School
of
Social
Work

University
of
Minnesota,
Twin
Cities,
USA

SW
8602
Direct
Practice
Evaluation

Jane
F.
Gilgun,
Ph.D.,
LICSW

December
2009


Direct
Practice
Evaluation:


Secondary
Trauma
and
Practice
Effectiveness


Secondary
trauma
is
an
occupational
hazard
for
social
service
professionals.



Unattended
secondary
trauma
affects
practitioner
effectiveness.
Because
of
its
implications


for
practice
effectiveness,
secondary
trauma
is
an
issue
in
direct
practice
evaluation.


Direct
practice
evaluation
is
a
set
of
procedures
that
social
work
professionals
use


to
figure
out
what
is
going
on
for
clients.

They
also
keep
track
of
what
is
going
on
for


themselves
because
what
they
do
influences
clients.

Evaluation
is
an
on‐going
process


where
service
providers
continually
modify
their
own
actions
and
words
in
response
to


clients’
actions,
words,
issues,
and
circumstances.
The
goal
of
direct
practice
evaluation
is


to
increase
effectiveness.


The
four
cornerstones
of
evidence‐based
practice
can
help
organize
ideas
about


practice
effectiveness.
The
four
cornerstones
are
best
research
evidence,
professional


expertise,
client
concerns,
values,
and
wants,
and
the
personal
experience
and
personal
and


professional
values
of
the
practitioner.
I
abbreviate
the
fourth
cornerstone
by
calling
it
the


person
of
the
practitioner.



 In
this
brief
essay,
I
discuss
secondary
trauma
of
professionals
as
an
issue
for


practice
effectiveness.

This
topic
falls
within
the
fourth
cornerstone.

 Gilgun secondary trauma
Page 2 of 2
Secondary
Trauma
&
the
Person
of
the
Practitioner


Secondary
trauma
interferes
with
social
workers’
capacities
for
empathy
and
for


thinking
clearly
about
client
issues.

By
definition,
when
we
experience
secondary
trauma,


we
are
at
risk
to
be
emotionally
upset
and
irritable,
to
avoid
reminders
of
the
trauma,
and


to
have
intrusive
thoughts
and
images.
This
interferes
with
our
effectiveness.
To
be


effective,
we
have
to
know
when
we
have
experienced
secondary
trauma
and
what
to
do


about
it.


Secondary
trauma
is
an
occupational
hazard
in
social
services
because
professionals


routinely
work
with
clients
who
have
experienced
trauma.

In
our
efforts
to
understand


others
and
to
be
responsive
to
them,
we
are
open
to
what
others
say
and
how
they
present


themselves.
We
want
to
be
empathic
while
not
losing
our
analytic
stance.

By
being
open


and
empathic,
we
are
exposing
ourselves
vicariously
to
trauma.

If
we
experience
trauma


vicariously,
we
may
lose
our
analytic
stance
and
become
less
effective
in
our
work.


Social
Services
as
a
Balancing
Act


Social
workers,
therefore,
are
engaged
in
an
on‐going
balancing
act.

On
the
one


hand,
we
want
to
be
open
and
empathic.

On
the
other
hand,
we
want
to
be
able
to
think


clearly,
plan
effectively,
and
get
an
idea
of
the
full
range
of
influences
on
client
functioning.


To
maintain
this
balance,
we
require
a
high
degree
of
self‐awareness
and
help
from
co‐

workers
and
supervisors.
Friends
and
family
can
be
helpful,
too,
but
many
social
workers


believe
that
problems
related
to
work
are
best
dealt
with
at
work.

We
do
not
want
to
bring


trauma
into
the
lives
of
family
and
friends.
We
also
want
to
keep
work
and
personal
life


separate.

 Gilgun secondary trauma
Page 3 of 3
Detecting
Secondary
Trauma


By
its
nature,
secondary
trauma
may
be
difficult
to
detect.
We
may
think
we
are
all


right
until
we
start
talking
about
a
case
with
co‐workers,
when
we
wake
up
in
the
middle
of


the
night
thinking
about
a
case,
or
when
we
are
behind
the
wheel
of
a
car
and
scream
at


another
driver
for
a
rude
action
such
as
not
using
a
turn
signal.




Therefore,
it
makes
sense
for
social
workers
to
check
in
with
themselves


immediately
after
meeting
with
clients.

A
few
simple
questions
can
be
helpful
to
detect


secondary
trauma.
These
questions
include


• What
went
well?


• What
could
have
gone
better?


• What
could
I
have
done
better?


• What
will
I
do
the
next
time
I’m
with
this
client?


• Am
I
relaxed?

Happy?

Upset?
Agitated?
Angry?


• Can
I
picture
a
client’s
story
in
my
mind?
Does
this
story
bother
me?


• Am
I
looking
forward
to
seeing
this
client
again?


• Am
I
looking
forward
to
my
upcoming
meeting
with
another
client?


A
simple
mental
check‐in
such
as
this
can
be
helpful
in
detecting
secondary
trauma.
If
there


is
trauma,
then
social
workers
have
to
decide
what
to
do
about
it.
Social
workers
can
also


use
this
checklist
in
supervision
and
consultations.


