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Chapter 6 Mental Health Needs

In the field of victim advocacy, conflicts can arise from the structure of organizations; the adversarial nature inherent in the justice systems; communication distortions and barriers; interpersonal or behavioral factors among individuals; and social conditions, such as conflicts of interest, dependency upon others for performance of one's job, and degree of participation in decision making within an organization or collaborative structure. This section discusses the unique stressors experienced by victim service providers, including those related to working with and providing advocacy for victims and dealing with the limitations, as well as adversarial nature, of the justice system. Techniques for recognizing and managing stress, preventing burnout, and conflict management are also presented.

Upon completion of this section, students will understand the following concepts:

• Unique sources of stress in working with crime victims.

• How to recognize signs of stress.

• How to recognize unhealthy coping skills.

• Techniques to relieve stress and to help prevent stress from becoming burnout.

• How to take charge of stress.

• Guidelines for managing conflict.

The cost of occupational stress to business and industry in monetary terms has become increasingly well documented. Annually, U.S. industry loses approximately 550 million working days due to absenteeism. It is estimated that 54% of these absences are in some way stress-related (Elkin and Rosch 1990). Moreover, researchers at the American Institute for Stress, a nonprofit organization based in New York, suggest that 75% to 90% of patients' visits to physicians are for ailments that have some kind of link with stress and that controlling stress could be instrumental in controlling rising health care costs (Nowroozi 1994, 82). Stress can influence the immune system, weakening the body's defenses against many viral disorders. Preliminary research conducted by Carnegie Mellon University in Pittsburgh, Pennsylvania, found that of 400 people intentionally exposed to common-cold viruses, those who scored highest on a test of stressful life events were more than twice as likely to develop colds after this exposure than people who scored the lowest (Ibid.). Clearly, occupational trauma and stress are critical problems faced by many professionals. Victim service providers, due to the inherently stressful and traumatizing nature of their work, are particularly vulnerable.

Professionals who serve crime victims face many unique sources of stress that go beyond the typical stressors experienced by professionals and volunteers in other work environments. Victim service providers are expected to provide comforting and compassionate support for crime victims while, at the same time, be outspoken advocates to ensure that victims are extended their rights within the justice system and receive necessary services. In addition, many crime victim assistance professionals work within the very system they are trying to change and improve; they know all too well its limitations. The responsibility of serving in roles that sometimes conflict can be a major source of stress.

Another source of stress that often affects those in helping professions relates to the desire to assist those in need. How do you know when "enough is really enough?" This question plagues the victim service profession and often arises in training sessions conducted on stress and burnout for victim service providers. With no clear standards for the field (varying organizational policies on how far the role of the victim service provider extends) and no "manual" on what it takes to provide reasonable and appropriate victim assistance, most victim service providers find they must set their own limits. This, too, can cause stress.

Finally, the nature of the work causes many crime victim advocates to be in regular contact with people who have suffered severe trauma and loss. The provision of effective victim assistance requires tremendous emotional energy and resilience, which can be a near-constant source of stress. The following are stressful situations that the victim-serving community may encounter:

• Working with victims and witnesses who have experienced or witnessed acts of indescribable human cruelty.

• Working with children who have suffered repeated inhumane acts of sexual, physical, or other abuse.

• Dealing with grieving family members of deceased victims, immediately after a homicide when providing death notification or in the weeks or months that follow.

• Assisting scores of victims and survivors in the aftermath of mass murder or terrorism.

• Working with victims who, for a variety of reasons, continue to be at risk for further abuse.

These represent work-related stressors that are quite different from most job settings and may affect an individual victim advocate in profound ways.

The field of victim services is paying increasing attention to the issue of vicarious trauma, which is defined as "a stress reaction experienced by therapists and researchers who are exposed to disclosures of traumatic images and materials by clients and research participants, in which the therapists or researchers experience enduring changes in the manner in which they view self, others, and the world" (McCann and Pearlman 1990).

Victim service providers become, in the line of duty, prime candidates for vicarious trauma. Their acute and chronic exposure to the trauma, grief, and other reactions that are common to many crime victims can have a cumulative, and often devastating, effect on their view of the world and, sometimes, on their choice of careers.

Dr. Charles Figley, Professor and Director of the Florida State University Traumatology Institute, developed a brief overview of the history of vicarious trauma, which is summarized as follows:

There are four "conceptual building blocks" that may occur prior to the emergence of vicarious trauma:

1. Countertransference.

2. Burnout.

3. Posttraumatic stress disorder (PTSD).

4. Secondary victimization.

COUNTERTRANSFERENCE

Countertransference can be used in several ways: as a reference to all the feelings a therapist has toward a client, as the therapist's reactions to a client's transference, or as the therapist's own transference toward a client. When the client's behavior evokes in the counselor (provider) conflicts relating to unresolved situations in the counselor's life, causing the counselor to respond to the client in nonobjective way, the counselor is experiencing a form of countertransference.

BURNOUT

The term "burnout" emerged from studying worker discontent, and is defined most recently as "a state of physical, emotional, and mental exhaustion caused by a long-term involvement in emotionally demanding situations" (Pines and Aronson 1988, 9).

