NEW: Reducing Compassion Fatigue, Secondary Traumatic Stress & Burnout: A Trauma-Sensitive Workbook (Oct. 2019 Routledge)
Allow me to briefly describe why I developed this workbook.
More Than A Reader
The minute readers begin the first session they realize they are more than a reader; they are a participant in a learning and transforming experience. Every session begins with a series of pre-session questions and activities for readers to complete. Following each activity, I detail the responses from participants in workshops I’ve conducted. This allows readers to compare their responses to those of their professional peers rather than simply being told “this is the way it is”. Filled with activities, worksheets, and assessment tools, each session helps readers to identify their personal self-care needs and arrive at an effective personal self-care plan that aids in recovery and prevention while promoting resilience in the face of daily exposure to trauma-inducing situations.
Identify the Differences
I have been in far too many workshops that simply list the wide range of CF/STS/BO symptoms but fail to walk participants through any activity that evaluates their ability to distinguish the source of their stress. In my recent book (link here), readers are asked to complete a pre-session activity that requires them to write out six statements that reflect the thoughts, behaviors, emotions and physical reactions for each of these three reactions CF/STS and BO. This presents them with the opportunity to identify whether they understand what constitutes CF versus STS versus BO as symptoms can appear similar for each yet are different. Consider the following statement, “There are days I don’t return client’s calls” would be considered burnout if the rest of the statement read something like, “…because all they want to do is talk and I don’t have the time.” This same statement could be considered secondary stress if the rest of the statement read something like, “…because what happened to these clients just triggers to many unwanted reactions I have trouble controlling.” And, finally the same statement could be considered compassion fatigue if the rest read, “…because I don’t think any amount of caring on my part will change anything.” When readers can identify these differences, it is so much easier to apply the appropriate intervention/self-care practices.
Throughout this work a number of Reality statements are identified. For example, We all experience stress, but we experience it differently. This is why what works for me may not work for you. In fact, not knowing what that subjective experience is like for you, what I might suggest you need to do to relieve that stress may be of no help whatsoever or make it worse rather than better.
This is why it is imperative that self-care become personalized; to do so requires an evaluation of our subjective reactions, our individual mindsets, behavioral, emotional and physical reactions to that stress as well as the organization/management practices contributing to that stress. To develop a personal self-care plan that fits you, it’s also necessary to identify your perceived levels of stress, engagement factors, resilience characteristics, spiritual intelligence, your specific internal responses to clients, the strength of your self-compassion, determining what matters most to you, evaluating the “wellness” of the work environment, the core STS competencies of supervisors and much more. The tools included allow readers to evaluate each of these areas.
Consider this. Engaging meditation may be of little help in reducing stress if you are responding from a mindset that is flawed, fixed or narrow or otherwise counter-productive to mitigating those stressors associated with CF/STS/BO. For example, the results of the Self-Compassion Survey may reveal that you are less compassionate with yourself than with those you care for or are responding to. Results of the Resilience Characteristics and other surveys may also reveal limited mindsets associated with resilience. Meditation will not alter the stress created by counter-productive mindsets. In the first two sessions 12 essential mindsets are presented; each following session then builds on these resilient focused, wellness mindsets.
Not Your Sole Responsibility
The literature often states that self-care is an ethical responsibility for all caregivers and responders. However, readers discover through various examples that how well or how successfully they manage the stress of what they do, is not always a matter of the way they care for themselves; it is also categorically dependent upon how well the organization, where they are working, cares for them and their well-being. Even in 2019 major organizations have failed to step up to the plate in this regard. Examples are presented to distinguish between organizations that are trauma-informed versus those that are trauma sensitive. You’ll be given the information needed to determine if your organization is engaging in those practices that help mitigate CF/STS/BO while supporting your overall well-being and enhancing your effectiveness with those you are caring for or responding to.
Evaluate, Track, Determine, Act
All of this is accomplished by moving through the activities in each session and completing the array of assessment tools and worksheets provided. The worksheets allow readers to track those self-care issues that are barriers to minimizing CF/STS/BO as well as those that are strengths, to clarify what does really matter and the priority actions needed to pursue these with purposeful defined activities.
