Thesis (Ph. D.)--University of Oregon, 2005. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 140-149). Also available for download via the World Wide Web; free to University of Oregon users.

Purpose: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for post-traumatic stress disorder (PTSD), acknowledged repeated or extreme indirect exposure to aversive details of traumatic event(s) in the course of professional duties, can lead to symptoms of PTSD. This has led to discussions around impact and prevalence of vicarious trauma in psychological therapists treating trauma clients. This study considers how therapists delivering trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) make sense of their experiences and protect themselves from any negative effects of the work. Furthermore, it considers if there is a distinction in therapist experience between the two modalities. Methodology/Method: An Interpretative Phenomenological Analysis (IPA) was conducted to explore how trauma-focused CBT and EMDR therapists engaged in trauma work, interpreted and made sense of their experiences; with a view to identifying any protective practice that informed clinical practice and helped ameliorate vicarious trauma. Recorded, semi-structured interviews were conducted with CBT and EMDR therapists (N=11). Before analysis, interviews were transcribed verbatim and sent to individual participants for validation of their authenticity. Data was analysed using descriptive, linguistic and conceptual comments to identify an initial seventy nine emergent themes. When refined, four master themes of ‘Nature of Trauma’, ‘Participant sense of self and managing the process of hearing trauma narrative’, ‘Participant experience of delivering the trauma models’ and ‘Protecting and sustaining the participant sense of self’ were identified to answer the research question and are discussed herein. Findings: This study forms part of the growing body of evidence towards understanding therapist vicarious traumatisation. It both supports and challenges findings of previous studies. It also introduces new concepts in relation to the vicarious trauma phenomenon. Whilst there are clear limitations associated with making generalisations from an IPA study, the findings from the study suggest EMDR may be a protective factor against the negative effects of hearing repeated trauma narrative. Furthermore, certain strategies such as time management, comprehensive trauma training and specific trauma supervision, may also reduce the negative effects of hearing trauma narrative. Finally, regardless of the difficulties faced, therapists enjoy their trauma work and feel a great sense of professional satisfaction. Implications/Recommendations: Indications from the findings of the study are that therapists working within primary care in particular, are becoming increasingly pressurised by cuts to funding within mental health services. Recommendations are that those components of trauma work which promote therapist wellbeing should be supported. In particular, realistic timeframes within which to work, good quality training and supervisors, ideally external to the workplace, who can provide trauma-specific supervision.

In a world where insecurities, violence and disasters seem to be increasing on a daily basis, compassion, a moral sentiment of co-suffering and motivation to alleviate it, plays an important role, especially in humanitarian action. However, compassion is not a constant feeling, and our emotions and compassion towards tragedies do not always resonate with egalitarian principles. This thesis seeks to explore the potential relationship between field experience, in humanitarian action, and compassion satisfaction and compassion fatigue. Departing from two contrasting hypotheses, grounded in theories of compassion, it investigates the factors, relating to field experience, that affect this moral sentiment, in a single case study of the Network on Humanitarian Action (NOHA). Through a quantitative survey design, combined with semi-structured interviews, the study finds that there exists no isolated correlation between field experience and compassion fatigue or satisfaction. However, the study concludes that compassion is affected by several intervening variables, relating to field experience, which can result in either compassion fatigue or satisfaction, resonating with both hypotheses.

Purpose: To conduct an educational intervention to reduce compassion fatigue among Arizona transplant nurses. Background: Burnout, secondary traumatic stress, and loss of compassion satisfaction raise the risk of compassion fatigue. Transplant nurses support the patient continuum of life and death, and often experience emotional and physical exhaustion and grief when dealing with poor outcomes or patient loss. When patients disregard the value of their new organ or are non-compliant with medications, nurses may feel conflicted. There is a paucity of research as to how those situations are experienced among transplant nurses. Method: Two workshops were conducted to reduce the risk of compassion fatigue among transplant nurses (n=7) through the delivery of educational and skills training. Education included symptoms, perceptions, triggers and outcomes of compassion fatigue. Skills to reduce compassion fatigue were outlined, such as self-reflection, mindfulness, healthy boundaries, and reaching out. Discussion content was analyzed for commonalities. Findings: Participants reported an overall high level of personal satisfaction within their specialty, relating this to the improved quality of life for patients who otherwise faced terminal illness or imminent death. Burnout and secondary traumatic stress experiences were deemed as inherent within this nursing practice. Symptoms of headaches, nausea, joint pain, and extreme fatigue were described as occurring in times of increased stress. Triggers reported for these symptoms included poor teamwork, lack of management support, and high nurse-to-patient care ratios. Ethical and moral dilemmas were unanimously reported as causing the highest levels of stress and professional dissatisfaction. Implications: Burnout among transplant nurses is perceived as inherent to this specialty due to associated challenges with a life and death continuum of patient care. Participants asserted that the nurse-to-patient relationship remains rewarding, which helps to prevent the onset of compassion fatigue. Participants conveyed that the term compassion fatigue is viewed as negative and does not accurately represent compassion levels when feeling fatigued from providing patient care.