POSTTRAUMATIC STRESS DISORDER

The term "posttraumatic stress disorder" emerged from the study of Vietnam veterans. PTSD is an anxiety disorder caused by a traumatic event or series of events and is characterized by symptoms of withdrawal to avoid the troubling memories that often intrude the lives of victims and cause distress. (See Section 1 of this chapter for further information on PTSD.)

SECONDARY VICTIMIZATION

Secondary victimization and secondary trauma occur when family members are traumatized by the symptoms of PTSD of a family member.

Secondary trauma stress. The concept of secondary trauma stress emerged from the study of trauma therapists, child protection workers, pediatric critical care nurses, law enforcement officers, fire fighters, emergency workers, and victim service providers. Secondary trauma stress is the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other, and the stress resulting from helping or wanting to help a traumatized or suffering person. Figley has also coined the term "compassion fatigue," which derives from secondary traumatic stress disorder (Figley 1999).

An individual's ability to tolerate stress often depends on the frequency, severity, and types of stressors confronted. It also depends on many intrinsic or personal characteristics:

• Past victimization. For many victim service providers, their past life experiences also involve personal victimization. The concept of "victims helping victims" is an inherent strength of America's victims' rights discipline. Many service providers have transformed tragic events into heroic and life-giving achievements. Sometimes termed "wounded healers," such individuals can possess a degree of fortitude, courage, and insight unattainable by other means, and yet, the very source of this transformed strength can be their deepest area of vulnerability to stress and secondary traumatization.

• Personal values and attitudes. All professionals and volunteers in the field of victim advocacy have a core foundation of values and attitudes that affects their perception of others, of their work environment, and of life in general. One's personal beliefs may conflict with the expectations of the job and affect, in particular, a person's individual interactions with others.

• Sense of control. While providing victims with resources to return control to their lives is a core tenet of victim services, it is also necessary for advocates to feel in control of their professional actions and decision making. With so many unknown and unpredictable factors in cases of crime and victimization, a sense of true "control" can be difficult to achieve.

• Personality. The job description for a victim advocate requests the strength of an ox, the patience of Job, and the resiliency of teflon. When one is expected to be a "pillar of strength" for countless people in need of support, the challenges of victim services can become overwhelming.

• Residual stress level. Unless victim advocates possess strong stress management skills, they are likely to develop cumulative "layers" of stress that eventually lead to burnout.

• General state of health. Both physical and mental health play a significant role in a victim advocate's ability to fulfill his or her job duties. Chronic illness or an acute ailment can weaken a person's ability to cope with job responsibilities. In addition, harmful coping skills such as smoking or substance abuse can affect one's overall health.

In addition, several external or organizational factors can contribute to stress:

• Work overload. There are few victim advocates whose jobs are limited to a forty-hour work week. An inability to say "no" to tasks that are not essential or to establish work priorities are common sources of both acute and chronic stress.

• Family conflicts. The difficulty of balancing the rigors of the job with a healthy family life at home is a common challenge to many professionals. For victim service providers, this problem is magnified because of the trauma and evils they can encounter on literally a daily basis. The burden of keeping this kind of daily exposure from negatively affecting victim service providers' relationships with family members can be tremendous.

• Threat of job loss. For victim service providers who work "grant-to-grant" or whose positions are reliant on external (and often unstable) sources of funding, the issue of job security is a major concern.

• Job conflict or job ambiguity. Without clearly defined boundaries and job descriptions that guide the duties of a victim advocate, conflicts are likely to occur. When system-based victim service providers find themselves advocating for victims whose cases have limited legal rights under state or federal law, anger and frustration can ensue.

• Interpersonal conflicts. Ongoing disputes can easily arise between people who have different personalities and outlooks. In addition, victim services is a field that requires a tremendous amount of collaboration which, when not approached with openness and honesty, can rapidly erode into competition. Indira Gandhi once described two kinds of people: "those who do the work, and those who take the credit." She suggested it was better to be in the first group, because there was much less competition!

• External agency conflicts. There are multiple sources of stress over which victim advocates have little control: lack of victims' rights laws; lack of continuous funding; a media barrage around a high-profile case; and the reliance on other individuals and agencies to complete part of a larger task in order for the advocate to be able to do his or her job, to cite a few. If victim service providers cannot control these, and similar, external forces, they must learn to be able to at least know about them and accommodate the possible influence of such forces on their work.

• Organizational culture. The atmosphere of one's work environment can either reduce or add to personal stress. If superiors are supportive and colleagues are understanding, the organization's culture can be a source of strength. On the other hand, many victim service providers work in environments that are frenetic, disorganized, and lack respect for individuals' needs and achievements. Moreover, victim advocates may work in organizational cultures that simply do not (traditionally) understand or support victim advocacy.

• Insufficient resources. There are few (if any) victim service agencies that have the financial, human, and community support resources needed to accomplish their mission and goals. While insufficient resources are often viewed as a significant barrier to success, they can also force victim assistance organizations to prioritize, set realistic goals, and learn to live within the limits of available resources. When this does not occur, organizational burnout (and even demise) are possible outcomes.

