-call duty and involvement with a minimum of ten calls. The statistical analysis was a two-way analysis of variance with repeated measures. ANOVA was used to determine differences pre/post, and between those advocates reporting previous victimization and those advocates with no prior trauma history. The results yielded statistically significant differences pre/post on three subscales. On the subscale Self-esteem of the TSI Belief Scale scores were higher indicating an increase in disrupted cognitive schemas in this need area. On the subscale Avoidance of the Impact of Event Scale scores were higher indicating the increased use of defensive avoidance and attempts at denial of memories and emotions related to advocate duties. On the subscale Personal Accomplishment of the Maslach Burnout Inventory scores were higher indicating an increased sense of achievement and accomplishment in one's labor. Results also indicated differences between advocates self-identified as victims and those not identified as victims on two subscales: Self-intimacy of the TSI Belief Scale and an interaction effect on the subscale Emotional Exhaustion of the Maslach Burnout Inventory. Non-victimized advocates had higher scores indicating greater disruption in self-intimacy, and there was an interaction effect on Emotional Exhaustion. Scores were higher for those advocates reporting previous trauma, and lower for those not reporting previous trauma. ======================================== Title: Traumatic effects of therapists working with perpetrators of sexual abuse. Author(s)/Editor(s): Moore, Donna L. Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 58(8-B) Feb 1998, US: Univ. Microfilms International; 1998, 4462 Abstract/Review/Citation: This study investigated the deleterious effects psychotherapists may experience as a result of fulfilling their professional duties. Therapist participants (N=75) were divided into various comparison groups for assessment of post-traumatic stress, vicarious traumatization and general distress symptoms. It was hypothesized that female therapists, less experienced therapists, therapists who felt professionally isolated, and therapists working with trauma clients would experience more stress from performing their clinical work. Multiple group comparisons did not lend support to four of the five hypotheses. No significant group differences were found. The hypothesis that less experienced therapists would have more stress than more experienced therapists was partially supported. While short-term trauma symptoms were significantly greater in the less experienced therapist group, therapists in the middle range of experience reported more long-term stress in the form of disrupted beliefs than therapists with more and less experience. Implications for these findings and study limitations are discussed. ======================================== Title: Vicarious traumatization, spirituality and the treatment of adult and child survivors of sexual abuse: A national survey of women psychotherapists. Author(s)/Editor(s): Brady, Joan Laidig Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 58(9-B) Mar 1998, US: Univ. Microfilms International; 1998, 5107 Abstract/Review/Citation: This study of psychotherapists was designed to empirically measure the consequences of conducting psychotherapy with sexual abuse survivors. This entailed an examination of therapists' vicarious traumatization, including the impact of conducting child versus adult treatment, and the influence of conducting psychotherapy with sexual abuse survivors on therapists' spirituality. A national survey was conducted of 1000 women psychotherapists who were either members of the American Professional Society on the Abuse of Children or members of the American Psychological Association with a specialty in psychotherapy. The survey consisted of items related to demographic data, therapists' work-related experience, training, and exposure to sexual trauma both professionally and personally. Vicarious traumatization was assessed using the Impact of Event Scale to measure intrusion and avoidance trauma symptoms and the TSI Belief Scale to assess disturbances in cognitive schemas. Spirituality measures included in the survey were the Spiritual Well-Being Scale and the Gorsuch Adjective Checklist. An overall return rate of 50.1% was obtained. Therapists who were exposed to more sexual abuse, as determined by psychotherapy hours spent with survivors and graphic details of abuse in their sessions, reported significantly more trauma symptoms on the Impact of Event Scale. However, no such relationship was found for disruption of cognitive schemas as measured by the TSI Belief Scale. No difference was found on these measures between those who treated more child sexual abuse survivors and those who treated more adult sexual abuse survivors. Respondents who saw more sexual abuse survivors received higher spiritual well-being scores and reported experiencing God/Higher Power to be more potent and relevant. A discussion of these results is included. ======================================== Title: Vulnerability factors for secondary traumatic stress in psychotherapists who treat traumatized clients. Author(s)/Editor(s): Price, Marilu Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 59(4-B) Oct 1998, US: Univ. Microfilms International; 1998, 1865 Abstract/Review/Citation: The purpose of the study was to examine the effects of working with traumatized clients in relation to the concept of secondary traumatic stress (STS). Similar concepts such as vicarious trauma, burnout, occupational stress, and countertransference reactions were described according to a review of the literature. Participants included 214 psychotherapists who were randomly selected from the American membership of the International Society for Traumatic Stress Studies. They varied with regard to gender and age, represented a broad range of disciplines, and worked with a variety of types of traumatized clients. Respondents completed a demographic questionnaire, the Florida Secondary Traumatic Stress Scale, the Impact of Event Scale, and the Maslach Burnout Inventory. Each research question was analyzed through multiple regression to evaluate relationships between STS and the variables of interest. With regard to exposure to traumatized clients, both current and cumulative exposure had small effect sizes when correlated with STS in therapists. A personal history of traumatization was slightly related to STS symptoms, with the number of traumatic events experienced resulting in a moderate effect size. Finally, years of experience, both general and trauma-specific, was also found to have a small effect size. The small to moderate effect sizes were consistent with prior research in this growing area of interest. Results from the present study indicate that a substantial number (27%, n = 58) of the trauma therapists were considerably distressed. This subset of 58 therapists had outlying scores on one or more scales measuring STS symptoms. Recognition of this occupational hazard is important to protect both therapists and clients from harm. Further research in this area is recommended, especially with therapists with less experience who may be more vulnerable to the effects of working with trauma survivors. ======================================== Title: Issues in treating rape and sexual assault. Author(s)/Editor(s): Weaver, Terri L.; Chard, Kathleen M.; Resick, Patricia A. Source/Citation: Treating complex cases: The cognitive behavioural therapy approach., Chichester, England: John Wiley & Sons Ltd; 1998, (xiv, 441), 377-398 Wiley series in clinical psychology. Source editor(s): Tarrier, Nicholas (Ed) Abstract/Review/Citation: This chapter presents a detailed examination of strategies for dealing with some of the most common difficulties which arise when the therapist is conducting trauma-focused therapy for rape and sexual assault. Toward this end, the chapter briefly reviews the research describing the available treatments for rape and sexual assault and describes the theoretical underpinnings of victims' responses and associated treatment approaches. The majority of the chapter focuses on specific strategies for dealing with complex cases and difficulties which arise during treatment, first with regard to client factors, and then with regard to therapist issues. Topics include: theoretical framework for rape and sexual assault treatment (cognitive behavioural treatments for posttraumatic stress disorder (PTSD)); client factors interfering with trauma-focused treatment; client noncompliance and problematic styles of avoidance (getting the therapeutic commitment, homework compliance, prior trauma history, dissociation, external barriers to recovery); and therapist factors interfering with trauma-focused treatment (misconceptions about trauma-focused treatment, inadvertent collusion with client avoidance, vicarious traumatisation). ======================================== Title: Heart rate during group flooding therapy for PTSD. Author(s)/Editor(s): Woodward, Steven H.; Drescher, Kent D.; Murphy, Ronald T.; Ruzek, Joseph I.; et al Source/Citation: Integrative Physiological & Behavioral Science; Vol 32(1) Jan-Mar 1997, US: Transaction Periodicals Consortium; 1997, 19-30, 75-83 Abstract/Review/Citation: Examined, via heart rate (HR), the arousal levels of participants in group trauma re-exposure therapy (GTRT) for posttraumatic stress disorder (PTSD) to gain insight into this type of therapy, with an emphasis on extinction. Six Vietnam combat-related PTSD inpatients participated biweekly in GTRT during which their electrocardiograms were recorded. Findings show HRs of Ss not directly engaged in imaginal re-exposure to their personal combat traumas (PCT) consistently exhibited mild linear declines from the beginnings to the ends of the 2.5 hour sessions. Ss actively engaged in PCT re-exposure exhibited higher whole-session HRs. Most also exhibited more specific elevation extending over the later portions of sessions during which intensive re-exposure usually occurred. No Ss exhibited focal increases in HR concurrent with periods of most intensive traumatic incident review. GTRT may not provide an opportunity for "vicarious" flooding in nonengaged Ss. ======================================== Title: The association between illusions of invulnerability and exposure to trauma. Author(s)/Editor(s): Roe-Burning, Shelley; Straker, Gill Source/Citation: Journal of Traumatic Stress; Vol 10(2) Apr 1997, US: Kluwer Academic/Plenum Publishers; 1997, 319-327 Abstract/Review/Citation: Investigated, in a high risk sample of 127 12-19 yr olds, the relationship between illusions of invulnerability and exposure to 6 specific traumatic events. The most significant finding was the significant negative relationship between exposure to trauma and level of invulnerability, indicating that the greater the exposure to trauma, the less the invulnerability expressed in regard to potential risk. A further significant finding of the study was that vicarious exposure to trauma affects how one estimates risk of death in relation to the "average other" but not in relation to the self. Direct experience of trauma, on the other hand, affects perceived risk in relation to both self and other. ======================================== Title: Community and domestic violence exposure: Effects on development and psychopathology. Author(s)/Editor(s): Osofsky, Joy D.; Scheeringa, Michael S. Source/Citation: Developmental perspectives on trauma: Theory, research, and intervention., Rochester, NY, US: University of Rochester Press; 1997, (xvii, 613), 155-180 Rochester symposium on developmental psychology, Vol. 8. Source editor(s): Cicchetti, Dante (Ed) Abstract/Review/Citation: This chapter discusses how children are traumatized by witnessing community or domestic