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Differentiation of Self: Enhancing Therapist Resilience When Working with Relational Trauma
Abstract
Clinicians are charged with being diligent in gaining competency in the latest trauma-informed interventions when working with relational trauma. This may invest therapists with an overresponsibility that is not only overwhelming and unrealistic, but serves to reduce autonomous functioning in family members. Therefore, clinicians need to become clear about what they are responsible for and what they are not, particularly when family members present as irresponsible or too anxious to think and act more effectively. Using a case vignette, this paper discusses how a clinician's focus on increasing their differentiation of self, a concept embeded in Bowen family systems theory, protects against vicarious traumatisation, secondary traumatic stress, and burnout whilst contributing to more autonomous functioning and better wellbeing outcomes for both clinicians and clients alike.
... According to a study by Bercier and Maynard (2015), between 5 and 15% of psychotherapists working in this setting suffer from clinical severity levels of VT and STS. Moreover, a high coexistence of and comorbidity between VT and STS has been found in most cases (Bercier & Maynard, 2015;MacKay, 2017;Sutton et al., 2022). Also related to VT is burnout syndrome, characterized by a combination of exhaustion, depersonalization, and feelings of ineffectiveness at work, due to an unfavorable work environment and high occupational stress (Freudenberger, 1974;Maslach, 1976;Roberts et al, 2022). ...
... The difference with VT is that burnout does not require indirect exposure to trauma, whereas it is an essential condition for the development of VT (Quitangon, 2019;Roberts et al., 2022). It is important to note that burnout, despite being more related to work stress, is posited as a possible predecessor of STS (MacKay, 2017). ...
... The results suggest that burnout could be a precursor of VT and STS, consistent with what was previously posited by MacKay (2017). Moreover, a high comorbidity between VT and STS was identified, congruent with previous research highlighting the complexity and interconnectedness of these phenomena in trauma psychotherapy (Bercier & Maynard, 2015;MacKay, 2017;Sutton et al., 2022). The coexistence of these disorders allows us to put forward three hypotheses: firstly, the correlation between independent disorders; secondly, that indeed, as pointed out by Sabin-Farrell and Turpin (2003) and Melaki and Stavrou (2023), the two disorders constitute the same problem, and; thirdly, that their high comorbidity can be explained on a continuum of psychopathological severity following indirect exposure to trauma. ...
The impact on psychotherapists’ mental health when addressing traumas is an area of research that has scarcely been investigated. This review focuses on the protective and predisposing factors of vicarious trauma in psychotherapists. Out of 202 indexed articles in Proquest, Web of Science, Scopus, and Pubmed databases, 22 met the inclusion criteria. Predisposing factors were identified such as limited experience, treating a high number of trauma cases, psychotherapists’ prior traumas, young age, female gender, limited sense of self and meaning of life, having religious beliefs, and professional practice in the private sector. Protective factors that emerged were perceived social support, coping strategies, having clinical supervision, and some personality-linked factors. Additionally, the potential interrelation between vicarious trauma and secondary post-traumatic stress is demonstrated and discussed.
The findings underscore the impact of indirect trauma exposure on psychotherapists’ mental health, emphasizing the need to implement prevention and intervention programs for those professionally dedicated to healing the traumatic
wounds of others.
... Según el estudio de Bercier y Maynard (2015) entre el 5 y el 15 % de los psicoterapeutas que trabajan en este ámbito sufren niveles de severidad clínicos de TV y EPS. Además, se ha encontrado una alta coexistencia y comorbilidad entre TV y EPS en la mayoría de los casos (Bercier y Maynard, 2015;MacKay, 2017;Sutton et al., 2022). Relacionado también con el TV se encuentra el síndrome de estar quemado o burnout, caracterizado por una combinación de agotamiento, despersonalización y sentimientos de ineficacia en el trabajo, debido a un ambiente laboral desfavorable y un gran estrés ocupacional (Freudenberger, 1974;Maslach, 1976;Roberts et al, 2022). ...
... Los resultados sugieren que el burnout podría ser un precursor del TV y del EPS, en concordancia con lo planteado previamente por MacKay (2017). Además, se identifica una elevada comorbilidad entre TV y EPS, congruente con investigaciones previas que subrayan la complejidad e interconexión de estos fenómenos en la psicoterapia del trauma (Bercier y Maynard, 2015;MacKay, 2017;Sutton et al., 2022). La coexistencia de estos trastornos permite plantear tres hipótesis: en primer lugar, la correlación entre trastornos independientes; en segundo lugar, que, efectivamente, tal y como señalan Sabin-Farrell y Turpin (2003) y Melaki y Stavrou (2023) ambos trastornos constituyan el mismo problema, y; en tercer lugar, que su alta comorbilidad pueda explicarse desde un contínuum de gravedad psicopatológica tras la exposición indirecta al trauma. ...
El impacto en la salud mental de los psicoterapeutas que abordan traumas representa un campo de estudio escasamente investigado. Esta revisión se centra en los factores protectores y predisponentes del trauma vicario en psicoterapeutas. De 202 artículos indexados en las bases de datos Proquest, Web of Science, Scopus y Pubmed, 22 cumplieron los criterios de inclusión. Se identificaron factores predisponentes tales como menor experiencia, tratar un elevado número de casos de trauma, traumas previos del psicoterapeuta, juventud, género femenino, limitado sentido de sí mismo y de la vida, tener creencias religiosas y ejercicio profesional en el sector privado. En contraste,surgieron como protectores el apoyo social percibido, diversas estrategias de afrontamiento, disponer de supervisión
clínica y factores ligados a la personalidad. Adicionalmente, se evidencia y discute la posible interrelación entre el trauma vicario y el estrés postraumático secundario. Los hallazgos resaltan el impacto de la exposición indirecta al trauma en la salud mental de los psicoterapeutas, subrayando la necesidad de implementar programas de prevención e intervención para quienes se dedican profesionalmente a sanar las heridas traumáticas de otros.
... Other researchers have understood BO as a distinct phenomenon separate from STS and CF, as it applies to working with any population. In contrast, STS, CF, and VT result specifically from interactions with trauma (Kanno & Giddings, 2017;Leung, et al., 2023;MacKay, 2017). Molnar et al. (2017) article uses STS and VT as synonymous and notes that the variability in how these terms are "defined and operationalized" complicates research into these constructs. ...
... According to Bowen family systems theory, DoS is the degree of one's emotional reactivity to others, potentially manifesting in relational extremes of emotional distancing and fusing (Bowen, 1978;MacKay, 2017). A low degree of self-differentiation is marked by a strong dependency on the acceptance of others. ...
Compassion fatigue (CF) has been a well-documented occupational hazard for clinicians over the past few decades. However, there are several limitations with the current conceptualizations describing the impact of indirect trauma. First, there is a lack of consistency in terms related to CF. Second, there is limited attention in the current models to clinicians’ relational triggers as a key factor impacting their emotional responses to clients. The current article proposes a new term, absorption vulnerability (AV), to capture the risk level and root causes of developing distress and impairment due to trauma work. This new AV model integrates secondary trauma exposure and relational triggers of personal trauma history, family of origin and attachment issues, and the degree of differentiation of self. Interventions to metabolize absorbed trauma and reduce future risk of AV are explored.
... Enhancing therapists' SD is essential in supporting them as they manage challenges and difficulties in practice (Halevi & Idisis, 2018;MacKay, 2017). Studies have found that higher levels of SD can profoundly benefit social workers; for instance, Torres (2016) found SD to be negatively associated with emotional exhaustion and depersonalization and positively related to personal accomplishment. ...
... This also corresponds with Bowen's (1978) conceptualization of SD, which claims that low-differentiated people require others' approval for their thought and actions and has a low capacity for conflicts, rejection, or criticism-all are an integral part of social workers' challenging routine. SD is profoundly influenced and shaped by the individual's family of origin, although some evidence suggests that focused training can help therapists increase their SD, thereby managing challenges more adaptively (MacKay, 2017;Regas et al., 2017). ...