Every session takes readers on a journey to discover, via the assessment tools, activities and worksheets, what matters most in their personal efforts to remain resilient, compassionate and consistently effective while daily assisting, caring for and or responding to trauma victims and those intensely emotionally challenged individuals and or situations. Consider this Reality statement, Failure to practice self-reflection is like being stuck on life’s treadmill, always moving but going nowhere. In the final session I ask readers to reflect on their assessment outcomes and complete several self-reflective questionnaires in order to arrive at their personalized, self-care priorities and action plans. This is where this journey ends and another begins; the one each decides to take to best manage the stress of what you do.
Whatever actions you decide to take remember there is no one way or best way; your way is what you discover in this journey matters the most to you. I am hopeful that the experiences this workbook introduces you to becomes an agent of change, one that brings strengthened resilience against the stress of caring.
It’s been awhile since my last blog. Being semi-retired has provided so much more time to relax, as well as pursue my passion for sharing best practices for helping anxious and traumatized children. Besides spending time these past few months fixing up our winter get away home, taking in the ocean, Florida’s wild life, balmy evenings and water side meals, I was collaborating with a number of leading practitioners to develop a publication about what matters most to anxious and traumatized student’s efforts to learn and regulate their behaviors. It speaks to everyone involved in the education and development of children today.
Due for publication by Routledge this December, Optimizing Learning Outcomes: Proven Brain-Centric, Trauma Sensitive Practices, is a collection of documented best practices.
What makes this resource unique?
1. 100 Links are presented to YouTube segments that support, elaborate and demonstrate the brain-based, trauma-sensitive learning and behavioral regulation practices detailed in this resource. Being able to virtually connect and quickly learn from our peers and leaders in the field (most segments are less than five minute) makes this a practical and easily usable learning and teaching resource.
2. These “virtual” conversations also support the professional credibility of the entire work and simultaneously introduce you to a long list of additional sources and conversations specific to each topic area.
3. Because there is no one practice or strategy that fits all students or schools, we have been fortunate to bring programs, strategies and practices to you from a diverse group of educators. They present a variety of ways to accomplish the same goal-improve academic outcomes and student regulation of otherwise challenging behaviors.
Following are comments from several of those who reviewed this work.
If you’re an educator or school mental health specialist, this book is a must read! Steve Sandoval, PhD, executive director of special services with Westminster Public Schools, Colorado, and one of Education Week’s 2016 “Leaders to Learn From”
“This book is a much needed resource and guide for novice and veteran teachers learning to create trauma-sensitive school environments. It provides a comprehensive review of information, examples, strategies, and tools based on research of effective trauma-informed practices.” Regena F. Nelson, PhD, professor and chair of the Department of Teaching, Learning and Educational Studies at Western Michigan University
“The editor and the book’s contributors provide readers with a detailed road map of practical, trauma-informed strategies and practices. They are not asking us to do more in our educational system. Instead, they are showing us, through a multitude of examples, that when we change our approach, we can maximize positive behavior and gains in student learning. What greater gift can we offer our most struggling students?” Jim Sporleder, MS, former principal at Lincoln High School in Walla Walla, Washington and featured in the award winning documentary Paper Tigers
This work describes the many successful brain-based, trauma-sensitive practices helping students and schools improve their learning outcomes while regulating behaviors and engaging in compassionate whole school approaches. Anyone in the position of helping children, including parents will be able to immediately integrate theses practices and activities into their daily routines.
William Steele PsyD, LCSW, MA
A mindset is a “lens or frame of mind, which orients an individual to a particular set of associations and expectations.” Science has demonstrated repeatedly that our mindset influences outcomes in all areas of life. For example, participants in one study were given two milkshakes. Each shake was described differently. Each produced different outcomes (https://www.youtube.com/watch?v=ev65KnPHVUk). The first milkshake was called the Sensi Shake. Participants were told that it contained only 140 calories, zero fat and only 20 grams of sugar. When they returned two weeks later they were given the Indulgent Shake. They were told it had 620 calories, 30 grams of fat and 56 grams of sugar. On both occasions they were hooked up to an IV to measure Ghrelin levels. Ghrelin is referred to as the hunger hormone. When Ghrelin levels increase significantly they signal the body that is time to stop eating- our hunger has been satisfied. After drinking the Sensi Shake Ghrelin levels increased only slightly. After drinking the Indulgent Shake Ghrelin levels increased three times more to a level satisfying hunger. However, each shake had the same Sensi Shake ingredients demonstrating that our mindset influences our biological responses.
