Animal attacks can be terrifying for children (and adults) and have long term effects

Post Traumatic Stress Disorder (PTSD) is a common long-term effect of being a trauma victim, and victims of animal attacks are no exception to this rule.

It is well documented in child welfare reporting that the majority of reported animal attack cases in the U.S. are on children.  According to The Center for Disease Control and the American Veterinarian Association, the highest reported incident rates involve 5-9 year olds, and 77% of those injuries are to the face, neck, and head. This, of course, is particularly terrifying for children, especially considering that the family dog is the aggressor in nearly half of the attacks.

Medical attention is usually the very first action taken when a child is bitten or attacked by a dog or other animal. A dog attack can cause lacerations, punctures, crush injuries, nerve damage, sprain and strain of muscles, infection… and of course, emotional distress.

A 2004 study found that over half of (studied) animal attack victims had symptoms of post-traumatic stress disorder 2 to 9 months after sustaining a dog bite injury. (Citation: Peters, V. et. al. Post-traumatic stress disorder after dog bites in children. J. Pediatrics, 2004, 144, 121-122.)

It’s therefore important that children (and anyone) who have been attacked by animals and exhibit PTSD symptoms are given follow-up psychological treatment.

Peter Levine, an expert in the field of healing trauma with a technique called somatic experiencing, names the following symptoms as common ones in the wake of an animal attack:

• excessive fear
• feeling that the world is a dangerous place
• anxiety
• sensitivity to sounds or light
• difficulty sleeping
• difficulty in defending oneself
• stuck in a pattern of compulsive attack or rage
• stuck in a pattern of running away (difficulty with commitment)
• helplessness
• frequent re-enactments

Interestingly, Levine makes the connection that we are all in fact animals, and that “the involuntary and instinctual parts of the human brain and nervous system are virtually identical to those of other mammals.” He goes on to explain how our own reaction to trauma mimics the Fight, Flight or Freeze response that wild animals instinctually use to survive.

However, it’s important to remember that we are not just animals.

The difference between people and animals lies in the prolonged state of the reaction to an attack. When an animal is no longer in danger, it is able to easily shake off the energy of fear and self-defense. This allows animals to return to their normal state of functioning pretty quickly. On the other hand, people who experience PTSD will suffer the negative effects of an attack long after the attack is over.

Animal attack victims suffering from PTSD may handle threats by reacting inappropriately aggressively (the “fight” response). They may, on the other hand, be in a constant hypervigilant state that prompts them to flee even the most minutely anxiety-provoking circumstances (such as hearing a dog bark in the distance). And in particular, animal attack PTSD sufferers tend to cleave to the “freeze” mentality, opting to numb out or check out when presented with stressful situations, rather than deal with them directly.

Studies show that traumatic events can actually result in neurological damage in children.

Reduced hippocampal activity in children with PTSD can affect their memory permanently.  In one study, “Children between the ages of 10 and 17 were divided into a group with a confirmed diagnosis of post traumatic stress disorder (arising from a variety of traumatizing events) and compared with a group of children with no post traumatic stress disorder. Brain scans (e.g. MRI) were taken simultaneously when subjects completed a test for verbal memory. The test consisted of having subjects read a list of words from one list, then read an additional set of words from another list, and then try to remember which words were on the original list. Compared with children without posttraumatic stress disorder, those with PTSD did poorly on this test, and during testing these subjects also showed considerably less electrical activity in their hippocampus.” (Citation: Carrión, V. et. al., Reduced hippocampal activity in youth with post-traumatic stress symptoms: An MRI study, J. Pediatric Psychology, 2010, in press)

The brutality of nature comes close to home when an animal attacks occurs. Whether it’s the rare tragic incident at a zoo or an all-too-common bite by a neighbor’s dog, being attacked by an animal is a terrifying event that can have lasting effects.

Barking dogs are a very common noise and almost impossible to avoid in daily life. Therefore, victims of animal bite trauma might be constantly reminded of their experience in their everyday lives.

