|Preventing Clinician Burnout|
|Tyffani Monford Dent, PsyD|
Monford Dent Consulting
ATSA At-Large Representative
Interim Co-Chair, Organization & Development
The term vicarious traumatization
was coined over 25 years ago to describe changes that occur within clinicians
resulting from their work with clients who have experienced sexual trauma
(McCann & Pearlman, 1990). It is
believed that in the process of working with sexually traumatized clients, one
is hearing the trauma narratives, going through the court proceedings with the
client, and in all other ways being “exposed” to the world as a place where
sexual victimization occurs. Yet, this
initial description of vicarious traumatization makes it clear that it is
reserved for those clinicians who provide services to victims, not those of us
who work with those who have caused the sexual trauma. In recent years,
researchers have begun to study secondary traumatic stress, vicarious trauma,
and burnout in those working with sexual offenders (Ennis, 2004; Sorrentino,
2013). Unfortunately within our work
with those who perpetrate sexual violence, we do not often have a “back-up”
person who can take our place in doing sexual offender treatment like we may in
other counseling services. In such situations, we may face burnout, or what I
refer to as “The joy in the work is gone” or the “I don’t care anymore.”
Oftentimes, this is in conjunction with compassion fatigue related to arguing for
a rational response to sexual violence in a world that operates on emotions, or
trying to instill hope in clients when registration and other legislation make
it nearly impossible to do so. Although
our experiences of vicarious traumatization may differ from those who provide
support and treatment to victims of sexual violence, some aspects are the
same. Individuals working in this area
may describe feelings of inadequacy or ineffectiveness, increased feelings of
cynicism, being overwhelmed, or even compartmentalizing to the point of being disconnected.
Conversely, we may become sensitized to potential risks, and may find ourselves
hypervigilant as it relates to our own family. We view with anxiety every
boundary violation and sexual exploration because we wonder if that will lead
to sexual violence or suggests that abuse has already occurred.
Unlike work done with victims of
sexual violence, society often does not want to hear about, nor do we have a
place to acknowledge, the impact of working with perpetrators of sexual
violence. Within our work with those who have engaged in sexual abuse, we face
the judgment and emotional reactions when others hear what we do, or they may view
us simply as “the sex offender lover/advocate”. We face a society that
sometimes views our work with sexual offenders as unnecessary or ineffective, despite
evidence to the contrary. The work done is often met with negative comments or
perceptions even by those within our lives, which can increase feeling hurt,
misunderstood, and disconnected (Australian Institute of Family Studies, 2007).
So, what can those of us working
with perpetrators of sexual violence do to decrease the likelihood of
experiencing vicarious trauma, compassion fatigue, or burnout?
Get a life and allow yourself to live it. Every waking moment of
our days cannot be spent reviewing sex offender legislation, reading articles
about treatment/risk, arguing on social media about the latest news headline
about a sexual violence, or even
discussing the merits of what we do. We must find time away from this difficult
work in order to be able to bring an energized perspective to it.
Connect with those doing the work. Working in the field of sexual
offender treatment can be isolating. Developing a support system of others who
are doing similar work allows for a safe space to voice concerns, doubts, and
receive validation that what we are doing is important. ATSA is a great place to foster such
connections, both internationally and especially through your state chapters.
Seek consultation. When experiencing burnout and fatigue, we often
lose sight of the value in the work we do and sometimes, how to do it well.
Having someone to discuss treatment progress and issues can help recognize the early
signs of burnout.
Mentor new clinicians. Sometimes we find that we take on more
clients and do more work because there is “no one else to do it”. By training the next generations of
clinicians, we allow ourselves the opportunity to share the work. In addition,
mentoring also assists us by keeping us current on what is occurring in the
field as well as being exposed to the “energy” of newer clinicians which can
help us maintain our own enthusiasm for this work.
Take a self-assessment. Really take the time to look at Physical
Self-Care, Psychological Self-Care, Emotional Self-Care, Spiritual Self-Care, Relationship Self-Care, and Other Areas of Self-Care that are relevant to you.
Write down each of these areas and identify what you are doing in each area to
keep yourself well. After doing so,
develop and implement a self-care plan and follow it. The University of Buffalo
has excellent resources on their website around taking self-inventory and
developing a plan (https://socialwork.buffalo.edu/resources/self-care-starter-kit/developing-your-self-care-plan.html).
The Centre for Addiction and Mental Health also has a resource entitled
Biopsychosocial-Spiritual Self-Care Plan that
addresses emotional, spiritual, physical, and social aspects of
self-care that may serve as a guide for developing your own plan (http://www.camh.ca/en/hospital/Documents/www.camh.net/Care_Treatment/Resources_clients_families_friends/Family_Guide_CD/pdf/Activity_54_self_care_plan.pdf).
In our work, we often provide compassion and
support to clients who have engaged in behaviors that cause others to not view
them as deserving of such. We must remember that, like Psychotherapist Piero
Ferruci said, “It’s all really very simple. You don’t have to choose between
being kind to yourself and others. It’s one and the same”. By taking care of ourselves in the process of
providing treatment to those who commit acts of sexual violence, we are
providing them with a healthier, better, therapeutic process.
Ennis L. & Horne, S. (2004).
Predicting psychological distress in sex offender therapists. Sexual
Abuse: A Journal of Research and Treatment 15(2); 149-57.
McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatisation: A
framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131-149
Sorrentino, R. (2013). Criminal
Law: Secondary Traumatic
Stress, Vicarious Trauma and Burnout: The Hazard of Working with Sex
Offenders. Bar News - January 18, 2013