• Inadequate job training. There are few institutions of higher education that adequately prepare students for a career in victim advocacy. Furthermore, on-the-job training opportunities are often limited because there is not enough time to "do the work, and do the training." The professionalism of the victims' rights discipline and, indeed, the sanity of professionals and volunteers within the field, require systematic attention to orientation and continuing education. The National Victim Assistance Academy text is designed to provide exactly this type of basic training for professionals in this field.

• Supervisor's attitudes. An understanding and supportive supervisor can be one of the greatest stress reduction assets to a victim advocate. However, when a supervisor fails to show respect and appreciation for and understanding of the work of a subordinate, the end result is chronic work-related stress.

• Changes in organizational structure or vision. As the victims' rights discipline has grown and matured, it has witnessed significant changes in the thousands of organizations that comprise it. Broadened funding bases, passage of new laws that increase victims' rights, the hiring of additional staff, and stronger links to the community are all positive outcomes of this growth and maturity. Yet it can be difficult to adapt to such changes, particularly if a victim advocate has become accustomed to "the old way" of doing business. Change can (and should be viewed as) positive. As Pauline Kezer noted, "Continuity gives us roots. Change gives us branches, letting us stretch and grow and reach new heights" (1992, 48).

Stress has an effect on all aspects of an individual's emotions, behavior, and physical health. Researchers generally divide the manifestations of stress into three general categories: psychological, cognitive, and physical.

The symptoms of psychological stress can include the following:

• Anxiety.

• Irritability.

• Mood swings.

• Sadness and depression.

• Low self-esteem.

• Emotional withdrawal.

• Hypersensitivity.

There are also cognitive symptoms associated with stress. These symptoms can affect an individual's work performance, such as follows:

• Inability to make decisions.

• Blocked creativity or judgment.

• Poor memory.

• Difficulty concentrating.

Finally, the physical manifestations of stress are often ignored by the individual experiencing long periods of stress until they reach the point of critical consequences. The following are common signs of the physical impact of stress:

• Changes in sleeping patterns, such as insomnia.

• Headaches.

• Backaches.

• Gastrointestinal disturbances.

• Fatigue.

• High blood pressure.

• Changes in eating patterns.

• Shortness of breath.

• Susceptibility to illness.

ADDITIONAL SIGNS OF STRESS

Other signs of being highly stressed include the following observations expressed by victim service providers who have attended stress workshops held at victims' rights conferences:

• Lowered productivity.

• Inability to feel empathy with all or some crime victims.

• Inability to meet deadlines.

• A constant frustration with the lack of adequate monetary compensation.

• Uncharacteristic forgetfulness, such as leaving a wallet or purse behind, or failing to keep a scheduled appointment with a victim or colleague.

• Fighting with friends and family over insignificant events; increased interpersonal conflicts.

• Feeling overwhelmed with the demands of the job and a sense that it is consuming one's life.

• A lack of being able to put current stressors into perspective.
• A feeling of inadequate reward, respect, and recognition for constant sacrifices from the agency.

• Being overwhelmed with the desire to seek other employment but feeling there are few options to do so.

There are many good ways to cope with and manage stress that are addressed later in this chapter. Too often, however, victim service providers choose to use (and in some cases, abuse) harmful coping mechanisms to reduce their stress when, in reality, they are more likely reducing the length and quality of their lives:

• Smoking cigarettes equates to ingesting poisons--tar and nicotine--which stimulate one's body to produce hormones (such as adrenaline) that increase one's energy and alertness. Cigarette addiction requires greater amounts of nicotine to produce the desired feeling. Instead of responding to stressful situations by seeking calm and respite, some victim service providers smoke cigarettes that, in essence, keeps their level of anxiety higher.

• Alcohol is the most widely used--and abused--drug in the United States today. While some victim service providers occasionally have a drink or two to unwind and relax, some use/abuse alcohol as a daily or regular stress-coping technique instead of utilizing other positive coping strategies:

When alcohol is abused, health problems, such as heart disease, raised blood pressure, brain dysfunction, cancer and sleep problems may arise. Many problem drinkers become alcoholics, which in turn can lead to malnutrition, blackouts, disrupted home life and job inefficiency. Alcohol is also high in calories, but low in nutrition (Cornelius 1994).

• Like alcohol, prescription drugs can be abused and used as a negative coping mechanism. Many Americans use tranquilizers to relax, calm down, and relieve the pressure and stress of every day living. Valium and similar drugs designed to reduce stress can effectively reduce anxiety and stress in the short term. If used chronically for long periods of time, however, addiction may develop. When a "hooked" worker tries to stop, he/she may experience anxiety, nervousness, taste and smell distortions, and difficulty sleeping (Cornelius 1994).

There are several approaches that victim service providers can take to address substance abuse within the profession:

• Be proactive in discussing substance use/abuse as a harmful way to cope with the stress of victim advocacy. By bringing the topic up on a regular basis, professionals and volunteers are constantly reminded to "self-check" for their own personal health.