Practicing social work involves unique difficulties, which may vary with seniority. This study aimed to identify these difficulties among social workers and social work students and to examine the associations between psychological flexibility (PF), self-differentiation (SF), and difficulties in practice in both groups. Ninety-one social work students and seventy-five social workers completed the following questionnaires: Difficulties in Practice, the Acceptance and Action Questionnaire-II, and Differentiation of Self Inventory. Results showed higher difficulties among social work students regarding their professional competence. Social workers demonstrated higher levels of PF, while no significant difference was found in SF. SF and PF were positively correlated, and both were negatively correlated with difficulties in practice in both groups. Among social work students, a moderating effect of PF was found for the association between SF and difficulties in practice. The current study emphasizes the importance of developing SF and cultivating PF during social work education to enhance professional competence and reduce difficulties in practice.
... The Bowen family theory as explained in Mackay's (2017) work elaborated on what makes one more resilient than another. It states that the ability of an individual to adapt to a situation depends to their level of sensitivity to that particular situation, the amount of attention needed, the expectation and assertion from others to the individual. ...
... All of these are further affected by the person's individuality and togetherness which occurs because of the need to be loved, accepted, emotionally connected and at the same time emotionally separated and independent. Also, the level of emotional maturity depends on the high immune response of an individual to other individuals and anxiety, which could be chronic or mild, is a major factor that determines how an individual react to other individuals' attributes and feelings (MacKay, 2017). Mackay (2107) while explaining the Bowen family theory added that the higher the level of anxiety, the lower the emotional maturity and independence. ...
The discovery of COVID-19 virus has altered almost all facet of human life and activities.
The COVID-19 pandemic changed the narratives in many facets of human activities
including romantic relationships. However, due the pandemic, many nations experienced
different phases of lockdown which affected the pattern and mode of interaction and
relationships mostly within the family and more specifically between romantic partners. As
such, this study sought to investigate if COVID-19 psychological stress affects relational
resilience among romantic partners. The study engaged 397 married individuals with self-administered survey questions that elicited information regarding their stress levels, depressive symptoms, anxiety, and coping processes with relational resilience. The study
makes interesting and purposeful findings. Results show that COVID-19 stress was
negatively significant to relational resilience. Findings also indicated that COVID-19 was
positively associated with stress to depressive symptoms, anxiety, and coping process.
Besides, the coping process was also significant but negatively associated with relational
resilience. Also, findings showed that depression, anxiety, and coping mediated the
relationship between COVID-19 stress and relational resilience.
... Resilience is an ability that develops in the individual over time where this skill will exist as strength in the individual (Osman et al., 2015). As a result of the stress faced, the resilience present in the individual can be translated through well-being, mental and physical health (Mackay, 2017). This is because according to McFadden et al. (2014), individuals who are resilient in the face of adverse experiences in life can avoid the adverse effects of the experience by converting such bad experiences to something that can benefit their lives. ...
Youths are the scion of future leadership who should be instilled with leadership style and skills for managing conflicts. Discussions related to leadership show that the leadership qualities found in youths varies from each other where the qualities are influenced by the environment and the ability of the youth. In addition to the challenges present, the exposure of youths to resilience is important for them to adapt to society. Thus, this study aimed to examine the relationship between authentic leadership and conflict management skills among youths in Malaysia with resilience as the mediating variable. This study used a quantitative approach through the distribution of questionnaires involving 439 respondents among youths comprising students of educational programme and novice teachers in the northern zone of Peninsular Malaysia. Authentic Leadership Questionnaire, The Connor-Davidson Resilience Scale and Rahim Organizational Conflict Inventory (ROCI II) were used in this study. The data was analyzed using SPSS 29 and SmartPLS 4 software. The findings showed that there was a significant relationship between authentic leadership and conflict management while resilience was a significant mediator between authentic leadership and conflict management among youths. Accordingly, individuals with a leadership style are able to manage conflicts due to the resilience skills inherent in them and are able to create positive emotions in the face of adversity.
... development of an Australian AAFT-accredited training program specialising in this approach (the Family Systems Institute, Sydney). Additionally, many articles on Bowen's theory have been published in this journal during this time by local and international authors 1 (see Brown, 2023aBrown, , 2023bCollier & Villareal III, 2022;Cooper et al., 2023;MacKay, 2012MacKay, , 2017Mackay & Brown, 2013;Palombi, 2018;Papero, 2014Papero, , 2017Wilt, 2023). ...
This paper overviews Bowen family systems theory and its approach to family therapy. It aims to introduce this influential approach and a sample of developments in theory and practice since Bowen's first publications of his research and theory. This paper is the second edition of a 1999 article with the same title (Brown, Australian and New Zealand Journal of Family Therapy , 20, 94 and 1999) and, 25 years later, offers new insights from the original author's ongoing research into the theory. This new edition is in collaboration with a second author and Bowen theory scholar, bringing fresh perspectives on the theory's applicability to family therapy practice. The core concepts are presented briefly, and a case example with a parent and symptomatic adolescent demonstrates how theory informs the role of the therapist and the therapeutic work. Examples of criticisms of Bowen theory are also discussed, including the misinterpretation around the idea of emotion in Bowen theory that is communicated in Gottman's training. Differentiation of self is clarified as the integration of emotion and intellect rather than privileging one over another, which affords the opportunity for individuals to avoid being governed by the invisible strings of sensitivities in relationships and instead be themselves in good emotional contact with the other person.
... This process may be influenced by the child and/or parents experiencing post-traumatic stress relating to past medical interventions (Page et al., 2020) with parents pre-emptively compensating for their child without allowing them the opportunity to initiate and sustain new mealtime behaviours themselves (Bowen, 1978;MacKay, 2017). Facilitating opportunities for the child's self-determination in striving to eat and drink independently through the frameworks provided by weaning programmes that incorporate IPFCC principles (Lively et al., 2019;Tarbell & Allaire, 2002;Wilken et al., 2013) promotes parents' self-determination as they witness their child's autonomy and competence in learning to eat and drink flourish. ...
Background
Persistent enteral tube feeding beyond the point of medical and/or physical necessity provides important nutrition to a child but may have implications for their development, gastrointestinal tract and quality of life. Tube dependency can affect parent–child relationships and sibling and family dynamics and place additional medical demands upon parents. It is therefore important to transition children from tube to oral eating and drinking as soon as is medically safe to do so. Tube weaning requires a skilled team to support the transition to oral intake; however, access to experienced teams is inconsistent. Without transparent discussions with their treating teams, many parents are left to navigate tube weaning options independently.
Methods
Fourteen parents were interviewed using semi‐structured interviews. We explored the experiences of parents across their child's progression towards oral feeding, from the decision‐making process to undertaking an intensive multi‐disciplinary tube weaning programme. Thematic analysis of the parents' stories shaped the development of seven themes.
Results
Parents were unaware that tube weaning would be required and how that would be facilitated. They expressed a strong belief that their child could learn to eat—if afforded an opportunity. Furthermore, parents are prepared to disengage from current services if they feel they are not respected members of their child's therapeutic team. Three key learnings were identified relating to the need for tube exit plans, parents as key team members and parents as change agents.
Conclusions
Parenting a tube‐fed child, initiating and engaging in tube weaning, is a stressful and emotional journey. However, by establishing care partnerships, parents are willing to put trust in a process if provided with options and afforded autonomy, empowerment, acknowledgement and relevant support.
... Moreover, therapists themselves also report symptoms of anxiety and depression (Guy & Liaboe, 1986); and are often seeing a therapist themselves (Moe & Thimm, 2021;Orlinsky et al., 2011). In previous years, clinical papers have emphasized the importance of enhancing therapists' resilience when working with relational trauma (MacKay, 2017) or with an offender population (Dreier, 2012) and have highlighted the experience of PTG in some clinicians treating accident victims (Koch & Cann, 2013). ...
