Supporting Indirectly Traumatized Populations: The Need to Assess Secondary Traumatic Stress for Helping Professionals in DSM--V

Abstract

Since the 1980s, concern has increased about how a challenging work environment consisting of a traumatized population of victims of violence and crime affects those professionals (including social workers, mental health workers, psychologists, nurses, and psychiatrists) who try to help these individuals. Data indicate that these helping professionals tend to develop occupational stress symptoms when they assist victims in managing their trauma or posttraumatic stress disorder (PTSD) (Boscarino, Figley, & Adams, 2004; Bride, 2007; Bride, Jones, & MacMaster, 2007). Working with traumatized clients or patients not only threatens the emotional balance of helping professionals, it may also cause these caregivers to suffer overwhelming negative feelings (Collins & Long, 2003; Halloran & Linton, 2000; Herman, 1992). Specifically, secondary traumatic stress (STS) symptoms have been viewed as the inevitable consequence of supporting victims of violence and crime (Bride, 2004; Figley, 1983, 1999). The symptoms of STS, which parallel those that appear in people directly exposed to trauma, include intrusive imagery related to the clients' traumatic disclosures, avoidant responses, physiological arousal, emotional numbing, distressing emotions, physiological somatic problems, hypervigilance, and functional impairment (Brady, Guy, Poelstra, & Fletcher-Brokaw, 1999; Chrestman, 1999; Dutton & Rubenstein, 1995; Figley, 2002; Pearhnau & Maclan, 1995). Helping professionals get STS either from their knowledge about a traumatic event or from their efforts to support traumatized or suffering people (Brown & O'Brien, 1998; Epstein & Silvern, 1990; Figley, 1995; Iliffe & Steed, 2000). STS has been measured by the Compassion Fatigue Self-Test (Figley, 1995) and the Secondary Traumatic Stress Scale (Bride, Robinson, Yegidis, & Figley, 2004). One essential factor in making STS a priority is societal. Statistics show that the United States continues to suffer from issues of violence and crime, although serious violent crime levels have declined in recent years (Bureau of Justice Statistics, 2006; Dye & Roth, 1990; Lindhorst, Nurius, & Macy, 2005; U.S. Department of Health and Human Services, 1996). Helping professionals in social service agencies, clinics, and hospitals have a higher probability of meeting traumatized populations, such as victims of violence and crime. For example, Bride (2007), who conducted an STS study of 282 social workers in a southern state, found that nearly all (97.8 percent) of the social workers he questioned indicated that their client population experienced trauma; most (88.9 percent) indicated that their work with clients addressed issues related to those client traumas. Bride's (2007) study revealed that 70.2 percent of the social workers had exhibited at least one STS symptom m the previous week, and 55.0 percent met the criteria for at least one of the core STS symptoms (intrusion, avoidance, and arousal). Another national STS study of 515 mental health workers (Ting, Jacobson, Sanders, Bride, & Harrington, 2005) found that over half (53.3 percent) acknowledged the effects of secondary trauma on their personal and professional lives. Both societal issues and the problem of turnover of helping professionals within the workplace raise concern that STS be addressed. Previous studies indicate that those helping professionals with STS symptoms tend to leave their jobs more frequently than those without STS (Beaton & Murphy, 1995). With the loss of experienced staff, social agencies, clinics, and hospitals will no longer be able to support or protect traumatized victims of violence and crime. Finally, because the symptoms of STS (intrusion, avoidance, and arousal) mimic those of PTSD, it would be reasonable for DSM-V to assess STS as it will PTSD. STS is almost identical to PTSD, except that STS applies to people who have been affected by the trauma of others (Figley, 2002). …