• Establish clear agency policies and procedures that discourage substance use/abuse as a means of coping with stress.
• Avoid group situations that include overuse or abuse of alcohol or other drugs. Instead of meeting after work for drinks, start a walking group to get exercise and discuss the events of the day or week.

• Have a list of referrals available through employee assistance for staff or volunteers who may be experiencing difficulties with substance abuse.

HARMFUL COPING MECHANISMS: CORE ISSUES

Regardless of the coping mechanism that victim service providers may use, the goal is probably the same: reduction of stress and, in some cases, a distancing of the providers' own sense of self from the traumas afflicting their clients. This can lead to more subtle versions of harmful coping mechanisms that represent an emotional shutting down. As described by Dr. Henry Tobey, Director of the Colorado-based Healthbridge Alliance, a trauma support and psychotherapy center, victim service providers (or other caregivers) can, as a consequence of long-term stressful service, " armor their hearts, to use Ram Dass' evocative phrase, and shift to a stance of what could be called 'professional warmth' in which they appear to be emotionally present with their client, but actually are not" (Tobey 1999). Although such behavior may be completely unintentional, the result can be that providers "in very insidious, hard-to-see, but ultimately injurious ways act to keep their clients from disclosing the real depth of their trauma because the provider cannot handle it anymore, or cannot tolerate that particular variety of it" (Ibid.). This is doubly tragic in that it prevents service providers from establishing a genuine healing connection with victims, while at the same time, they personally will lose the enriching aspect of that connection, which for many providers was a fundamental motivation for entering the field of victim services.

In addition to the inherent stress involved in responding to crime victims, victim service providers also face many other circumstances that add to stress in their working environments. While criminal- and juvenile justice-based victim service professionals may face different stressors than professionals in community-based agencies, common stressors are experienced by most victim service providers.

In March 1997, the National Institute of Justice (NIJ) released a comprehensive report entitled Developing a Law Enforcement Stress Program for Officers and Their Families. NIJ's Report provides a list of psychological stressors facing law enforcement officers. Developed by Dr. Terry Eisenberg, the report has been used by the International Association of Chiefs of Police in their law enforcement training programs. The following overview of stressors facing victim services professionals has been adapted from Dr. Eisenberg's work as reported in the NIJ Report.

• Isolation. Victim service providers often experience a sense of isolation if they feel they work for the only victim-serving agency in the community, or if there is not an ongoing network of support among victim assistance professionals to help them cope with chronic stress. In addition, if victim advocates are working on an initiative that lacks support from allied professionals in justice and public safety, feelings of isolation are likely to be exacerbated.

• Funding pressures. Most (if not all) victim service agencies face funding pressures and must seek financial support for their agency from a variety of local, state, and federal sources. This can give staff a sense of insecurity in not always knowing if their positions will be funded for the following year, or if the provision of comprehensive, quality victim services will continue.

• Irregular work schedules. Many victim services agencies offer twenty-four-hour, seven-days-a-week assistance to victims of crime; thus staff must rotate their schedules to provide adequate coverage. Even in agencies that have "regular" business hours, staff often have to work overtime to meet the needs of crime victims, for example helping to make funeral arrangements, preparing victims for trials, providing crisis intervention and counseling, and responding to unexpected high-profile crimes.

• Sense of helplessness or hopelessness. The inability to completely resolve victims' problems and help them cope with the trauma of victimization confronts victim service providers on a daily basis.

• Absence of "closure." Much of the work of victim service providers is fragmented: making a referral, helping a victim complete a compensation claim, or providing short-term crisis intervention. Very few victim service providers help and guide the victim through the entire criminal or juvenile justice process. The crisis counselor on call when the victim first contacts the agency may not be the same advocate as the one who provides court support. Thus, advocates must rely on allied professionals to provide a continuum of quality support and services. Consequently, opportunities for feedback on the ultimate outcome of a case are minimal.

• Role conflict. It has long been said that an effective victim service provider must be able to wear many hats: one moment being a kind, sensitive, supportive counselor, and the next moment, being a strong, outspoken advocate on behalf of victims to ensure that their rights are accorded. When advocates work in a justice system that cannot always meet the expectations and needs of the victims they serve, it can be very frustrating.

• On-going human suffering and cruelty. On a daily basis, victim service providers are exposed to the inequalities and brutalities of life. Over time, the exposure to human suffering, and the daily outpouring of empathy by victim service providers to each victim they serve, may take its toll.

• Lack of referral agencies. Often, the lack of other agencies to help victims, whether they are other criminal or juvenile justice system-based or community-based agencies, can frustrate victim services providers and may add to their already overburdened workload.

• Frustration with the criminal or juvenile justice system. Victim service providers, both within and external to the criminal and juvenile justice systems, are often frustrated with many aspects of justice processes, finding out the hard way that many victims' rights are simply not implemented due to a lack of education and knowledge of justice professionals about victims' rights, a lack of funding for victim assistance programs across the justice continuum, and often, because basic victims' rights are not legislated in their states or jurisdictions.

