The document discusses the "Treatment Triangle" model, which explores the roles that social workers and clients can take on in their relationship: rescuer, victim, and persecutor. It describes how social workers working with trauma clients can slip into an unhealthy cycle moving between these roles if boundaries are not maintained. Specifically, it outlines how social workers may start in a rescuer role but then feel like a victim when clients do not show appreciation. This can then lead to taking on a persecutor role if feelings of victimization persist. The article stresses the importance of supervision and self-reflection to help social workers step outside of this dynamic and maintain effective, empathetic practice.
Disruptive Innovation transforms Adult SMI Clinic in Maricopa County (all parties agreed to image participation in presentation provided to Arizona NAMI Annual Meeting 2009).
Discussion 1 - Week 6
Counter transference, Secondary Traumatic Stress Disorder, and Vicarious Traumatization
In previous weeks of this course, you explored many major aspects of crisis and intervention including the scope of crisis; skills, strategies, and models of intervention; the characteristics and nuances of crises affecting individuals, couples, families, and systems; and the collaborative nature of crisis intervention. Until now, your primary focus has been on the intricacies of how to help others experiencing a crisis. All too often, however, this unwavering focus on helping others cope with crises can lead human services professionals to their own personal and professional crises. In some cases, this can take the form of counter-transference, in which human services professionals attribute their own personal experiences, feelings, or behaviors to the client they are treating. For example, a human services professional who felt guilty and inadequate for not being able to spend more time with a terminally ill family member in the past might find these feelings of guilt and inadequacy resurfacing during therapy sessions with a terminally ill client. Countertransference is especially common when human services professionals engage in intense therapy sessions with clients about highly sensitive topics such as abuse and suicide ideation.
In other cases, human services professionals may find themselves struggling with secondary traumatic stress disorder (STSD), also referred to as compassion fatigue. Secondary traumatic stress disorder is similar to post-traumatic stress disorder (PTSD). Like a sufferer of PTSD, a human services professional afflicted with STSD might experience recurrent nightmares of traumatic events, flashbacks, intense physical reactions to external cues reminiscent of the events, and feelings of numbness or detachment in their everyday lives. The difference is that these symptoms are due not to the direct experience of the traumatic events, but rather to secondary exposure to these events via conversations and interactions with clients who have experienced them.
Related to STSD is the phenomenon of vicarious traumatization. With vicarious traumatization, human services professionals experience fundamental, long-term, potentially permanent changes in their psyches and worldview as a result of working with survivors of crisis. Human services professionals may display the symptoms of an individual who has experienced a trauma although they, in fact, have been exposed to it only through the relating of these traumatic events to them by clients.
It is not difficult to understand why human services professionals working with crisis and intervention may be especially vulnerable to counter-transference, STSD, and vicarious traumatization. Professionals who choose these specialties tend to be (and in fact
need
to be) extremely empathic, compassionate, and caring individuals. At the same time, these qualities can mak ...
Disruptive Innovation transforms Adult SMI Clinic in Maricopa County (all parties agreed to image participation in presentation provided to Arizona NAMI Annual Meeting 2009).
Discussion 1 - Week 6
Counter transference, Secondary Traumatic Stress Disorder, and Vicarious Traumatization
In previous weeks of this course, you explored many major aspects of crisis and intervention including the scope of crisis; skills, strategies, and models of intervention; the characteristics and nuances of crises affecting individuals, couples, families, and systems; and the collaborative nature of crisis intervention. Until now, your primary focus has been on the intricacies of how to help others experiencing a crisis. All too often, however, this unwavering focus on helping others cope with crises can lead human services professionals to their own personal and professional crises. In some cases, this can take the form of counter-transference, in which human services professionals attribute their own personal experiences, feelings, or behaviors to the client they are treating. For example, a human services professional who felt guilty and inadequate for not being able to spend more time with a terminally ill family member in the past might find these feelings of guilt and inadequacy resurfacing during therapy sessions with a terminally ill client. Countertransference is especially common when human services professionals engage in intense therapy sessions with clients about highly sensitive topics such as abuse and suicide ideation.
In other cases, human services professionals may find themselves struggling with secondary traumatic stress disorder (STSD), also referred to as compassion fatigue. Secondary traumatic stress disorder is similar to post-traumatic stress disorder (PTSD). Like a sufferer of PTSD, a human services professional afflicted with STSD might experience recurrent nightmares of traumatic events, flashbacks, intense physical reactions to external cues reminiscent of the events, and feelings of numbness or detachment in their everyday lives. The difference is that these symptoms are due not to the direct experience of the traumatic events, but rather to secondary exposure to these events via conversations and interactions with clients who have experienced them.
