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