• Poor equipment. The lack of access to current technology that makes the demands of the workplace easier (computers and software programs for entering client reports and reporting data to funding agencies, Internet access for research and communications, or automated victim notification systems) adds to the workload and frustration of victim service providers.

• Lack of career opportunities. Opportunities for promotion are viewed by some victim assistance professionals as being limited or unfair. This is a particular problem in victim service agencies that have a limited number of staff and few opportunities for advancement within the agency.

• Inadequate rewards. Recognition for a job well done is rare; however criticism for mistakes seems to occur on a regular basis. Unless one examines, and is cognizant of, the significant impact victim service providers have on the people they help, inadequate recognition of small successes and significant accomplishments can be very frustrating.

• Extensive paperwork. The need for extensive or duplicate reporting on client case loads to meet the reporting requirements of different federal and state grants that support agency activities is viewed as burdensome.

Burnout is a severe reaction to stress that results in a state of physical and emotional depletion caused by the conditions of one's occupation (Canadian Public Service Commission 1992). Because of the intense nature of the work required in the field of victim assistance (dealing on a daily basis with issues involving injury and violent death; frustrations faced with each new case requiring renewed advocacy, compassion, and vigor; and often low pay and a lack of job security), burnout can occur. In addition to reducing the number of stressors, the following techniques are suggested for program directors to help prevent staff burnout; they also can serve a useful purpose for program staff to assess whether their agency is taking necessary steps to prevent staff burnout.

(The following information has been adapted from Developing a Law Enforcement Stress Program for Officers and Their Families, National Institute of Justice, March 1997.)

To prevent burnout of victim services staff, program directors should:

• Warn new victim assistance staff about not over-identifying with the job. Let them know about the possibility, nature, and symptoms of burnout, and encourage them to monitor their own vulnerability. Keep a close eye on professionals and volunteers who appear to be overwhelmed with their job responsibilities.
• Meet regularly with staff to discuss and resolve problems of work overload. Many staff have difficulty saying "no" to added responsibilities. It is helpful to conduct reality checks on a regular basis to assure that no one individual is overburdened with job duties.

• Arrange for scheduled staff meetings at which experienced and inexperienced victim service providers discuss the impact of their work on their own emotions and lives.

• Help victim service providers set limits on how much time they will spend on the job and give them an opportunity (without guilt) to refuse on occasion to accept certain assignments, especially if the individual is responding too often to emergencies.

• Help victim service providers understand the limits of what they can expect to accomplish in their work in terms of helping victims as well as in achieving organizational or system-wide change. Provide opportunities for group brainstorming and working toward collaborative solutions, when possible.

• Help victim service providers to tolerate common stressors by providing opportunities for them to develop an awareness that they are doing important work that affects people's lives in positive (and often monumental) ways. This obvious, but critical information, is often forgotten or minimized by overworked staff.

• Encourage victim service providers to take vacation time, without their work files, laptop computer, and pagers!

• Promote a work environment that encourages victim service providers to get regular exercise before, during, and after work. Explore agency discounts for group health club memberships. Organize a walking group at lunch. Coordinate a fifteen-minute stretching or yoga session for staff a few times a week.

• Encourage your agency to provide training opportunities for staff to increase their knowledge, skills, and confidence level in their daily work, and to foster opportunities to promote career advancement and build networks with allied professionals.

TIPS FOR HELPING TO RELIEVE STRESS

Time management. It is important to have balance in your life: balance between work and play; between adult social time and alone time; between family time, physical activity time and spiritual expression. Assess your priorities; make time for each category. Look at how you establish your priorities. Do you only do things you "have to" or do you include things you "want to" do? Try to turn the "have-to's" into "want-to's."

Attitude. How you think can have a profound affect on your emotional and physical well-being. Each time you think a negative thought about yourself, your body reacts as if it were in the throes of a tension-filled situation. If you see good things about yourself, you are more likely to feel good; the reverse is also true. Eliminate words such as "always," "never," "should," and "must." These are telltale marks of self-defeating thoughts. Talk to yourself, switch negative self statements to positive statements. For example, "I can do . . . (whatever it is you are setting out to do)" or, "I made a mistake, but I can do . . . (whatever it is you are setting out to do)," or "I made a mistake, but I do a lot of things right."

Relaxation, meditation, guided imagery. Physiologically relaxing your body brings down heart rate and blood pressure and slows breathing. These are all manifestations of stress release in your body. At least once per day (twenty to thirty minutes) center yourself with meditation, relaxation exercises, or guided imagery tapes.

Exercise. Our bodies were designed to move. Built-up stress can often be relieved by physical activity. Walk if you cannot do anything else. Aerobic activity, on a regular basis, plays a significant role in boosting the immune system. Work up to incorporating some form of physical exercise three times per week.

Fun and laughter. There is a measured effect of the relaxation response after a good laugh. Laughing reduces stress! Do something playful at least once per week, if not once per day. Have fun in your life!

RELAXATION EXERCISES FOR RELIEVING STRESS

Stress can be relieved in a number of ways. The same method may not work each time an individual attempts to relieve stress; so try different things. One way to reduce stress is to employ relaxation techniques. The following overview provides some exercises that victim service providers can use to relax. Each exercise usually takes fifteen to twenty minutes, but "mini" sessions can always be tried in situations where one is pressed for time and in desperate need of some stress relief (Sharp 1996).