Related to STSD is the phenomenon of vicarious traumatization. With vicarious traumatization, human services professionals experience fundamental, long-term, potentially permanent changes in their psyches and worldview as a result of working with survivors of crisis. Human services professionals may display the symptoms of an individual who has experienced a trauma although they, in fact, have been exposed to it only through the relating of these traumatic events to them by clients.
It is not difficult to understand why human services professionals working with crisis and intervention may be especially vulnerable to counter-transference, STSD, and vicarious traumatization. Professionals who choose these specialties tend to be (and in fact
need
to be) extremely empathic, compassionate, and caring individuals. At the same time, these qualities can mak ...
The development of closed cultures in healthcare is not a new phenomenon. Closed cultures can occur in any industry, profession, or team because closed cultures are the product of several conditions that have been established.
HSM Discussion Board and examplesBriefly summarize the five huma.docxpooleavelina
HSM Discussion Board and examples
Briefly summarize the five human services values presented in this week’s readings. Then describe a situation in which you would have difficulty using one of those values as a guiding principle for your actions. Why is the human services value you selected difficult to practice? Propose solutions that address these difficulties.
Example 1:
Class,
In our textbook Woodside and McClam (2019) describe the 5 values important to the practice of human services. They are:
1. Acceptance: the ability of the helper to be receptive regardless of behavior or dress.
2. Tolerance: ability of the helper to be fair and patient toward each client, and not to judge, blame, or punish for prior behaviors.
3. Individuality: Recognizing and treating each person individually and not based off of stereotypes such as lifestyle, problems, assets, and previous life experiences.
4. Self-determination: Allows the client to make up their own mind when it comes to decision-making and actions to be taken.
5. Confidentiality: Helper will not discuss client’s cases with others, nor will they use what they discuss with clients as conversation fodder with friends and family.
I would have a hard time exercising tolerance if my client was a repeat offender for domestic and/ or child abuse. It would be very difficult not to judge that behavior or to want to help that client. I would feel torn between wanting to get them the help they needed in order to hopefully stop the cycle of violence, but in my heart I would want to be helping ensure the child or domestic partner was out of that situation and never had to see my client again, unless they chose to. On the flip side, if my client was the abuse victim and continuously kept an abuser in their life, and those of their children, it would be equally difficult to be tolerant of that behavior. I would definitely feel the urge to throw the value of self-determination out the window as well and make decisions for my client...which I know is not an option.
Tolerance can be hard to practice when other's actions go against your own moral and ethical values. You pretty much need to shut your own emotions up in a box and try and connect people to services no matter what. I think with proper training and confidence in the services you are providing, one can practice the 5 values. If I come to believe in a program that I think may help an abuser learn to reverse their behavior in future, maybe I would have more tolerance when working with them.
Woodside, M., & McClam, T. (2019). An introduction to human services (9th ed.). Boston, MA:
Cengage.
Example 2:
Hi everyone,
The follow are the top five human service values discussed in our book, Introduction to Human Services (Woodside & McClam, 2019)
1. Acceptance is the ability of the helper to be receptive to another person regardless of dress or behavior
2. Tolerance is the helper’s ability to be patient and fair toward each client rather than judging, blamin ...
Top tips on managing professional boundaries in Social WorkAlex Clapson
As with all professions, social workers are expected to uphold key boundaries to protect themselves, their clients and the organisation they work for. These boundaries are meant to ensure that relationships between social workers and clients remain professional, even when working on very personal and difficult issues.
Talk by Dr Simon Duffy for AACQA on equal citizenship and aged care systems. Dr Duffy explores the meaning of citizenship and the problems inherent in support systems that are not focused on community inclusion.
You have been successful in your application for the position be.docxbriancrawford30935
You have been successful in your application for the position below and are invited to interview – time and date to be arranged.
Job Title: Social Care Worker – Residential services Panel
The social care worker will…
· work with children / young people, families and / or significant others, Social Work teams, other healthcare providers and agencies, schools, training agencies and community groups.
· care for, protect, and support vulnerable or dependent clients, individually or in groups, in conjunction with the wider multidisciplinary team and other relevant agencies. S/he will ensure the welfare of those under his / her care and will act as an advocate as appropriate.
· contribute to the planning and evaluation of individualised and group programmes of care, which are based on needs, identified in consultation with the client and others and delivered through day-to-day shared life experiences.
· work as part of a team to provide a safe, caring environment for resident clients/ children / young people with the primary aim of providing the intervention necessary to address the issues that are preventing them from fulfilling their outcomes.