violence and examines the potential developmental sequelae of such traumatization. Topics addressed include: child characteristics and differential outcomes related to violence exposure (developmental considerations, differential response according to gender and ethnicity); mediating factors influencing the effects of violence on children (severity of exposure, victimization vs witnessing vs vicarious exposure, witnessing verbal vs physical aggression, witnessing violence against relatives/friends vs strangers/acquaintances); and effects of trauma on development and psychopathology. ======================================== Title: Vicarious traumatization in therapists treating adult survivors of childhood sexual abuse. Author(s)/Editor(s): Simonds, Susan Lee Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 57(8-B) Feb 1997, US: Univ. Microfilms International; 1997, 5344 Abstract/Review/Citation: This study investigated the impact of treating adult survivors of childhood sexual abuse on therapists. This is the first study to explore the relationship between vicarious traumatization and therapists' exposure to specific aspects of clients' trauma. The definition of exposure included exposure to clients' graphic trauma material, exposure to people's cruelty to one another, and observation of and participation in traumatic reenactments (Pearlman & MacIan, 1995; Pearlman & Saakvitne, 1995a). The study found that exposure to clients' sexual abuse trauma was significantly related to secondary traumatic stress reactions and disruptions in cognitive schemas. Several other variables were found to be related to vicarious traumatization, including (1) less experience working as a therapist, (2) the percentage of sexually abused child clients in a therapist's caseload, and (3) the percentage of sexually assaulted adult clients in a therapist's caseload. In this sample of therapists, vicarious trauma reactions were not related to the therapist's own history of sexual trauma, to percentage of adult survivors of childhood sexual abuse in the therapist's caseload, or to receiving helpful supervision or consultation. The findings also support the vicarious traumatization model of indirect trauma which encompasses changes in experiences of self, others, and the world. Although therapists in the study experienced low levels of posttraumatic symptoms, they reported negative transformations of world view and increased fears about the safety of children, suggesting that vicarious traumatization is an occupational hazard that must be acknowledged and addressed. ======================================== Title: Vicarious traumatization: Impact of trauma work on the clinician. Author(s)/Editor(s): Cunningham, Maddy Source/Citation: Dissertation Abstracts International Section A: Humanities & Social Sciences; Vol 57(9-A) Mar 1997, US: University Microfilms International; 1997, 4130 Abstract/Review/Citation: This study was designed to empirically test whether clinicians who work with trauma may be negatively affected. More specifically, the research question explored was: Do clinicians who work with a naturally caused trauma, such as cancer differ from clinicians who work with a human-induced trauma, such as sexual abuse? The concept of vicarious traumatization, which describes the experience of the clinician working with traumatized clients, was used as a framework. Vicarious traumatization has two aspects: disruption in cognitive schemas and the intrusion and/or avoidance symptoms associated with post-traumatic stress disorder (PTSD). The research was conducted in 1995 with two groups of clinicians chosen from the membership listings of two professional organizations. The sample size was 182. The response rate was 59.9%. The sample was predominantly female (N = 149) social workers (N = 173). There was a significant negative correlation between working with cancer patients and working with sexually abused clients, indicating that the two groups of interest were independent of each other. Two instruments were used in the study. The Traumatic Stress Institute Belief Scale (Revision L) (TSIBS) was used to measure clinicians' cognitive schemas. The Impact of Event Scale (IES) was used to measure the intrusion and/or avoidance symptoms of the PTSD. Major findings of the study indicate that clinicians working with sexual abuse were more negatively affected than those who worked with cancer. Clinicians working with sexual abuse reported more disruptions in several cognitive schemas on the TSIBS, including the safety schemas, other-trust and other-esteem. However, those with higher percentages of sexually abused clients reported fewer PTSD-like symptoms on the IES. Those who worked with cancer patients reported significantly less disruptions in the safety schemas. For all subjects years of experience correlated negatively and special training correlated positively with several sub-scales of the TSIBS. A confounding variable of interest was the clinician's own personal history of trauma. Eighty-one subjects (44.5%) reported a history of trauma with 31 (17%) reporting a history of sexual abuse. Those reporting a history of sexual abuse were significantly more likely to work with sexually abused clients and reported significantly more disruptions on the self-safety, self-esteem and other-esteem sub-scales of the TSIBS. When history of sexual abuse was statistically controlled for, there were still significant differences between the clinicians who worked with sexual abuse and those who worked with cancer. In summary, the findings of this study support the notion that clinicians working with sexually abused clients may be negatively impacted by the work. Further exploration of vicarious traumatization and the experience of clinicians working with cancer patients is needed. The findings of this study may reflect a defensive stance on their part of the clinician or some other type of coping strategy which effectively ameliorates the deleterious effects of working with this trauma. ======================================== Title: Stress, vicarious traumatization, and coping: Therapists' efforts to manage the stress of treating sexual trauma. Author(s)/Editor(s): Everett, Susannah Rene Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 57(10-B) Apr 1997, US: Univ. Microfilms International; 1997, 6568 Abstract/Review/Citation: The purpose of this study was to examine vicarious or secondary traumatization: the process through which therapists' indirect exposure to trauma via the psychotherapeutic relationship affects therapists. Specifically, this study was designed to explore the coping methods that therapists employ to manage the stress of treating survivors of sexual assault and sexual abuse, and to investigate the relationships among therapists' exposure to sexual trauma survivors, their coping efforts, and therapists' symptoms of burnout and post-traumatic stress disorder (PTSD. Members of three Virginia mental health professional organizations completed questionnaires regarding themselves, their work, their perceptions of how working with clients affect their own adjustment and well-being, and the methods they use to manage the stress of working with trauma survivors. Contrary to expectations and previous findings presented in earlier studies examining vicarious traumatization, exposure to clients who were survivors of sexual assault and sexual abuse did not predict symptoms of PTSD or burnout among therapists. Among the individual and environmental variables, only therapist age was significantly and negatively related to outcome measures. The results of additional analyses suggest that the environmental variable of work setting (specifically, public sector vs. private practice) may play a significant role in the development of vicarious traumatization. These results point to the complex nature of the construct of secondary trauma, and suggest the necessity of further research investigating factors that may prevent, mitigate, or intensify the effects of work with trauma survivors on therapists. ======================================== Title: Ritual abuse: The experience of therapists working with controversial narratives. Author(s)/Editor(s): Rudikoff, Ellen Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 57(11-B) May 1997, US: Univ. Microfilms International; 1997, 7235 Abstract/Review/Citation: In this study I explored therapists' experiences of working with controversial clinical material, specifically Satanic Ritual Abuse (SRA). I conducted in-depth interviews with eight licensed doctoral level psychologists who worked extensively with trauma clients. My results indicated that they experienced both the content of SRA narratives, and the treatment context, to be qualitatively different, more complicated, and more disturbing, than other clinical material. My study was situated within the theoretical frame of social constructionism with particular emphasis on the concepts of subjectively determined truths and the co-creation of narratives. As the process and content of treatment simultaneously draws together many narratives, or truths, including those of clients, clinicians, the psychological community, and the dominant culture, I suggest it is important to consider their influences on the intimate dyadic treatment relationship. The five major findings that emerged in my study reflected profound personal and professional challenges to participants. My findings were that participants (a) experienced vicarious and active traumatization, (b) felt silenced and professionally isolated, (c) struggled to provide treatment in the midst of uncertainty, (d) confronted the concept of evil, and (e) found ways to cope with their experiences. It is hoped that these findings increase our knowledge of the therapeutic process when it involves controversial material, increase our awareness of the importance of the larger contexts in which that process occurs, and encourage us to consider what we, as individuals and as a discipline, can do to better support that process. Specifically, I suggest that psychologists (a) examine the content and supporters of controversy, (b) explore active traumatization, and (c) provide a safe professional forum for all narratives. When therapists work with narratives embedded in the context of professional and cultural controversy they are caught in the position of providing treatment that is intensely experienced by clients, the professional community, and the larger culture, while attempting to interpret clinical material, set therapy goals, findsupport and supervision, and help clients give language to their experiences. I suggest it is crucial that therapists first give language to their own experiences. ======================================== Title: The vicarious effects of treating female rape survivors: The therapist's perspective. Author(s)/Editor(s): Lobel, Jennifer Anne Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 57(11-B) May 1997, US: Univ. Microfilms International; 1997, 7230 Abstract/Review/Citation: Literature that describes therapists who treat sexual offenders (Farrenkopf, 1992) and incest survivors (Hollingsworth, 1993; McCann & Pearlman, 1990a, 1990b; Pearlman & Saakvitne, 1993) indicates that these trauma workers' cognitive schemata may negatively change as a result of repeated exposure to traumatic material. This process is known as vicarious traumatization (McCann & Pearlman, 1990a, 1990b). The present investigation has attempted to examine and document the incidence of both vicarious traumatization and positive outcomes for therapists treating rape survivors. This was a qualitative investigation employing semi-structured and open ended interviews with 10 therapists who treat women raped in adulthood. The participants' interviews, once transcribed, summarized, and analyzed, were returned to them for their verification. A