• Deep breathing. Take a deep, slow breath. Let the air come in through your nose and move deep into your lower stomach. Then breathe out through your mouth. Repeat this for several minutes. Imagine that the air coming in carries peace and calm, and the air you exhale contains your tension.

• Body scan. Close your eyes and do some deep breathing exercises. Then, in your mind, do a scan of your entire body, beginning with the top of your head and moving down to your feet. With each breath, focus on a different part of your body. As you breathe in, notice any muscle tension in the various parts of your body. As you breathe out, let go of that tension.

• Progressive muscle relaxation (PMR). As you perform a body scan, tighten the muscles in each area to increase the tension. Then slowly release the tension. Do this for each part of your body, from head to toe. You will find that you feel much more relaxed after letting go of the tension.

• Meditation. Find a comfortable place to sit or lie down and close your eyes. As you breathe deeply, repeat a word or sound over and over again either to yourself or softly aloud. Concentrating on your breathing or on the repeated word helps you to focus your attention. Meditation can help you to slow down your breathing and heart rate, ease muscular tension, and respond calmly to stressful situations. Once you are used to meditating, you can use it to relieve stress while you stand, walk, or jog. Some people even meditate while doing everyday things such as waiting for the bus, doing the dishes, etc.
• Guided imagery. Find a quiet, comfortable place to sit. Then close your eyes and take a few slow, deep breaths. Now imagine you are in a place where you know you can relax, such as on the beach or in your bed. Now visualize yourself at this one spot. Take in the sounds, smells, and scenery around you. Savor them one by one. As you become more experienced with imagery, you can use it anywhere. For example, if stress takes over your mind while you are waiting for someone to show up for an appointment, take a couple of minutes to use imagery to relax so you can focus.

• Yoga. This is one of the oldest relaxation techniques. There are many different kinds of yoga, but all involve physical poses, meditation, and deep breathing. Everything you do as you practice yoga helps to strengthen, stretch, and relax both your mind and body. There are many classes, books, and videos available to help teach you how to practice this ancient relaxation technique.

• Aerobic exercise. Finally, any kind of physical exercise, whether it is a team sport or a simple walk at lunch time, can help reduce stress. Remember, if you can release pent-up energy, your body will benefit in the long run.

ADDRESSING STRESS THROUGH MUTUAL SUPPORT

Many victim advocates find that the greatest tool for stress maintenance and reduction is mutual support. Just as many victims find comfort and solace in speaking with others who have endured similar experiences, so can victim service providers. The fortunate aspect of this technique is that victim advocates possess many relevant skills: empathy, understanding, listening, validation, brainstorming, and a strong dose of humor!

The "sixth sense" that many victim advocates have that helps them assess when a victim needs immediate help or crisis support can be utilized for their peers as well. By keeping a vigilant watch on colleagues who appear to be under a great amount of stress, service providers can and should intervene, as appropriate, when support is needed.

Mutual support can be achieved through a variety of venues. Victim service providers can do any of the following:

• Schedule and participate in informal meetings to share ideas, discuss current cases with a focus on problem solving, and talk about mutual concerns. In some communities, victim service providers meet for regularly scheduled brown-bag lunches, coffee, or potluck dinners that provide great forums for support.

• Consider initiating or joining a discussion group or chat room on the Internet. This approach crosses boundaries of geography and time, and "widens the net" of advocates who need, or are eager to provide, mutual support. The Internet also provides excellent, cost-effective opportunities for rapid communications through e-mail, listservs, and user groups.

• Make exercise a scheduled group activity. At many training forums (including the National Victim Assistance Academy), regular morning or evening walks give victim service providers an opportunity to get fresh air and exercise and discuss current events and issues. One victim service organization has a volunteer who is a masseuse and yoga instructor; these skills, when applied to weary victim advocates, combine to make her "volunteer of the year"!

• Schedule retreats for staff and volunteer rejuvenation, seeking low-cost or donated sites and resources to provide an atmosphere of relaxation, mutual support, and planning for the future. For example, long-time victim advocates try to meet at least annually for their national "Old Buffalo" reunion, whose major agenda items are mutual support and laughter, as well as examining important trends and topics that contribute to the future of victims' rights and services in the nation.

(The outline for this section is derived from Stress Management: How to Handle Life's Challenges," published by Great Performance in 1995. It has been adapted to specifically address stress and the victim advocate.)

In any stressful situation, one has four choices: accept, avoid, alter, or adapt.

ACCEPT

Sometimes all one can do is learn to accept things as they are. Victim advocates should consider:

• Learning from past experiences. Too often, victim advocates "fight the same fights" over and over again, which leads to both cumulative stress and tremendous frustration. It is helpful to consider similar situations from one's past: Did the actions taken resolve the situation or stressor? Was there one approach that worked better to reduce stress? Was there one significant barrier (human, monetary, or otherwise) that was insurmountable, and required adaptation to cope?