· treat clients/ children/ young people and their families with dignity and respect, promoting a culture of unconditional positive regard at all times.
· recognise clients/ children / young people as expert through experience, promoting their participation in care planning, placement planning, decision-making and service delivery.
· contribute to the promotion of good links with neighbours, local community resources, i.e. schools, employment schemes and clubs, local Gardai and any other appropriate service.
· engage in reflective and evidence based practice
. That guideline to use to answer this question 1 to 3
1. Creative practice, reflective practice and team skills
It is important that the Social Care Worker can work independently as well as part of a wider healthcare team, building and maintaining relationships and understanding and valuing individuals and their respective professional roles. S/he should be able to identify the limits of their practice and know when to seek advice and additional expertise or refer to another professional. S/he should be able to give and receive feedback and to input their learning into their practice.
In the space below, please give an example of a situation where you were responsible for an individual piece of work with a service user/group of service users and which demonstrates your ability in the above areas
2
.
Flexibility, resilience and ability to deal with challenges.
An effective Social Care Worker demonstrates a commitment to providing a quality service. S/he is innovative and open to change in striving to ensure high standards in service delivery. Challenges can arise in many ways in the course of Social Care practice and an ability to manage adversity when it arises is an important professional skill.
In the space below, please give an.
The development of closed cultures in healthcare is not a new phenomenon. Closed cultures can occur in any industry, profession, or team because closed cultures are the product of several conditions that have been established.
HSM Discussion Board and examplesBriefly summarize the five huma.docxpooleavelina
HSM Discussion Board and examples
Briefly summarize the five human services values presented in this week’s readings. Then describe a situation in which you would have difficulty using one of those values as a guiding principle for your actions. Why is the human services value you selected difficult to practice? Propose solutions that address these difficulties.
Example 1:
Class,
In our textbook Woodside and McClam (2019) describe the 5 values important to the practice of human services. They are:
1. Acceptance: the ability of the helper to be receptive regardless of behavior or dress.
2. Tolerance: ability of the helper to be fair and patient toward each client, and not to judge, blame, or punish for prior behaviors.
3. Individuality: Recognizing and treating each person individually and not based off of stereotypes such as lifestyle, problems, assets, and previous life experiences.
4. Self-determination: Allows the client to make up their own mind when it comes to decision-making and actions to be taken.
5. Confidentiality: Helper will not discuss client’s cases with others, nor will they use what they discuss with clients as conversation fodder with friends and family.
I would have a hard time exercising tolerance if my client was a repeat offender for domestic and/ or child abuse. It would be very difficult not to judge that behavior or to want to help that client. I would feel torn between wanting to get them the help they needed in order to hopefully stop the cycle of violence, but in my heart I would want to be helping ensure the child or domestic partner was out of that situation and never had to see my client again, unless they chose to. On the flip side, if my client was the abuse victim and continuously kept an abuser in their life, and those of their children, it would be equally difficult to be tolerant of that behavior. I would definitely feel the urge to throw the value of self-determination out the window as well and make decisions for my client...which I know is not an option.
Tolerance can be hard to practice when other's actions go against your own moral and ethical values. You pretty much need to shut your own emotions up in a box and try and connect people to services no matter what. I think with proper training and confidence in the services you are providing, one can practice the 5 values. If I come to believe in a program that I think may help an abuser learn to reverse their behavior in future, maybe I would have more tolerance when working with them.
Woodside, M., & McClam, T. (2019). An introduction to human services (9th ed.). Boston, MA:
Cengage.
Example 2:
Hi everyone,
The follow are the top five human service values discussed in our book, Introduction to Human Services (Woodside & McClam, 2019)
1. Acceptance is the ability of the helper to be receptive to another person regardless of dress or behavior
2. Tolerance is the helper’s ability to be patient and fair toward each client rather than judging, blamin ...
Top tips on managing professional boundaries in Social WorkAlex Clapson
As with all professions, social workers are expected to uphold key boundaries to protect themselves, their clients and the organisation they work for. These boundaries are meant to ensure that relationships between social workers and clients remain professional, even when working on very personal and difficult issues.
Talk by Dr Simon Duffy for AACQA on equal citizenship and aged care systems. Dr Duffy explores the meaning of citizenship and the problems inherent in support systems that are not focused on community inclusion.
You have been successful in your application for the position be.docxbriancrawford30935
You have been successful in your application for the position below and are invited to interview – time and date to be arranged.
