|Occupational Exposure to Primary and Secondary Trauma in Corrections|
|By Caterina Spinaris|
In this article we aim to identify and discuss the impact of certain realities of the corrections workplace on corrections professionals, and consequently on the workplace climate and culture of corrections organizations.
To illustrate the issues that will be addressed here, we present three vignettes of stories provided to us by corrections professionals. Identifying details have been removed. These stories describe the perceived impact of corrections workplace events on the corrections workers who provided them. The vignettes help illuminate the relevance of the effects of work-related direct (primary) and indirect (secondary) traumatic exposure.
Vignette 1: During the course of my 15-year career as a correctional officer at the jail I have watched countless videos of inmate fights, stabbings, killings. That’s part of training. Once in a while they show us videos of staff getting assaulted, or we read on the Internet about such assaults all over the country. I have also witnessed many such incidents first-hand, probably about 10 serious ones (inmates were killed or had to receive medical care at a hospital), and another 30-40 garden-variety assaults and group fights. I myself have been seriously assaulted three times—cold-cocked while trying to restrain an inmate, kicked, and cut with a shank. I’ve also responded to three inmate suicides. I had to perform CPR on one of them, even though he was cold—too far gone. Really, nothing that I see at work upsets me anymore. The only thing that gets to me is staff who are too soft or weak. My wife tells me that I’ve become hard, uncaring. When I tell her that dead inmates don’t bother me, she is shocked. The other day she asked me how I can possibly deal with murders and suicides and not blink an eye. She asked, “Does this come with the job or are you just heartless?” My children seem to be a little afraid of me as I am strict and fly off the handle easily. Once in a while I have a nightmare about the jail. It causes me to bolt straight up in bed sweating, my heart racing.
Vignette 2: I have been working as a sex offender therapist at a minimum State prison for about four years now. We are contract workers and we do not have to respond to emergencies. I am told that this institution is very low-key. We have not had any serious incidents since I’ve been here, just a small fight here and there. I’ve heard though that a few years ago, before I hired on, there was an inmate murder over a gambling debt. Still, my work is hard. The worst part is having to listen to what the sex offenders have done and to their sexual fantasies. I am haunted by what I hear during our sessions. Sadistic sexual behavior and sexual torture bother me the most. Unfortunately, images of what the offenders are saying get conjured up in my mind automatically while I listen to them and I’m not able to shake them off. These images pop up in my head while I am being intimate with my husband, and on more than one occasion I’ve felt aroused by them. I am so ashamed of myself. I am not a pervert! When this happens I want to stop what I am doing with my husband, but I don’t dare tell him what is going on. So I “check out,” be-cause I can’t relax and enjoy sex with him anymore. Lately I also caught myself “going away” during therapy sessions—tuning the offenders out.
Vignette 3: As a probation officer, part of my job is to write presentencing reports. To do so I pour over documents related to crimes committed. I’ve always thought of myself as a tough guy. Lately though, when I deal with cases where the victim was a child, I can’t shake the anger I feel. I find myself wanting to punch something. Sometimes I’ve even felt like crying, but I just won’t allow myself to do that, because I’m not weak. Instead I end up hating the world. More than once I’ve caught myself putting off looking through files. Frequently on my way home I buy a six-pack. I then go to take care of my horses, drinking while I do that. I stay away from my family’s happy chatter as much as I can. They are so naïve and ignorant! I don’t want to burst their bubble, so I don’t talk to them about my work. But I worry constantly about my children’s safety. I am very strict with them, especially about where they go and who they hang out with. I get into arguments with my wife who objects to my repetitive coaching of my kids to not trust anyone outside immediate family. I often fantasize about what I would do to an offender if he hurt one of my kids.
Corrections work of all disciplines, whether in institutional or community-based settings, has been recognized as being exceptionally stressful (e.g., Finn, 2000; Schaufeli & Peeters, 2000). Research suggests that repeated expo-sure of corrections professionals to a wide variety of potentially traumatic incidents contributes to the stressfulness of this type of work (Spinaris, Denhof & Kellaway, 2011; Standyk, 2003).
Corrections professionals indeed operate in environments that are routinely punctuated and colored by threats, violent behavior, injury, and death. This type of exposure is akin to what police officers (Finn, Talucci & Wood, 2000) and combat military men and women experience (Meis, Barry, Kehle, Erbes, & Polsuny, 2010). Many of these experiences represent and meet the criteria of what constitutes a primary (direct) traumatic stressor as defined by the Diagnostic and Statistical Manual of Mental Disorders (APA, 2000). Exposure to such stressors can lead to symptoms of Post-Traumatic Stress Disorder (PTSD). A few examples of primary (direct) traumatic stressors are: witnessing offender-on-offender violence in real time, discovering bodies of offenders who committed suicide, or being physically assaulted oneself or threatened with physical or sexual violence. Examples of indirect (secondary) traumatic stressors are: exposure to the above events through electronic means (e.g., training videos) or hearsay, or through reading of presentencing reports or offender files.