focus group was assembled with three of the participants for further explanation of the data. A co-researcher was employed to bolster the authenticity of the findings. Responses were rated as either positive, negative, mixed, or no change. This study found that seven out of ten participants do experience negative long-term changes in some of their cognitive schemata, thus supporting McCann and Pearlman's model of vicarious traumatization. Three participants reported no vicarious traumatization. Moreover, eight out of ten participants cited positive formulations in some of their cognitive schemata. The most frequently reported was that the work elicited no change in cognitive schemata. The most frequently reported was that the work elicited no change in the schemata as cited by nine of ten participants. Of those who reported change, overall, therapists were more positively than negatively affected by their work. The following are the patterns of change: (1) The most commonly reported positive formulation was found in the esteem schema. (2) The most commonly reported negative change was in the frame of reference schema. (3) Vicarious enrichment was found which refers to the positive effects the participants experienced from their work. An educational model is presented as a beginning step both to mitigate negative disturbances in trauma workers and to disseminate information concerning positive formulations. ======================================== Title: Therapist traumatization from exposure to clients with post-traumatic stress disorder. Author(s)/Editor(s): Curtis, Albert Bruce Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 57(12-B) Jun 1997, US: Univ. Microfilms International; 1997, 7720 Abstract/Review/Citation: This study was designed to explore the notion that psychotherapists who treat trauma survivors are themselves subject to traumatization through a vicarious or secondary process. 'Secondary Traumatization' is a term used by Figley (1983) to describe a process by which those who are in close contact with trauma survivors may become indirectly traumatized by the trauma. While some authors conceptualize therapist traumatization with the larger context of burnout (Doyle & Bauer, 1989) or countertransference (Newbury, 1985; Kinzie & Boehnlein, 1993), others argue that it is a distinct process (McCann & Pearlman, 1990). This study relationship between therapists' exposure to six major diagnostic categories drawn from DSM-1V (Schizophrenia, Mood Disorders, Post-Traumatic Stress Disorder, Substance Abuse, Borderline Personality Disorder, Adjustment Disorders) and the therapists' own PTSD Symptomatology as measured by the Impact of Events Scale (Horowitz, Wilner & Alvarez, 1979) and the BriefSymptom Inventory (Derogatis & Spencer, 1982). Sixty therapists in outpatient and inpatient urban mental health centers in the Northeastern United States completed self-report instruments. Therapists' level of PTSD symptomatology was found to be significantly related to their degree of exposure to schizophrenic clients. Other variables found to be related to therapists' symptoms were: (1) support from personal therapist, (2) perceived effectiveness with adjustment disorders, (3) years of experience as a therapist, (4) education level, and (5) field of study. PTSD symptomatology was not found to be related to exposure to other difficult client populations including Post-Traumatic Stress Disorder. The results suggested that working with schizophrenic clients may result in PTSD symptomatology in therapists and that other factors such as years of experience, education level, and social support may be important. ======================================== Title: Vicarious traumatization of therapists working with trauma survivors: An investigation of the traumatization process including therapists' empathy style, cognitive schemas. Author(s)/Editor(s): Walton, Denise Trevisan Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 58(3-B) Sep 1997, US: Univ. Microfilms International; 1997, 1552 Abstract/Review/Citation: This research was designed to identify the process by which therapists working with trauma survivors acquire symptoms of Post Traumatic Stress Disorder (PTSD). Traumatization of therapists was examined at two levels: the external level of how trauma effects are transferred from survivors to therapists and the level of internalized change therapists undergo as a result of contact with survivor clients. The external process of traumatization was explored by measuring the relationship between therapists' empathic engagement style and PTSD symptoms. Internalized change in therapists was examined by investigating the relationships between ten disrupted cognitive schemas and PTSD symptomatology. Four protective factors: social support, self-disclosure, specialized supervision and trauma therapy conceptualization were researched to discover whether they would predict PTSD symptoms. ======================================== Title: Trauma and the therapist: Visual image making, countertransference, and vicarious traumatization. Author(s)/Editor(s): Rozelle, Deborah Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 58(4-B) Oct 1997, US: Univ. Microfilms International; 1997, 2136 Abstract/Review/Citation: This dissertation describes a training program for experienced trauma therapists who wish to address countertransference and vicarious traumatization experiences. The main objective of the dissertation is to present a way for trauma therapists to use visual image making as a nonverbal form of dialogue within dyadic peer consultation in order to understand, address, and ameliorate their own countertransference and vicarious traumatization reactions. The dissertation's other objective, to describe a conceptual and scholarly framework for visual image making technique in peer consultation, forms the basis for the main objective. To accomplish these tasks, the dissertation addresses the needs of trauma therapists, shows why a visual image technique may be useful, and discusses how training in making visual images may help address these needs. It also presents a conceptual framework for using visual image making strategies when addressing countertransference and vicarious traumatization reactions. In a comprehensive literature review drawing from sources that address post-traumatic stress disorder, countertransference, vicarious traumatization, creativity, and art therapy, the dissertation discusses therapists' responses to traumatic material and assesses current methods for preventing or ameliorating the negative responses. Using the current literature as a source for comparison, the dissertation proposes a specific visual image making technique to address countertransference and vicarious traumatization reactions and a training program that introduces the technique to interested therapists. The training program design includes a description of the training workshop and a dyadic peer consultation practice period for experienced trauma therapists, as well as some reflections on the training workshop and the visual image making process. The dissertation ends with some recommendations for research. ======================================== Title: Interpersonal violence education of mental health professionals: Survey and curriculum. Author(s)/Editor(s): Kelly, Vanessa Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 58(5-B) Nov 1997, US: Univ. Microfilms International; 1997, 2683 Abstract/Review/Citation: This study investigated and compared the prevalence and quality of formal training pertaining to four areas of interpersonal violence (sexual assault, domestic violence, and childhood sexual and physical abuse) in psychology doctoral level programs and psychiatry residency training programs. This was a more detailed and comprehensive investigation than prior research; data were collected through a survey as well as in in-depth interviews regarding the content areas covered and the teaching methods used. The final goal was the development of a model curriculum for interpersonal violence graduate education. Surveys were sent to 583 programs, resulting in 105 responses (18% response rate). Results indicate that education about adult sexual assault and domestic violence was offered significantly less often than education about childhood sexual and physical abuse. Only 20% of programs offered all areas of training, while 31% of the psychology programs and 15% of the psychiatry programs offered nothing in these areas. Additionally, 95% of psychology programs and 88% of psychiatry programs did not require any training in interpersonal violence, although 97% of psychology programs and 98% of psychiatry residency programs stated that they believed they should provide it. Overall, psychiatry residency programs required more exposure to interpersonal violence issues than psychology programs, although less than 12% of all programs required exposure to all four areas. Other findings include: the majority of programs are not doing any research on interpersonal violence; assessment, diagnosis, and treatment are covered most often, while vicarious trauma of the practitioner, psychological effects of trauma, and treatment of male victims, child victims of domestic violence, and adult survivors of childhood abuse are covered least often. When interpersonal violence education is taught, the majority of hours spent per area is less than five. The findings reveal a minimal amount of training with wide variations in depth and scope, and no consistent rationale for providing it. Without mandated profession-based standards and support for education, it is doubtful that more in-depth professional training on interpersonal violence will occur. Finally, the model curriculum consists of two courses addressing the full continuum of interpersonal violence, including assessment and treatment. ======================================== Title: Care of clinicians doing trauma work. Author(s)/Editor(s): Blanchard, Ellen Arledge; Jones, Mirta Source/Citation: Sexual abuse in the lives of women diagnosed with serious mental illness., Amsterdam, Netherlands: Harwood Academic Publishers; 1997, (xix, 391), 303-319 New directions in therapeutic interventions, Vol. 2. Source editor(s): Harris, Maxine (Ed) Abstract/Review/Citation: Focuses attention on the needs of clinicians doing trauma work. Treating women with serious trauma histories can be vicariously traumatizing for clinicians working with them. This chapter specifically addresses these issues for clinicians working with seriously, mentally ill female survivors of sexual abuse. ======================================== Title: When trauma hits home: Personal trauma and the family therapist. Author(s)/Editor(s): Carbonell, Joyce L.; Figley, Charles R. Source/Citation: Journal of Marital & Family Therapy; Vol 22(1) Jan 1996, US: American Assn for Marriage & Family Therapy; 1996, 53-58 Abstract/Review/Citation: Discusses immediate and long-term psychosocial consequences of traumatic events that may affect family therapists, with reference to experiences reported by J. L. Lewis and D. R. Stokes. Therapists may be traumatized directly through the death of a spouse, or indirectly by working with traumatized clients. The latter relates to secondary traumatic stress, compassion fatigue, vicarious traumatization, and countertransference. These events may invade both work and personal life, and create both opportunities and dangers for the therapists. The solo nature of most therapy and the caveats concerning disclosure of personal problems may be responsible for the absence of a model for therapists to heal themselves in the event of trauma. A few brief treatments are being investigated to provide a solution to this pervasive problem. ======================================== Title: Primary and secondary trauma in a non-clinical