Objective:
This study aimed to examine therapists' unfolding response to the challenges of vicarious traumatization and transitioning to online therapy in the wake of the pandemic. This is the first study to empirically examine therapists' experience of resilience and posttraumatic growth during COVID-19.
Method:
This longitudinal study reports on the self-reported resilience and posttraumatic growth of 185 psychotherapists (mostly White, female and North American) across 4 time points during the COVID-19 pandemic. Therapist-reported working alliance, vicarious traumatization, and acceptance of online therapy at baseline were examined as potential predictors of professional self-doubt at baseline as well as potential predictors of subsequent resilience (e.g., reduction of professional self-doubt) and posttraumatic growth.
Results:
Therapists experienced moderate levels of professional self-doubt, more than outside pandemic times, and this self-doubt decreased over time, thus showing a resilient trajectory. Professional self-doubt at baseline was predicted by higher vicarious trauma and weaker working alliance, less clinical experience, and less acceptance of online therapy technology. Higher levels of resilience over time were predicted by less acceptance of online therapy. Moreover, therapists reported relatively low levels of posttraumatic growth, and this remained consistent during the subsequent 12 weeks. Posttraumatic growth was predicted by high levels of vicarious trauma, and acceptance of online therapy technology.
Conclusions:
Therapists in our study reported resilience during the initial months of COVID-19. Those who were relatively more traumatized and more comfortable in their online work during the pandemic experienced more posttraumatic growth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... However, this study did not examine the perception of parental anxiety or the perception of parental involvement with the EA participants. In adult therapeutic communities, lower levels of DoS have been found to contribute to greater risk of worker/clinician burnout, vicarious traumatisation, and secondary traumatic stress given the intensity of working with traumatised, illresourced, and marginalised client populations (Halevi & Idisis, 2018;MacKay, 2017). ...
To date, limited research has been undertaken regarding the interplay between differentiation of self (DoS), parental involvement, and the prevalence of psychological symptoms in emerging adults (EA) aged between 18 and 25 years in Australia. The current study aims to assess whether there is an association between mental health symptoms, perceptions of parental warmth, involvement, and autonomy support and indicators of DoS, including self-regulation capacity and emotional reactivity. In a study of 129 undergraduate students aged between 18 and 30 years, greater DoS, involving both lower emotional reactivity and the ability to take an ‘I position’ in relation to others, was found to be associated with fewer depressive and anxiety symptoms in EA. In addition, EA who demonstrated lower levels of emotional reactivity (higher DoS) had lower scores in depressive and anxiety symptoms. Parenting variables of caregiver warmth and autonomy granting were also found to be related to lower depressive and anxiety symptoms as well as greater DoS in EA. Regression models show that there were main effects for DoS on depressive symptoms; however, parenting behaviours were not found to moderate this relationship. Overall, this research is important as it supports Bowen’s (1978) theorising in relation to the relationship between DoS and mental health, and consideration of the contribution of parenting variables to indicators of well-being in EA. In this, family therapy has a role in educating both young adults and their parents in how best to promote independence and autonomy for improved psychological health. Further research should focus on the complexity of parenting controlling behaviours on mental health symptoms in EA.
... Over time, working with complex trauma, such as suicide or homicide, can adversely impact the emotional and physical well-being of therapists. Research has suggested this leads to increased levels of burnout and compassion fatigue (Iqbal, 2015;MacKay, 2017), particularly in inpatient settings or when caseloads are largely based on posttraumatic stress disorder (Craig & Sprang, 2010). Furthermore, the scant research on the topic of self-care with child therapists suggests that working with children is more demanding due to the level of attuned presence needed to facilitate the play therapy process . ...
Play therapists inevitably work with traumatic death loss at some point in their careers. Unfortunately, most play therapists are not specialty-trained in traumatic loss, creating a treatment gap with this unique population. Although traditional methods of play therapy are empirically effective for traumatic death loss, adjustments in intake, toy selection, and termination can greatly enhance the therapeutic process. This article reviews the short- and long-term impacts of traumatic death loss, with a discussion of developmental processes and reactions to this painful experience. A detailed description of toy selection and traumatic play themes are discussed along with types of play demonstrated by traumatically bereaved children.
... Counselors face the most devastating traumas the human condition can offer, often without prior warning. It is important that each member of (MacKay, 2017), unique to their own person, and use them for processing these moments of pain in an effort to release them from their own psyche. Finally, the student could face a crisis of concept, realizing the simple solutions they were prepared to deliver mechanically for certain problems do not work in the nuanced scenarios of helping real people. ...
The use of the monomyth to shape the narratives of fiction with deep meanings, while feeling both new and recognizable, is consistently experienced across all cultures throughout time. As past publications have utilized this approach to subconscious symbolism to explain many experiences, it has not yet been utilized to explain the process of counselor development. The structures utilized in this exploration of the Hero’s Journey concept include the seminal work Hero with a Thousand Faces by Joseph Campbell (1949) being applied to the structure of counseling development as reviewed by Rønnestad and Skovholt (2003). Each stage of the journey will be translated into an understanding of how students grow from before their master’s program through their senior years as experts in the counseling field. The following article will engage this metaphor to explore the narrative of a counseling student on their quest to become a counseling professional through use of the stages from the monomyth as used to describe the Hero’s Journey.
Mental health clinicians (MHCs) are at known risk for adverse outcomes such as compromised well-being, mental health challenges, burnout, and secondary traumatic stress. Prior research has identified demographic and work-related risk factors, but fewer studies have examined personal capacities that might reduce risk and simultaneously promote MHC well-being. Research is also needed on the interplay between these factors and wider contextual influences. This mixed methods study explored MHC functioning and factors contributing to their experiences coming out of the COVID-19 pandemic. We used a concurrent triangulation design and collected cross-sectional survey data between 2022 and 2023 from a U.S. sample of MHCs (N = 116). Latent profile analysis identified four distinct profiles on indicators for self-compassion, differentiation of self, burnout, well-being, and work-related secondary traumatic stress. Concurrently, we used reflexive thematic analysis to analyze MHCs’ responses to open-ended questions about their experiences, including (a) work-related situations that contributed to overwhelm, fear, and/or helplessness, (b) what they found challenging about their work, (c) what fueled or sustained them to continue in their work, even under stressful conditions, and (d) and what they needed to thrive. Finally, we integrated latent profile analysis and qualitative findings. Our findings signal the potential benefits of holistic MHC development for mitigating risk and supporting well-being, as well as highlighting how systemic ingenuity will be necessary to address the organizational and contextual factors compounding risks when working with distressed and traumatized populations. Implications and directions for future research are discussed.
Family and social support can enhance our perception of our ability to cope with stressful life events, as well as our psychological flexibility and mental well-being. The main goal of this unique study was to explore how a complex interplay of family, social, and personal factors contribute to mental well-being and life satisfaction. We hypothesized that differentiation of self (DoS) and social support (from family, friends, and significant others) would be positively associated with mental well-being and life satisfaction through the mediation of resilience. The sample included 460 participants (mean age 45.2; 236 males), who filled out questionnaires examining DoS, social support, resilience, mental well-being, and life satisfaction. In light of gender disparities evident in both existing literature and the current study, we analyzed the model separately for women and men. The findings revealed a mediation model, indicating that resilience mediated the relationship between two dimensions of DoS (emotional reactivity and I-position) and mental well-being for males, while DoS and social support contributed to women’s mental well-being without the mediation of resilience. Two factors emerged as contributors to improved mental well-being and life satisfaction: DoS and social support. Specifically, DoS was deemed important for both men and women, while social support emerged as a crucial dimension mainly for women.
In clinical work with families in which a young person is at real and significant risk of self‐harm or even death by suicide, predictable emotional triangles both within the family and within the treating system intensify. As understandable fear and worry in parents and clinicians rises in response to potential risk, these emotionally driven relational processes become even more rigid. This typically results in a reduction in cognitive and behavioural flexibility, which can potentially and unwittingly increase the risk of self‐harm by suicide. This article outlines some basic principles pertaining to the notion of emotional triangles, a central concept in Bowen family systems theory; its relevance for clinicians working with suicidal youth and their families; and its application to the context of a community child and youth mental health service. Practical application of theory to clinical work is demonstrated through clinical vignettes that describe the work of two clinicians and their clinical supervisor. The authors reflect on their understanding of the development of emotional triangles in the vignettes presented alongside their efforts to navigate these triangles through the regulation of their own anxiety and more objective thinking.