• Talking with someone about the situation. The concept of "mutual support" that is critical to victim assistance is also helpful for service providers. Sometimes, options and solutions become more clear when they are discussed with somebody who has shared similar experiences. For example, the National Center for Victims of Crime has established a network of "mentors" and "protegees" for adult corrections-based victim advocates. If an advocate has a problem or issue that is causing frustration or stress, he or she is a telephone call or e-mail away from support and/or technical assistance. Many problems are solved with the guidance of "someone who has been there."

• Using positive self-talk. When overwhelmed by stress, it can be difficult to remember there is the "light at the end of the tunnel." It is helpful when work and home life are relatively calm, to make a mental or written list of one's strengths, such as "I have good people skills," "I am patient," "I can make people laugh," "I know how to stretch a tiny little paycheck," etc. During times of stress, reliance on one's inveterate strengths and abilities can contribute to a sense of control.
• Keeping a smile, even in difficult times. The power of a simple smile can be remarkable. One victim advocate tells how she copes with her monotonous subway commute: She smiles at everybody in the station and on the train and finds great delight in the fact that many (not all . . .) smile back.

AVOID

To avoid needless stress, victim advocates can try to plan ahead and rearrange their surroundings, to the degree possible, by doing the following:

• Avoiding someone who constantly bothers you. When conflict management techniques are unable to adequately address a personal conflict, it is a good idea to control the amount of time one must spend with the person who is causing friction or stress. One victim advocate speaks of physically removing herself from a room in which a person with whom she cannot get along is, or physically distancing herself by moving to the other end of a room. While attempts at total avoidance do not resolve a stressful situation, they can give a degree of control to the situation.

• Leaving for work or home earlier to avoid traffic, maintaining a flexible lunch schedule, etc. If flexibility is at all possible in a victim advocate's work schedule, it can also offer a degree of control in avoiding minor stressors that contribute to cumulative, chronic stress and eventual burnout. One group of victim service providers maintains a flexible lunch schedule in order to take group walks when the weather permits.

• Avoiding taking on more work than one can handle. The capacity to say "no" to increasing workloads is a crucial skill that many victim service providers lack. It is important to remember that one's capabilities to provide quality assistance to victims and support to allied justice professionals are seriously eroded by chronic work overloads.

• Avoiding discussion of a specific topic or subject. If there are certain topics that create friction among co-workers or professional colleagues, there can be a general agreement to "not go there." Avoiding controversial topics can help victim service providers avert what is guaranteed to be a stressful situation.

It is always important to consider options that help elude stress. It is impossible, however, to avoid all stressors in life.

ALTER

Altering a stressful situation in some ways might be the best response. In the field of victim advocacy, control is a major tenet of helping victims reconstruct their lives in the aftermath of a crime. Similarly, seeking control over untenable situations can help victim service providers avoid the cumulative effects of stress. Options include the following:

• Asking someone to change their behaviors and being willing to also change. When stress is interpersonal, it is a good idea to identify specific behaviors that are irritating or contribute to chronic friction. Often, it is fairly simple to pinpoint recurring behaviors that can be easily remedied such as "When you always turn in your time sheet late, I can't complete my monthly reports" or "Every time you make an inappropriate victim referral to my agency, it can be traumatic for the victim, and a poor use of time for both you and me." Such discussions can result in a "give-and-take" of new information that contributes to problem solving; avoiding such discussions can contribute to chronic stress.

• Communicating feelings in an open way. Open communications require both bravery and honesty on the part of all parties involved in a stressful situation. It helps to "compartmentalize" stressors into manageable issues that can be addressed one at a time. It is also a good idea to avoid discussions among colleagues in an attempt to shore up support for "one's side." The concept of "staff infection" in dealing with conflict results in a "no-win" situation for all involved.

• Taking risks. ". . . if you don't risk anything, you risk even more." This observation by Erica Jong contains valuable advice for victim service providers. When one avoids taking chances, the end result is stagnation. When victim advocates are willing to take risks to confront their sources of stress, the results can be positive and empowering.

• Managing time better. The longstanding technique of developing a "time-task" assessment is helpful to determine how time can be better spent serving victims. Is time wasted responding to nonemergency calls? Would it help to consolidate monthly report writing into a standardized time frame every week? Can the agency develop information packages for "the most frequently asked questions" that are easily replicated and disseminated by a volunteer? While the process of "time-tasking" is time-consuming in itself, it is guaranteed to save time and reduce stress in the long run.

• Collaborating on problem solving. One agency of victim advocates created a "problem-solving bulletin board" where staff can post specific information about cases (without, in any way, identifying the victims involved), or barriers to successfully completing their work assignments. Often, a colleague may have dealt with a similar situation that was resolved with a certain strategy. This information should be shared!

• Being more assertive. Susan B. Anthony said: "Cautious, careful people, always casting about to preserve their reputations, can never effect a reform." Victim advocates can gain considerable control over stressful situations by clearly defining problems, offering options for solutions, speaking out, and working hard (often collaboratively) to achieve success.