Job Title: Social Care Worker – Residential services Panel
The social care worker will…
· work with children / young people, families and / or significant others, Social Work teams, other healthcare providers and agencies, schools, training agencies and community groups.
· care for, protect, and support vulnerable or dependent clients, individually or in groups, in conjunction with the wider multidisciplinary team and other relevant agencies. S/he will ensure the welfare of those under his / her care and will act as an advocate as appropriate.
· contribute to the planning and evaluation of individualised and group programmes of care, which are based on needs, identified in consultation with the client and others and delivered through day-to-day shared life experiences.
· work as part of a team to provide a safe, caring environment for resident clients/ children / young people with the primary aim of providing the intervention necessary to address the issues that are preventing them from fulfilling their outcomes.
· treat clients/ children/ young people and their families with dignity and respect, promoting a culture of unconditional positive regard at all times.
· recognise clients/ children / young people as expert through experience, promoting their participation in care planning, placement planning, decision-making and service delivery.
· contribute to the promotion of good links with neighbours, local community resources, i.e. schools, employment schemes and clubs, local Gardai and any other appropriate service.
· engage in reflective and evidence based practice
. That guideline to use to answer this question 1 to 3
1. Creative practice, reflective practice and team skills
It is important that the Social Care Worker can work independently as well as part of a wider healthcare team, building and maintaining relationships and understanding and valuing individuals and their respective professional roles. S/he should be able to identify the limits of their practice and know when to seek advice and additional expertise or refer to another professional. S/he should be able to give and receive feedback and to input their learning into their practice.
In the space below, please give an example of a situation where you were responsible for an individual piece of work with a service user/group of service users and which demonstrates your ability in the above areas
2
.
Flexibility, resilience and ability to deal with challenges.
An effective Social Care Worker demonstrates a commitment to providing a quality service. S/he is innovative and open to change in striving to ensure high standards in service delivery. Challenges can arise in many ways in the course of Social Care practice and an ability to manage adversity when it arises is an important professional skill.
In the space below, please give an.
You have been successful in your application for the position be.docx
Treatment Triangle - Austen
1. STEPPING OUTSIDE THE TRIANGLE BY MELITdPA &T,}$TEN
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Social workers are uniquely placed within
the refugee and asylum seeker sector
in a variety of roles as caseworkers, PERSECUTOR
trauma counsellors, and in community
development. The social justice context in
which we work can inspire and engage us
in our practice. However, the complex and
dynamic nature of trauma work can also
bring a number of professional and personal
cha llenges.
Much has been written about the potential
for burnout and vicarious trauma while
working with vulnerable populations where
organisations are frequently resource-
stretched and at the behest of changes
in Government policy and community
attitudes. As a clinical supervisor for the
Red Cross and a counsellor at the Victorian
Foundation for Survivors of Torture and
Trauma, I am particularly interested in
exploring the interface between social
worker and client as a means to reduce the
potential for vicarious trauma, encourage
self-care and invite effective social work
practice. This article has arisen from fruitful
discussions with Red Cross caseworkers
in both individual and group supervision
sessions.
The Treatment Triangle
The Drama Triangle is a model developed by
Dr Stephen Karpman, out of Dr Eric Berne's
1950's Transactional Analysis. lt explores
the interplay of roles between one or more
people in mutual exchange. When applied
to a clinical setting, the Drama Triangle is
commonly referred to as the Treatment
Triangle.
Knowledge of the Treatment Triangle
assists Mental Health SocialWorkers to
identify transference in their professional
relationship wlth clients and highlight
potential boundary crossings. The Treatment
Triangle invites reflection when working
with clients with complex needs and a
greater awareness of the potential impact of
trauma work on oneself.
lf we consider a traditional story plot, there
is usually a victim (Snow White), a rescuer
VICTIM
(Prince Charming) and a persecutor (evil
Step-mother). ln our professional practice,
we may locate ourselves in any one of these
roles at different times.
Rescuer
The social justice conviction which
motivates social workers to provide services
that support and empower clients may, at
times of stress, spill into client rescue. Whilst
social workers mostly attempt to provide
an equivalent level of care for all clients,
as per their individual needs, some people
inevitably touch us more personally.
Some clients may present with particularly
distressing stories or may, consciously or
unconsciously, remind us of someone close
to us, triggering a response of increased
support and intervention. Social workers
may also find it difficult to stay emotionally
present, with feelings of inadequacy when
working with stories of human rights
abuses. They could even end up trying to
fill a growing sense of helplessness with
activity as it can be easier to feel useful
by focusing on tasks rather than facing
personal helplessness. This can include
scheduling additional client sessions,
contacting clients between sessions,
accompanying clients more often to
appointments, and/or offering additional
advocacy. Professional boundaries may be
breached due to these.
