Every now and then one makes a decision that some time later proves to have been the perfect choice for the time. This is the case with MTA's decision to focus its community service projects on Care for the Caregiver.
Reinette Evans of Helderberg Rape Crisis, where I am involved with community service, recently sent me a copy of a letter she had received from the Western Cape Province's Department of Health and Social Services, congratulating her on the work done at the centre.
"It is an absolute morale booster to read about initiatives such as the use of massage therapy for both survivors and the caregivers," Leana Olivier of the Maternal, Child and Women's Health Sub-Directorate writes, "We are currently attending to challenges such as vicarious trauma and it seems you (Helderberg Rape Crisis) are already way ahead regarding this matter!"
Media reports in the past few months repeatedly reported on the enormous burden carried by public caregivers including health-care professionals, law enforcers, even teachers. I want to include in this group, volunteer workers who do counselling, training etc. for the myriad of support organisations such as Rape Crisis. They confront the worst of humanity and the pain and suffering of traumatised victims every day.
Increasingly, attention is turning to the consequences of indirect trauma on caregivers. Also known as compassion fatigue, secondary victimisation and even soul sadness, vicarious trauma is a risk for caregivers who are continually exposed to people who are actively experiencing trauma. The signs and symptoms of the indirect trauma resemble those of direct trauma -intrusive imagery and thoughts, physiological arousal, irritability, avoidance and anxiety. They experience disruptions in their personal and professional relationships, in managing boundaries and regulating their emotions. Often they withdraw from others, have nightmares, have trouble sleeping and eating. It may result in permanent cognitive changes e.g. heightened feelings of vulnerability, an exaggerated sense of helplessness or of control, chronic bitterness, cynicism and alienation. Unlike counter transference, vicarious trauma is not a state that one 'snaps out of' but a state that is cumulative and permanent. It changes a caregivers view of self, the world and the future. These feelings often lead to burn out, substance abuse, chaotic relationships characterised by isolation, disconnection and mistrust, behaviours that parallel those of primary trauma survivors.
Vicarious trauma can have negative effects on those around the caregiver - family, friends, colleagues and clients. People who treat those with trauma and who do not attend to their indirect trauma are at risk of becoming ineffective in their work, violating boundaries in professional and personal relationships and making bad judgements. Eventually they become burdens to colleagues and the organisations they work for.
A variety of interventions can disrupt the process of vicarious trauma: supervision, personal therapy, support groups, stress management programmes and of course, therapeutic massage.
Therapeutic massage can assist a caregiver with vicarious trauma on several levels. The most important is the normalisation of physiological manifestations of stress on the body by inhibiting the sympathetic nervous system also known as the fight-or-flight response and activating the restorative effects of the parasympathetic nervous system. It is an effective tool in the management of conditions associated with a state of hyper arousal - sleeping and eating difficulties, a lowered immune system, hypertension, digestive difficulties and depression. Massage seems to gently modulate mood producing hormones inducing feelings of internal control (the ability to self-regulate the emotions), well-being and relaxation.
Therapeutic Massage can a play a vital role in the self-care programmes of caregivers to prevent the manifestation of vicarious trauma and to support those affected by it.
But a word of warning: Therapeutic Massage Therapists are also caregivers! If you are continuously exposed to trauma narratives from patients, attend to basic self-care - balance work, play and rest and above all, go for regular massage!
ANON, International Society for Traumatic Stress Studies (ISTSS), 5 October 2001: Indirect Trauma http://www.istss.org/indirect.htm
Fritz, S (2000) Fundamentals of Therapeutic Massage. St, Loius, Missouri : Mosby
Gabriel, M.A. 5 October 2001: Surviving Listening and Witnessing: Vicarious Traumatization in Social Work Practitioners http://www.naswnyc.org/p30.html
Spahn Nelson, T. 5 October 2001 Vicarious Trauma: Bearing witness to another's trauma. http://www.uic.edu/orgs/convening/vicariou.htm