Exposure to secondary trauma has been studied primarily in terms of its impact on mental health professionals. It has been referred to as Secondary Traumatic Stress (STS), Compassion Fatigue and Vicarious Traumatization (VT). The term Compassion Fatigue was coined by Figley (1995) as a less stigmatizing label for the phenomenon of Secondary Traumatic Stress (STS), and it is used interchangeably with that term. STS refers to the emotional distress and PTSD-like symptoms that result when an individual hears about the firsthand traumatic experiences of another. As Figley (1995) notes, “the process of empathizing with a traumatized person helps us to under-stand the person's experience of being traumatized, but, in the process, we may be traumatized as well” (p. 15). STS mimics the symptoms of Post-traumatic Stress Disorder, but to a lesser extent and without meeting the full criteria for the disorder.
The term Vicarious Traumatization (VT) is defined as “the transformation that occurs in the inner experience of the therapist that comes about as a result of empathic engagement with clients’ trauma material" (Pearlman & Saakvitne, 1995, p. 31). VT is a theoretical term that is based on the Constructivist Self Development Theory pro-posed by Pearlman and McCann (1995), a theory that describes changes in the self of survivors of psychological trauma. The concept of VT focuses less on classic PTSD symptoms and more on changes in a therapist’s core be-liefs following cumulative verbal exposure to another person’s traumatic material.
The concepts of STS and VT differ from a third concept of “burnout” (Maslach, 1976). The concepts of STS and VT emphasize the impact of secondary exposure to the traumatic material of another due to empathizing while in a listening capacity as a helping professional. By contrast, the concept of burnout addresses job demands that are typically unrelated to traumatic exposure, such as working long hours, having little down time, and experiencing continual peer, customer, and supervisor demands and surveillance.
Researchers acknowledge that among helping professionals there is an interactive relationship in the effects of primary traumatic stress, STS, and burnout, and that in order to treat STS and/or burnout among caregivers, primary traumatic stress must first be addressed and treated successfully (Gentry, 2002). It would seem plausible, even probable, that corrections professionals similarly suffer from interactive effects of primary and secondary traumatic stress, and other co-occurring stressors, and that all these effects must be addressed for successful resolution. But there are distinct differences between the work experiences of corrections professionals and those of helping professionals employed in non-corrections environments that would need to be taken into account.
For example, corrections work of all types focuses on offender containment, management, and rehabilitation. It is conducted in a context of unusually heightened and sustained mental vigilance by necessity, to maintain sheer physical safety for both offenders and staff. While sustained vigilance reduces the frequency of violent incidents, some instances of violence, injury and death are inevitable and occur periodically. The work of helping professionals, on the other hand, focuses on assisting clients to heal from their past traumatic experiences, and it is normally conducted in a physically and psychologically safe environment.
Thus since there are stark differences in the work experience of corrections staff of all disciplines versus non-corrections helping professionals, it is our opinion that the concepts of Compassion Fatigue (STS) and VT do not fully capture the complexity and uniqueness of corrections professionals’ work realities.
Taking all of the above factors into account, we propose that the term and concept of Corrections Fatigue provides a better fit and usefulness than the Compassion Fatigue/Secondary Traumatic Stress or Vicarious Trauma alternatives. Corrections Fatigue more accurately encapsulates the complexity of the multiple and uniquely adverse influences of the corrections’ workplace. This term, coined by Caterina Spinaris in 2000, has been defined as the cumulative negative transformation of the self or personality of corrections professionals as a result of insufficient strategies for adapting to the demands of the corrections workplace. This definition has a pragmatic focus that encourages action to address the problem—through implementation of more functional strategies for adaptation.
Attempting to address symptoms alone is not enough for individuals who must maintain continued immersion in an unusually detrimental work environment. The cumulative effect of work environment stressors, especially potentially traumatic stressors and the changes they generate within workers, must be addressed as a deeper source of continued symptoms and problems. The Corrections Fatigue concept is evidence-based and supported by empirical studies (Dollard & Winefield, 1999; Kellaway et al., 2012; Spinaris et al., 2012).
The development of the concept was inspired by the Constructivist Self Development Theory proposed by Pearlman & McCann (1995)—the same theory upon which VT is based. Corrections Fatigue accounts for personality changes as well as stages of professional change of corrections professionals during the course of their career. Its level of severity is proposed to exist on a continuum, and symptoms are considered to be potentially reversible.
Corrections Fatigue stems from a variety of sources in the corrections workplace—organizational stressors (e.g., staff interpersonal conflict, role conflict), operational stressors (e.g., shift work, mandatory overtime), and traumatic stressors (primary and secondary). The Corrections Fatigue concept also allows for interactions of the above categories of stressors with personal stressors unrelated to the workplace (e.g., pre-existing trauma history or other pre-existing mental health issues, current financial stress, or a dependent’s illness).