population. Author(s)/Editor(s): Dorsett, Evelyn Marie Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 56(10-B) Apr 1996, US: Univ. Microfilms International; 1996, 5762 Abstract/Review/Citation: This study compared the effects of direct and vicarious trauma in a non-clinical lay population and the extent to which these effects resembled PTSD. The subjects were 252 undergraduate students (83 males and 169 females), mean age 20.1, 84.9% Caucasian. Most subjects in this sample reported at least one potentially traumatic event (70%). Events such as sexual assault and relationship violence, which involve interpersonal violence, were most clearly related to psychological distress. A small number of subjects reported scores on measures equivalent with a clinical sample. Multiple events, particularly events that happen to significant others, were predictive of the variance in measures of distress. The results support a relationship between measures of PTSD and traumatic events, and an association between coping strategies and distress is also suggested. ======================================== Title: Vicarious traumatization of therapists: The impact of working with trauma survivors. Author(s)/Editor(s): Van De Water, Roxanne Carla Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 57(3-B) Sep 1996, US: Univ. Microfilms International; 1996, 2168 Abstract/Review/Citation: This study investigated the impact of trauma work on therapists who work with trauma survivors. Recent literature has suggested that therapists exposed to survivors' experiences of incest, rape, violent crime and combat may experience similar symptoms to the survivors they treat. These symptoms include concern for safety; sensory imagery disruptions; mood changes; difficulties with relationships; distrust of others and alterations in world view. It was also suggested these reactions were exacerbated in therapists who had a personal history of trauma. A literature search revealed that no instrument to assess therapists' reactions to trauma work existed. Hence, the Trauma Work Impact Scale was designed to measure therapists' reactions to the following trauma work variables: length of time treating survivors, total number of survivors treated during therapists' careers, percentage of survivors in therapists' current caseloads, exposure to clients' symptoms (e.g., self-mutilating behaviors, chronic suicidality), and a personal history of trauma. The sample included 130 female and 35 male trauma therapists. Construct validity was determined by a factor analysis. Cronbach alphas established scale reliability. Subscale reliabilities ranged from.39to.80. Total scale reliability was.90. The results indicated that therapists with a high percentage of survivors in their current caseloads (e.g., 76% or above) experienced increased concern for the safety of others, female therapists were highly concerned for personal safety, and therapists with a history of incest or rape experienced a very high degree of difficulty in their personal relationships. However, having a history of domestic violence was related to less difficulty with professional relationships. Other findings suggested that feeling adequately trained for trauma work was predictive of less work related 'burnout,' having children was related to less difficulty in listening to trauma material, negative feelings ======================================== Title: Trauma and coping in homicide and child sexual abuse detectives. Author(s)/Editor(s): Hallett, Sarah Jane Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 57(3-B) Sep 1996, US: Univ. Microfilms International; 1996, 2152 Abstract/Review/Citation: This study examined the impact of vicarious traumatization in law enforcement professionals as a result of being immersed in work that involves chronic exposure to human pain and destructiveness. A cross-sectional, correlational design was used to explore the effects of prolonged exposure to traumatic material in patrol officers and detectives. The purpose of the study was to obtain information on the use of dissociation in those exposed to cumulative trauma, to assess police officers with a validated measure of PTSD symptoms, to obtain information regarding coping strategies in police work, and to determine the utility of projective assessment in assessing extent of trauma exposure. The study included 126 police personnel from 14 law enforcement agencies. Participants completed the Police Officer History Questionnaire, The Violence History Questionnaire, The Trauma Symptom Inventory, The Dissociative Experiences Scale--Revised, The Coping Styles and Strategies Inventory. Participants also were administered the Rorschach Inkblot Test and took part in a semi-structured interview. Major findings include the importance of dissociation and maladaptive coping as predictors of pathology and distress, the impact of critical incident exposure on pathology and distress, the utility of the Rorschach in assessing exposure to trauma, the tendency for those with personal histories of child abuse to work in units with high exposure to trauma, and the vulnerability of those with trauma history to dissociative and anxiety disorders. ======================================== Title: Transforming the pain: A workbook on vicarious traumatization. Author(s)/Editor(s): Saakvitne, Karen W.; Pearlman, Laurie Anne Seller: Traumatic Stress Inst Source/Citation: New York, NY, US: W. W. Norton & Co, Inc; 1996, (159) A Norton professional book. Abstract/Review/Citation: In your profession, do you help or work with people who have been traumatized? Do you listen to stories of abuse, suffering, or trauma from your clients every day? If so, you know it is impossible to hear and bear witness to trauma survivors' experiences and not be changed. You know firsthand the personal cost of the work you do and the struggle to make sense of powerful, often painful, feelings and altered beliefs. This transformation of a helper's inner experience is called vicarious traumatization (VT); it is an inescapable effect of trauma work. "Transforming the Pain" is the first workbook to address VT. It is designed to take care of the helper--to help you assess, address, and transform your own VT. [This book] defines and describes the VT process and offers reassurance that you are not alone with these painful experiences. It includes self-assessment worksheets, and guidelines and specific exercises for addressing VT and improving self-care. It is designed to be used by a wide range of professionals and paraprofessionals, including, but not limited to, therapists, police, medical personnel, crisis workers, and clergy. After working with [this book], you will find that you have a new awareness of the ways your work affects your life as well as new skills and tools for improving your emotional well-being. Notes/Comments: About the authors Acknowledgments Introduction What is vicarious traumatization? Assessing vicarious traumatization Addressing and transforming vicarious traumatization Exercises for individuals, dyads, and groups Maintaining the commitment References Annotated bibliography TSI/CAAP resources techniques for self assessment & care & improvement of emotional well-being, professionals & paraprofessionals with vicarious traumatization from working with trauma survivors, workbook, self help resource ======================================== Title: Impact on law enforcement and EMS personnel. Author(s)/Editor(s): Dick, Lois Chapman Source/Citation: Living with grief after sudden loss: Suicide, homicide, accident, heart attack, stroke., Philadelphia, PA, US: Taylor & Francis; 1996, (viii, 261), 173-184 Source editor(s): Doka, Kenneth J. (Ed) Abstract/Review/Citation: reminds us that sudden loss may affect many of those who may never have known the deceased, but are involved, in one form or another, in the death / provides a . . . description of the+ many ways that crisis workers [specifically law enforcement and emergency medical personnel] may be troubled by the loss / emphasizes the critical importance of self care / not just crisis workers but anyone involved in these situations may experience vicarious grief and shock / [argues] that caregivers develop ways to nurture themselves traumatic/critical incident stress [CIS] reactions / impact of CIS/death in the US / law enforcement/emergency services personality traits / personality traits vs successful trauma recovery / caring for and counseling the traumatized / what to say, not to say to the traumatized / what do we tell the kids / facing one's own mortality / the time remaining / physical exercises to relieve stress/trauma / a safe place to let it out in Portland, Oregon / the best and final advice ======================================== Title: Understanding and treating post-traumatic stress disorder symptoms in female partners of veterans with PTSD. Author(s)/Editor(s): Nelson, Briana S.; Wright, David W. Source/Citation: Journal of Marital & Family Therapy; Vol 22(4) Oct 1996, US: American Assn for Marriage & Family Therapy; 1996, 455-467 Abstract/Review/Citation: Addresses the fact that women in long-term relationships with veterans suffering from posttraumatic stress disorder (PTSD) commonly experience PTSD-like psychiatric symptoms themselves. Four primary experiences or characteristics of these PTSD partners are described: caretaking, gender roles, survivor skills, and psychological symptoms. Four areas of interpersonal problems associated with PTSD are examined: coping with the veteran's PTSD symptoms, unmet needs, violence, and emotional abuse. Vicarious or secondary traumatization and primary traumatization are explored as explanatory considerations for partners' PTSD symptoms. Effective types of treatment are discussed including family psychoeducation, support groups for both partners and veterans, concurrent individual treatment, and couple or family therapy. ======================================== Title: Empathy and the therapeutic dialogue: An historical-conceptual overview of self psychology and a brief clinical example. Author(s)/Editor(s): Ornstein, Paul H. Source/Citation: The subject and the self: Lacan and American psychoanalysis., Northvale, NJ, US: Jason Aronson, Inc; 1996, (xiv, 266), 77-86 Source editor(s): Gurewich, Judith Feher (Ed) Abstract/Review/Citation: task [is] to present a brief survey of the core ideas of self psychology; to define its basic concepts: the selfobject and selfobject transferences; to elaborate on the centrality of the method of empathy (i.e., vicarious introspection); and to show how the theory of self psychology and its application in the analytic process depend on the systematic application of the empathic method of observation and on phrasing our interpretations from the perspective of the patient's subjective experience / a clinical vignette [of a 25-yr-old male] should serve as an illustration of the manifestations of a self disorder as well as of the usefulness of some of the core concepts of self psychology, and will provide a demonstration of the manner in which these concepts guide the analyst in his or her participation in the psychoanalytic treatment process This chapter is followed by a commentary by M. David-Menard entitled "The Signifier at the Crossroads between Sexuality and Trauma." ======================================== Title: Vicarious trauma: The effects on female counselors of working with sexual violence survivors. Author(s)/Editor(s): Schauben, Laura J.; Frazier, Patrica A. Source/Citation: Psychology of Women Quarterly; Vol 19(1) Mar 1995, US: Cambridge Univ. Press; 1995, 49-64 Abstract/Review/Citation: Assessed the effects on counselors of working with sexual violence survivors. 