EAP CIR Provider Safety

As our attention turns to the citizens and employers/employees of Buffalo, and acts of violence all around us, let us not forget our own and the challenging work that is underway and to come.

As an EAP CIR responder, secondary trauma (ST) is an occupational risk. In other words, if you do this work you will, at one time or another, even multiple times, experience secondary trauma. Secondary trauma can be incurred when an individual is exposed to people who have been traumatized themselves, disturbing descriptions of traumatic events by a survivor, or others inflicting cruelty on one another. (Cieslak, 2014). Survivor experiences and the impact from traumatic loss are powerful. By being active listeners we expose ourselves to the intense levels of fear and horror many have encountered. With the use of empathy as our primary tool to foster connections and increase emotional safety, the question becomes how can we do this without adding risk our own personal, emotional well-being?

There isn’t a simple trick I can tell you. The answer is comprehensive.

The best case scenario when responding to such a high impact critical incident, is that we enter it grounded in experience, training, with good health, and support.

First, if we are not in good health, we should not go.

Second, while experience will vary, training and support should not. These are controllable. Training provides the elements of a plan, guidelines, technique and structure. This increases our sense of mission, provides clarity when there is confusion, promotes efficacy when surrounded by uncertainty, and at the end of the day, assurance that we provided services for the best possible outcome.

When we are inadequately trained and do not know what to do, or try to apply peripheral training concepts, we increase the risk of becoming overwhelmed by the task at hand. When we experience an overwhelmed feeling, it means our usually effective coping skills are taxed, which is fertile ground for ST.

Responding to large critical incidents should not be faced alone. These are not single responder events. At the very least there needs to be a buddy system with the power of the EAP and/or crisis team in the background providing support. The content heard during the interventions will need some personal processing and access to our own compassionate listeners, preferably those with you at the scene (homogeneous), can be most helpful.

Listening with empathy is necessary, but it needs to be purposeful and with boundaries. In other words, we have to be careful that we do not get so engulfed by the content of the narrative where we lose ourselves in their experience, hanging onto every word as if in a trance. This is an example of losing our boundaries while listening. Some of what you will hear has the power to do that. Purposeful listening adds some structure to the listening process. For example, in reflective listening, which builds empathy, we repeat back the content and emotion expressed. This requires us to be more cognitive oriented in our approach. Our purpose is to hear the content accurately and verify it to the survivor. Then normalize and validate as appropriate.

In addition and consistent with the Multi-Systemic Resiliency Approach, we are listening for the survivors own personal strengths, and/or attributes emerge in the dialogue. Again, listening with this purpose positions us to elevate these strengths to the forefront and help survivors reconnect with them in a mindful manner. It is purposeful, cognitive, and offers some protection by keeping our Amygdala in check.

As a recurring survivor of secondary trauma, I can tell you it is not PTSD, nor even debilitating. It is however noticeable and temporary. For me it usually is a one to two week period of time where my anxiety level is raised, mood more easily agitated, some hypervigilance and behaviors of avoidance (staying out of malls). I’m likely to have a dream or two with the incident intertwined in the dream imagery. There will be some preoccupation afterwards with the survivors and how they are recovering. It is hard to let the incident go and move on. Talking and resting work.

Some other considerations to reduce ST.

1. Manage your own stress reaction. Many of us in this field are drawn to tragedy. We want to help. We can save that analysis for another day, but our own stress reactions, will influence our decisions on how we help and how available we make ourselves. It is easy to rationalize your sacrifice in the face of so much tragedy, but there are limits and you must set them.

2. Manage your fatigue level. If you are already tired or feeling burned out before the incident, you are at higher risk. If you extend yourself during the intervention when fatigued, you are at higher risk.

3. Stay within the boundaries of your training. Your training in CIR serves as your guard rails. It is where you can be most effective. Outside of these tried and true processes, lie uncertainty. Not only from the disruption but also inviting ethical dilemmas. Now it is important to be flexible and at times creative, but these should be decisions about safe access not technique or intervention processes.

4. Do not tour the scene. I first heard the term, “Crisis tourism” from Jeff Gorter from then, Crisis Care and now, R3 Continuum. Going off and wandering around with the desire or need to see the scene. This goes back to #1, managing our stress response. We are drawn to these scenes and that curiosity carries a price. The actual scene is very real and powerful even haunting. In the presence of the scene, all of your senses are engaged and stimulated by the raw material all around you. Scenes have odors and it usually catches people off guard. I am usually more affected after I have experienced the physical environment. If you are thinking it will position you to be more effective as a counselor, the answer is maybe. I’ve used that argument myself, but I can also tell you, you do not need to see the bullet holes, blood stains, or the crime scene to be effective.

5. Stay hydrated, eat, sleep and maintain your routines. Do not give your entire being over to the incident. Limit media exposure.

Remember, you are not the only one at risk for ST. ST can be experienced by other survivors in the group interventions that you are running. Know what to look for. Have a plan to address it. Do not be a passive group leader. Remember this is crisis intervention not therapy.

For training in EAP CIR Multi-Systemic Resiliency Approach click here.