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Book Review-Healing Secondary Trauma: Proven Strategies for Caregivers and Professionals to Manage Stress, Anxiety, and Compassion Fatigue

What you see and do changes what you see and do.  It’s a simple statement with profound effects.  It’s a recognition that you can’t see others’ trauma without being changed by it.  You can’t be in the presence of others’ suffering without suffering yourself.  Healing Secondary Trauma: Proven Strategies for Caregivers and Professionals to Manage Stress, Anxiety, and Compassion Fatigue is designed to provide tools that allow us to stay in contact with the trauma longer, to suffer less ourselves, and to help more.

Healthy Tactics

The set of strategies that Healing Secondary Trauma recommends are proven to be useful.  There’s no problem there.  However, the problem is that the recommended strategies are patches.  They don’t address the core problem.  They’re good to help you reduce the suffering to the point that you can do real work on the trauma.  However, they’re not a final solution.

Put Out the Fire

The Symptoms

Gilbert-Eliot shares what she believes are the symptoms of secondary trauma: anger, sadness, exhaustion, and compassion fatigue.  That’s problematic, because while they can be symptoms of secondary trauma, there are also many other causes of these symptoms.

I’ve discussed how anger is disappointment directed.  (See Destructive Emotions and my explanation in Conflict: Anger.)  Disappointment is certainly something that one could experience when we see how humans treat other humans or the destruction that can come from “acts of God.”  So, it’s quite plausible that it would have an impact – but the solutions offered don’t provide a way to work through these disappointments and disable the anger.

Sadness is less frequently discussed than happiness.  In fact, happiness is one of the philosophical ideals that can keep people very busy.  A lack of enjoyment with life and a sense of sadness can be a result of secondary trauma, but here, too, there’s little advice on what to do.  (See Happiness, Hardwiring Happiness, The Dalai Lama’s Big Book of Happiness, and more for more on happiness.)

Exhaustion is hard, because it’s simply exertion.  What’s missed is the reality that people are holding back emotional release, and this consumes energy.  Much like stress is a friction that reduces our efficacy, holding back memories of the trauma can rob us of the energy we need to live.  (See Nurse Burnout for stress as friction.)  So, the problem isn’t so much exhaustion directly, it’s the work that we’re doing to maintain compartmentalization of the trauma long after it should have been released.

Compassion fatigue is trickier to explain, because it’s often confused with burnout.  (See Is It Compassion Fatigue or Burnout?)  However, neither phenomenon is directly related to trauma.  Both seem to have elements of a failure to feel effective or a belief that you’re not enough.

The Tactics

Gilbert-Eliot also identifies, “Healthy tactics for managing anger include assertiveness, problem solving, cognitive restructuring, and acceptance.”  Here, too, Gilbert-Eliot misses the target.

Assertiveness is a good tool to help people take more control of their lives.  Greater degrees of control (or perception of control) are associated with better outcomes across a wide variety of mental maladies.  However, assertiveness does nothing to help someone process a trauma they’ve experienced.

Problem solving is an interesting – but difficult – tool for all sorts of things, but most traumas don’t represent a problem (or puzzle) to be solved.  Problem solving is difficult to teach just as creativity is difficult to teach.  Creative Confidence explains that we’re all born with it, and we just need to recreate situations for our stifled creativity to reemerge.  Problem solving is that, but it’s also the development of greater capacity for mental models.  Gary Klein in Sources of Power explains how mental models allow for the solution of problems, like the best way to deploy firefighters to a fire.  If we were to extend this further, we’d ideally teach people to think in systems, so they can see what kinds of things they might do to solve the problem.  (See Thinking in Systems for more.)  Even people with a high degree of problem solving skills encounter trauma and struggle with it, because it’s not a problem to be solved as much as it is an experience to be processed.

Cognitive restructuring is a solid recommendation.  It’s at the heart of cognitive behavioral therapy (CBT) and is recognized for improved mental health.  What is missing is only that the restructuring often is about accurately perceiving and responding to reality as well as creating a better sense of innate safety.

Acceptance indirectly helps trauma by increasing safety and allowing the trauma to be processed more readily.  Richo explains in How to Be an Adult in Relationships how his five As, including acceptance, can lead to better relationships – and a better life.

False Explanations

One of the tragedies heaped on tragedy is when people have a period of memory loss associated with a trauma, and they believe, in that gap, they did something awful.  Instead of assuming that they behaved consistently with their character in a professional, respectful way, they assume that, for the memory to be missing, it must be because they did something bad.  This is rarely the case.  In most instances, the memory disruption causing amnesia is related to the event itself and not to the person’s reactions.  Even in cases where it was related to their actions, it’s often because of the ethical dilemma or moral injury situation they were placed in.

Ethical dilemmas are where you’re faced with two bad choices, and you’ve got to pick the one that seems least bad to you.  Consider a train barreling down the tracks, with 10 people on board; around a curve (unseen), there are 10 people working on the railroad tracks.  There is a switch you can throw to cause the train to go down another track and miss the workers, but it will almost certainly cause the train to derail and cause injury to the train driver and the passengers.  Do you throw the switch?  In either case, someone is getting injured.

A moral injury goes farther: you behave in ways that you disagree with, because you believe it’s required to keep your job.  Consider a train operator who believes the train can safely travel at 30 miles per hour.  The company insists on 45 miles per hour to keep the schedule.  A person jumps in front of the train – intending to die – and the operator can’t stop.  The operator faces moral injury, because they believe they’re being asked to operate in a way that is immoral.  (See How Good People Make Hard Choices and Moral Disengagement for more on these topics.)

Even in these cases, a missing memory doesn’t indicate something evil or wrong done by the individual but rather protection from the pressures of these situations.

Splitting

A major concern with trauma is the splitting of personality, which Gilbert-Eliot correctly raises.  To put it in context, it’s believed that people naturally fragment parts of their experience.  No Bad Parts explains the Internal Family Systems (IFS) view, where we have protectors and victims that are all operating semi-autonomously in our heads.  The goal of IFS is to help reintegrate those parts to lead to better mental health and wellbeing.

Dissociation – a natural and normal reaction to trauma – isn’t a problem as a temporary coping mechanism.  However, when it crosses over into a permanent separation from oneself – or a part of oneself – there’s more cause for concern.  Monitoring the degree of splitting of personality and developing a sense for when the splitting may cause problems can be an important part of Healing Secondary Trauma.

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