Family violence is becoming increasingly visible in Australia, with many state and federal governments taking on more responsibility to address family violence and its impacts on those affected. Current efforts are focused on practice frameworks, identifying and responding to risk factors, and social justice frameworks including legislating against family violence in a range of jurisdictions and addressing more broadly the structural and cultural forces that perpetuate violence and further oppress those victimised. Family violence is not unique to Australia, with prevalence rates internationally suggesting family violence occurs irrespective of country, race, age, culture, effectiveness of social policies or socioeconomic status. This paper explores relevant foundational concepts of Bowen family systems theory (BFST) as it relates to family violence and explores opportunities to evolve practice in this area. BFST offers a unique contribution towards addressing family violence, particularly in relation to the public health challenge of addressing family polyvictimisation. The paper also explores how BFST conceptualises family violence and the role of the professional in working with the family as a single emotional unit. The unique focus of BFST on observing and defining self within the emotional family unit through observation of the underlying multigenerational emotional patterns of functioning provides unique opportunities to evolve and develop both the capacity of clinicians and responses to families who are navigating the serious and challenging impacts of family violence.
Introduction to Family Processes: Diverse Families, Common Ties serves to provide an explanation of the complex workings of inner family life. The text primarily focuses on family processes and dynamics (the "inside" of families) as opposed to sociological trends, political topics, or the individual psychological approach. The text further presents the research underlying these processes and effectively presents ways to increase the positive aspects of family life. Great book for introduction to family classes, as well as overview for graduates/professionals working with families.
https://www.routledge.com/Introduction-to-Family-Processes-Diverse-Families-Common-Ties/Bodman-Van-Vleet-Day/p/book/9781138312876
The COVID-19 pandemic has changed the narratives in many facets of human activities including romantic relationships. As such, this study sought to investigate if COVID-19 stress affects relational resilience among romantic partners. Using the relational resilience theory which has an interpersonal communication theory, we engaged 510 married individuals with self-administered survey questions that elicited information regarding their stress levels, depressive symptoms, anxiety, and coping processes with relational resilience.
This chapter outlines the structure and therapeutic foundation for a play-based bereavement center geared toward children and families experiencing grief. Organizational structure and duties are discussed along with information regarding developing a playful facility including art/expressive writing, music, drama, symbolic play, and emotional regulation and release therapeutic opportunities. The author focuses on the supervision and training of community volunteers and counselors-in-training to increase positive outcomes and drive sustainability.
The world we live in involves the fact that terrible things happen to people, often perpetuated by other humans. We hear about tragedies in detail and are required to be present with a number of different intense emotions in others as well as ourselves. Trauma is contagious, and as witnesses to suffering, working with traumatized people can take a toll on our minds, bodies, and spirits. I will describe vicarious trauma, compassion fatigue, and secondary traumatic stress and the impact of trauma work on our personal and professional lives. As therapists, we bring unique strengths and vulnerabilities to our clinical work. Self-care is vital to manage the impact of our exposure to trauma and to prevent burnout.
This chapter outlines the structure and therapeutic foundation for a play-based bereavement center geared toward children and families experiencing grief. Organizational structure and duties are discussed along with information regarding developing a playful facility including art/expressive writing, music, drama, symbolic play, and emotional regulation and release therapeutic opportunities. The author focuses on the supervision and training of community volunteers and counselors-in-training to increase positive outcomes and drive sustainability.
This article presents 3 different studies of in-session changes in emotionally focused couples therapy (EFT). Studies of in-session conflict events demonstrate both that couples’ conflict interaction at the end of treatment is more affiliative and interdependent than at the beginning of treatment and that peak session conflict interaction is deeper in level of experience and more affiliative than the interaction in poor session conflict episodes. In addition, events beginning with intimate, affective self-disclosure by one partner were found to involve greater affiliation in spouses’ responses to the self-disclosure than in a control event not involving self-disclosure. The possible change processes in EFT are discussed in light of these results.
Systems thinking is the ability to reason about biological systems in terms of their characteristics and can assist students in developing a coherent understanding of biology. Literature reports about several recommendations regarding teaching systems thinking, while it seems that systems thinking has not reached classroom practice. The main aim of this study was to identify design guidelines to implement systems thinking in upper-secondary biologyeducation. Based on the recommendations of literature and experience a teacher team developed, tested and evaluated two lessons in two upper-secondary biology classes (15–16 years old students, n = 26, n = 19) using Lesson Study. Lesson one focused on the application of seven system characteristics: boundary, components, interactions, input & output, feedback, dynamics, and hierarchy. Lesson two focused on the improvement of students’ understanding of the characteristics feedback and dynamics by using a qualitative modelling approach. Based on classroom observations, student products and interviews, the results suggest that a first step is made: most students are able to name and apply the seven characteristics. It seems important to pay attention to the: (1) introduction of the seven characteristics; (2) application of the characteristics in a wide variety of contexts; (3) individual characteristics; (4) explicit use of system language.
Since at least the middle of the 19th century clinicians have been interested in the symptoms expressed by individuals following exposure to situations inducing severe and chronic stress (trauma). The symptom cluster has been labelled differently over the years. The current diagnosis of post-traumatic stress disorder (PTSD) refers to these symptoms. Although not formally noted in the diagnostic categories, the literature has included much discussion of complex of PTSD (C-PTSD), also often referred to as disorders extreme stress not otherwise specific (DESNOS). The linking of PTSD and C-PTSD to early developmental environments represents an important step in understanding the individual's susceptibility to subsequent stress. The focus of clinical assistance has generally settled on the symptomatic individual. Various treatment approaches and techniques have been applied with varying results. The notion that the individual symptoms might be addressed with therapeutic processes applied beyond the individual to the relationship systems, particularly the family, in which the symptomatic individual lives and functions, has received less attention. The idea of chronic anxiety, included in Bowen's discussion of the relationship between anxiety and family relational activity (Bowen, 1978), provides a conceptual framework from which specific therapeutic processes directed to the relationship system itself can be hypothesised and implemented.
Objective:
This study comprises a first attempt to explain and predict vicarious traumatization among therapists by means of Bowen's Family Systems Theory (Bowen, 1978), especially with reference to the phenomenon "differentiation of self," a central feature of his theory.
Method:
A sample of 134 individual and group therapists who work in public and private clinics completed a series of questionnaires that provided data regarding demographic information, differentiation of self, and a belief scale that measures the existence of vicarious trauma.
Results:
The findings indicate a strong negative correlation between vicarious traumatization and differentiation of self. In addition, participant age and "being in therapy" were both found to correlate with differentiation of self and vicarious traumatization.
Conclusion:
These findings point to the importance of differentiation of self as a resilience factor protecting against vicarious trauma, and have the potential to contribute to the development of tools for efficiently and accurately assessing predisposition toward vicarious traumatization among therapists. (PsycINFO Database Record
We examined self-reported maternal and paternal harsh parenting (HP) and its effect on the moment-to-moment dynamic coupling of maternal autonomy support and children’s positive, autonomous behavior. This positive behavior coupling was measured via hidden Markov models as the likelihood of transitions into specific positive dyadic states in real time. We also examined whether positive behavior coupling, in turn, predicted later HP and child behavior problems. Children (N = 96; age = 3.5 years at Time 1) and mothers completed structured clean-up and puzzle tasks in the laboratory. Mothers’ and fathers’ HP was associated with children’s being less likely to respond positively to maternal autonomy support; mothers’ HP was also associated with mothers’ being less likely to respond positively to children’s autonomous behavior. When mothers responded to children’s autonomous behavior with greater autonomy support, children showed fewer externalizing and internalizing problems over time and mothers showed less HP over time. These results were unique to the dynamic coupling of maternal autonomy support and children’s autonomous behavior: The overall amount of these positive behaviors did not similarly predict reduced problems. Findings suggest that HP in the family system compromises the coregulation of positive behavior between mother and child and that improving mothers’ and children’s abilities to respond optimally to one another’s autonomy-supportive behaviors may reduce HP and child behavior problems over time.