Secondary
Trauma
Requires
Attention


Any
responses
that
suggest
secondary
trauma
require
attention.

Some
social


workers
like
to
journal,
and
they
will
therefore
write
about
their
responses
to
clients,


reflect
upon
them,
and
plan
for
the
next
steps.

Self‐expression
about
distressing
subjects

 Gilgun secondary trauma
Page 4 of 4
can
help
social
workers
feel
better
and
clear
their
heads.

They
are
more
able
to
meet
the


demands
of
work
and
their
personal
lives
and
find
satisfaction
in
doing
so.


Talking
with
supervisors
and
co‐workers
about
cases
and
responses
to
them
also
is


helpful
in
dealing
with
the
effects
of
secondary
trauma.
Talking
and
feeling
understood
not


only
bring
relief
and
help
social
workers
to
manage
their
thoughts,
emotions,
and
intrusive


images,
but
doing
so
also
clears
their
minds
so
they
can
do
constructive
thinking
and


problem‐solving.

They
also
can
go
home
at
night
prepared
to
be
emotionally
and


psychologically
relaxed
and
available
to
family
and
friends.


Some
work
situations
are
unsafe
for
the
discussion
of
secondary
trauma.
Under


these
conditions,
it
is
important
to
find
someone
else,
or
a
group
of
people,
who
are


trustworthy
and
who
understand
secondary
trauma.

In
group
situations,
social
workers


can
learn
a
great
deal
about
secondary
trauma
and
how
to
handle
it
effectively
by
listening


and
responding
to
others.



Some
practitioners
talk
out
loud
to
a
tape
recorder.

This
can
be
beneficial.

By


talking,
we
not
only
feel
better,
but
we
also
express
ideas
and
emotions
we
didn’t
know
we


had.

Playing
back
the
recording
can
be
reassuring
that
our
responses
not
only
are


understandable
but
manageable,
too.


Learning
as
much
as
we
can
about
a
practice
area
that
is
troubling
can
also
help


service
professionals
deal
with
secondary
trauma.
Talking
to
knowledgeable
others,
going


to
workshops,
and
reading
about
the
topic
all
help.

There
is
a
great
deal
of
reliable


information
on
the
internet
from
a
variety
of
professional
organizations.


Be
Open
to
Others



We
sometimes
are
unaware
of
how
secondary
trauma
affects
us.

Therefore,
we


have
to
prepare
ourselves
to
be
open
to
others,
such
as
family,
friends,
supervisors,
and
co‐
 Gilgun secondary trauma
Page 5 of 5
workers,
when
they
ask
us
about
how
we
are
feeling,
how
we
are
doing,
or
when
they


question
our
judgment
about
a
case.

While
we
may
be
tempted
to
be
defensive,
we
have
to


train
ourselves
to
think
automatically,
“You
could
be
right.

Let
me
listen
to
what
you
have


to
say.

I
might
learn
something.
I
might
become
more
effective
as
a
social
worker.

If
you


are
wrong,
no
harm
done.”
Saying
“You
could
be
right”
is
a
principle
of
assertiveness


training.

Thinking
or
saying
this
cuts
down
on
defensiveness
and
shows
respect
for
others.


What
Research
Says
about
Secondary
Trauma


Trauma
is
an
event
that
is
life‐threatening
or
psychologically
devastating
to
the


point
where
individuals’
capacities
to
cope
are
overwhelmed.

Intrusive
thoughts
and


images,
avoidance
of
reminders
of
the
trauma,
and
emotional
arousal
are
three
main


classes
of
responses
to
trauma
(APA,
2000).

The
DSM‐IV‐TR
has
a
diagnostic
category


called
post‐traumatic
stress
disorder
(PTSD).
Secondary
trauma
is
characterized
by
these


same
three
classes
of
responses
(Bride,
2007).




Most
of
the
clients
with
whom
service
providers
work
have
experienced
traumas.



Examples
include
child
abuse
and
neglect,
physical
assault,
rape,
child
sexual
abuse,


witnessing
violence,
family
violence,
violent
crime,
loss
of
loved
ones
through
civil
war,


natural
disasters,
torture,
war,
terrorism,
and
forced
migration
including
refugee
status.



There
is
little
research
on
secondary
trauma
of
social
workers
in
the
United
States,


but
there
is
a
growing
body
of
research
in
allied
professions.

This
brief
review
will
cover


only
the
readings
for
the
course
Direct
Practice
Evaluation.



In
a
survey
of
almost
300
social
workers
in
a
southern
state,
Bride
(2007)
found
that


about
70%
experienced
one
of
the
symptoms
of
PTSD
in
the
previous
week,
more
than
half


met
one
diagnostic
criteria,
about
20%
met
the
criteria
for
two,
and
15%
met
all
three


diagnostic
criteria.
He
also
found
that
about
45%
of
the
sample
reported
intrusive

 Gilgun secondary trauma
Page 6 of 6
thoughts,
45%
reported
avoiding
reminders
of
the
traumatic
event,
and
about
25%


reported
emotional
and
physiological
arousal.
These
are
high
numbers.
Left
unattended


these
responses
can
affect
quality
of
services.