In this article we’ll focus on the contemporary Western attitude toward and definition of incest. According to Incest: The Nature and Origin of the Taboo, by Emile Durkheim (tr.1963), “The incest taboo is and has been one of the most common of all cultural taboos, both in current nations and many past societies.”

Incest is a type of sexual abuse that can (but does not always) include sexual intercourse, sexually inappropriate acts, or the abuse of power based on sexual activity between blood relatives.  The important thing to remember is that incest is a form of sexual abuse.  As a form of abuse, it is highly damaging to a child’s psyche and most often results in prolonged Post Traumatic Stress Disorder (PTSD).

Feminist.com says that “Incest and sexual abuse of children take many forms and may include sexually suggestive language; prolonged kissing, looking, and petting; vaginal and/or anal intercourse; and oral sex. Because sexual contact is often achieved without overt physical force, there may be no obvious signs of physical harm.”

Incest is a reprehensible form of abuse not just because it is cloaked in shame and stigma, but because this type of sexual abuse (like many other types of abuse, unfortunately) affects young victims by implicating and damaging their primary support system. This can be very confusing for children who have been taught to be wary of strangers, but to trust in family.  Because they are in the beginning stages of developing their value systems and trust models, the betrayal of incest can be utterly confusing, if not permanently damaging, to a child’s delicate psyche.

Statistics

The statistics on incest are extremely difficult to pinpoint because most cases of incest are never reported due to the intense level of shame associated with this type of sexual abuse. Aside from the misdirected shame that victims of incest often feel, there is increased pressure to keep it a secret because of fear of disrupting the family dynamic or experiencing blame or anger from other family members. However, it’s believed that the most common form of incest happens between older male relatives and younger females.

How incest PTSD manifests

PTSD as a result of incest can result in a variety of coping mechanisms including:

• Self-injury
• Substance abuse
• Eating disorders
• Issues with disassociation
• Promiscuity

How to handle a suspected case of incest

The most important thing to remember when dealing with those who have suffered incest (especially if the victim is yourself) is that shame and guilt, while a common response, is not an appropriate one. The biggest immediate help you can offer to a victim of incest is to listen with respect and compassion… and belief.  In other words, the first step is always to believe the victim.

RAINN (The Rape, Abuse and Incest National Network) has a protocol in terms of who a victim can feel safe reporting an incest situation to:

• A parent
• A teacher
• A school counselor
• A friend’s parent
• Your doctor
• Your minister (or pastor, priest, rabbi, imam, etc.)

To report suspected incest to authorities, call Child Protective Services (see this directory: http://www.rainn.org/public-policy/legal-resources/mandatory-reporting-database)

How to report child abuse and incest: http://www.americanhumane.org/about-us/newsroom/fact-sheets/reporting-child-abuse-neglect.html

Emotional abuse can be overt, such as intimidation, threats, verbal abuse, berating, belittling, or constant yelling. Or it can be more subtle, such as neglectful behavior, manipulative withdrawal of affection, or repeated disapproval.

In any case, emotional abuse eventually corrodes a child’s self-confidence and self-trust, leaving them in judgment of their perceptions and at the mercy of the abuser. Emotional abuse can cut to the very core of a child’s psyche, leaving them confused, scared, and damaged in ways that can ultimately be even more traumatizing than those of physical abuse.

National Child Protection Clearinghouse refers to emotional abuse as “the hidden form of maltreatment.” With child victims of emotional abuse, parents or caregivers are obviously the most common abusers.

It’s important to note that emotional abuse goes beyond verbal abuse. Emotional abuse can impact a child’s self-worth and is a basic threat to their healthy human development. And, because it can be one of the most difficult types of abuse to detect, its malignant effects are insidious.

Ways that emotional abuse can manifest
(source: www.findcounseling.com)

• Belittling
• Coldness
• Corrupting or exploiting
• Cruelty
• Extreme Inconsistency
• Harassment
• Ignoring
• Inappropriate Control – lack of control, over control, and inconsistent control
• Isolating
• Rejecting
• Terrorizing

How does emotional abuse impact a child?