Just as mindset can alter biological outcomes, it can alter academic success and teacher interactions in ways that positively change student academic outcomes and behaviors. Researcher, Stanford University Professor and author of “The Secret of Raising Smart Kids” has documented that there are “growth mindsets” that are associated with optimal learning. Praising effort rather than outcomes maximizes the motivation to learn (https://www.youtube.com/watch?v=hiiEeMN7vbQ).
Once trauma informed, we learn that the behaviors of anxious and traumatized students are fear driven and pain based. In the face of anxiety/trauma their behavior is often misunderstood as oppositional, willful and deliberate as opposed to communicating what they do not have the words to communicate in the midst of their fear. Once we understand this mid-brain limbic response our mindset will trigger reactions that are far more proactive than reactive. For example, our response to a disruptive behavior will be, Not, “He’s pushing my buttons” but “I’m lucky he’s letting me know he needs something.” This mindset allows us to calmly direct our attention to helping children regulate their fear responses using a variety of regulation activities or resources.
In my three-day Brain-Based Trauma-Informed Classroom Practices training we present sixteen trauma-informed mindsets and a variety of activities to calm the dysregulated nervous systems of anxious and traumatized students not only to assist with their reactions/behaviors but to also assist with focus and attention. Next time you are indulging in a thick creamy milkshake remember that mind-sets matter.
William Steele PsyD, MSW
I’m often asked for resources that offer a wide variety of practical, multi-sensory therapeutic processes and strategies. Crenshaw and Stewart’s Play Therapy A Comprehensive Guide To Theory And Practice, a 2015 Guilford Press publication, is one such invaluable resource. 36 chapters written by most of the leading figures in play therapy provide practices applied across a wide range of client problems. Topics cover play therapy with or for
Theory, research, clinical application, practice guidelines and an abundance of case examples fill every chapter. Given what neuroscience has taught us about the importance and need for sensory-based approaches this rich resource should be on every practitioner’s must read list.
Regarding multi-sensory approaches, Impact Therapy uses a wide variety of visual “props” to reinforce strength based, resilience focused client thought processes. The following 12 minute video segment provides an excellent demonstration. I’m sure it will have you thinking of a variety of visual ways you can communicate new concepts to clients to reshape the way they think about themselves and the challenges they face. It’s well worth the time. Good reading and good viewing. https://www.youtube.com/watch?v=e6qqy2DsXuk
ASD is not currently a formal diagnosis found in the American Psychiatric Association DSM 5 manual of diagnostic categories yet Serious implications related to academic decline, productivity, compromised relationships, mental health and health related issues. Recurrent “neuroeconomic” research outcomes more than substantiate existing manifestations that will likely make ASD a global disorder. “Neuroeconomics” refers to the study of the neurological, biological and psychological outcomes of exposure to a variety of incidents and behaviors. In this case ASD refers to the symptoms now associated with repetitive exposure to television screens, gaming screens, computer screens and smartphone screens.
NOTE: As you read through the list of symptoms/behaviors listed below, I’m sure you will agree they could easily lead to misdiagnosis if we fail to evaluate for the level of screen exposure of those presenting such symptoms today.
Based on research, this future diagnosis would likely be given when:
A. Three or more of the following symptoms are present and represent a change in functioning. Onset can be progressive and or sudden.
1. Difficulty with tasks and problems requiring focused attention
2. Easily distracted into off task behaviors
3. Lower test scores compared to those limiting screen usage
4. Weakened declarative memory
5. ADD behavior and symptoms
6. Decrease in productivity
7. Increase in depression and social anxiety
8. Compromised relationships
9. Compromised ability to empathize and be attuned to others
10. Weight gain/ weight loss
11. Delayed sleep/difficulty falling asleep /reduction in hours of sleep
12. Addictive stimulant driven behaviors and withdrawal reactions
B. The symptoms cause impairment in learning, academic/occupational performance, relationships, mental health and other health related issues.
C. Symptoms are not attributable to substance usage or other medical conditions.
D. Daily screen time for children 3-18 years is three hours or more. APA recommends no more than three hours for this group and no screen time for children two years and under (14). (Most are far exceeding this time period.)