The Corrections Fatigue construct has received research support, including a nationwide study (Kellaway, et al., 2012; Spinaris et al. 2012) of 3,599 corrections professionals of all disciplines (e.g., custody, administrative, medical, education staff) and types of workplaces (e.g., prison, jail, probation, parole). The nationwide study found a high incidence of post-traumatic symptoms that increased with exposure to workplace violence, injury and death (Kellaway, et al, 2012; Spinaris, et al., 2012). Within the sample, 27% of the respondents met full criteria for PTSD, based on a leading screening device, the PCLC, and based on events taking place during the last 30 work days. An additional 17% met criteria for partial PTSD. Additional findings indicated that men staff, as compared to women staff, had significantly higher exposure rates to incidents of violence, injury and death, and also significantly higher PTSD and partial PTSD rates. Corrections professionals in the custody staff role also demonstrated significantly higher exposure to incidents of violence injury and death, and significantly higher PTSD and partial PTSD rates compared to non-custody staff. These numbers are alarmingly high, even when compared to military returning from combat (Meis, et al., 2010).
In line with the Corrections Fatigue concept, the DWCO study found the following concurrent measures to be significantly higher for corrections staff who met PTSD criteria (compared to those not meeting PTSD criteria): quantity of sick leave, extent of health services utilization, extent of clinical and subclinical mental health conditions, extent of physical stress-related illnesses, and frequency of alcohol and tobacco product use. Additionally, individuals who met PTSD criteria reported significantly lower life satisfaction, lower personal and professional functioning, and lower utilization of health-promoting activities. Severity of these effects increased with PTSD symptom severity.
Preceding the above study, a nationwide pilot study of 720 corrections staff conducted by DWCO in 2010 found that 39% of the respondents met criteria for PTSD symptoms experienced over the past 6 months. Again, severity of symptoms increased with exposure to violence, injury and death, and men corrections professionals had higher expo-sure to such incidents and higher PTSD rates than women corrections professionals.
The results of these two studies are in line with the only other study that explored PTSD rates in Canadian Corrections Officers (Standyk, 2003), and which reported a PTSD rate of 27%. Standyk also found increased sick leave, utilization of health services and alcohol use, and decreased job satisfaction for those who met PTSD criteria versus those who did not.
Additional data, described below, were collected through an assessment tool designed to assess the degree of Corrections Fatigue being experienced by individuals or groups. These figures give further indication of the breadth of Corrections Fatigue symptoms in corrections professionals across the United States.
The Corrections Fatigue Status Assessment-Version 2 (CFSA-V2) was developed by Denhof and Spinaris (2012) to quantitatively measure the extent of the phenomenon of Corrections Fatigue for individuals and groups, as a basis for gauging symptom severity and fashioning commensurate interventions. The CFSA-V2 assessment is available at http://correctionsfatigue.com. It is offered online to individual corrections professionals for repeated use at no charge, and provides an automated interpretation of scores. The CFSA-V2 currently has good foundational psycho-metric properties. It was developed using recommended principles of clinical assessment instrument development, based on factor analysis and repeated sampling to derive the most unitary and distinctively-related assessment items from an initial pool generated by content experts. The CFSA-V2 demonstrates excellent internal consistency reliability (alpha=.89), and content and factorial validity (i.e., discriminant and convergent validity of constituent items). The instrument has also demonstrated a modest and statistically significant positive correlation with a measure of self-reported exposure to incidents of violence, injury and death, supporting the theoretically expected relationship be-tween traumatic exposure and Corrections Fatigue.
Through 08/06/12, the CFSA-V2 was completed by over 600 corrections professionals from 37 different States and diverse jobs roles, years of experience and age groups. This sample also had good gender representation (56% male; 44% female). Statistical analyses indicated that the average total CFSA-V2 score within the normative sample was 53, from a range of possible scores spanning from 23 to 92. Approximately 37% of assessed individuals scored higher than 58, which is interpreted as demonstrating a moderate degree of Corrections Fatigue. Such individuals averaged a "Mostly True" response to numerous statements of symptoms and indications of Corrections Fatigue. Even more concerning is that 10% indicated a high degree of Corrections Fatigue.
The above findings shed light on the problem of Corrections Fatigue, and the question of what to do about it becomes paramount. Corrections Fatigue trainings developed at DWCO are among notably few current offerings specifically developed and tailored to corrections professionals and the unique circumstances of correctional work environments. Desert Waters trainings provide strategies to equip corrections professionals to progress toward “Corrections Fulfillment.” Corrections Fulfillment is another construct coined by Spinaris in 2004, in this case to denote positive trans-formations, post-traumatic growth, good functioning, and well-being that follow from successful implementation of effective coping and adaptation strategies. Corrections Fulfillment is exemplified by finding positive meaning in corrections work, pursuing opportunities for professional development, and experiencing post-traumatic growth following critical incidents. Corrections Fulfillment includes elements analogous to the concepts of Compassion Satisfaction (Stamm, 2010) and Post-traumatic Growth (Tedeschi & Calhoun, 1996).
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