Emotional abuse has an impact on a child’s cognitive, emotional, psychological and social development.

Typical behavioral changes may include:

• Withdrawal
• Depression
• Anxiety
• Aggressive behavior

The National Society for the Prevention of Cruelty to Children (NSPCC) has this to say about how the effects of emotional abuse can have a powerful hold on victims: “… the effects are damaging and long lasting. They can lead to serious behavioral, learning, emotional or mental disorders. All of which affect the child’s chances of developing into a healthy, well-adjusted adult.”

AmericanHumane.org says, “Although the visible signs of emotional abuse in children can be difficult to detect, the hidden scars of this type of abuse manifest in numerous behavioral ways, including insecurity, poor self-esteem, destructive behavior, angry acts (such as fire setting and animal cruelty), withdrawal, poor development of basic skills, alcohol or drug abuse, suicide, difficulty forming relationships and unstable job histories.”

Not all bad days constitute emotional abuse

All parents have their bad days. The occasional negative attitude or action does not make for an abusive caregiver. Emotional abuse is based on a pattern of behavior that takes place over at least a one-year period of time, and often in conjunction with other types of abuse.  However, it’s when emotional abuse is found in isolation that it can be truly dangerous, because it is inherently hard to identify… and to handle legally. Because issues surrounding emotional abuse can seem open to interpretation, they can be hard to pinpoint and remedy.

Just like with sexual abuse, most parents who abuse their children emotionally were themselves emotionally abused as children. This is why it’s important that adults who believe they were emotionally abused as children seek counseling in order to thwart the pattern before they unwillingly repeat it with their own children and loved ones.

http://ptsd.about.com/od/glossary/g/hypervigilance.htm

Trauma has occurred when symptoms have developed and have become visible. One type of trauma results from natural disasters such as earthquakes, tornados or hurricanes, forest fires, floods, volcanic eruptions, landslides, or tsunamis. These types of experiences are particularly insidious because they tend to traumatize large populations of people at once, and can result in epidemics of Survivor Guilt along with other PTSD symptoms.

Like many causes of trauma, natural disasters can be sudden and overwhelming. The most immediate and typical reaction to a calamity is shock, which at first manifests as numbness or denial. Quickly—or eventually—shock can give way to an overemotional state that often includes high levels of anxiety, guilt or depression.

If victims have lost their loved ones or their homes, they may feel helpless. This can be exacerbated if they have to live in shelters without support from relatives or friends for extended time periods. However, living with other survivors can be a time to reconnect, talk about the event with others, and help to reframe the event. Being able to help another survivor can reduce helplessness, and may start the healing process.

Natural disasters in particular can bring victims a feeling of being betrayed by “their god,” which can result in a loss of faith.  Making peace with “the divine” might be one step toward healing and gaining faith back.

It’s hard to predict when PTSD will set in with a survivor of a traumatic natural disaster. Some victims seem at first perfectly (or even abnormally) fine, only to be beset with symptoms later on.  Survivors are recommended to seek professional guidance if they find themselves unable to regain control of their lives or if they continue to suffer from PTSD symptoms for more than a month.

Victims do not need to have experienced a disaster firsthand in order to suffer from PTSD. As an example, an emigrant from Haiti living abroad at the time of the recent earthquake could be profoundly affected by the countless hours of television coverage of the disaster, especially if they still had family living in Haiti at the time of the event who they were unable to contact or gain information about.

It’s very important with natural disaster trauma that the victim give himself time to heal and pass through an appropriate mourning process. Only by processing the experience over a realistic period of time is healing possible.

Over the next few months, I’ll touch upon the most common types of trauma and the ones I see most frequently in my practice. You can also read a longer version of this article on Examiner, Psychology Today, and Womens Radio (published 3/3/10).

trust

“We’re never so vulnerable than when we trust someone—but paradoxically, if we cannot trust, neither can we find love or joy.” — Walter Anderson

Merriam Webster dictionary defines trust as the “assured reliance on the character, ability, strength, or truth of someone or something” and “one in which confidence is placed.”