Pludio
(2007)
reported
on
her
interviews
with
50
social
workers
who
provided


services
to
survivors
of
the
9/11
attack
in
New
York
City.

She
also
drew
upon
the
training


she
did
for
service
providers
on
secondary
trauma.
As
in
Bride’s
(2007)
study,
Pludio


observed
in
her
work
that
professionals
experienced
long‐lasting
symptoms
of
PTSD


including
emotional
arousal,
intrusive
thoughts
and
images,
and
avoidance
of
reminders
of


the
trauma.



She
found
the
rates
of
secondary
trauma
to
be
alarmingly
high,
a
situation
she


believed
lack
of
supervision
worsened.
Social
workers
found
processing
their
sessions
with


clients
to
be
highly
stressful,
and
they
often
wept
after
being
with
clients.
Their
work
with


children
particularly
filled
them
with
anguish.

They
often
felt
as
if
they
re‐lived
the
events


of
9/11
over
and
over
again.
They
felt
frustrated
and
helpless
when
they
were
unable
to
be


of
help
to
survivors.



These
professionals
attempted
to
hold
their
responses
in
check
for
a
year
or
two


after
their
work
ended,
only
to
experience
intrusive
thoughts
and
images,
anger
and


irritability,
and
avoidance
of
reminders,
all
symptoms
of
PTSD.



Supervision
and
debriefing
were
insufficient
during
their
direct
work
and
difficult
to


come
by
once
they
had
completed
their
work.
Many
took
the
initiative
and
found
their
own


sources
of
professional
support
and
consultation
to
help
them
deal
with
their
own
trauma‐

related
responses.

Humor
during
supervision
and
consultation
can
relieve
stress
and
open


up
possibilities
for
problem‐solving
and
effective
actions
(Gilgun
&
Sharma,
submitted
for


publication).
Humor,
of
course,
has
to
be
well‐timed,
and
social
workers
must
perceive

 Gilgun secondary trauma
Page 7 of 7
remarks
intended
to
be
amusing
to
be
amusing.



Both
Bride
(2007)
and
Pludio
(2007)
reflected
upon
their
findings.
Bride
pointed


out
that
many
people
believe
that
secondary
trauma
is
a
reason
why
professionals
leave


human
services,
that
many
service
providers
have
short‐
and
long‐term
effects
of


secondary
trauma,
that
the
effects
can
put
strains
on
personal
relationships,
and
that


secondary
trauma
can
affect
practice
effectiveness.

He
recommended
further
research
on


these
areas.

Pludio
(2007)
made
many
suggestions
about
how
to
provide
resources
and


support
to
professionals
with
secondary
trauma.

These
include
supervision,
de‐briefings


after
sessions,
training,
and
peer
support.
At
the
agency
level,
she
recommended
that


supervisors
and
other
administrators
receive
training
on
managing
and
preventing


secondary
trauma,
and
change
the
organizational
structure
to
provide
support
for


professionals,
including
providing
for
a
varied
caseload
and
not
only
clients
with
high


degrees
of
trauma.

She
noted
that
social
workers
wanted
a
repository
of
information
on


secondary
trauma,
client
responses
to
trauma,
and
referral
sources.
She
also
said
that
any


disaster
response
plan
must
include
strategies
for
dealing
with
secondary
trauma.


Discussion



 Secondary
trauma
affects
most
service
providers.

Left
unattended,
such
trauma
can


affect
quality
of
services
and
therefore
practice
effectiveness.

This
article
discussed


strategies
for
identifying
and
dealing
with
secondary
trauma.

The
benefits
of
doing
so
are


high
for
clients
and
for
practitioners
themselves,
both
professionally
and
personally.
Social


workers
who
last
and
have
satisfying
work
and
personal
lives
have
mastered
many


different
ways
of
managing
secondary
trauma.


References


American
Psychiatric
Association.
(2000).
Diagnostic
and
statistical
manual
of
mental

 Gilgun secondary trauma
Page 8 of 8
disorders
(4th
ed.,
text
rev.).Washington,
DC:
Author.



Bride,
Brian
E.
(2007).
Prevalence
of
secondary
traumatic
stress
among
social

workers.
Social
Work,
52(1),
63‐70.




Gilgun,
Jane
F.,
&
Alankaar
Sharma
(submitted
for
publication).
Humor
in
social

services.



Pulido,
Mary
L.
(2007).

In
their
words:
Secondary
traumatic
stress
in
social
workers

responding
to
the
9/11
terrorist
attacks
in
New
York
City.

Social
Work,
57(3),
279‐281.





About
the
Author


Jane
F.
Gilgun,
Ph.D.,
LICSW,
is
a
professor,
School
of
Social
Work,
University
of
Minnesota,


Twin
Cities,
USA.

See
Professor
Gilgun’s
other
articles,
children’s
stories,
and
books
on


Amazon
Kindle,
scribd.com/professorjane,
and
stores.lulu.com/jgilgun.