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Ameliorating vicarious trauma is yet another subject that is not clear-cut. It was surprising to see the many misgivings and concerns about this issue. For instance, some authors have expressed concerns about the negative impact of amelioration (Elwood et al., 2011; Kadambi & Ennis, 2004). Others have raised the question as to whether these amelioration strategies even work (Bober & Regehr, 2006; Sabin-Farrell & Turpin, 2002). As stated previously, some feel that the diagnostic limits of post-traumatic stress disorder have been far over-reached to include vicarious trauma (McNally, 2003).

The credibility of vicarious trauma is questioned by several authors as the evidence-base to support either its existence or its prevalence, is in their opinion, modest (Jenkins & Baird, 2002; Kadambi & Ennis, 2004). Sabin-Farrell and Turpin (2002) have found that symptoms of post-traumatic stress disorder, burnout, and general psychological distress have been implicated by many research studies on trauma-work, but that most of the correlations described were weak. Similarly, Jenkins and Baird (2002) found few studies that have examined the construct validity of vicarious trauma and associated concepts. Accordingly, it might be argued that the eminence accorded to vicarious trauma may be premature and not well supported by research evidence at all.

In the same vein, Kadambi and Ennis (2004) state that the notion of vicarious trauma has been warmly and eagerly embraced. They add that it has called for changes in the workplace to improve wellness and working conditions, even long before researchers pinpointed what vicarious trauma is. Furthermore, Sabin-Farrell and Turpin (2002) refer to the valuable lessons learnt from psychological debriefing implemented without due consideration. Out of concern, several organisations enforced debriefing programmes to curb a host of different types of traumas, long before research evidence for the effectiveness of debriefing was considered. Subsequent controlled trials later offered very little consistent support of the role of debriefing in the reduction of post-

traumatic stress symptoms (Sabin-Farrell & Turpin, 2002). From this research, some evidence emerged which suggested that debriefing might actually harm more than help. They concluded that this lesson emphasised the value of collecting research evidence and critically evaluating it before initiating any intervention, treatment or prevention strategies. This lesson also showed that not nearly enough research has been done on the value of debriefing.

Bober and Regehr (2006) drew attention to a similar scenario. Their study looked into the efficacy of strategies that are often prescribed to reduce secondary traumatic stress. These included self- care, leisure-time, supervision, active participation in research as well as programme planning and development. They could find no evidence that these coping strategies offered significant protection against the symptoms of acute distress. They also add that those with long-term negative outcomes, such as negative cognitive schemas, particularly in the areas of self-intimacy and other- intimacy, are naturally less inclined to engage in leisure activities. It makes sense that those workers affected by vicarious traumatisation might not recognise the value of ameliorating activities to begin with and might thus not be motivated to participate in them.

The same can be said of increasing social support. It might be quite a challenge to convince a person who is not normally inclined to seek out the company of others, to suddenly become more socially connected. As stated earlier, even a strategy as benign sounding as increased support can be a double-edged sword and, despite how helpful supportive relationships mostly are, they can just as easily induce tremendous stress (Figley, 2002a; Lutrin, 2005). Bober and Regehr (2006) insist that, unless the value of a strategy is well-recognised and fully embraced, it is unlikely that workers would devote any time and energy to it.

As also pointed out before, Sabin-Farrell and Turpin (2002) fear that alongside the recognition of vicarious traumatisation also came the vilification of a process that is natural, normal and expected. They conclude that researchers might be medicalising something that is nothing more than normal distress from hearing traumatic stories. Sabin-Farrell and Turpin (2002) further argue that post- traumatic stress disorder might be a socially constructed rather than a psychopathological concept. This is a valid point and increased awareness might very well have contributed to displacing a natural response into the domain of psychopathology.

However, even though the emotional responses documented by researchers might not differ from natural responses to hearing traumatic stories, the fact that certain worker groups are exposed to

such stories continuously is nonetheless a concern. It is one thing to hear a traumatic story, as everyone does from time to time, and quite another to be confronted with such unsettling stories on a daily basis. Therefore, although one does not want to vilify or medicalise a normal human response, it is the frequency with which these responses are experienced by some workers that raises concern – not the response itself.

Furthermore, concluding that a response is normal is also not a convincing argument and does not take away from the deleterious nature of some normal responses. Stress is also a completely normal human response. But if left unchecked it can cause illness and even death. Stress has been described to be one of the most pressing health issues of our time (e.g. Coetzer & Rothmann, 2002; Lu, Tseng & Cooper, 1999). Just because a response falls within the realm of a natural human response does not mean that it cannot bring serious harm or that it does not need to be addressed. Furthermore, Elwood et al. (2011) suggest that even the mere encouragement among workers to be aware of any negative emotional reactions associated with vicarious trauma could turn into a self- fulfilling prophecy. There is value in this argument as it can easily be fathomed how the expectation of negative outcomes might actually create them. The realisation that work could be potentially harmful might cause stress in and of itself. It could cause workers to become hyper- vigilant and perhaps even lead to over-interpretation of every response, or overreaction towards the slightest inkling of a symptom. It is true that insurers calling attention to the potential hazards of working with traumatised individuals could potentially dissuade prospective claims workers from entering into this profession in the first place.