Working within the framework of the Bowen’s Family Systems Theory and using data from 318 non-clinical participants, the present study assessed a model in which codependent behaviors were predicted by dyadic adjustment in couple relationships and differentiation of self. Results indicated that the dimensions of differentiation of self (I-position, emotional reactivity, emotional cutoff, fusion with others) were more important in explaining the codependent behavior compared to the dimensions of dyadic adjustment (dyadic satisfaction, cohesion, consensus, affective expression). These results suggest the importance of considering the dynamics and outcomes of the process of differentiation of self both in research and in counselling and clinical practice with individuals, couples, and families.
The aim of the current study was to identify personal and work-related risk factors for vicarious traumatization among social workers in Israel, as well as the contribution of relational-oriented supervision in mitigating the consequences of working with traumatized clients. Data was collected from 109 social workers who were employed in various agencies. Participants were asked about their personal trauma history, trauma work experience, work-related measures of trauma exposure, and supervision characteristics. Findings showed that social workers with trauma history, who worked mainly with survivors of human-induced trauma, and who had experienced more threat while working with traumatized clients, had higher levels of vicarious traumatization. Furthermore, social workers who reported they were receiving a more relational-oriented supervision and who evaluated their supervision as more effective had lower levels of vicarious traumatization. These findings suggest that beyond personal characteristics, the level of exposure to traumatized clients has a significant effect on social workers’ well-being. Additionally, these findings underscore the importance of a relational-oriented supervision in the context of trauma. Implications for social work practice are emphasized, as well as recommendations for future research.
Treating traumatized patients famously takes its toll on the treating therapist. This process has most often been called “vicarious traumatization,” although other terms have been used. The author proposes a more interpersonal term, “countertrauma.” Although countertrauma is a common occupational hazard when working with trauma victims, it is rarely discussed in depth from a personal perspective. Drawing from the author's experiences working with sexually abused men over almost three decades, he tracks his emerging conflicts and reactions to his work. These constitute his own countertraumatic as well as counterresilient reactions to engaging intimately with patients’ trauma experiences.
The present study compared secondary traumatization among child protection social workers versus social workers employed at social service departments. In addition, based on Conservation of Resources (COR) theory, the study examined the contribution of working in the field of child protection as well as the contribution of background variables, personal resources (mastery), and resources in the workers' social and organizational environment (social support, effectiveness of supervision, and role stress) to secondary traumatization. The findings indicate that levels of mastery and years of work experience contributed negatively to secondary traumatization, whereas exposure to child maltreatment, trauma history, and role stress contributed positively to secondary traumatization. However, no significant contribution was found for social support and effectiveness of supervision. The study identifies factors that can prevent distress among professionals such as child protection workers, who are exposed to the trauma of child abuse victims. Recommendations are provided accordingly.
Despite burgeoning evidence linking early exposure to child maltreatment (CM) to deficits in self-regulation, the pathways to strong regulatory development in these children are not well understood, and significant heterogeneity is observed in their outcomes. Experiences of autonomy may play a key role in transmitting self-regulatory capacity across generations and help explain individual differences in maltreatment outcomes. In this study, we investigated multigenerational associations between Generation 1 (G1)–Generation 2 (G2) mothers' early experience of warmth and autonomy in relation to their own mothers and their Generation 3 (G3) children's autonomic physiological regulation in CM (
n
= 85) and non-CM (
n
= 128) families. We found that G2 mothers who recalled greater autonomy in their childhood relationship with their G1 mothers had preschool-age G3 children with higher respiratory sinus arrhythmia at baseline when alone while engaged in individual challenge tasks, during social exchanges with their mother in joint challenge tasks, and during the portions of the strange situation procedure when the mother was present. Although no clear mediators of this association emerged, multigenerational links among G1–G2 relations, maternal representations of her child, child behavior, and child respiratory sinus arrhythmia differed by maltreatment status, thus possibly representing important targets for future research and intervention.
In recent years, there has been growing interest in examining role competence and the factors that can contribute to a sense of role competence among social workers. In the present study, we used the occupational competence model (OCM) as a basis for examining the contribution of the personal dimension (mastery, self-esteem, and secondary traumatization),environmental dimension (support systems),-and occupational dimension (exposure to the field of family violence) to the social worker’s subjective sense of role competence. Participants in the study were 214 social workers employed at centers for prevention of family violence, at shelters for victims of violence against women, and at social service bureaus. The findings indicate that in the occupational dimension, the contribution of exposure to work in the field of family violence contributed significantly to two components of the participants’ subjective sense of role competence: general sense of role competence and task knowledge/problem solving. In the personal dimension, the contribution of secondary traumatization and mastery to a sense of role competence was significant. In the environmental dimension (i.e., support systems), the specific contribution of managerial support to the participants’ sense of role competence was significant. In light of these findings, practical recommendations for developing a sense of role competence among social workers are provided.
There have been significant advances in the treatment of posttraumatic stress disorder in the last two decades. Further improvements in outcomes will be supported by recognition of the heterogeneity of symptoms in trauma populations and the development of treatments that promote the tailoring of interventions according to patient needs. Collaboration with patients regarding preferences about treatment structure, process, and outcomes is critical and will benefit the effectiveness and quality of treatments as well as the speed of their dissemination. New research methodologies are required that can incorporate important variables such as patient preferences and symptom heterogeneity without necessarily extending already lengthy study times or further complicating study designs. An example of alternative methodology is proposed.
The negative psychological impacts of working with traumatised people are well documented and include vicarious traumatisation (VT): the cumulative effect of identifying with clients' trauma stories that negatively impacts on service providers' memory, emotions, thoughts, and worldviews. More recently, the concept of vicarious resilience (VR) has been also identified: the strength, growth, and empowerment experienced by trauma workers as a consequence of their work. VR includes service providers' awareness and appreciation of their clients' capacity to grow, maintaining hope for change, as well as learning from and reassessing personal problems in the light of clients' stories of perseverance, strength, and growth. This study aimed at exploring the experiences of mental health, physical healthcare, and settlement workers caring for refugees and asylum seekers in South Australia. Using a qualitative method (data-based thematic analysis) to collect and analyse 26 semi-structured face-to-face interviews, we identified four prominent and recurring themes emanating from the data: VT, VR, work satisfaction, and cultural flexibility. These findings-among the first to describe both VT and VR in Australians working with refugee people-have important implications for policy, service quality, service providers' wellbeing, and refugee clients' lives.
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This study aims to challenge the current conception of secondary traumatization (ST) as a pathological response of therapists working with trauma victims. One hundred two experienced therapists in both public and private practice, treating adult victims of childhood sexual abuse, participated in the study. The results support the main premise of the study; namely, high levels of posttraumatic growth (PTG) are positively associated with therapist ST symptoms, with levels of both positive and negative experiences related to exposure to the abuse in the context of therapy. These results imply that trained therapists might anticipate and process ST and other personal negative responses as a beneficial and empowering phase of therapy, thus ultimately perceiving them positively.
Working with survivors of trauma is mostly challenging, exhausting, long-term and often ‘messy’, when interventions that ‘should’ work, don't, or the unexpected arises. Nevertheless, explanations that speak to recovery from trauma more and more rely on neurobiological concepts to account for any positive change. Combining the family systems approach of Murray Bowen and recent research on the brain and trauma, post trauma symptoms are viewed as part of the ‘family emotional process’ even when traumatic events have emanated from outside the family system itself. Variations in responses to trauma, including dissociation and self-harm are discussed in relation to chronic anxiety and ‘differentiation of self’.