RESCUER
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2. Rescuing differs from supportive
practice, as the'Rescuer' takes
full responsibility for addressing
client issues without awareness of
transference issues or their personal
investment in helping.
While the majority of refugee and
asylum seeker clients require at least
some level of support to aid settlement
and address trauma issues, many
also maintain a level of resilience and
resourcefulness born of the refugee
experience. Many have managed
a journey to Australia in extreme
conditions and have found the
means to meet many of these needs.
Excessive helping can deny clients the
ability to make their own choices or
navigate their own way through new
circumstances. lt can discourage client
consultation, self-determination and
empowerment.
Victim
lnevitably, workers taking on a rescuer
role may experience resentment or lack
of appreciation. This may be triggered
for several reasons. These can include,
but not be limited to when clients: miss
multiple appointments, refuse housing
that has been difficult to secure, don't
follow up on external referrals, don't
engage well in counselling, complain
about the service or make a complaint
about ourselves.
When frustrations build from our
unmet expectations of the client, we
may begin to see ourselves as'victimsi
This could be caused by a feeling of
having wasted our time or being taken
for granted - especially if we had other
pressing client issues or administrative
deadlines. The small rejections of
assistance or complaints may feel
particularly frustrating and unfair.
As well as experiencing victimhood,
social workers may also feel like victims
of the system, due to working within
a changing socio-political context
and within organisational constraints.
Becoming overwhelmed from an
increased workload, along with hearing
traumatised client stories, may result
in a reduced sense of personal efficacy,
motivation, vulnerability, inadequacy or
powerlessness.
Persecutor
When an experience of victimhood is
prolonged, social workers may become
angry and begin to blame or punish
their clients. Persecution can occur in
subtle ways through the withdrawal
of care-taking. We may become less
available, refer clients back to drop-in
intake services, reduce appolntments
or cease our work with the client
altogether. We may become less
invested in client needs and less active
in the provision of advocacy or support.
ln the persecutor role, social workers
often deny the impact of our own
power on the client and, discount the
powerlessness of clients who have been
traumatised, faced dangerous refugee
journeys, prolonged detention and
insecure settlement.
lnevitably, social workers reconnect
with client powerlessness and their
potential for suffering. We are reminded
of our original motivation for entering
the sector, which is often out of our
concern for the political and personal
rights of refugee and asylum seeker
clients.
Guilt at the potential for a persecutory
response can then propel us back into
the rescuer role and the cycle begins
again.This is not helpful.
Stepping Outside the Triangle
Effective practice requires us to step
outside the cycle of the triangle,
and supervision can be particularly
helpful for this. Taking a bird's eye view
encourages awareness and invites
self-responsibility for our actions and
attitudes. For example, identifying onet
propensity for rescuing, recognising
personal secondary gains and
questioning whether one has become
over or under involved with client
issues.
Recognising the personal impact of
working with traumatised clients is
a starting point for addressing the
experience of victimhood. A sense of
personal power can be realised through
greater focus on: work practices within
our control, attempts at advocacy
within organisational boundaries,
reminding ourselves of the reason for
doing this work, involvement in staff
support activities and through self-care
measures such as work/life balance,
and connection to colleagues and
community.
Social workers in casework roles are
encouraged to consider the importance
of being the first point of contact
for many traumatised clients. Being
experienced by clients as reliable,
consistent and caring, is as important as
being effectively task-focussed, as it can
help rebuild trust. The value of fostering
these personal qualities often goes
unrecognised by stressed out workers.
Conclusion
Being able to recognise the potential for
falling into the roles of rescuer, victim
and/or persecutor when working with
traumatised clients, is a reminder of the
power of the inter-relationship between
worker and client. Self reflective
practice helps us maintain personal and
professional boundaries, acknowledge
client strengths and stay tuned to our
self-care needs; all of which ensure
effective practice, best client outcomes
and greater work satisfaction.
Melinda Austen is a Mental Health
Social Worker and Couple Therapist
in private practice in Carlton, with
person2person Counseliing and
Consultancy. She is passionate
about clinical supervision and
committed to reflective practice
as both a clirician ard supervisor.
Melinda first came across the
TreatmenL Triangle wnen working
for STARTTS, the Service ofthe
Treatment and Rehabilitation of
Torture and Trauma Survivors and
has been applying it everywhere
since. An expanded version ofthe
article is availab{e at;u.linke r:in.
'u^. I t ''",- 1i.' rr .rr.