NOTE: It is important to note that the percentage of kids from infants up to eight years of age who have used mobile devices has nearly doubled from 38% to 72% since 2011 (17). Continued usage increases are expected, as are the problems associated with screen exposure especially in early years when brain functions are developing. (Comments are taken from a variety of articles referenced at the end of the post- ( # ) indicates referenced article)
The research is especially strong in the area of cognitive deficits resulting from screen exposure. French scientists Slyvain Charron and Etienne Koelich have discovered that our brains struggle to process attention across more than two tasks at any given time, so when you think you might be multitasking, what your brain is actually doing is rapidly skipping from task to task, not focusing on any on thing for any significant time (6). Therefore devoting single attention to something, especially if it’s something new you’re attempting to learn, is not easy with a brain predisposed to rapidly skipping from task to task due the brain’s rewiring from repetitive and prolonged multimedia usage.
Furthermore learning essentially relies on being able to place information in context, something the conditioned multitasking brain is increasingly unable to cope with. Think about this. Ten years ago, the average attention span was 12 minutes – now it’s just 5 seconds (1). Other studies show that 25% of users forget names and details of friends and even relatives (1). Not only does short- term memory suffer, declarative memory also suffers. Declarative memory (long-term memory) refers to applying material learned earlier to current situations/problems/explanations (13). These alterations do reduce academic outcomes. Studies have found, for example, a correlation between lower GPA averages in college students using Facebook than those who avoid Facebook (5).
Susan Greenfield, Professor of Synaptic Pharmacology at Oxford University, argues that because real-world experiences are inherently slower than online ones, especially the ability to process multiple streams of information across multiple networks, a heightened increase in attention-deficit disorder (ADD) behaviors results (10). This also has implications for classroom practices. For example, participants’ multitasking during a lecture scored lower than those who did not multitask. And, this is critical, those who were in direct view of those multitasking also scored lower on tests than those who were not in direct view (16).
A survey from Hearst Communications found that productivity levels of people that used social networking sites were 1.5% lower than those that did not (8). One has to wonder what will happen when future generations of screen addicted users are unable to call upon the focus and attention needed to examine situations in depth, unable to avoid shallow reactions and responses and become more reactive rather than proactive.
Fear and anxiety about face –to-face interactions with others, being negatively evaluated by others, embarrassed, humiliated, rejected and bullied are now associated with multimedia usage (17). Regression analyses revealed that increased media multitasking was associated with higher depression and social anxiety symptoms, even after controlling for overall media use and the personality traits of neuroticism and extraversion. The unique association between media multitasking and these measures of psychosocial dysfunction suggests that the growing trend of multitasking with media may represent a unique risk factor for mental health problems related to mood and anxiety (5). Others have found that 3 hours of television watching per day was linked to worse conduct (13).
Compromised Empathy and Attunement
We are primarily social beings. In fact our neurology, biology and psychology are designed to connect and interact with others face –to-face. Online communications do not fulfill this basic need. For example, watching videos was strongly associated with more negative feelings. However, face-to-face communication was positively associated with feelings of social success and consistently associated with a range of positive socio-emotional outcomes (5). Studies on infant brains have shown that knowledge retention is only truly possible for the long-term when accompanied with personal interaction, an aspect that becomes a lot more important as we age (15). To best appreciate how our systems are “wired” to connect and interact, and, in so doing, learn critical social skills from others, it is important to appreciate the importance of “mirror neurons and their role in learning, empathy, attunement and fulfilling the need to be connected. I recommend watching https://www.youtube.com/watch?v=Xmx1qPyo8Ks a Nova produced video on mirror neurons.
If you watched the above video it is not surprising to read that screen users experience compromised levels of empathy and experience the fears associated with social anxiety (10). It has also been said that we are becoming more of an ADD culture (2, 3). Though we’re no less social, we are more distracted. Putting down our social media connections to focus on the ones right in front of us is something that takes a real effort. Just observe how parents interact (don’t) interact with their children while in a restaurant-all are easily distracted by their smartphones, mini- iPads and gaming devices. Despite its goal to connect, social media can instead isolate some teens and provide a forum for bullying. Even typical kids can be affected emotionally by what's going on in social media sites because it can be one little thing that's said that then spreads like ripples in a pond and people keep posting against it and suddenly it becomes part of that person's persona (17).