But unfortunately, trust can be broken in many ways. We may have been betrayed, mistreated, lied to or hurt by someone such as a partner, family, friend or colleague.

Instead of developing mistrust only for the person who hurt us, we often begin to be suspicious of every person from that point on. Out of protection to avoid getting hurt again, we carry our unpleasant memories of that original person with us and displace the distrust onto other relationships. Sometimes it only takes one person to determine that nobody is in fact trustworthy due to past trauma. In the process, we often lose trust in ourselves—simply because our judgment of the person or circumstance was incorrect—and we then wonder how we can believe our own judgment. As a result, we might close our hearts, repress our emotions, and walk around numb or suspicious in relationships.

The problem is, we need to be able to trust in order allow ourselves to fall in love and to feel loved. Yes, we can live our life by carrying our hurt everywhere we go… but not without consequences. The consequences of not trusting (and therefore not feeling) may hurt others who were not responsible for our pain and may deprive us of feeling loved, and emotional wellness. This eventually leads to loneliness, depression, and relationship difficulties.

The first step to recovering our sense of trust is to learn to trust our own judgment and feelings again. The following is a somatic exercise to learn increase trust in yourself:

• Sit or lie down so that you are comfortable and are in a safe place.
• Now, how can you make it even more comfortable? Get a blanket, a pillow, whatever will make you feel relaxed and content.
• Once you are settled, ask yourself: “How do I know this is comfortable?” This might appear to be a silly question, and perhaps even confusing. However, it is an important one in increasing your skills of building trust.
• Continue to explore what sensation you feel that you recognize as comfort. For example, you might think, “I do not feel any pain,” “I breath easily,” or “I feel relaxed.”

You might be anticipating that this feeling won’t last, which is true. We can’t control or grasp to this pleasurable feeling. It’s only important that you are in the present moment right now, not drifting into thoughts of the future or the past. Thinking of the future can create anxiety; thinking of the past can create depression.

This is an awareness exercise so that you learn to trust what you are feeling right now. Remain aware of any sounds, the temperature, the light, and your physical sensations. Can you let yourself simply enjoy the moment?

You can practice this exercise for as long as you prefer and as time allows you. Just keep checking in with your level of comfort. What feelings indicate that you are comfortable? With time, you may start to trust your feelings again.

When you start to say to yourself; “I trust myself,” you begin to restore faith in your judgment of others and situations, and as a result, you open your heart to love, joy and feeling safe again.

Chronic pain is defined as prolonged physical pain that lasts for longer than the natural healing process should allow. This pain might stem from injuries, inflammation, or neuralgias and neuropathies (disorders of the nerves), but some people suffer in the absence of any of these conditions. Chronic pain can debilitate one’s ability to move with ease, may hinder their normal functioning, and the search for relief can lead to pain medication addictions, which compound the problem. Chronic pain is also often accompanied by feelings of hopelessness, depression and anxiety.

Many people are already familiar with the fact that emotional stress can lead to stomachaches, irritable bowel syndrome and headaches, but might not know that it can also cause other physical complaints and even chronic pain. One logical reason for this: studies have found that the more anxious and stressed people are, the more tense and constricted their muscles are, over time causing the muscles to become fatigued and inefficient. More subtly, one might develop psychosomatic symptoms or stress-related symptoms because of unresolved emotional issues. These are not new discoveries; researchers have studied the mind/body interrelationship for several decades because of the importance of this link.

Experts have noticed that experiencing a traumatic event can have an impact on the development of pain. In fact, approximately 15-30% of patients with chronic pain also have PTSD. Peter Levine, an expert on trauma, explains that trauma happens “when our ability to respond to a perceived threat is in some way overwhelming.” Most researchers disagree on a precise definition of trauma, but do agree that a typical trauma response might include physiological and psychological symptoms such as numbing, hyperarousal, hypervigilance, nightmares, flashbacks, helplessness, and avoidance behavior.