In a comparative qualitative study of 13 organizations worldwide working with survivors of extreme trauma, the relationship between work-related stress and conflict and the structure of the organization is examined. Seventy-two caregivers, supervisors, and experts are interviewed and external organizational analyses and capacity assessments analyzed. The results show that organizations with high stress and conflict levels exhibit considerable structural deficiencies and an atmosphere shaped by a reenactment of the traumatic world of clients. This chaotic, unstructured, unpredictable environment parallels the total absence of structure that exists when a victim is at a perpetrator’s disposal. Organizations with low stress and conflict levels, however, prove to have fairly clear organizational structures. The results of this study show that structural shortcomings are an important source of work-related stress and conflict in organizations dealing with extreme trauma. Furthermore, the study raises the question whether the stress symptoms experienced by caregivers amount to a diagnosis of “secondary” or “vicarious traumatization.” Caregivers in organizations with structural deficiencies show symptoms described by others as secondary traumatization. However, these symptoms subside after organizational transformation and structural improvement. It is found that caregivers in well-structured organizations exhibit almost no such symptoms.
The purpose of this article is to identify how Bowen family systems theory may be incorporated into individual counseling with adolescents when family involvement is not possible or contraindicated. Outcome and basic research supporting the application of Bowen family systems theory is reviewed. Specific clinical interventions for counseling adolescents that derive from Bowen family systems theory are provided, and a case study demonstrating these clinical interventions is presented.
The authors examine the role of Bowen family systems theory in predicting physical child abuse potential. Relations between differentiation of self, perceptions of personal problem-solving skills, and child abuse potential were tested in a sample of 210 single young adults who were not yet parents. Greater differentiation of self—that is, lower reactivity, emotional cutoff, or fusion with others, and better ability to take “I” positions in relationships—along with better problem-solving skills, predicted lower physical child abuse potential. Those undecided with respect to college major reported lowest levels of differentiation and highest child abuse potential. Implications for counseling, limitations, and directions for further research are discussed.
There is burgeoning interest in secondary traumatic stress, compassion fatigue, and self-care in the helping professions. This multimethod study focused on therapists' stress and coping in their work with trauma survivors, identifying factors related to resilience and burnout. Semistructured interviews were conducted with 20 clinicians subscribing to a systems perspective, and 104 clinicians were administered a questionnaire inquiring about their caseloads, trauma history, coping styles, emotional self-awareness, work stress, compassion satisfaction, compassion fatigue, and burnout. Interview data demonstrated that therapists detect job stress through bodily symptoms, mood changes, sleep disturbances, becoming easily distracted, and increased difficulty concentrating. Self-care strategies included processing with peers/supervisor, spirituality, exercise, and spending time with family. In the quantitative study, social support, work hours, and internal locus of control accounted for 41% of the variance in compassion satisfaction. Multiple regression procedures accounted for 54% of the variance in compassion fatigue and 74% of the variance in burnout. Implications for clinical training and organizational policy are discussed.
Parent-Child Interaction Therapy (PCIT) is an empirically supported treatment for conduct-disordered young children in which parents learn the skills of child-directed interaction (CDI) in the first phase of treatment and parent-directed interaction (PDI) in the second. This study examined the long-term treatment outcome for 13 families who had participated in a treatment study examining the effects of treatment phase sequence one and two years earlier. Seven families were in the CDI-First treatment group and six families were in the PDI-First group. Immediately after treatment, 11 of the 13 families had achieved clinically significant changes on both observational and parent report measures, and there is no significant difference between treatment groups. Treatment effects were maintained at one-year follow-up for eight of the 13 families, and at two-year follow-up for nine families, with no long- term impact of phase sequence evident at either follow-up assessment. This study represents the first long-term follow-up of families treated with PCIT. Results suggest that this treatment may be successful in achieving long-term gains for most families of conduct-disordered preschoolers and that phase sequence has little impact on treatment outcome.
Explores the ways in which psychotherapists function as attachment figures for their patients. The history of attachment theory is reviewed, and the work of J. Bowlby (1969, 1973) is cited. The role of the therapist is evaluated in terms of being a secure base for exploration, an insurer of survival, and an object of intense affect. Although there are multiple commonalities between childhood attachments and the patient–therapist relationship (e.g., the provision of a secure base for exploration), the latter relationship is necessarily mediated by unique temporal, financial, structural, and ethical boundaries that render it significantly different from childhood attachment relationships. Viewing the therapist as an attachment figure can offer new perspectives on therapeutic work, particularly with boundary issues. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Circle of Security (COS) Project is a 20-week, group-based, parent intervention program designed to alter the developmental pathway of at risk parents and their young children (Marvin, Cooper, Hoffman, & Powell, 2002). As the demand for early intervention intensifies, the call for effective, evidence-based, systematic treatment protocols is becoming more urgent. In response to that call, attachment theory and research have spawned an increased number of early childhood intervention programs (see Bakermans-Kranenburg, van IJzendoorn, & Juffer, 2003; Berlin, Chapter 1, this volume; Egeland, Weinfeld, Bosquet, & Cheng, 2000; and Lieberman & Zeanah, 1999, for reviews). The COS was developed to enhance relationships between young children and their parents or caregivers, what we term "attachment-caregiving relationships." To reach this goal, we integrated congruent developmental theories and object relations theory into the protocol (see, e.g., Schore, 1994). The COS was field-tested with Head Start/Early Head Start child-caregiver dyads (see, e.g., Cooper, Hoffman, Marvin, & Powell, 2000). Neil Boris and Sherry Heller at Tulane University are currently replicating the work within an experimental design; variations of the COS protocol are being implemented and tested in various sites across the country. In developing this protocol, one of our primary goals has been to incorporate advances in attachment theory and research into the actual intervention process, as well as to use attachment-based procedures for measuring outcome of the intervention. In an earlier paper (Marvin et al., 2002), we presented the general conceptual framework and a detailed description of the intervention protocol. Because the COS intervention utilizes a simple and intuitive approach to teach parents sophisticated theoretical concepts, on first view the protocol itself may appear simpler than it actually is. In this chapter, we begin with a brief description of the complex and multifaceted COS approach, and then focus on four specific principles and the COS procedures that follow from each of these principles. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article provides the theoretical rationale and overview of a neurodevelopmentally-informed approach to therapeutic work with maltreated and traumatized children and youth. Rather than focusing on any specific therapeutic technique, the Neurosequen-tial Model of Therapeutics (NMT) allows identification of the key systems and areas in the brain which have been impacted by adverse developmental experiences and helps target the selection and sequence of therapeutic, enrichment, and educational activ-ities. In the preliminary applications of this approach in a variety of clinical settings, the outcomes have been positive. More in depth evaluation of this approach is warranted, and is underway. Over the last 30 years, key findings in developmental neurobiology have informed and influenced practice in several clinical disciplines, includ-ing pediatrics, psychology, social work, and psychiatry. Despite this influ-ence, the capacity of these large clinical fields to incorporate and translate key neurobiological principles into practice, program, and policy has been inefficient and inconsistent. The purpose of this article is to present prelimin-ary efforts to integrate core concepts of neurodevelopment into a practical clinical approach with maltreated children. This neurosequential model of therapeutics (NMT) has been utilized in a variety of clinical settings such as therapeutic preschools, outpatient mental health clinics, and residential treatment centers with promising results (Perry, 2006; Barfield et al., 2009).
Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism, and inefficacy. The past 25 years of research has established the complexity of the construct, and places the individual stress experience within a larger organizational context of people's relation to their work. Recently, the work on burnout has expanded internationally and has led to new conceptual models. The focus on engagement, the positive antithesis of burnout, promises to yield new perspectives on interventions to alleviate burnout. The social focus of burnout, the solid research basis concerning the syndrome, and its specific ties to the work domain make a distinct and valuable contribution to people's health and well-being.