Purpose: The purpose of this project was to conduct an educational workshop among ICU nurses working in rural areas, to reduce risk of compassion fatigue. Background: Compassion fatigue is a job-related hazard unique to professionals in caring professions such as nursing. Rural ICU nurses represent a population that may encounter unique triggers for the risk of compassion fatigue due to professional isolation, less resources and more risk of knowing the patient as a community member. A review of literature reveals limited research related to compassion fatigue development in rural ICU nurses. Method: Two educational workshops were conducted among rural ICU nurses (N=3). Workshop content included discussion about symptoms, triggers, and outcomes of compassion fatigue, as well as positive coping strategies. Participants journaled physical and emotional responses to situations such as ethical or moral dilemmas, boundary issues, and aspects of self-care. Each workshop included time to discuss the educational content and participant experiences; the resulting narratives were analyzed for commonalities. Findings: Universally, burnout was viewed as inherent to the profession. All participants recounted past traumatic patient encounters that preoccupies their thinking when in similar situations. Symptoms identified as compassion fatigue included chronic, constant, generalized pain, symptoms of depression, isolation, withdrawal and lack of interest in enjoyable activities. Triggers were prolonged patient hospitalizations due to lack of resources, lack of supporting services, lack of leadership support, unexpected patient loss, witnessing patient trauma and grief, caring for patients who did not seem to really need ICU, social situations surrounding patients 10 and floating to different departments. Increased alcohol intake, sarcasm, and venting were the most reported mitigation strategies among participants. Implications: Compassion fatigue negatively impacts the lives of rural ICU nurses on many dimensions, although it is perceived as inherent to the profession. These participants desired support from nursing leadership and a supportive work environment. Participants expressed they continued to feel compassion, despite experiencing the phenomenon described as compassion fatigue. A less stigmatizing term might better capture the phenomenon now labeled as compassion fatigue.

Vicarious traumatization (VT) describes the gradual, transformative shifts in internal experience that occur as a result of cumulative exposure to clients’ trauma material. VT is thought to develop in the therapist due to empathic engagement with clients, resulting in profound disruptions in frame of reference. Because VT is conceptualized as a condition that develops due to frequent exposure to clients’ traumatic material, a rapidly emerging body of theoretical literature suggests that clinicians can safeguard against VT by maintaining a more balanced workload (i.e., a caseload of clients with a variety of presenting problems) and limiting the number of trauma cases. However, the quantitative research base on VT is limited and has been plagued by several methodological shortcomings, most notably the lack of comparison groups of non-trauma clinicians. As such, a primary aim of the present study was to characterize the prevalence and severity of VT among one group of clinicians treating predominantly traumatized populations, and one group providing treatment for a wider variety of presenting issues. Further, a secondary aim of this project was to identify both therapist-level and occupational-level contributors to VT. In our cross-sectional, online survey study of 114 generalist mental health providers (Mage = 33.36, 75.4% female, 88.6% Caucasian) and 107 trauma clinicians (Mage = 42.66, 81.3% female, 86.9% Caucasian) recruited from various professional organizations, levels of VT were low and not significantly different between the two provider groups. Risk factors for VT included fewer years of experience, having a greater personal history of trauma, and a personal distress empathy style. Protective factors included a perspective-taking empathy style, problem-focused and emotion-focused coping styles, and high-quality supervision. When the VT construct was examined alongside similar (but conceptually different) occupational stress constructs of secondary traumatic stress and burnout, there was a high degree of overlap, indicating that VT may not be a distinct phenomenon or unique to working with trauma clients. Results suggest that claims about the deleterious effects of trauma therapy are likely overstated, thereby refuting the original conceptualization of VT. Future research directions and implications for prevention and intervention are discussed.

Secondary exposure to trauma has been found to be related to increased burnout and secondary traumatic stress among professionals who work with clients who have experienced trauma (Bride, 2007; Brady, 2008; Peltzer, Matseke, & Louw, 2014; Shoji et al., 2015). Interpersonal factors such as self-efficacy and empathy may support those who experience secondary exposure to trauma by reducing burnout and secondary traumatic stress, and increasing compassion satisfaction (Shakespeare-Finch, Rees, & Armstrong, 2015; Wagaman, Geiger, Shockley, & Segal, 2015). School counselors have not been included in previous studies related to secondary exposure to trauma; however, their professional role in providing support to students in schools places them in direct contact with children and adolescents who have experienced traumatic events. This study investigated the relationships among secondary exposure to trauma, self-efficacy, empathy, and professional quality of life (i.e. burnout, secondary traumatic stress, and compassion satisfaction) for school counselors. A correlation analysis indicated that self-efficacy and empathy were both significantly correlated with burnout and compassion satisfaction. Self-efficacy and secondary exposure to trauma were both significantly correlated with secondary traumatic stress. Hierarchical linear regression analyses revealed that self-efficacy and empathy were predictors of burnout and compassion satisfaction and self-efficacy and secondary exposure to trauma were predictors of secondary traumatic stress. Implications and recommendations for professional school counselors and school counselor educators are provided.