Adding to the relational/interaction information just presented, it is essential that we appreciate the difference between connecting and interacting. Studies have found that day-to-day interactions are based almost entirely on nonverbal communication. A study from UCLA found that when we send a message, its meaning is derived from three sources, 20% from words spoken/written, 25% from tone of voice and expressed attitude and 55% from body language (12). When we interact with others, we are continuously processing wordless signals like facial expressions, tone of voice, gestures, body language, eye contact, and even the physical distance between us and them. These nonverbal signals are the heart and soul of the interaction. We cannot understand the true meaning of an interaction if we do not have the ability to interpret these nonverbal signals (11).
In contrast, online interactions are devoid of emotions. One tragic example involves a mother, Sharon Seline, who often exchanged text messages with her daughter, who was away at college. One afternoon, they ‘chatted’ back and forth, with mom asking how things were going and daughter answering with positive statements followed by emoticons of smiles and hearts. Later that night, the daughter attempted suicide. Their relationship was comprised in the worst possible way. The signs of depression were there, but could only have been interpreted through face-to-face communications and the sharing of her emotional state (11).
Oxytocin/Blue Light Addictive Stimulants
Studies show that the use of social media produced a calming, soothing, pleasurable effect that is chemically measurable in the brain. They show a 13.2% spike in users levels of oxytocin, and a reduction in a number of stress-related hormones (13). Perhaps this is why millions of people use these platforms – our brain feels good on them. Furthermore, this oxytocin stimulant response is reinforced by the “blue light” emitted on screens. Blue light, which in nature is most abundant in the morning, tells you to get up and get moving. Red light is more common at dusk and it slows you down. Now, guess what kind of light is streaming from that little screen in your hand at 11:59 P.M.? Your iPad, your phone, your computer emit large quantities of blue light," says sleep researcher and chemist Brian Zoltowski of Southern Methodist University (7).
Unfortunately, this “feel good” reaction can lead to an addictive usage- the need for constant connectivity and connection. Now guess what happens to our neurological, biological and psychological systems when these stimulants are removed for 24 hours? Research shows that after 24 hours following withdrawal, we experience mixed anxiety and depression, sense of loss/connectivity to others, restlessness, irritability and persistent excessive worries such as, “what others might be posting about me in my absence, what I might be missing out on, loss of social media status, loss of relationships” (1, 15). Metabolic changes are also reported by addicted screen users and manifested in weight loss or gain (10). If you want to do a quick check on your level of addiction, try to go one week without any screen time one hour before going to bed. Even better go at least two days with out using your smart phone and observe what happens to your body, feelings and thought processes.
Screen Induced Sleep Disorder
In a study of 10,000 16 to 19-year-olds, researchers in Norway found that the longer a young person spent looking at an electronic screen before going to bed, the worse quality sleep they were likely to have. Those who spent more than four hours a day looking at screens had a 49 per cent greater risk of taking longer than an hour to fall asleep and were three and a half times more likely to sleep for under five hours a night (4, 7).
I encourage you to read the reference articles. They provide much more detail supporting how screen exposure is changing our brain, how we think, learn, process information, relate, perform and produce. Screen usage has its benefits (see http://uncw.edu/newsletters/flash/2015/02/social-media-and-emotional-health.html) but can also be harmful. Implications dictate ongoing scrutiny but also heeding the advice (found in reference articles) being given parents, teachers, office managers as well as screen users regarding managing screen exposure.