118 women psychologists and 30 sexual violence counselors completed questionnaires regarding the extent of their work with survivors and their psychological functioning. Counselors who had a higher percentage of survivors in their caseload reported more disrupted beliefs, more symptoms of posttraumatic stress disorder (PTSD), and more self-reported vicarious trauma. Symptomatology was not related to counselors' own history of victimization. Qualitative data regarding difficult and enjoyable aspects of working with survivors corroborated findings that counselors working with victims experienced emotional distress and changes in belief. Counselors in this sample coped with their stress by using active and adaptive strategies and by seeking both instrumental and social support. ======================================== Title: The risks of treating sexual trauma: Stress and secondary trauma in psychotherapists. Author(s)/Editor(s): Kassam-Adams, Nancy Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 55(10-B) Apr 1995, US: Univ. Microfilms International; 1995, 4606 Abstract/Review/Citation: This study was designed to provide an empirical test of the widely discussed notion of secondary, or vicarious, traumatization in psychotherapists who treat traumatized clients. The concept of secondary traumatization implies a specific effect of trauma therapy on the therapist, akin to the intrusion and avoidance phenomena of post-traumatic responses in direct trauma survivors, but distinct from 'burnout' or other forms of occupational stress. The study examined the relationship between psychotherapists' exposure to sexually traumatized clients and the therapists' own symptoms of work stress and post-traumatic stress disorder (PTSD). 100 psychotherapists in outpatient mental health agencies in Virginia and Maryland completed self-report measures. Therapists' level of PTSD symptoms related to their work with clients was found to be significantly related to their level of exposure to sexually abused or assaulted clients (measured as the percentage of a therapist's caseload that presented these issues in therapy). The therapist's gender and personal history of trauma (particularly trauma that occurred in childhood) were also significant predictors of trauma symptoms. PTSD symptoms were not found to be related to exposure to other difficult client problems or diagnoses, such as depression, schizophrenia, or personality disorders. Generic work stress symptoms were not significantly related to doing therapy with sexually traumatized clients. These results provide empirical support for the notion of secondary traumatization in psychotherapists who treat sexually traumatized clients, and also point to the role of other factors, such as the therapist's gender and personal history of trauma that may affect this phenomenon. ========================================
Title: Family violence in Chile: A qualitative study of interdisciplinary teams' perspectives. Author(s)/Editor(s): Bacigalupe, Gonzalo Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 56(3-B) Sep 1995, US: Univ. Microfilms International; 1995, 1691 Abstract/Review/Citation: Family violence, particularly the battering and abuse by men of women and children, has taken on different meanings over time in various cultures. This study looked at how therapeutic teams in Chile, working to intervene in cycles of violence, understand and define family violence in the 1990's. Using a qualitative and collaborative methodology, this research analyzed family violence discourses by looking at practitioners' personal, professional, and political ideas about physical and sexual abuse within the home. First, the literature about family violence in Chile was reviewed, as well as the political and legal issues that affect clinicians working in this area. Then, four interdisciplinary teams were interviewed with a reflecting team format. Three major themes emerged in the interviews with the teams. One theme was how family violence is defined including individualistic, societal, gender-sensitive, and systemic explanations, and the problems confronted in this task. Family violence was primarily defined as a political problem that is experienced as a private matter mostly by women and children. A second theme was the recursive relation that exists among the teams' interventions to care for their clients and the teams' evolving definitions of their clients. A third theme was the process by which the personal lives of the practitioners are affected by stories of family violence and trauma. Clients' experiences often reminded practitioners of their own vulnerability and potential for vicarious traumatization. The conclusion integrates these findings and outlines implications for research, training, and policy including: the potential of the reflecting team technique as a research tool, the need to include clients in further collaborative research and for gender based participatory research, the development of a curriculum to train practitioners that includes the exploration of personal experiences of family violence and how to confront vicarious traumatization. ========================================
Title: Dissociative identity disorder: Theoretical and treatment controversies. Author(s)/Editor(s): Cohen, Lewis M.; Berzoff, Joan N.; Elin, Mark R. Source/Citation: Northvale, NJ, US: Jason Aronson, Inc; 1995, (xxii, 560) Abstract/Review/Citation: Since 1994 when the controversy surrounding DID [dissociative identity disorder] culminated in the alteration of its very name and diagnostic criteria, DID (or MPD [multiple personality disorder]) has been held up to public and professional scrutiny. . . . This book offers a . . . forum for skilled clinicians and academicians to grapple with the existence of DID, its prevalence, etiology, treatment modalities, and related controversies. Clinicians concerned and curious about this intense debate will find a thorough discussion of DID, its theoretical ramifications, and the extreme feelings that it evokes. Encounters with people diagnosed with DID invariably transform therapists into enthusiasts or skeptics. This is a book written by both enthusiasts and skeptics. Notes/Comments: Acknowledgments Contributions Introduction Part I: Does dissociative identity disorder exist? The manufacture of personalities: The production of multiple personality disorder Harold Merskey Correspondence: Reactions and replies Maeve Lawler-Fahy, Ann Chande, Harold Merskey, Paolo Novello, Alberto Primavera, Frank W. Putnam, G. A. Fraser, Alfonso Martinez-Taboas, Margarita Francia and David Spiegel A sociocultural analysis of Merskey's approach Alfonso Martinez-Taboas The validity and reliability of dissociative identity disorder Colin A. Ross Part II: Theoretical controversies Gullible's travels, or the importance of being multiple Michael A. Simpson A skeptical look at multiple personality disorder August Piper, Jr. Dissociative identity disorders and the trauma paradigm Denise J. Gelinas A developmental model for trauma Mark R. Elin Diagnosis of dissociative identity disorder Colin A. Ross Cultural variations in multiple personality disorder Deborah Golub Allegations of ritual abuse David K. Sakheim Current controversies surrounding dissociative identity disorder Richard P. Kluft Part III: Treatment controversies Misalliances and misadventures in the treatment of dissociative disorders Seth Robert Segall Current treatment of dissociative identity disorder Colin A. Ross Consequences of arriving at the diagnosis of multiple personality disorder Alan E. Siegel Treatment of character or treatment of trauma? Joan Berzoff and Jaine Darwin Vicarious traumatization: Countertransference responses to dissociative clients Karen W. Saakvitne Treatment of multiple personality disorder in a community mental health center Ellen Nasper and Tracy Smith The role of the client's partner in the treatment of multiple personality disorder Mark A. Karpel Credits Index controversies surrounding prevalence & etiology & diagnosis & treatment of dissociative identity disorder ========================================
Title: Therapists' responses to dissociative clients: Countertransference and vicarious traumatization. Author(s)/Editor(s): Saakvitne, Karen W. Source/Citation: Dissociative identity disorder: Theoretical and treatment controversies., Northvale, NJ, US: Jason Aronson, Inc; 1995, (xxii, 560), 467-492 Source editor(s): Cohen, Lewis M. (Ed) Abstract/Review/Citation: addresses countertransference and vicarious traumatization in psychotherapy with severely dissociative clients / highlight some general issues in diagnosis and treatment techniques / components of trauma therapy / countertransference to dissociation / functions of dissociation / dissociation from affect / dissociation from traumatic memories and imagery / dissociation from the self / dissociation from the other / organizational countertransference ========================================
Title: Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Author(s)/Editor(s): Figley, Charles R. Source/Citation: Philadelphia, PA, US: Brunner/Mazel, Inc; 1995, (xxii, 268) Brunner/Mazel psychological stress series, No. 23. Abstract/Review/Citation: "Compassion Fatigue" focuses on those individuals who provide therapy to victims of posttraumatic stress disorder (PTSD)--crisis and trauma counselors, Red Cross workers, nurses, doctors, and other caregivers who themselves often become victim to secondary traumatic stress disorder (STSD) or "compassion fatigue" as a result of helping or wanting to help a traumatized person. It addresses such questions as: What are compassion stress and compassion fatigue? What are the unintended, and often unexpected, deleterious effects of providing help to traumatized people? What are some examples of cases in which individuals were traumatized by helping, and how were they traumatized? What are the characteristics of the traumatized caregiver (e.g., race, gender, ethnicity, age, interpersonal competence, experience with psychological trauma) that account for the development, sustenance, preventability, and treatability of secondary traumatization? Is there a way to theoretically account for all these factors? What are the characteristics of effective programs to prevent or ameliorate compassion stress and its unwanted consequences? [The book] brings into clear focus the extreme psychological vulnerability of crisis workers exposed daily to trauma victims and the efforts that can be made towards averting compassion fatigue. Notes/Comments: Editorial note by the series editor Acknowledgments Contributors Introduction Compassion fatigue as secondary traumatic stress disorder: An overview Charles R. Figley Survival strategies: A framework for understanding secondary traumatic stress and coping in helpers Paul Valent Working with people in crisis: Research implications Randal D. Beaton and Shirley A. Murphy Working with people with PTSD: Research implications Mary Ann Dutton and Francine L. Rubinstein Sensory-based therapy for crisis counselors Chrys J. Harris Debriefing and treating emergency workers Susan L. McCammon and E. Jackson Allison, Jr. Treating the "heroic treaters" Mary S. Cerney Treating therapists with vicarious traumatization and secondary traumatic stress disorders Laurie Anne Pearlman and Karen W. Saakvitne Preventing secondary traumatic stress disorder Janet Yassen Preventing compassion fatigue: A team treatment model James F. Munroe, Jonathan Shay, Lisa Fisher, Christine Makary, Kathryn Rapperport and Rose Zimering Preventing institutional secondary traumatic stress disorder Don Catherall Epilogue: The transmission of trauma Name index Subject index factors affecting development & treatment & prevention of secondary traumatic stress disorder & compassion fatigue, crisis workers & therapists of trauma victims ========================================
