Intervención Quirúrgica

To better understand a phenomenon and its effects on organisms and systems, one course of action might be to view the phenomenon in relation to other related variables. Another might perhaps be to consider the phenomenon from various perspectives and within different contexts. This multidimensional, eclectic and holistic way of thinking has always resonated with the author. For these same reasons, a bio-psychosocial approach was considered appealing for the present study. This endeavour aimed at comprehensiveness and elucidation united aspects and theories from three domains of functioning, these being biological and psychological (intrapersonal) as well as sociocultural (interpersonal). To gain insight into the effects of vicarious trauma at these various levels, a bio-psychosocial approach was adopted for the study. However, the model serves purely as a structuring agent to systematically and comprehensively gauge the wide array of effects within different areas. As this is mainly an exploratory study, looking at vicarious trauma from different perspectives and within different domains of functioning seemed to be a sound starting point in illuminating this complex phenomenon.

Even though bio-psychosocial theory did not play a central role in the present study, it nonetheless warrants some discussion. Its main strength lies in its non-dogmatic allowance for any and all approaches and its not excluding any method or favouring another as being superior (Ghaemi, 2011). This theory also emphasises the complexity and importance of the domain of interaction in illuminating important processes (Gilbert, 2002). The bio-psychosocial model was developed by George Engel around 1977, and this “systems thinking” has continued to evolve (MacDonald &

Mikes-Liu, 2009, p. 271). It, however, maintained an emphasis on conceptualising the complexity of individual responses. As stated before, the model is theory neutral and encourages the application of a wide range of theories within a comprehensive assessment process (MacDonald & Mikes-Liu, 2009). These authors note that it therefore does not adhere to any prescribed structure, though some have been proposed. Bio-psychosocial theory is essentially a conceptual framework which accommodates all aspects relating to a particular problem, is congruent with other modern- day theories and is responsive to empirical scrutiny (British Columbia Ministry for Children and Families, 1996).

Within this eclectic framework, phenomena – including vicarious trauma – are viewed as complex, involving a dynamic and multifaceted interplay of factors (Schwartz, 1990). For instance, our inherent biological and psychological vulnerabilities are brought into all life situations. Social and environmental factors play precipitating roles, triggering these biological and psychological predispositions (Schwartz, 1990). These aforementioned tenets tie in well with the constructivist self-development view, one of the two theories employed by the study, that trauma and vicarious trauma filter into all aspects of existence (McCann & Pearlman, 1990). In other words, disruptions and effects can potentially be experienced at the biological, psychological and social levels.

A bio-psychosocial stance served as the overarching framework which united the theories employed in the present research. Within this framework, Figley’s model of compassion fatigue (2002a), developed for therapists, served to expound the process of vicarious trauma. The study also intended to establish whether Figley's model can be applied wider, to include the claims workers earmarked by the present study. It is important to stress that Figley's model was not tested per se, but its suitability to the administrative context was considered and argued. Constructivist self- development theory further assisted in illuminating the cognitive aspects of vicarious trauma, as well as how cognitive changes can affect one’s cognitive orientation towards the world and, ultimately, its impact on behaviour and relationships.

A bio-psychosocial framework further enabled the study to evaluate outcomes of vicarious trauma within various areas. In the psychological domain, the two most widely reported outcomes of vicarious trauma, those of secondary traumatic stress and negative cognitive schemas, were investigated. These are mainly intra-psychic artefacts of trauma, but also include a physical element, often entailing somatic symptoms that share features with post-traumatic stress disorder. In conjunction with the aforementioned concepts, qualitative data on physical effects were further

utilised to gauge the physiological facet of vicarious trauma. Data on interpersonal experiences and perceived support brought the bio-psychosocial conceptualisation full circle. In order to ascertain the relevance of Figley’s model to the claims worker context focused on in the study, key aspects such as empathy and compassion satisfaction were measured, which are further psychological constructs. Although most of the constructs outlined in this paragraph are mainly intra-psychic concepts, each also strongly regulates our experiences and behaviours in the interpersonal and social domains.

Bio-psychosocial theory is, however, far from perfect, often eliciting strong criticism. However, these debates are not developed further for the sake of brevity, seeing that the approach was utilised merely as a structuring tool. Finally, within the context of claims workers, the work setting constantly exposes them to client traumata, which could trigger pre-existing biological and psychological vulnerabilities or facilitate undesirable outcomes. It is also reasonable to note that traumatising and distressing aspects of their work could permeate other levels of functioning and continuously affect most other areas of their lives. Subsequently, Figley's model and its role in the present study are looked at.