During a traumatic event, the nervous system goes into survival mode (the sympathetic nervous system) and sometimes has difficulty reverting back into its normal, relaxed mode again (the parasympathetic nervous system). If the nervous system stays in survival mode, stress hormones such as cortisol are constantly released, causing an increase in blood pressure and blood sugar, which can in turn reduce the immune system’s ability to heal. Physical symptoms start to manifest when the body is in constant distress.

If someone has experienced a trauma prior to their current injury or trauma, old memories can potentially be triggered, exacerbating the effects of the newer trauma. Dr. Bessel van der Kolk, a well-known trauma researcher, explains; “Research has shown that, under ordinary conditions, many traumatized people, including rape victims, battered women and abused children, have a fairly good psychosocial adjustment. However, they do not respond to stress the way other people do. Under pressure, they may feel (or act) as if they were traumatized all over again.”

Often, physical pain functions to warn a person that there is still emotional work to be done, and it can also be a sign of unresolved trauma in the nervous system. Even if one has grieved and processed the emotional impact of a trauma, the nervous system might still unwittingly be in survival mode.

Maggie Phillips, author of Reversing Chronic Pain, writes: “Whether or not trauma was connected to the event or condition that originated their pain, having a chronic pain condition is traumatizing in and of itself.”

Since trauma has been found to have a strong correlation to chronic pain, a combination of psychotherapy and physical therapy would be the most logical pain management option for stress and chronic pain relief. Maggie Phillips states that imagery is a more effective intervention than verbal therapy, because trauma tends to impair the language and the mind’s organizational capacities. Psychotherapy that uses imagery, addresses the nervous system, and facilitates cognitive behavioral therapy is recommended.

To tackle the physical aspect of chronic pain, Mindy Marantz, director of the Healthwell clinic in San Francisco, suggests focusing on alignment in the body, as well as posture that supports organized alignment. Additionally, she advises to address potential inflammation, and provides strategies to help calm the nervous system such as Craniosacral therapy or Feldenkrais Movement Re-education. “These both will help ‘stoke’ the lymphatic system, which in turn helps diminish the effects of fluids that pool as a result of injury. Lymphatic massage as well as compression wraps and education help bring this often overlooked pathway to recovery to patients’ attention.”

Beginning a daily program of walking can help to mobilize the muscles and is the best way to stimulate the lymph system to do its job and oxygenate injured muscles. The International Association for the Study of Pain concluded that acupuncture is also effective in long term chronic pain reductions related to musculoskeletal pain.

PTSD and chronic pain are often connected, and both must be addressed in order to help a person be fully functional again. Although one might not be aware of the lingering effect of the trauma, or believe that the traumatic event has been put behind them, the body could be clinging to unresolved issues. Relevant psychotherapy can help to resolve the physical problems.

What does psychological stress do to you physically?

Studies have shown that chronic pain might not only be caused by physical injury but also by stress and emotional issues. The more anxious and stressed you are, the more tense and constricted your muscles can become. As a result, they may fatigue and be inefficient over time. For that reason, just stretching or massaging your muscles may not accomplish the goal of being active without underlying muscle tension….treating the whole person is important.

Peter Levine explains: “The rain of pain is mainly in your brain.”

Many people are already familiar that emotional stress can lead to stomachaches, irritable bowel syndrome, and headaches but might not know that it can produce other physical complaints and chronic pain. However, these are not new discoveries; researchers have studied the mind body interrelationship for several decades because they saw the importance of this link.
One might also develop psychosomatic symptoms or stress-related symptoms because of unresolved emotional issues that they have not dealt with and which are causing physiological as well as mental health issues.

Unresolved memories might hinder the healing of physical injuries or medical procedures as well. Additionally, stress hormones such as cortisol increase your blood pressure and blood sugar which can reduce your immune system’s ability to heal. For example, one woman, who already felt emotionally stressed due to a break-up with her boyfriend, found that when she had a car accident she could not find relief from her pain until she dealt with her emotional loss as well.

Often, pain has the function of warning a person that there is still something to work on. It can point to a need for emotional healing.