This study tested relations between differentiation of self, adult attachment, and effortful control in a sample of 225 adults. Results indicated that adult differentiation of self uniquely predicted greater effortful control, after accounting for variance due to attachment security. Greater ability to take I positions in relationships, along with lower emotional reactivity (ER) and attachment anxiety, were unique predictors of effortful control. Significant relationships emerged between dimensions of attachment and differentiation of self, with strongest associations observed between attachment avoidance and emotional cutoff (r = –.78), and attachment anxiety and ER (r = –.60).
Our study dealt with the positive and negative implications of working with victims of family violence on therapists in terms
of secondary traumatization, vicarious traumatization, and growth. In addition, we examined positive and negative changes
that the therapists experienced in themselves, their lives, and their families as a result of their work. The research population
consisted of 143 social workers employed in the field of family violence, and 71 social workers who were not employed in that
field. Comparisons between the two groups were conducted for all of the research variables. The two groups did not differ
significantly in levels of secondary traumatization. However, significant differences were found in levels of growth, as well
as in levels of positive and negative changes that the participants experienced in themselves, their lives, and their families.
This study examined underlying similarities between the Personal Authority in the Family System Questionnaire (PAFS; Bray, Williamson, & Malone, 1984a) and the Differentiation of Self Inventory (DSI; Skowron & Friedlander, 1998). Generalized least-squares factor analysis yielded two related factors, Self Regulation and Interdependent Relating, accounting for 60% of the variance in the solution. Greater Self Regulation—comprised of DSI scales characterized by less emotional reactivity and the ability to take an I position in relationships—and Interdependent Relating—marked by greater personal authority, intergenerational intimacy and less intergenerational fusion on the PAFS and less emotional cutoff on the DSI—predicted well-being among both women and men. Implications for family therapy and suggestions for future research are discussed.
This study examined relations between cardiac reactivity, family violence exposure (i.e., child maltreatment [CM] and inter-partner violence [IPV]), and preschool children's emotional adjustment. A sample of 92 mother-preschooler dyads was drawn from predominantly low-income, rural communities. Dyads participated in a laboratory session in which children's Electrocardiograph (ECG) monitoring occurred during a resting baseline, joint-challenge, and individual emotional and cognitive tasks. Mothers consented to review of Children & Youth Services (CYS) records for CM and completed an IPV measure. Mothers rated children's emotional adjustment, and observers rated children on their frustration and positive affect. Children's vagal suppression was shown to moderate relations between family violence exposure and emotional adjustment. Findings indicated that children greater in vagal suppression showed better emotional adjustment when from families low in violence. However, regardless of children's level of vagal suppression, all children showed poorer emotional adjustment when from families high in violence.
Objectives:
The study investigated the relationship between exposure to trauma work and well-being (general psychological distress, trauma symptoms, and disrupted beliefs) in trainee clinical psychologists. It also assessed the contribution of individual and situational factors to well-being.
Design:
A Web-based survey was employed.
Methods:
The survey comprised the General Health Questionnaire, Secondary Traumatic Stress Scale, Trauma and Attachment Belief Scale, Trauma Screening Questionnaire, and specific questions about exposure to trauma work and other individual and situational factors. The link to the online survey was sent via email to trainee clinical psychologists attending courses throughout the UK RESULTS: Five hundred sixty-four trainee clinical psychologists participated. Most trainees had a caseload of one to two trauma cases in the previous 6 months; the most common trauma being sexual abuse. Exposure to trauma work was not related to general psychological distress or disrupted beliefs but was a significant predictor of trauma symptoms. Situational factors contributed to the variance in trauma symptoms; level of stress of clinical work and quality of trauma training were significant predictors of trauma symptoms. Individual and situational factors were also found to be significant predictors of general psychological distress and disrupted beliefs.
Conclusions:
This study provides support for secondary traumatic stress but lacks evidence to support belief changes in vicarious traumatization or a relationship between exposure to trauma work and general psychological distress. The measurement and validity of vicarious traumatization is discussed along with clinical, theoretical implications, and suggestions for future research.
Practitioner points:
Secondary traumatic stress is a potential risk for trainee clinical psychologists. Training courses should (a) focus on quality of trauma training as it may be protective; (b) advocate coping strategies to reduce stress of clinical work, as the level of stress of clinical work may contribute to trauma symptoms.
Limitations include:
Exposure to trauma work only uniquely explained a small proportion of variance in trauma symptoms. The study was cross-sectional in nature therefore cannot imply causality.
No one has a definitive answer as to why the same parents often raise children that turn out very differently, but it happens time and again. I grew up in such a family. One of my brothers never “lifted off ” to function independently of my parents. Occasional forays towards independence invariably ended in some type of crash and burn. He would lose a job, get sick, or be terribly lonely. My parents would again take care of him. He was a source of great anguish for my family. My other two brothers and I coped and assumed adult responsibility more easily. How to understand this? My parents were good, hard-working people and dearly loved all of their children.
In my practice as a psychiatrist specializing in treating families, I routinely consult with parents who are having more difficulty raising one child than the others. The child is usually having some mixture of academic, behavioral, or health problems. Whether he is the oldest or the youngest child, the parents often say that he or she seems less mature, more insecure, more intense, more sensitive, or more dependent than their other children. They are worried and usually at their wits' end about how to help their son or daughter.
The differences between siblings are not always marked, but statistical studies show that significant disparities in the overall life adjustment of siblings are more the rule than the exception.
The issue of gender is largely ignored in studies of secondary traumatization (STS). This article addresses the question of gender differences in susceptibility to STS among clinicians who treat traumatized clients. It does so by systematically reviewing the very limited body of published findings on this subject to date. These are 10 published studies that measure STS by post-traumatic stress disorder (PTSD) symptomatology and 4 studies that measure it using Stamm's Professionals Quality of Life Survey (ProQOL), which queries PTSD symptomatology along with other difficulties that may arise in helping traumatized clients. Almost all the studies based on PTSD symptomatology show greater female susceptibility. Although the pattern is less clear in the ProQOL studies, the article argues that the research to date does not really show mixed findings, as is repeatedly claimed, but greater susceptibility among female clinicians. It also points out that the findings do not mean that male clinicians are unaffected by their traumatized clients and notes the various manifestations of their distress reported in the reviewed studies. The article offers a variety of explanations for the heightened female susceptibility.
© The Author(s) 2015.
The following values have no corresponding Zotero field:
ID - 47
The following article provides a comprehensive guide to the clinical implementation of the Safety First Assessment Intervention (SFAI). The SFAI is a systemised, whole family approach for young people with high-risk issues presenting in a mental health crisis. It is underpinned by the Safety First Model (Bickerton et al., 2007) and promotes community-based care. The SFAI operationalises the foundation levels of the Safety First Model (SFM) through a highly structured clinical process. It draws on family systems theory, predominantly the work of Bowen (1978), to conceptualise distress through a multi-generational systems lens and to prioritise the young person's natural support system (their family, friends, school and community) as their key resource. The SFAI engages this natural support system and facilitates open communication about symptoms, distress, safety and risk. This promotes a shared understanding of the key issues in a relational context and forms the basis of collaborative risk management. Thus, a system of safety emerges prioritising the family's role in optimising the young person's community-based recovery. The need for pharmacotherapy and hospitalisation is therefore minimised. The article includes background theory, an outline of the structured assessment intervention and clinical techniques, including strategies for complex family situations. Specific strategies are illustrated with fictional vignettes. The work is based on the authors' accumulated experiences of working with young people and their families and carers in an acute Child and Adolescent Mental Health Service (CAMHS) for over a decade.
The latest iteration of the posttraumatic stress disorder (PTSD) criteria presented in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes specific elaborations of the gatekeeper criteria, a new category of stressor, an expansion in the number of symptoms, addition of a new subtype of PTSD, and an enlarged text discussion that breaks new ground in defining the criteria. We first trace the rationale underlying these changes and their impact on the prevalence of PTSD diagnoses in clinical studies and then present potential implications of the new criteria for forensic assessment methodology and the detection of malingering, interpretations of criminal responsibility and mitigation, evaluation of the reliability of witnesses, the scope of claims in civil and employment cases, and eligibility for disability.