Title: Treating therapists with vicarious traumatization and secondary traumatic stress disorders. Author(s)/Editor(s): Pearlman, Laurie Ann; Saakvitne, Karen W. Source/Citation: Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized., Philadelphia, PA, US: Brunner/Mazel, Inc; 1995, (xxii, 268), 150-177 Brunner/Mazel psychological stress series, No. 23. Source editor(s): Figley, Charles R. (Ed) Abstract/Review/Citation: focuses on trauma therapists, with special emphasis on those [doing psychotherapy with] adult survivors of childhood sexual abuse / [notes] that these therapists find that their inner experiences of "self" and "other" transform in ways that parallel the experience of the trauma survivor / this transformation, which the authors deem "vicarious traumatization," involves changes in the therapist's frame of reference / this is a special manifestation of STSD [secondary traumatic stress disorder] that includes modifications in one's identity and world view, self capacities, ego resources, psychological needs and cognitive schemas, and sensory experiences that are part of the authors' constructivist self development (CSD) theory / based on CSD theory, . . . suggest that treatment of STSD--especially vicarious traumatization in therapists--must focus on 3 realms: personal, professional, and organizational / discuss specific strategies for each realm to counteract the negative effects of trauma work on the therapists / the strategies emphasize the necessity of balance; the use of external resources, self-atonement; connection; and the need to foster one's sense of meaning, interdependence, and hope ========================================
Title: Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. Author(s)/Editor(s): Pearlman, Laurie Anne; Saakvitne, Karen W. Source/Citation: New York, NY, US: W. W. Norton & Co, Inc; 1995, (xix, 451) Abstract/Review/Citation: "Trauma and the Therapist" explores the role and experience of the therapist in the therapeutic relationship [with adult incest survivors] by examining countertransference (the therapist's response to the client) and vicarious traumatization (the therapist's response to the stories of abuse told by client after client). Therapists' awareness of attunement to these processes will inform their therapeutic interventions, enrich their work, and protect themselves and their clients. The authors also offer many strategies for avoiding the countertransference vicarious traumatization cycle. The authors' approach is broad, drawing from and synthesizing the diverse literature on countertransference and trauma theory. Notes/Comments: Acknowledgments Preface Introduction Part one: Theoretical underpinnings The therapeutic relationship as the context for countertransference and vicarious traumatization Psychoanalytic theory and psychological trauma: Historical and critical review Contructivist self development theory and trauma therapy Part two: Countertransference in psychotherapy with incest survivors Countertransference responses to incest Countertransference responses to common transference themes with incest survivor clients Countertransference responses to dissociative processes in psychotherapy The influence of countertransference on therapeutic frame and boundaries Countertransference themes for survivor therapists The role of gender in transference and countertransference Therapeutic impasses with survivor clients Cotherapists' countertransference in group therapy with incest survivors Double jeopardy: Countertransference with clients sexually abused by previous therapists Part three: Vicarious traumatization in psychotherapy with incest survivors Vicarious traumatization: How trauma therapy affects the therapist What contributes to vicarious traumatization? Part four: The interaction between countertransference and vicarious traumatization The countertransference-vicarious traumatization cycle Countertransference and vicarious traumatization across the therapist's professional development Part five: Therapist self-care Supervision and consultation for trauma therapies Addressing vicarious traumatization The rewards of doing trauma therapy Appendix References Index countertransference & vicarious traumatization in psychotherapy with adult incest survivors, psychotherapists ========================================
Title: Issues in the professional development of psychotherapists: Countertransference and vicarious traumatization in the new trauma therapist. Author(s)/Editor(s): Neumann, Debra A.; Gamble, Sarah J. Source/Citation: Psychotherapy: Theory, Research, Practice, Training; Vol 32(2) Sum 1995, US: Division of Psychotherapy, A.P.A.; 1995, 341-347 Abstract/Review/Citation: Describes countertransference responses that are common to work with survivors of chronic childhood trauma. The phenomenon of vicarious traumatization (i.e., the impact on the therapist's psyche of empathic engagement with trauma survivors) is also examined. Both aspects of trauma therapy are framed in light of their particular impact on new trauma therapists. New trauma therapists often experience rescue fantasies and intense preoccupation with childhood trauma patients. They may also experience a voyeuristic countertransference response. Organizational and personal factors that can ameliorate these negative correlates of trauma work are described. By proactively addressing these issues, organizations, training programs, supervisors, and therapists can promote the personal and professional development of new clinicians. ========================================
Title: Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Author(s)/Editor(s): Pearlman, Laurie Anne; Mac Ian, Paula S. Source/Citation: Professional Psychology: Research & Practice; Vol 26(6) Dec 1995, US: American Psychological Assn.; 1995, 558-565 Abstract/Review/Citation: This study examined vicarious traumatization (i.e., the deleterious effects of trauma therapy on the therapist) in 188 self-identified trauma therapists. Participants completed questionnaires about their exposure to survivor clients' trauma material as well as their own psychological well-being. Those newest to the work were experiencing the most psychological difficulties (as measured by the Traumatic Stress Institute Belief Scale; L. A. Pearlman, in press) and Symptom Checklist-90--Revised (L. Derogatis, 1977) symptoms. Trauma therapists with a personal trauma history showed more negative effects from the work than those without a personal history. Trauma work appeared to affect those without a personal trauma history in the area of other-esteem. The study indicates the need for more training in trauma therapy and more supervision and support for both newer and survivor trauma therapists. ========================================
Title: The nurse_patient relationship and victims of violence. Author(s)/Editor(s): Hartman, Carol R. Source/Citation: Scholarly Inquiry for Nursing Practice: Special Issue: Nursing's response to our culture of violence; Vol 9(2) Sum 1995, US: Springer Publishing Co.; 1995, 175-192 Abstract/Review/Citation: Describes the predicament of nurses who vicariously experience a form of trauma when working with traumatization victims. The reenactment of the traumatic experiences transmits the emotionally laden aspects of the original violence and thus is a source of emotional arousal and distress for the nurse working with victims of violence. This source of emotional arousal shapes the underlying approach-avoidance dynamic of countertransference responses. Case consultation and supervision are necessary to protect the integrity of the nurse-patient relationship. The current isolating changes in the work setting cut the nurse off from needed support in working with victims of violence. The emotional risks inherent in working with victims of violence require that the nurse seek professional support for the interpersonal aspects of practice. ========================================
Title: Beyond the "victim": Secondary traumatic stress. Author(s)/Editor(s): Figley, Charles R.; Kleber, Rolf J. Source/Citation: Beyond trauma: Cultural and societal dynamics., New York, NY, US: Plenum Press; 1995, (xviii, 313), 75-98 Plenum series on stress and coping. Source editor(s): Kleber, Rolf J. (Ed) Abstract/Review/Citation: [shows] that the experiences of a traumatized person affect those of other members of a social system in many ways / not only are family and friends of people exposed to primary stressors (i. e., [posttraumatic stress disorder (PTSD)] victims) vulnerable to secondary traumatic stress and disorders, but so are the colleagues, mental health professionals, and other helpers / focuses on these secondary victims / [provides] an explication of secondary traumatic stress, [and] the indirect and peripheral responses to trauma / review . . . the theoretical and research literature that supports the existence of secondary traumatic stress / the neglect of the surrounding others / who are the significant others / the impact of traumatic stress on family members [Israeli war veteran families, spouses of Vietnam war veterans, children] / worker-related secondary traumatic stress [colleagues in high-risk occupations, crisis workers and other helpers in emergency situations, helping professionals: psychotherapists] ========================================
Title: Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators. Author(s)/Editor(s): Stamm, B. Hudnall Source/Citation: Lutherville, MD, US: The Sidran Press; 1995, (xxiii, 279) Abstract/Review/Citation: Beginning with the assumption that caring for people who have experienced highly stressful events puts the caregiver at risk for developing similar stress-related symptoms, this book brings together some of the best thinkers in the trauma field to write about the prevention and treatment of Secondary Traumatic Stress. This . . . material not only reflects the current state of knowledge about secondary traumatization, but in a personal way explores our ethical obligations to each other, to our communities, and to future trauma research. Notes/Comments: Preface [by] B. Hudnall Stamm Introduction [by] B. Hudnall Stamm Part one: Setting the stage Compassion fatigue: Toward a new understanding of the costs of caring Charles R. Figley Secondary exposure to trauma and self-reported distress among therapists Kelly R. Chrestman The risks of treating sexual trauma: Stress and secondary trauma in psychotherapists Nancy Kassam-Adams Part two: Therapist self-care models Self care for trauma therapists: Ameliorating vicarious traumatization Laurie Anne Pearlman Helpers' responses to trauma work: Understanding and intervening in an organization Dena J. Rosenbloom, Anne C. Pratt and Laurie Anne Pearlman Coping with secondary traumatic stress: The importance of the therapist's professional peer group Don R. Catherall Part three: Beyond the therapy room Communication and self care: Foundational issues Chrys J. Harris and Jon G. Linder Painful pedagogy: Teaching about trauma in academic and training settings Susan L. McCammon Trauma-based psychiatry for primary care Lyndra J. Bills Kelengakutelleghpat: An Artic community-based approach to trauma Michael J. Terry Creating virtual community: Telemedicine and self care B. Hudnall Stamm and Frederick W. Pearce Part four: Ethical issues in self-care Ethical issues associated with secondary trauma in therapists James F. Munroe Self care and the vulnerable therapist Mary Beth Williams and John F. Sommer, Jr. No escape from philosophy in trauma treatment and research Jonathan Shay The germ theory of trauma: The impossibility of ethical neutrality Sandra L. Bloom Contributors About the Sidran Foundation self care issues in prevention & treatment of secondary traumatic stress, health care professionals treating traumatized patients ========================================