1. Bennet, S. (2011). Is Social Media Ruining Our Minds? [INFOGRAPHIC]. Retrieved June 18, 2015 from http://www.adweek.com/socialtimes/this-is-your-brain-on-social-media/458276
2. Chopra, K. (2013). The Effects of Social Media on How We Speak and Write. Retrieved July 17, 2015 from
3. Clark,K. (2014). Social media affects social skills, future jobs. Retrieved Juje 12, 2015 from http://www.bgnews.com/in_focus/social-media-affects-social-skills-future-jobs/article_d7500336-9394-11e3-a4de-001a4bcf887a.html
4. Cooper, C. (2015). Too much exposure to smartphone screens ruins your sleep, study shows. Retrieved July 29, 2015 from http://www.independent.co.uk/life-style/health-and-families/health-news/too-much-exposure-to-smartphone-screens-ruins-your-sleep-study-shows-10019185.html
5. Education, Social Media (2013). Multitasking, social media and distraction: Research review. Retrieved July 7, 2015 from
6. Edwards, L. (2010). Brain splits to handle two jobs at once. Retrieved June 8, 2015 from http://phys.org/news/2010-04-brain-jobs.html
7. Fishman, J (2014). How Your Smartphone Messes with Your Brain—and Your Sleep. Retrieved august 1, 2015 from http://blogs.scientificamerican.com/observations/how-your-smartphone-messes-with-your-brain-and-your-sleep/
8. Gaudin, S. (2009). Study: Facebook cuts productivity at work. Retrieved June 24, 2015 from http://www.computerworld.com/article/2526045/web-apps/study--facebook-use-cuts-productivity-at-work.html
9. Gomsner, J. (2015). This is what happens to your brain and body when you check your phone before bed. Retrieved August 1, 2015 from http://www.businessinsider.com/smartphone-impact-brain-body-sleep-2015-2
10. Greenfield, S. (2104). Mind Change: How Digital Technologies Are leaving Their Mark On Our Brain. NY. Random House
11. Margalit, L. (2014). The Emotional Involvement Behind Social Media Interactions. Retrieved July 29, 2015 from http://thenextweb.com/socialmedia/2014/07/19/emotional-involvement-behind-social-media-interactions
12.Oakes, D. (2012). What You Said Isn’t What I Saw. Retrieved July 29, 2015 from http://daveoakesseminars.com/what-you-said-isnt-what-i-saw/
13. Peneberg, A. (2010). SOCIAL NETWORKING AFFECTS BRAINS LIKE FALLING IN LOVE. Retrieved July 5, 2015 from http://www.fastcompany.com/1659062/social-networking-affects-brains-falling-love
14. Powell, K. (2014). How kids’ screen-time guidelines came about — and how to enforce them. Retrieved July 27, 2015 from http://www.washingtonpost.com/national/health-science/how-kids-screen-time-guidelines-came-about--and-how-to-enforce-them/2014/03/31/4a394c10-af9f-11e3-9627-c65021d6d572_story.html
15. Scarpelli, M. (2009). Social media’s Affect On learning. Retrieved July 7. 2015 from http://blogs.wsj.com/digits/2009/07/30/social-medias-effect-on-learning/
16. Strauss, V. (2014). Why a leading professor of new media just banned technology use in class. Retrieved July 27, 2015 from http://www.washingtonpost.com/blogs/answer-sheet/wp/2014/09/25/why-a-leading-professor-of-new-media-just-banned-technology-use-in-class/
17. Tanner, L. (2011). Docs warn about teens and Facebook depression. Retrieved July 20. 2015 from
18. (2013). New Research from Common Sense Media Reveals Mobile Media Use Among Young Children Has Tripled in Two Years. Retrieved June 8, 2015 from https://www.commonsensemedia.org/about-us/news/press-releases/new-research-from-common-sense-media-reveals-mobile-media-use-among
I met a number of survivors and responders in the weeks and months following the bombing of the Federal Building in Oklahoma in 1995. Over the years a number of iconic images associated with that traumatic incident and far too many since remain quite vivid. The one image I will never forget related to Oklahoma is that of fireman Chris Fields coming out from the rubble carrying the young Baylee Almon in his arms. She died shortly afterwards. She would be 20 years old if she were living today. This image was a frequent lead into the numerous news broadcasts in the months that followed. Although I never met Baylee’s mother, I often wondered how she managed such a horrific loss. When doing some research for Trauma In Schools and Communities: Recovery Lessons From Survivors and Responders http://www.routledge.com/books/details/9781138839502/ I came across this brief article (Boyle, 2013) that speaks to the resilience of Baylee’s mom.
The world can seem so random. It could have been a different child, or a different firefighter, or a different photographer. But on that day, in the face of that tragedy, for that time, everything came together for that one photo to define the Oklahoma City Bombing. Her mother said, ”I feel like Baylee was put on this earth to do what she did, and that was to represent everyone who died in the building that day.”
