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Trauma is not limited to domestic or sexual violence. We live in a world prone to floods, hurricanes, and earthquakes, not to mention other sorts of natural disasters. Without warning, people die or are injured every day in cars on our nation's streets and highways.
Despite wonderful technological advances in medicine, people still experience life-threatening medical conditions and painful procedures. The media provides us with a picture of escalating community violence, drug abuse, and other dangers. Even from an adult perspective, the world can be a very frightening place!
Three Case Examples
There are hundreds of
different ways in which professionals and
caregivers can be impacted by trauma. We
will present three examples to illustrate
key elements that may be common to many of
the situations confronting professionals
working with traumatized or maltreated
children.
Case 1: Duress in
unusual circumstances: Working with the
Branch Davidian Children.
For many weeks,
caseworkers and supervisors from the Texas
Department of Protective and Regulatory Services
(TDPRS) had been working overtime under
tremendous duress. The small regional
division had been suddenly and dramatically
thrust into the public eye in one of the
most high-profile child protection issues of
the last decade – the Branch Davidian
assault and siege. In the three days
following the ATF raid, 21 children were
released into the care of the state. The
local Child Protective Service units
mobilized; the State sent supervisory
assistance and the entire staff were
besieged by press, public and other agencies
(e.g., FBI and Texas Rangers). The staff
worked hard to find shelter and
services and to create disposition plans for
these 21 children. This immediate crisis
phase - the first weeks following the raid –
was followed by a five-week period of
"unknown." The TDPRS and the partnering clinical
treatment team prepared for the release of
the other Branch Davidian children (at least
40 more) still in the compound not knowing
when or how the remaining children would be
released. While media pressures
continued; so did the efforts to help
the 21 released children, screening and
briefing the children's families as well as
trying to find healthy, safe placements.
The staff was overworked, overwhelmed and
over-exposed.
Through video, family
interviews and review of case material, the
clinical team came to know the children and
some family remaining in the compound. The
expectation was that the situation would be
defused and these children would become the
responsibility of TDPRS and the partnering
clinical team. Over the six weeks spent in
Waco,
the clinical team came to know the 21
released children very well. By the time of
the final assault and the fire, the TDPRS
and clinical staff had been emotionally
drained. The horror of the fire left so many
of the team with sense of helplessness and
frustration. The senseless loss of life and
the continuing confusion about motivations
on all sides added to the distress. The
tasks of telling the children, facing the
press, the sudden decompression of the
chronic tension related to the anticipation
of the other children being released all
added to the distress of the staff. Many of
the staff were devastated. Emotions ranged
from profound sadness to anger to relief to
guilt. The staff was listless, numb,
exhausted and had a difficult time focusing
on any other work. The TDPRS and clinical
team were experiencing secondary trauma.
The impact of chronic
duress and atypical circumstances can be
devastating. These situations reveal the
"fault lines" in an organizational structure
and magnify any of the typical personality
or supervisory issues that are often a
common part of any organization. In these
situations, the immediate response tends to
bring people together; however, with bad
outcomes, or if the duress is chronic, temporary alliances and accommodations
can fray.
With exhaustion, tension and frustration,arrise individual and systemic problems.
Extended duress and unusual
circumstances include natural and man-made
disasters (e.g., floods, hurricanes, school
shootings, plane crashes) will
transiently bring out the best in most
people but often leave a wake of destruction
and pain for the survivors and surviving
community (e.g., the Columbine High School
shootings, the Oklahoma City bombing). In
these situations, as time passes, the pain
of senseless loss can easily be turned on
others or haunting guilt can be turned
internally. The rates of trauma-related
symptoms can be astounding. A study of the
Oklahoma City community demonstrated that
more than 50% of the community experienced
residual trauma-related emotional and
behavioral symptoms one year after the
bombing.
In the case of the TDPRS
staff working with the Branch Davidian
children, informal and formal actions led to
the long process of coping. Probably the
most effective approaches were individual.
Caseworkers and the other professionals
talked with each other on an informal basis
and drew upon their existing personal and
professional support systems. A series of
community services for the Branch Davidians
were helpful to some. Several
‘debriefing’ and educational events about
secondary trauma that were provided but, for
the most part, talking with
and supporting each other were the major
healing processes. To this day, many of the
participants have strong emotional feelings
when talking or thinking about the Branch Davidian children or the assault, siege and
fire. Ten years after this tragic event,
individual members of the treatment team
report episodic intrusive ideations,
permeating anger or sadness when reminded of
the event and active efforts to avoid
reminders of the entire event. Clearly the "cost
of caring" for these healers was high.
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