When your body is in pain and you are not healing the way you should, there might be emotional issues, waiting to be resolved.

Therefore, a combination of psychotherapy and physical therapy might be the best pain management option to reduce stress and recover from your chronic pain when nothing has worked so far.

Please, read the following interview with Mindy Marantz:

Mindy Marantz is the director and clinician at the Healthwell Physical Therapy Group in San Francisco and is currently active in the National Pain Foundation.

Dr. Babbel:
Mindy, your clinic has been very successful addressing chronic pain when people thought there was no way out. What have you noticed that makes it easier or more difficult for people to recover?

Mindy Marantz:
First of all, when an individual picks up the phone to call for help, recovery has begun. Our initial job at Healthwell, as I see it, is to help guide the individual through the biomechanical mechanisms which help the body heal. This is relatively easy. We help focus on alignment and the postural attitudes that support organized alignment. This can very quickly reduce pain intensity.

We also address inflammation, and we immediately provide strategies to help calm the nervous system, like Craniosacral therapy or Feldenkrais Movement Re-education.

These both will also help “stoke” the lymphatic system, which in turn helps diminish the effects of fluids that pool as a result of injury. We use lymphatic massage as well as compression wraps and education to help bring this often overlooked pathway to recovery to our patients’ attention.

Beginning a daily program of walking and helping to mobilize the muscles is the best way to stimulate the lymphatics to do their job and oxygenate injured muscles!

Finally, we help our patients reflect on their lifestyle, and the things that contribute to their wellness, and those habits which will tend to slow their recovery.

Our care is about them, carving out a time frame to focus on their well-being and health. This is the realm where recovery occurs best. Optimally, a patient will be fortunate enough to find concomitant care by a somatic psychologist to help dissipate the deeper impact of trauma, which is why our clinic often works with Dr. Babbel.

Please e-mail or call Dr. Babbel at Susanne@bodyconversations for a FREE handout on “Specific Techniques and Resources to Help you Ease your Pain.” This handout was prepared in collaboration with Mindy Marantz.

If you have further questions for Mindy Marantz please visit her website www.healthwellpt.com

Find out if you might have acute stress symptoms and what to do about it.

Definition of acute stress disorder:

Acute Stress Disorder (ACD) describes a response to a life threatening or terrifying event occurring within one month of the stressor. If ACD is not addressed it might turn into Post Traumatic Stress Symptoms.

“Most Americans will be involved in a traffic accident at some point in their lives, and 25% of the population will be involved in accidents resulting in serious injuries. The National Comorbidity Survey of 1995 found that 9% of survivors of serious motor vehicle accidents developed ASD or PTSD.”

Symptoms:

Flashbacks of car accident several times a day
Difficulty sleeping/Nightmares
Problems concentrating
Anxiety and depression
Over emotional: easily irritated, sudden sadness,
Avoiding scene of accident, people, places, and conversations
Hyppervigilant-constantly over-reacting to traffic sounds with startle response
Feeling numb or frozen-inability to perform daily tasks
Daydreaming

Factors influencing development of symptoms:

Age
Former Trauma Experiences
Internal and External Resources:
Vulnerability, Support of Family and Friends

Treatments:

A combination of physical and psychological treatment such as physical therapy, acupuncture, message, chiropractic care, and psychotherapy is suggested.

Compassion Fatigue

Medical professionals such as physicians, nurses, psychotherapists, and emergency workers, who help traumatized patients may develop their own Post Traumatic Stress Disorder (PTSD) symptoms as an indirect response to their patient’s suffering. This phenomenon has been referred to as compassion fatigue, vicarious traumatization or secondary traumatic stress.

A survey showed that “86.9% of emergency response personnel reported symptoms after exposure to highly distressing events with traumatized people” . . . [and] . . . “90% of new physicians, between 30 to 39 years old, say that their family life has suffered as a result of their work”. When health care professionals struggle with their responses to the trauma suffered by their patients, their mental health, relationships, effectiveness at work, and their physical health can suffer.