Most law enforcement officers experience a traumatic event within the first 3 years of duty but may not receive proper mental health training in the police academy to prepare them for a career in law enforcement, and little is understood about police academy training regarding mental health. Using secondary traumatic stress (STS) as a conceptual framework, the purpose of this qualitative study was to understand the perspective of law officers on the usefulness of academy training to prevent or manage mental health issues that may arise from law enforcement duty. Data were collected from 35 law enforcement officers in a Southern state through an online, qualitative survey. These data were inductively coded and subjected to a thematic analysis procedure. Findings indicate that both STS and post-traumatic stress disorder (PTSD) are shunned topics in the law enforcement community. Additionally, respondents perceived that reconstructing police academy training manuals to include personal stress management and increasing awareness of STS may better protect law enforcement officers and enhance community relations while providing a more sustainable police force. The positive social change implications of this study include recommendations to police academies to include mental health training and preparation as part of early academy training to promote better mental health among police officers and reduce the negative effects of STS and PTSD.

No description available.

In December 2019, a novel version of the SARS virus, called SARS-CoV-2 (COVID-19), emerged in Wuhan, Hubei Province of China. By mid-March of 2020, the United States had begun the process of the shutting down and quarantining to minimize the spread of the virus. In conjunction with a dramatic shift in professional experiences, counselors would also be exposed to greater stressors associated with COVID-19 while continuing work as shadowed "frontline" workers tending to the surge of those seeking mental health care resulting from increasing anxiety, depression, PTSD, and other mental health conditions. However, despite the emerging information regarding the professional quality of life (ProQOL) and wellness of "frontline workers" there was little evidence emanating related to how the stressors of COVID-19 were impacting counselors. Compassion fatigue (CF), burnout and secondary traumatic stress (STS) are occupational hazards threatening counselors resulting from exposure to trauma, interpersonal stress and vocational demand. These phenomena have been extensively researched among counselors and demonstrate positive relationships between counselors' experiences of stress and higher levels of negative compassion outcomes. Similarly, wellness has been empirically supported as a countermeasure to these professional threats, serving to minimize the effects of burnout, CF and STS by improving the internal resiliency of counselors while simultaneously improving experiences of compassion satisfaction (CS). However, aside from conceptual speculation and preliminary investigation into counselor coping patterns, little evidence has surfaced demonstrating what relationship exists between counselor wellness and the unique stressors related to the COVID-19 pandemic. This study used quantitative methodology to analyze a cross-sectional survey of a national sample of counselors in the United States (N = 318) that assessed for counselor wellness, ProQOL and reported, COVID-19 related stress. This investigation examined how counselor wellness and ProQOL differs during a later stage of the COVID-19 pandemic compared to previous samples, how specific counselor demographics related to COVID-19 stress appraisal and how counselor reports of COVID-19 related stress relates to their wellness and ProQOL. Results indicate a significant difference between counselor reports of wellness and ProQOL compared to previous investigations, with a pattern of this sample producing lower wellness and CS scores and higher burnout and STS scores. Additionally, significant relationships between counselor gender and racial identities and COVID-19 related stress were found. Lastly, results indicate significant, negative relationships between reported COVID-19 stress and multiple aspects of wellness, while significant, positive relationships were found between reported COVID-19 stress and both burnout and STS. The findings of this investigation will contribute to the foundational insight into how counselor reports of COVID-19 related stress relates to their wellness and ProQOL. / Doctor of Philosophy / Over the last two years, the United States has been experiencing the stress and loss associated with the world-wide, SARS-CoV-2 (COVID-19) pandemic. Counselors have continued to provide mental health and school-counseling related services to their clients and students despite exposure to the unique demands and stressors related to COVID-19. Regardless of increased stress exposure, little evidence is available to explain how stress related to COVID-19 has impacted counselor professional quality of life (ProQOL) and wellness – both of which are essential for professional longevity and ethical practice. The current investigation explored and examined how current, reported COVID-19 related stress related to reported wellness and ProQOL for counselors within the United States. Counselors were found to have lower wellness and compassion satisfaction (CS) scores, and higher burnout and secondary traumatic stress (STS) scores, as compared to samples from before the pandemic. Counselors with racial and gender minority identities were also found to demonstrate higher COVID-19 stress appraisal. Lastly, COVID-19 related stress was found to have negative relationships with counselor wellness and positive relationships with both burnout and STS, thus forming a negative relationship with CS. Further research is needed to help determine how sociocultural events within the United States upon counselor wellness and professional quality of life, as these have occurred in conjunction with the COVID-19 pandemic. Additionally, further research is required to understand how minority groups of counselors have uniquely experienced the COVID-19 pandemic and how those experiences impact their reports of wellness and ProQOL.