Back To Blog > Self-Care for Case Managers Dealing With Traumatised Individuals

This post is by Dr Sandi Mann of Sparta Health

Trauma is arguably unique amongst mental health conditions in that others can ‘catch’ it vicariously.  It is true that all emotions are contagious in some way and that therapists, carers and case managers can pick up the mood of their client if effective boundaries are not in place (and sometimes even if they are), but trauma goes well beyond this. A clients’ trauma can leap across the most robust of boundaries and in some cases, even produce PTSD-like symptoms in a person who was never exposed to the trauma themselves.  Case managers who hear the stories of trauma from their clients can sometimes feel overwhelmed and may even experience some of the same feelings that their clients do. They can sometimes hear such disturbing tales that this can affect their own functioning, with intrusive thoughts, images, and sleep disturbances plaguing them. Anyone who engages empathetically with traumatised individuals can develop ‘vicarious’ or secondary trauma – so self-care is essential for all Case Managers involved with such clients.

According to the British Medical Association some of the most common signs of vicarious trauma include:

  • becoming overly involved emotionally with the client
  • experiencing bystander guilt, shame, feelings of self-doubt
  • being preoccupied with thoughts of patients outside of the work situation
  • over identification with the client (e.g. having horror and rescue fantasies)
  • difficulty in maintaining professional boundaries with the client, such as overextending self (trying to do more than is in the role to help the client).
  • Loss of sense of personal safety and control

The real key to vicarious trauma is that there is some shift in thinking in the carer – some change in their belief in the safety and security of the world or of themselves.

Self care for case managers dealing with traumatised individuals involves intervention and awareness at two points; at the prevention stage and at the management stage.

Self-care to reduce the risks of vicarious trauma

Many case managers have to work with traumatised clients but there are important self-care measures that you can adopt to minimise the risk of ‘catching’ some of their trauma. Research carried out following 9/11 suggested that those workers most susceptible to VT were those with a history of personal trauma, fewer years of professional experience, fewer hours of individual supervision, and larger caseloads 1. This suggests an interaction between the individual, the organisation and life situation factors.  Thus self-care would seem to be especially important for less experienced case managers and those with their own history of trauma.

The first step to self-care is to become better at self-monitoring; case managers might be so busy observing their clients for red flags that they forget to check their own mental health. Watch out for any of the signs listed above. It is also important to manage your case load, as the 9/11 research suggests, and if a smaller caseload is not feasible, then trying not to have too many traumatic cases can help. A strong work-life balance is essential to minimise risk. If possible try to ensure that you have regular breaks away from work and that you have a good mix of other interests and hobbies. These can ground you so that you don’t become too absorbed in the problems of your clients; other interests that engage you pull you away from their world of trauma and into your own world of safety.

A trap that case managers can fall into is trying to be the hero by ‘saving’ the client.  Accepting that they can’t make things right but only better (hopefully) is a vital step in self-awareness. It is about being realistic about what can be accomplished; having a mentor, buddy or peer support can help with the balancing act.

Self-care to manage vicarious trauma once it develops

Many case managers who might recognise their vicarious trauma make the mistake of being very dismissive of their own reactions and feel that they have no right to experience them given the very real trauma that their client went through. Recognising and validating your own feelings and reactions is thus essential to developing vicarious resilience.

Peer support is very useful in managing reactions to dealing with people’s trauma. It can be hard to work through feelings in isolation so having plenty of opportunity to discuss, chat, validate, explore – and even laugh (humour is very important) can be vital to nurture a case manager working with traumatised individuals. Experienced emotions can be very confusing; the case worker who is experiencing compassion fatigue (see next section) might feel very different from the one having intrusive and disturbing thoughts – but both are normal. Discussing emotional reactions can help normalise them.

Compassion Fatigue

A word must also be said about the compassion fatigue that often characterises those who are exposed to so much distress from clients that they are unable to find time to engage in the sort of self-care that protects them from getting burnt out. Compassion fatigue does not typically involve a change in thinking or an experiencing of any PTSD symptoms, but it can lead to physical and mental exhaustion. It is often characterised by a reduction in feelings of caring so it is essential to be on the lookout for signs such as:

  • Being increasingly irritated by distressed clients
  • Seeing clients as numbers to be processed rather than people
  • Increasing feelings of disconnect from clients
  • Feeling guilty about the above symptoms

If you notice these signs take action; prioritise your own self-care with exercise, sleep, healthy diet, engaging hobbies, journal writing, social networks etc.

A final word for those ‘too busy’

In my experience those people most susceptible to compassion fatigue or vicarious trauma tend to be the ones who give so much to others that they have little time or energy left for their own self-care. Self-care should not be seen as a luxury but as an essential part of being able to deliver good quality care, especially when working with traumatised clients.

About Dr Sandi Mann 

Dr Sandi Mann is part of the Clinical Advisory Team at Sparta Health, in addition to being a highly experienced Chartered Psychologist with over 15 years’ experience working in the NHS and private sector.

Sandi, described by her peers as a one of the most practical experts in her field, has a Doctorate in Psychology, Masters in Organisational Psychology, BSc in Psychology and Diploma in CBT.

Sandi is an Associate Fellow of the British Psychological Society and an Accredited EMDR Practitioner and member of the EMDR Association UK and Ireland. Sandi’s specialisms include panic, phobias, anxiety conditions, OCD, PTSD and depression.

Sandi has published (Hodder & Stoughton) various self-help psychology books; is a columnist for the British Association of Counselling and Psychotherapy (BACP) journal Counselling at Work and is an invited speaker at conferences across the UK. She appears regularly in the media as an expert psychologist and is the Module Leader for MSc Applied Clinical Psychology and BSc Clinical Psychology at the University of Central Lancashire.

References

  1. Quitangon, Gertie & St. Cyr, Kate & Nelson, Charles & Lascher, Steven. (2016). Vicarious Trauma in Mental Health Professionals Following the 9/11 Terrorist Attacks. Journal of Mental Disorders and Treatment. 2. 10.4172/2471-271X.1000118.
  2. The British Medical Association is the trade union and professional body for doctors in the UK. 2020. Vicarious Trauma: Signs And Strategies For Coping. [online] Available at:<https://www.bma.org.uk/advice-and-support/your-wellbeing/vicarious-trauma/vicarious-trauma-signs-and-strategies-for-coping> [Accessed 25 June 2020].
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