Opinion: Why Self-care Isn’t Enough: Resilience for Trauma-informed Professionals

The well-established finding that a majority of youth in the juvenile justice system have been exposed to trauma has led to a clarion call for the implementation of trauma-informed practices. 

However, to date, less attention has been paid to the importance of providing juvenile justice staff with the tools needed to carry out trauma-informed practices in ways that protect them from the potential risks associated with this work. In fact, recognition of such risks is relatively new; only in 2013 did the official diagnosis of post-traumatic stress first recognize that secondary exposure to another person’s trauma is a bona fide type of traumatic experience. Such secondary traumatic stress (STS) — also termed vicarious trauma or compassion fatigue — has mostly been the focus of attention among mental health professionals and first responders. 

But well known in the juvenile justice community — even if not well recognized outside of it — is that working with traumatized youth and families, reading their extensive trauma histories, performing trauma screenings and delivering trauma-informed programming all bring us into contact with thoughts, feelings and images that can be difficult to put aside at the end of the day. What can be done?

Self-care: strengths and limitations

Patricia K. Kerig

To date, most of the strategies designed to prevent or intervene with STS have been focused on self-care and wellness promotion, which are certainly of value. For example, this Self-Care Assessment includes activities such as physical self-care (healthy eating, exercise, taking time off), psychological self-care (engaging in self-reflection, decreasing life stress), emotional self-care (maintaining interpersonal relationships, engaging in comforting activities), spiritual self-care (finding a spiritual community, contributing to others) and professional self-care (taking breaks, seeking support from colleagues). 

However, there are limits to self-care as a practice and a concept. For example, a 2006 study of 259 clinicians working with trauma survivors found that participating in trainings on self-care did not result in more time spent in self-care activities. Even more importantly, time spent engaging in self-care did not result in decreased STS. 

Why might this be so? Here are some possibilities to consider:

1. Most suggested self-care activities take place when we go home at the end of the day, long after we have been exposed to work-related STS. What is needed are strategies we can use in the moment, in the here and now when we are exposed to STS in the workplace. By the same token, we need strategies that are integrated with our workplace environments and that are readily implemented before, during or immediately after STS exposure in the course of the workday. 
2. By a similar token, although reaching out for social support is often mentioned in lists of self-care strategies, the emphasis tends to be placed on solo activities (e.g., reading a book, taking a break, going for a walk). However, when STS is work-related, there are critical benefits to be gained from developing a social ecology of mutual recognition and support with our colleagues. 
3. Also, the focus of many self-care activities is on distracting activities that allow us to distance ourselves from unpleasant emotions. However, attempting to suppress our emotions can paradoxically heighten them, whereas fully engaging with our emotions, even when they are distressing, is associated with recovery and returning to a state of calm and self-regulation. Similarly and again in somewhat of a paradox, passively “relaxing” activities during which our minds are disengaged can allow our brains to drift into the default mode network, which is associated with the tendency to ruminate on negative thoughts and feelings — this is the reason people will sometimes report feeling unrefreshed after a vacation in which they have spent their time entirely inactive and mentally unengaged. 
4. Similarly, although many self-care activities are pleasant and certainly would provide a nice reprieve after a stressful day, recovering our balance after exposure to trauma likely requires something more. In particular, recovery from STS may require engaging in activities mindfully and intentionally in order to address what is underlying our STS reaction (for example, taking a walk outside with the intention of reminding ourselves of nature’s capacities for renewal and regrowth). 
5. In addition, suggestions for self-care activities are not always guided by recognition of ethnic, racial, religious and cultural diversity in the ways in which people experience trauma and the practices that provide them healing. The term “self-care” itself may be off-putting for those whose cultural values prioritize group welfare and communality over individuality. In this regard, it can be valuable to reframe the goal as one of maintaining our capacity to be helpful to others. In short, we can be most effective in protecting those we care about when we are clear-thinking, calm, strong and healthy ourselves. 
6. Finally and perhaps most importantly, self-care is often talked about as an individual person’s responsibility; literally, that we should take care of ourselves. However, for those whose work involves exposure to traumatized individuals or trauma-related material, STS should be considered not as a “personal problem” but as an essential professional competency to be developed and kept honed and ready in our professional toolkits. Considering STS as a professional competency also points to the responsibilities that need to be met at the organizational level, including ongoing training and monitoring to recognize, prevent and respond to STS.

Resilience for trauma-informed professionals

Pivoting from a focus on self-care to a focus on resilience has a number of benefits for developing STS prevention and intervention efforts in juvenile justice contexts. First, resilience is not a static state, but rather is a process that involves an interaction between what we bring to the situation and the social environment in which we find ourselves. Thus, resilience fits well with the idea of STS as a professional competency integrated with the workday rather than a personal activity we are responsible for engaging in at home at the end of the day. 

Resilience also is not a personality trait; it doesn’t involve being armor-plated, hazmat-protected or impervious to adversity, but rather encompasses the ways in which we engage with the stressors that impinge on us; thus, resilience refers to a set of skills that can be learned. Resilience also is not a unidimensional construct; it is made up of a number of strengths and protective factors, including those in the domains of emotions (e.g., awareness of emotions, the capacity for affect regulation, honesty and humility), meaning-making (e.g., maintaining a sense of purpose, optimism, connection to cultural and family values) and interpersonal relationships (e.g., generativity, compassion, sense of community). Consequently, resilience is not an all-or-nothing state of being; rather, it involves a set of competencies that we may be proficient at in some ways and yet still learning, or even struggling, in others. 

Putting resilience at the forefront has guided the development of a curriculum specifically designed for staff working with traumatized individuals, “Resilience for Trauma-Informed Professionals.” While the evidence base for “what works” in addressing STS is still under development, R-TIP incorporates best-practice recommendations that have emerged in the literature to date for recognizing and addressing STS among those implementing trauma-informed practices. 

From this literature emerge six core protective factors:

1. appraisals, or the meaning we make of our experiences
2. self-efficacy, preparedness and concrete skill-building
3. emotional awareness, acceptance and engagement
4. skills for restoring our balance and re-regulation of our emotions
5. resilience promotion and a strengths-based focus
6. recognizing the possibility and power of preventing unnecessary STS exposures.

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Within each core domain, strategies involve not only individual but also organizational and social ecological factors, as these are brought to bear at each stage of the encounter with secondary traumatic material: 1) pre-exposure preparation and prevention (e.g., organizational and personal strategies to limit egregious trauma inputs; emotional awareness and self-monitoring regarding emerging STS reactions); 2) coping in the presence of secondary exposure (e.g., tools for responding helpfully to trauma disclosures and triggered reactions; here-and-now self-regulating strategies to maintain grounding and inner balance while being exposed to trauma-related information), and 3) recovery in the aftermath of trauma exposure (e.g., helpful strategies for debriefing, meaning-making, creation of a mutually supportive STS “learning collaborative” culture in the workplace, tapping into sources of vicarious resilience and compassion satisfaction). 

Although self-care comes into play in the recovery phase, the emphasis in R-TIP is on wellness promotion as a socially embedded and relational activity rather than an individual responsibility. As with most programs for addressing STS, R-TIP has not yet been subject to empirical validation and only a small-scale pilot program has been published to date. As more evidence emerges to support this and other STS efforts, we will have taken important steps toward developing effective strategies to promote resilience among those implementing trauma-informed practices in settings such as the juvenile justice system.

Patricia K. Kerig is a professor of clinical psychology at the University of Utah. She also currently serves as the editor in chief of the Journal of Traumatic Stress and is a co-director of the Center for Trauma Recovery and Juvenile Justice.