Caregivers who reported experiencing compassion fatigue, expressed such feelings as, “I frequently dissociated and felt that I walked around in an altered state. I didn’t realize that I had been in a gray space all year. That had sort of creeped in” and “It got to the point where I would feel physically sick before the appointment and feeling nauseous.” Others described that they picked up their client’s symptoms and explained that they had “tightness in the exact same spot” as their clients and continued to carry the sensation sometimes for days. One psychotherapist expressed, “I am the empathy lady from the old Star Trek episode and get may be 45 % hit of what my patients might be feeling 100% of.”

The helpers symptoms, frequently unnoticed, may range from psychological issues such as dissociation, anger, anxiety, sleep disturbances, nightmares, to feeling powerless. However, professionals may also experience physical symptoms such as nausea, headaches, general constriction, bodily temperature changes, dizziness, fainting spells, and impaired hearing. All important warning signals for the caregiver that need to be addressed or otherwise might lead to health issues or burnout.

Researchers and authors such as Babette Rothschild, Charles Figley, Laurie Anne Pearlman and Karen Saakvitne, and B. Hudnall Stamm have recognized that medical personnel and psychologists may experience trauma symptoms similar to those of their clients. They speculate that the emotional impact of hearing traumatic stories could be transmitted through deep psychological processes within empathy. Further, Babette Rothschild hypothesizes that it is the unconscious empathy, the empathy outside awareness and control that might interfere with the well being of the caregiver.

Hearing and witnessing horrific stories of abuse and other traumas can be very stressful and trauma experts have found that self-care techniques, both psychological and somatic, can reduce susceptibility to the internalization of traumatic stress and compassion fatigue. Bernstein indicates that paying attention to and being aware of physiological signals and somatic counter transference such as “dizziness, emptiness, hunger, fullness, claustrophobia, sleepiness, pain, restlessness, sexual arousal, and so forth” can be an important method of preventing and managing compassion fatigue. Somatic countertransference entails the psychotherapist’s reaction to a client with bodily responses such as sensations, emotions, and images that can only be noticed through body awareness. Since somatic countertransference is often neglected in both the literature and in the caregiver’s training, many are not aware of the somatic countertransference elicited in the helper-patient relationship.

Reducing compassion fatigue means not fighting the symptoms but working with  feelings which occur during and after the interactions with the traumatized patient. One psychotherapist shared;  “If I start to not feel my body, I pause and just take a moment.” There is a lot to take in. Giving oneself permission to take a break for a short time and taking care of oneself, may not only help the caregiver but may also provide a role model of self-care for the patient. Taking a break might be just to stop and feel one’s body, asking the patient to slow down, taking a deep breath, or making a small movement, which are forms of regulating the nervous system and decreasing the stress of working with traumatized patients.

Since caregivers commonly dissociate, staying connected or reconnecting to one’s identity and physical presence has been rated as very important as well. Some professional helpers use visual or kinesthetic reminders of their lives outside of their work. Visual reminders might be placing pictures of family, certificates, and favorite artwork in the office. Whereas kinesthetic reminders bring awareness back to the body and might be accomplished by feeling one’s feed on the floor, intentionally fiddling with a wedding ring or holding the office chair. One caregiver expressed, every time she closes the office door she uses the door as a kinesthetic reminder and says, “This is my life outside and that’s where I’m entering.”

Studies have also shown that the attitude toward life such a sense of humor, self confidence, being curious, focusing on the positive, and feeling gratitude ranked high in being helpful in treating traumatized people. Additionally, support, supervision, balancing work and private life, relaxation techniques, and vacation time have been useful.

Research indicates that caregivers are not immune to trauma and might experience compassion fatigue. A better understanding and knowledge about this phenomenon as well as self care techniques that include both psychological and somatic tools can help caregivers to more effectively deal with patients’ sufferings.

Susanne Babbel, MFT, PhD is a licensed marriage and family therapist, somatic psychotherapist, and workshop leader in San Francisco. If you would like further information on this topic please visit her website: www.bodyconversations.com