According to Maruska and Perry, talent development “remains mired in nineteenth‐century top‐down thinking.” People should take charge of their own development, an outcome that leaders should welcome. A seven‐point manifesto is provided, with the areas of using untapped talents and opportunities, accessing hopes to drive better results, becoming talent catalysts for one another, tapping into abundant resources, using time creatively and productively, creating a self‐organizing culture that leads to fulfillment, and using the “See one, do one, teach one” approach. Hope “can be a practical and powerful way to tap the passion, energy, and creativity that lie within us,” the authors write.
This study examined concordance in heart rate (HR) and respiratory sinus arrhythmia (RSA) in a sample of 104 child-maltreating (CM) and nonCM mother-preschooler dyads (208 individuals). In a laboratory setting, mother and child cardiac physiology was simultaneously monitored via ECG in a 5-min resting period. Mothers ranged in age from 20 to 49 years; children ranged in age from 3 to 5 years. Significant within-dyad (WD) and between-dyad (BD) associations were observed for mother HR and both child HR and RSA, and the associations were moderated by CM status. Only CM dyads exhibited BD associations: Higher average maternal HR was associated with higher child HR and lower child RSA. By contrast, when the time interval was divided into 30 s epochs, nonCM dyads exhibited positive WD (dynamic) associations in mother and child HR, and both CM and nonCM dyads showed negative WD associations in mother HR and child RSA. Further, mothers' mean HR levels moderated the extent of epoch-by-epoch WD concordance observed in mother and child, such that elevated average maternal HR was associated with lower levels of WD (dynamic) concordance. No BD or WD concordance in maternal and child RSA was observed. The findings suggest that measures of intraindividual variation provide useful, alternate perspectives in the study of dyadic processes in at-risk families. © 2013 Wiley Periodicals, Inc. Dev Psychobiol.
This research considers the role of communicative responsiveness, empathic concern, and emotional contagion as precursors to burnout among human service workers. Theory and research drawn from the areas of stress and burnout, empathy, and patient‐doctor communication are used to formulate a causal model of the burnout process. The model is tested with data from employees at a large psychiatric hospital. The results indicate that empathic concern leads to communicative responsiveness but that emotional contagion decreases responsiveness. Communicative responsiveness, in turn, leads to the prediction of three dimensions of burnout and occupational commitment. The implications of the model for theory and practice are discussed.
The purpose of this investigation was to test whether differentiation of self in couple members affected the trajectories of marital satisfaction, marital commitment, and individual well-being across the early sessions of therapy while taking into account the level of distress the couple was experiencing. The sample consisted of 127 couples seeking services at an on-campus couple and family therapy clinic. A latent growth curve modeling approach was used for data analysis. Even though differentiation of self or distress levels were not found to be predictive of change in marital satisfaction, commitment, or well-being, for both husbands and wives higher levels of differentiation were predictive of lower distress scores and higher baseline scores for well-being. Higher levels of distress were associated with lower levels of marital satisfaction for both husbands and wives. When there was a change in commitment, both husbands and wives seemed to change together. Implications of the results for clinical practice and future research are discussed.
Previous investigations of the impact of trauma-related psychotherapy on clinicians have emphasized the hazardous nature of such work. The present study is the first exploration of clinicians’ perceptions of trauma work to investigate in depth the positive consequences of working with trauma survivors. A sample of 21 psychotherapists participated in a naturalistic interview exploring the impact of trauma work with a particular focus on (a) changes in memory systems and schemas about self and the world (the hallmarks of vicarious traumatization) and (b) perceived psychological growth. In addition to reporting several negative consequences, all of the clinicians in this sample described positive outcomes. These descriptions of positive sequelae are strikingly similar to reports of growth following directly experienced trauma and suggest that the potential benefits of working with trauma survivors may be significantly more powerful and far-reaching than the existing literature’s scant focus on positive sequelae would indicate.
The concept of self-soothing originating in the psychodynamic tradition has attracted interest from therapists as a key skill in the managing and regulating of strong affect and emotional discomfort. While a capacity for self-soothing is implicit in, and a vital prerequisite to, the process of differentiation, Murray Bowen also predicted that the outcome of increased differentiation is improved emotional equilibrium and a capacity for self-soothing, clearly a recursive process. The attention of Bowen family systems theory to both the relational and intrapsychic aspects of human functioning provides a useful framework through which to explore these aspects of the dynamics of self-soothing. This article describes some of the key processes involved in developing a self-soothing capacity within an effort to define a more autonomous self in significant relationships. The author contrasts Family Systems thinking with other theoretical perspectives that speak to the importance of self-soothing. Finally, the role of the therapist as a facilitator of an environment in which the self-soothing resources of clients can emerge is considered alongside suggestions and strategies for how a therapist may contribute to a client's own efforts.
"Trauma and the Therapist" explores the role and experience of the therapist in the therapeutic relationship [with adult incest survivors] by examining countertransference (the therapist's response to the client) and vicarious traumatization (the therapist's response to the stories of abuse told by client after client). Therapists' awareness of attunement to these processes will inform their therapeutic interventions, enrich their work, and protect themselves and their clients. The authors also offer many strategies for avoiding the countertransference vicarious traumatization cycle.
The authors' approach is broad, drawing from and synthesizing the diverse literature on countertransference and trauma theory. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In response to a study of Canadian child welfare workers that unexpectedly found participants scoring high on a measure of emotional exhaustion (burnout) and, at the same time, high on overall job satisfaction, this paper reviews research that has investigated these constructs in the social work literature as well as in selected studies from sociology, social psychology, management and women’s studies. The review reveals that some previous studies also report the coexistence of high levels of emotional exhaustion and strong job satisfaction in child welfare and social worker samples. Several studies have suggested that individual characteristics, including finding reward in helping others, having a commitment to the mandate of child welfare and believing that one’s labour is ‘making a difference’, contribute to satisfaction with child welfare work in spite of work overload and emotional exhaustion. Attributions regarding causes of exhaustion, coping strategies and goal orientation may also attenuate the expected negative effects of emotional exhaustion. Considerable evidence supports the positive influence of variables organizational managers can control, including job autonomy, supportive supervisors, workload, promotional opportunities and perception of personal safety. The degree to which this phenomenon is associated with female socialization and the ‘ethic of care’ underlying social work is discussed. Implications for child welfare research, practice and policy are offered.
Job stress, perceived social support, coping self-efficacy, and coping strategies were studied as predictors of emotional
exhaustion and reduced personal accomplishment among a sample of 123 female shelter workers. Overall, these workers did not
meet the collective criteria for burnout as defined by Maslach and Jackson (1986) and perceived social support and coping strategies did not account for unique variance in the prediction of emotional exhaustion
and reduced personal accomplishment. Rather, high levels of time pressure and low levels of self-efficacy for being productive
at work were identified as predictors of emotional exhaustion. Personal accomplishment was predicted by time pressure and
robust levels of self-efficacy for dealing with stressors at work.
Within the context of their new constructivist self-development theory, the authors discuss therapists'' reactions to clients'' traumatic material. The phenomenon they term vicarious traumatization can be understood as related both to the graphic and painful material trauma clients often present and to the therapist''s unique cognitive schemas or beliefs, expectations, and assumptions about self and others. The authors suggest ways that therapists can transform and integrate clients'' traumatic material in order to provide the best services to clients, as well as to protect themselves against serious harmful effects.
Presented here is a family theory of emotional illness and its component system of family psychotherapy, which is one of several different theoretical approaches to the family, and one of many different kinds of “family therapy” that have come on the psychiatric scene in little more than one decade. A brief review of the family movement attempts to put this system into a kind of perspective with the overall family movement. Since this system places maximum emphasis on “family” as a theoretical system, the theory has been presented in some detail. The shorter section of family psychotherapy presents both broad principles and specific details about the usefulness of family concepts in clinical practice.