Our efforts to assist victims must be directed at helping them discover their inner resilience, to find meaning, purpose and strength despite what they have endured. In 2012 Dr. Lennis Echterling http://www.psyc.jmu.edu/gradpsyc/people/echterling.html shared with me what he refers to as “countless nuggets of resilience.” He was in Lebanon working with adult survivors of land mine explosions. The purpose was to train theses survivors to promote resilience in peer-to-peer relationships with other survivors. At the very start of the program one land mine survivor introduced himself and then said, “I am not a victim of a land mine. The land mine is a victim of me. I survived-the land mine did not.”
The iconic images of war, terror, trauma are never forgotten and yet these survivors demonstrate the strength and resilience of the human spirit. I would love to hear your resilience stories as they can be used as a source of hope for others.
Boyle, Louise (2013) Extraordinary bond between grieving mother and firefighter, who was the last one to hold her dying baby in iconic Oklahoma City bomb photo. Retrieved 1/15/14 from
Steele, W. (2015). Trauma In Schools and Communities: Recovery Lessons from Survivors and Responders New York, Routledge: A Taylor and Francis Group.
Do you integrate into your trauma intervention process worksheets listing various statements and thought processes that help educate and normalize for survivors the secondary and self-induced wounding frequently following exposure to trauma? Over the past 20 years I’ve conducted full day trauma trainings to an estimated 60,000 school mental health professionals. I always begin by asking a series of questions to evaluate attendee’s knowledge base. Unfortunately the same limited show of hands to the above question raised 20 years ago has not changed today.
These wounds involve guilt and shame associated elements that survivors rarely reveal without encouragement- in this case a visual aid with a listing of common secondary and self-induced thought processes and space to list other ways they have been wounded. Left hidden and unattended they can and do lead to a number of self-defeating and destructive trauma related symptoms (van der Kolk, 2014).
Secondary wounding is primarily induced by the comments of others and include statements like:
It couldn’t have happened that way.
You really can’t remember that kind of detail.
Your imagination is running away with you.
He/she would never do that.
There are people who have had it harder than you.
Consider yourself lucky.
You’re still young.
You’re overreacting. You need to put this in perspective.
Secondary wounding also occurs when friends and loved ones withdraw their support and comfort or otherwise distance themselves from the survivor.
Self-induced wounding occurs when 1) comparing our actions and reactions to the behaviors and reactions of other survivors, 2) by real or perceived expectations others have of us or we have of ourselves, or 3) when we compare our behaviors and reactions to norms in our society or a culture that is associated with being an “okay person” versus “not okay person.” Examples include,
He was my best friend. I should have known he was thinking about killing himself. It is my fault.”
They tell me I’ll be better if I talk about what happened, but I don’t want to. It’s too hard. What’s wrong with me?
They told me not to, but I wanted to prove I could. I’m so stupid.
Had I not been so scared maybe I could have helped the others; I’m such a coward.
In these combined statements we hear “You are wrong” (guilt) and “What’s wrong with me” (shame). Each is painful, demoralizing and fear driven (Anthony, 2014), attacking every positive view of our self prior to that trauma. Think of guilt and shame each as a heavy weight on opposites ends of an interconnected cord acting like a Spanish Bolas that when thrown is designed to entangle the legs of its victims thereby capturing its victims-in this case capturing that resilient view of self that would otherwise help move us toward recovery - posttraumatic growth. Of the two, shame is the most insidious and infectious. Left to faster it leads to view of self as unlovable, defective, inadequate, cowardly, worthless, and having no honor. It attacks our moral integrity (Neff, 2015), self-worth (Herman & Dearing, 2011) and sense of hope (Knust, 2013).
This initial education/normalizing process makes it easier for survivors to acknowledge, externalize, begin to discuss and integrate their experiences into a new view of self in the face of what they experienced and learned.
Anthony. (2014) Guilt and Shame, Retrieved May 1, 2015 from https://www.myptsd.com/c/thevault/guilt-and-shame.34/
Herman, J. L. & Dearing, R. L. (2011). Posttraumatic stress disorder as a shame disorder. In. J. Tangey (Ed), (2011). Shame in the therapy hour. (pp. 261-275). Washington, DC, US: American Psychological Association.
Knust, J. (2013). When Shame and Hate Tear Hope Apart. Retrieved May 11, 2015 from https://www.psychologytoday.com/blog/headshrinkers-guide-the-galaxy/201301/when-shame-and-hate-tear-hope-apart
van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. NY. Viking