However, this does not mean that claims workers should not be informed of the hazards of vicarious trauma. To leave workers to their own devices out of fear of harming them further by informing or educating them about vicarious trauma would be equally unwise and even irresponsible. Elwood et

al. (2011) indicate that how vicarious trauma is portrayed is imperative. Excessively negative

portrayals seem to be at the helm of what is causing a whole host of problems as well as fuelling the objections heard from scholars. Therefore, rather than enjoining employers to eschew education about vicarious trauma, workers should rather be informed in a thoughtful and sensible manner, without minimizing or inflating what vicarious trauma is.

Another point of criticism is that some strategies such as additional supervision, counselling or debriefing could systematically eat away at precious resources from organisations that might

already be financially over-extended (Elwood et al., 2011). This would be especially true for the South African context, given our socio-economic situation, as well as the current persistent downturn in the international economy. However, amelioration need not be a costly exercise. There is ample evidence that indicates even the most modest of strategies to be effective (e.g. Collins, 2009; Gentry, Baranowski & Dunning, 1997; Salston & Figley, 2003).

For instance, Gentry et al. (1997) devised a comprehensive accelerated recovery programme for compassion fatigue, which embraces simple but highly effective self-help strategies. They prescribe commitment to a self-care discipline that calls for focus in four areas: skills acquisition, increased self-care, forging a connection with others and addressing internal conflicts. Salston and Figley (2003) strongly agree that it often takes very little to ameliorate secondary traumatic stress. Another simple but effective strategy is visiting with friends and family, staying connected to others and spending time with those whose company is enjoyed (Radey & Figley, 2007). Also, Figley (2002b) is a firm believer in the power of humour to inject positive energy into one's life.

From looking at the Self-Care Assessment Worksheet devised by Saakvitne and Pearlman (1996), a checklist that keeps self-care efforts structured and on track, it becomes clear that they also value the power of a positive affect. Within the realm of finding more joy, they suggest participating in activities that the person finds enjoyable – such as dancing, receiving a massage, taking time to be sexual, finding things that makes the person laugh and even just wearing clothes the person likes. Radey and Figley (2007) conclude that organisations should offer their support and be devoted to promoting a warm, friendly, and inviting environment where workers feel valued and where they can depend on colleagues when they need to.

It was gathered from reviewing the many studies on amelioration of vicarious trauma that the strategies for general wellness in the workplace as well as minimising secondary traumatic stress often intersect. For instance, simple strategies, such as exercising, eating healthily and regularly, taking time off, as well as allowing time for self-reflection, have been shown to greatly alleviate secondary traumatic stress (Radey & Figley, 2007). When considering these strategies carefully, these simple life-style changes are often prescribed by most physicians and healthcare practitioners to combat an array of diseases, to promote wellness, to improve health and to combat stress. These practices would also most definitely create wellness in other areas of one's life, as well as equip one better to deal with stress and pressure, not only at work, but in all areas of life. Therefore, organisations that are experiencing financial strain do not necessarily have to invest in costly

services and programmes. They need only instil, promote and perhaps motivate health-promoting behaviours among their staff, a point that will be returned to later.

Despite the many misgivings outlined earlier, there are nonetheless ample sapient as well as seminal studies that clearly highlight the negative effects of vicarious trauma within a variety of work settings (e.g. Adams et al., 2008; Anderson, 2004; Annschuetz, 1999; Bell et al., 2003; Black & Weinreich, 2000; Collins & Long, 2003; Figley, 2002a; Hesse, 2002; Levin & Greisberg, 2003; McCann & Pearlman, 1990; Newman & Kaloupek, 2004; Pross & Schweitzer, 2010; Pyevich et al., 2003; Saakvitne, 2002; Schauben & Frazier; 1995; Sexton, 1999; Simpson & Boggs, 1999; Stamm, 1997; Stebnicki, 2007; Steed & Downing, 1998; Way et al., 2007). The threats associated with vicarious trauma can therefore not be ignored. The points of criticism raised earlier do not mean that amelioration should not take place. One very valid point that can be taken from the research information outlined here is that amelioration is not a simple issue and should be approached with great care and circumspection. It should be entered into thoughtfully and not over-hastily.

It also means that every decision or strategy should be carefully weighed and, where possible, based upon sound research findings before they are implemented. For the purposes of the present study, it is felt that neither education about nor amelioration of vicarious trauma should be abrogated. Employers should perhaps seek ways to educate and ameliorate vicarious trauma without perpetuating stress over it. The point of whether vicarious trauma should be ameliorated or not is revisited at the end of the thesis when the concluding thoughts on this point are presented. The next chapter looks at the theoretical framework that will both structure and inform the present research.

CHAPTER FOUR: THEORY Theoretical Framework 1 Theoretical Framework for the Study

This chapter considers the various theories demarcated by the study. The bio-psychosocial model is discussed first, which provided the study with an overarching structure. Next, Figley's model of compassion fatigue (2002a) served as a cornerstone to the study and further aided in structuring the research. Concomitantly, the different concepts and variables explored by the study and how each of these was approached, are also outlined. Constructivist self-development theory is then examined, which added the interesting dimension of cognitive outcomes to the study. Finally, mixed methods theory, which drove the research design and practical execution of the research, concludes this chapter.