Title: Self-care for trauma therapists: Ameliorating vicarious traumatization. Author(s)/Editor(s): Pearlman, Laurie Anne Source/Citation: Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators., Lutherville, MD, US: The Sidran Press; 1995, (xxiii, 279), 51-64 Source editor(s): Stamm, B. Hudnall (Ed) Abstract/Review/Citation: those who voluntarily engage empathically with survivors to help them resolve the aftermath of psychological trauma open themselves to a deep personal transformation / this transformation includes personal growth, a deeper connection with both individuals and the human experience, and greater awareness of all aspects of life / the darker side of the transformation includes changes in the self that parallel those experienced by survivors themselves / conceptualize these latter changes within Constructivist Self Development Theory . . . as vicarious traumatization / vicarious traumatization is a process of change resulting from empathic engagement with trauma survivors / it can have an impact on the helper's sense of self, world view, spirituality, affect tolerance, interpersonal relationships, and imagery system of memory / outlines the areas impacted by vicarious traumatization and suggests self-care strategies that apply to each area of disruption / these self-care recommendations for therapists working with trauma survivors are based in theory, in the suggestions made by the many therapists who have attended our vicarious traumatization workshops, and in self-report data from a broad range of mental health professionals / these strategies fall within the personal, professional, and organizational realms / some address the prevention or minimization of vicarious traumatization, others relate to self-care for the vicariously traumatized therapist ========================================
Title: Helpers' responses to trauma work: Understanding and intervening in an organization. Author(s)/Editor(s): Rosenbloom, Dena J.; Pratt, Anne C.; Pearlman, Laurie Anne Source/Citation: Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators., Lutherville, MD, US: The Sidran Press; 1995, (xxiii, 279), 65-79 Source editor(s): Stamm, B. Hudnall (Ed) Abstract/Review/Citation: present a theory-based structure to guide our understanding of how helpers are affected by their work at a given time / focus on issues pertaining to therapists and other individuals directly involved with providing services to clients and patients who are addressing difficult traumatic life events / present an organizational model for self care, drawing from the experiences of the Traumatic Stress Institute [TSI] / vicarious traumatization [VT] / frame of reference / psychological needs [safety, trust, esteem, intimacy, control] / variables that contribute to VT / TSI organizational context ========================================
Title: Countertransference in the treatment of PTSD. Author(s)/Editor(s): Wilson, John Preston; Lindy, Jacob D. Source/Citation: New York, NY, US: The Guilford Press; 1994, (xxv, 406) Abstract/Review/Citation: Mental health professionals who work with trauma victims are themselves at risk for powerful countertransference reactions (CTRs), vicarious victimization, and stress-related "burnout." This volume is the 1st book in the field of traumatic stress studies to systematically examine the unique role of countertransference processes in psychotherapy outcome. Emphasizing the need for carefully deliberated action, this volume offers . . . new insights into the victim-healer relationship and presents detailed techniques to promote awareness of affective reactions for anyone working with sufferers of posttraumatic stress disorder (PTSD) and its comorbid conditions such as anxiety, depression, and substance abuse. Notes/Comments: I. Theoretical and conceptual foundations of countertransference in post-traumatic therapies Empathic strain and countertransference John P. Wilson and Jacob D. Lindy Empathic strain and therapist defense: Type I and II CTRs John P. Wilson, Jacob D. Lindy and Beverley Raphael Empathic strain and countertransference roles: Case illustrations Jacob D. Lindy and John P. Wilson II. Countertransference in the treatment of victims of sexual, physical, and emotional abuse The dance of empathy: A hermeneutic formulation of countertransference, empathy, and understanding in the treatment of individuals who have experienced early childhood trauma I. Lisa McCann and Joseph Colletti Countertransference in the treatment of multiple personality disorder Richard P. Kluft Inner city children of trauma: Urban violence traumatic stress response syndrome (U-VTS) and therapists' responses Erwin Randolph Parson Countertransference in the treatment of acutely traumatized children Kathleen Nader Rape and the phenomena of countertransference Carol R. Hartman and Helene Jackson III. Countertransference reactions in work with victims of war trauma, civil violence, and political oppression Countertransference in the treatment of Southeast Asian refugees J. David Kinzie Determinant factors for countertransference reactions under state terrorism Inger Agger and Soren Buus Jensen Countertransference in the treatment of war veterans Michael J. Maxwell and Cynthia Sturm Countertransference and World War II Resistance fighters: Issues in diagnosis and assessment Wybrand Op den Velde, G. Frank Koerselman and Petra G. H. Aarts IV. Countertransference in "at-risk" professionals: Rescue workers, mental health providers, and persons at the workplace When disaster strikes: Managing emotional reactions in rescue workers Beverley Raphael and John P. Wilson Trauma and countertransference in the workplace Christine Dunning Countertransference, trauma, and training Yael Danieli Beyond empathy: New directions for the future Jacob D. Lindy and John P. Wilson Index countertransference processes in psychotherapy, patients with posttraumatic stress & comorbid disorders ========================================
Title: Trauma and countertransference in the workplace. Author(s)/Editor(s): Dunning, Christine Source/Citation: Countertransference in the treatment of PTSD., New York, NY, US: The Guilford Press; 1994, (xxv, 406), 351-367 Source editor(s): Wilson, John Preston (Ed) Abstract/Review/Citation: examine trauma in the workplace / emphasize the emotional reactions of fellow workers, supervisors, and others whose roles are to document the traumatic event and assist the worker's recovery / [consider] countertransference broadly to include emotional reactions evoked in those directly or indirectly (vicariously) exposed to the trauma, especially those whose regular and expected tasks in the workplace could facilitate or hamper the recovery process / role of empathy and social support in the workplace / the trauma story: disclosure in the workplace / countertransference in supervisory and investigative relationships / traumatic contagion within an organization / vicarious traumatization and countertransference in the investigator / organizational countertransference to traumatized workers / mobilizing help: formal and informal organizational change ========================================
Title: Group therapists and AIDS groups: An exploration of traumatic stress reactions. Author(s)/Editor(s): Gabriel, Martha A. Source/Citation: Group: Special Issue: The challenge of AIDS; Vol 18(3) Fal 1994, US: Kluwer Academic/Plenum Publishers; 1994, 167-176 Abstract/Review/Citation: Examines how multiple AIDS-related deaths of group members exert a traumatizing effect on group therapists (GPTs), creating vicarious traumatization. Vignettes are presented that illustrate reactions associated with traumatic stress, including death images, survivors' guilt, psychic numbing, suspicion of counterfeit nurturance, and struggle for meaning. Therapeutic interventions for GPTs coping with multiple deaths are also explored. Using R. J. Lifton's (1980) conceptualizations, it is suggested that GPTs who experience deaths of AIDS group members may themselves manifest symptoms of traumatic stress symptoms observed in trauma survivors. Preventive interventions are urged to alleviate any potential emotional and psychological hazards, including varying the caseload with other groups or periodic rotation in other therapeutic areas, specific inservice training, and instituting formal, stress-alleviating grieving rituals. ========================================
Title: Direct and vicarious trauma and beliefs as predictors of PTSD. Author(s)/Editor(s): Spellmann, Mark E. Source/Citation: Dissertation Abstracts International; Vol 54(5-B) 1993, US: Univ. Microfilms International; 1993, 2773 Abstract: [None] ========================================
Title: Psychotherapy with abused children and adolescents. Author(s)/Editor(s): Marvasti, Jamshid A. Source/Citation: Countertransference in psychotherapy with children and adolescents., Northvale, NJ, US: Jason Aronson, Inc; 1992, (xxii, 356), 191-214 Source editor(s): Brandell, Jerrold R. (Ed) Abstract/Review/Citation: psychotherapy with childhood victims of incest, physical abuse, and profound neglect . . . is often further complicated by the strong countertransference reactions that clinicians tend to develop in such clinical situations / describes a variety of countertransference reactions and responses in clinical scenarios involving abused and neglected children and their families / emphasizes the importance of considering such reactions in light of the therapist's own unresolved issues as well as those that the patient's transference may evoke / suggests that countertransference is not restricted to the treatment proper, but may also be involved in the reporting of suspected abuse or even in the selection of the treatment modality / the notion of countertransference as vicarious traumatization in the psychotherapy of abused and profoundly neglected children is also explored ========================================
Title: Empowering and healing the battered woman: A model for assessment and intervention. Author(s)/Editor(s): Dutton, Mary Ann Source/Citation: New York, NY, US: Springer Publishing Co, Inc; 1992, (xx, 202) Abstract/Review/Citation: In this volume, Mary Ann Dutton presents her innovative work with battered women. It is solidly grounded in research as well as in the social and political analysis of domestic violence. Dutton first outlines a conceptual framework for understanding the battered woman's response to violence, abuse, and control. This serves as the foundation for both assessment and intervention. Her framework has application within both a clinical and a forensic context. She also discusses battered women's strategies for escape, avoidance, and survival. The text spells out, in concrete, practical terms, what it means to place the pathology outside the battered woman, and its implication for practice--that battered women are not "sick," but they are in a "sick" situation. From this premise, Dutton creates a model with three primary goals for working with battered women: 1) safety first, 2) empowerment through choice-making, and 3) healing the psychological trauma. This is an essential book for mental health professionals involved with clinical intervention in domestic violence and for legal professionals interested in understanding the impact of domestic violence on battered women. Notes/Comments: Foreword by Lenore E. A. Walker Preface Acknowledgments Part I. Conceptual framework and assessment Women's response to battering: A psychological model Understanding the nature and pattern of abusive behavior Strategies of assessment Impact of assessment procedures Strategies to escape, avoid, and survive abuse Self-defense as survival response Psychological effects of abuse Psychology of traumatic response Diagnostic issues Mediators of the battered woman's response to abuse Part II. Intervention The framework for intervention with victims and survivors of domestic violence Ethical and legal considerations Protective interventions Recurrent abuse/victimization Suicide risk Homicide risk Acute and severe stress reaction Making choices Posttraumatic therapy: Healing the psychological effects of battering Compounded trauma: When battering is not the only trauma Adjunctive therapies Issues for the professional working with abuse Vicarious traumatization Therapist's self-care Appendix A: Abusive Behavior Observation Checklist (ABOC) Appendix B: Questionnaires for assessing battered woman's cognitions about violence Appendix C: Response to Violence Inventory: Strategies to Escape, Avoid, and Survive Abuse Appendix D: Normative data from a sample of battered women on measures of psychological effects of trauma Appendix E: Psychological Evaluation Report References Index provides a framework for assessment & intervention with battered women in clinical settings ========================================
Title: Mode of onset of simple phobia subtypes: Further evidence of heterogeneity. Author(s)/Editor(s): Himle, Joseph A.; Crystal, David; Curtis, George C.; Fluent, Thomas E. Source/Citation: Psychiatry Research; Vol 36(1) Jan 1991, US: Elsevier Scientific Publishers; 1991, 37-43 Abstract/Review/Citation: As a further test of the notion of heterogeneity of the Diagnostic and Statistical Manual of Mental Disorders-III--Revised (DSM-III--R) simple phobia diagnostic category, mode of onset was examined in 84 simple phobic outpatients. Patients were separated into 1 of 4 subtypes: animal or insect, blood and injury, situational, and choking-vomit phobias. Five distinct mode-of-onset categories were identified: direct trauma, spontaneous, vicarious learning, gradual, and lifelong. Significant mode of onset differences were observed across groups. Situational phobics reported a preponderance of spontaneous onsets as compared to the other groups studied. Results offer further evidence of the heterogeneity of the simple phobia diagnostic category and also support the contention that situational simple phobias are closely related to agoraphobia. ========================================
Title: Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Author(s)/Editor(s): McCann, I. Lisa; Pearlman, Laurie A. Source/Citation: Journal of Traumatic Stress; Vol 3(1) Jan 1990, US: Kluwer Academic/Plenum Publishers; 1990, 131-149 Abstract/Review/Citation: Presents a new constructivist self-development theory for understanding therapists' reactions to clients' traumatic material. This theory is contrasted with previous conceptualizations such as burnout and countertransference. The phenomenon termed "vicarious traumatization" can be understood as related both to the graphic and painful material that trauma clients often present and to the therapist's unique cognitive schemata or beliefs, expectations, and assumptions about self and others. Therapists may experience disruptions in their schemata of dependency, safety, power, independence, esteem, intimacy, and/or frame of reference. Ways that therapists can transform and integrate clients' traumatic material in order to provide the best services to clients, as well as to protect themselves against serious harmful effects, are discussed. ========================================
Title: God is a trauma: Vicarious religion and soul-making. Author(s)/Editor(s): Mogenson, Greg Source/Citation: Dallas, TX, US: Spring Publications, Inc; 1989, (vi, 167) Abstract/Review/Citation: This book, despite its title, is not a theology book. It is not a book about God as God. In identifying the two words "God" and "trauma," I wish to focus attention on the religious dimension of the psychology of those overwhelming events we describe as traumatic. A principal theme we shall pursue through the pages of this book is the impact on the soul of monotheistic theology's noname God. What happens to the soul when it reflects upon its problems in the terms of so absolute and generic a spirit? Does it assist the soul in its soul-making? Does it help the soul to "mediate events" and to "make differences between ourselves and everything that happens"? Or does it galvanize those events with the numinous sheen of the unapproachably holy? Does invoking the name of the Lord preserve the overwhelming quality of overwhelming events, embedding the traumatic? Notes/Comments: Acknowledgments Introduction The God-trauma The wrath of God The suffering God Monotheism, trauma, and the failure of calf-making C. S. Lewis's theodicy of pain Masochism and mysticism Schizoid defenses Incarnation and the bomb Healing through heresy Gnosticism Trauma in transference Romanticism The pleasure of dis-carnation Baptism Normal unhappiness Dreams Deliver us from salvation Repeating, imagining, and making a crust The crust around the pleasure principle Nietzsche's body Death-drive and transference Homogeneity, homoeroticism, and homeopathy The trauma of incarnation and the sur-natural soul Chronicity Refusing incarnation The fallacy of susceptibility Traumatology Gnostic transference Phone home! Fatality The end? ========================================
Title: The present in the past versus the past in the present. Author(s)/Editor(s): Schudson, Michael Source/Citation: Communication; Vol 11(2) Feb 1989, Switzerland: Gordon & Breach Science Publishers; 1989, 105-113 Abstract/Review/Citation: Argues that although the past is constantly being retold in order to legitimate present interests, in some ways the past is highly resistant to efforts to make it over. Three factors that constrain full freedom to reconstruct the past are discussed. The structure of available pasts is such that individuals, groups, organizations, nations, and societies do not have all possible materials available to them from which to construct a past. The structure of individual choice is constrained by psychological factors in the freedom to choose (trauma, vicarious trauma, channel, and commitment). Intersubjective conflicts among choosers constrains reconstruction in that people's ability to reconstruct the past just as they wish is limited by the crucial social fact that other people within their awareness are trying to do the same thing. ========================================
Title: Post-traumatic family therapy. Author(s)/Editor(s): Figley, Charles R. Source/Citation: Post-traumatic therapy and victims of violence., Philadelphia, PA, US: Brunner/Mazel, Inc; 1988, (xiv, 370), 83-109 Brunner/Mazel psychosocial stress series, No. 11. Source editor(s): Ochberg, Frank M. (Ed) Abstract/Review/Citation: describes a family-centered treatment program . . . based on the assumptions that each person experiencing traumatic stress must be viewed within a social network of supporters, including family members, and that by focusing attention on this system of social support, individual and systemic symptoms of post-traumatic disorder become evident / specifies goals and objectives of treatment, the preconditions prior to treatment, assessment/diagnosis / review the literature on the significance of the family to victim recovery / detecting traumatic stress / confronting the trauma / urging recapitulation of the catastrophe / facilitating resolution of the conflicts / cost of caring / simultaneous effects / vicarious effects / chiasmal effects: "infecting" the family with trauma / family relations skills / social supportiveness / adaptability/cohesion / building commitment to the therapeutic objectives / framing the problem / reframing / developing a healing theory ========================================
Title: Origins and development of human fear reactions. Author(s)/Editor(s): Hekmat, Hamid Source/Citation: Journal of Anxiety Disorders; Vol 1(3) 1987, US: Elsevier Science Inc; 1987, 197-218 Abstract/Review/Citation: Investigated factors leading to the development and maintenance of human fear reactions in 56 animal phobics and 18 nonphobic undergraduate controls. Ss completed questionnaires assessing the etiology of human fear and personality styles in reacting to stressors. There was evidence for fear acquisition through conditioning, vicarious processes, and information/instructions pathways. Animal phobics displayed significant negative evaluative reactions in their semantic differential ratings of phobic verbal stimuli as well as significant difficulties in turning off the image of their fear objects. Fear-relevant self-instructions of these Ss were significantly polarized and negative. Results support a paradigmatic behaviorism conceptualization of human anxiety reactions. ========================================
Title: Secondary traumatization in children of Vietnam veterans. Author(s)/Editor(s): Rosenheck, Robert; Nathan, Pramila Source/Citation: Hospital & Community Psychiatry; Vol 36(5) May 1985, US: American Psychiatric Association; 1985, 538-539 Abstract/Review/Citation: Presents the case history of the 10-yr-old male child of a Vietnam veteran. The relationship between the father's war experiences and subsequent posttraumatic stress disorder and the S's own secondary traumatization is discussed. Symptoms included intense involvement in the emotional life of the father; deficient development of his ego boundaries; high levels of guilt, anxiety, and aggressiveness; and conscious and unconscious preoccupation with specific events that were traumatic for the father. The case is compared with symptoms reported in children of Holocaust survivors. ========================================
Title: Psychic trauma in children and adolescents. Author(s)/Editor(s): Terr, Lenore C. Source/Citation: Psychiatric Clinics of North America; Vol 8(4) Dec 1985, US: W.B. Saunders & Co.; 1985, 815-835 Abstract/Review/Citation: Defines and reviews the literature on childhood trauma, emphasizing the most recent studies in the field. Psychic trauma is said to be that emotional condition following from a sudden, unexpected, and intense external blow that overwhelms crucial coping and defensive operations, temporarily rendering the individual helpless. Child abuse and incest are not the same as trauma. Research studies before and after 1970 are outlined. Case vignettes are used to illustrate cognitive-perceptual difficulties, the collapse of developmental accomplishment, and contagion as a result of childhood trauma. Prevention techniques include preparation for disasters in school and community programs. Therapies used include pharmacotherapy, desensitization, group, family, play, and individual approaches. New research has been done in the following areas: cross-cultural studies, the child as a courtroom witness, childhood bereavement, sexual assault, physical injury, child abuse, child snatching, vicarious traumatization, and the common nature of fright and shock. (116 ref) ========================================
Title: The emotionalized attitudes: the contribution of research to teachers concerned with learning, conduct and character. Author(s)/Editor(s): Briggs, T. H.; et al Source/Citation: NY: Bureau of Publications, Teachers College, Columbia University; 1940, (v, 107) Abstract/Review/Citation: The nature and conclusions of research on emotionalized attitudes are systematically surveyed and discussed for the teacher as follows: the various techniques for measuring attitudes by means of verbalizations, the reliability and validity of such methods, and a list of attitude tests selected for the use of teachers; the principal causal factors of emotionalized attitudes, such as consciousness of atypical conditions, sex, maturation, vicarious experiences, personal influences, institutions, social mores, trauma, and environmental influences; the effects of emotionalized attitudes upon learning, character, and conduct; the modification of emotionalized attitudes by individuals and institutions, by experience with an emotional concomitant, by instruction, by repetition, and by release of emotional tension. A selected bibliography.
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