In seeking to alter a stressful situation, it is helpful to rehearse before it occurs and anticipate what might happen. Usually, it is fairly simple to anticipate possible responses related to people or situations that cause stress, which lead to options for positive responses that offer control.

ADAPT

Adapting to stressful situations and learning to cope with them can be a better response than accepting, avoiding, or altering. By anticipating stressors and making plans to adapt, victim advocates can go a long way toward stress reduction. Options include the following:

• Changing one's thinking. Seek as much information as possible that contributes to positive decision making and, ultimately, stress reduction. Accumulating facts and other relevant background information may contribute to a change in one's perception of a situation, and/or provide information that can help change others' thinking as well.

• Looking at stress as an opportunity. Some individuals appear to thrive in stressful situations. They view the act of overcoming stress as a source of strength. However, it is important to avoid adopting a "martyr" complex when it comes to handling multiple stressors at the same time.

• Thinking of the positive things in life. The comparison of assets to deficits in certain situations can be a useful stress reduction technique. In many (if not most) situations, building upon assets instead of mulling over deficits can have a positive influence on one's life and ability to manage stress. Visualization of positive (and often simple) things that bring joy to life, from a beautiful sunrise to a favorite vacation spot, can alleviate the effects of acute stress.

• Considering how much this will matter in a year. Sometimes, a "global" perspective of a bigger picture can make a stressful situation seem minor. By simply asking, "Will this matter in the long run?" victim advocates can put a stressful situation in perspective.

• Considering whether it is worth getting upset over. If it is not ultimately worth the time and energy to focus one's limited resources on a stressful situation, it is time to move on.

• Changing one's actions. By slowing down, talking to someone about feelings and concerns, and seeking information and advice, victim advocates have the power to change stressful situations by changing their own actions in positive ways. Many victim advocates find it helpful to discover a new hobby: one victim service provider took up boxing, another discovered a talent for painting, and yet another discovered a "green thumb" for gardening. It is imperative to avoid making matters worse by using destructive coping techniques, such as caffeine, smoking, alcohol and other drugs, and eating disorders (overeating or bulimia or anorexia), as they may temporarily reduce stress, but cause long-range and potentially severe physical and mental health problems.

"Conflict" describes a situation in which the concerns or interests of two or more parties appear to be incompatible. This simple definition clearly characterizes a number of situations that are common to victim advocacy. Conflicts can occur within individuals in an organization, between two different agencies, and/or among the many entities that seek to promote public safety and victim assistance.

Traditionally, "conflict resolution" has been a goal of individuals and entities that need to work together in order to resolve the situation and achieve mutual success. There is a new trend, however, toward "conflict management" and learning to work within conflict (which recognizes that while not all conflicts can be resolved, most can be managed with positive results and success for all involved parties).

The American Association of University Women (AAUW) identifies five ways that people deal with conflict (1977):

1. Compromise. Each party gives a little and gets a little in seeking resolution.

2. Competition. One party gets all his or her needs met, while the other gets nothing.

3. Accommodation. One party gives in, and another gets everything.

4. Avoidance. Neither party confronts the conflict, and neither gets their needs met.

5. Collaboration. A problem-solving process where the problem/issue is redefined to find a "win-win" situation where all parties involved get what they need.

MANAGING CONFLICT

The AAUW (1977) recommends a conflict management process that incorporates problem clarification and problem solving into six steps:

Step 1: Define the problem in terms of needs (not competing solutions). This is a critical step. The problem should be stated in a way that does not suggest blame or judgment, then verbalized from the other person's point of view. This takes time and may require that the problem be redefined as it is discussed. Mutual understanding and acceptance of the (possibly new) problem definition, as well as a willingness for involved parties to work together to find a solution that is acceptable to all, should be tested.

Step 2: Generate possible solutions. Creativity and exploration of alternatives are critical. Parties should avoid being evaluative and critical of new suggestions and treat all ideas with respect.

Step 3: Evaluate and test various solutions. There should be tremendous honesty at this stage. Are there weaknesses in any of the solutions proposed? Will it be too difficult to implement? Is it fair to both/all parties involved? In the process of evaluation, a new and even better solution may be discovered and tested.

Step 4: Decide on a mutually acceptable solution. A mutual commitment to one solution should be agreed upon. It is recommended that the solution be written down so that misunderstandings do not develop later.

Step 5: Implement the solution. When arriving at a creative solution, it is important to determine "who does what by when." It is crucial to trust that the other person will carry out his/her part of the decision, and to offer suggestions to help him/her remember to do what is expected, and what was agreed to.

Step 6: Evaluate the solution. If the solution does not work out, the original problem should be re-examined, with other possible solutions generated. Solutions are always open for revision, but neither party should unilaterally modify a decision.

Some of the best tools for effective problem-solving and conflict management include:

• Active listening.

• Clear, honest communication.

• Respect for the needs of others.

• Trust.

• Being open to new data and information.

• Firmness in one's willingness to have the solution "fail."

• Persistence.

• In 1998, The Office for Victims of Crime awarded a grant to the Healthbridge Alliance, a Colorado-based trauma and psychotherapy center, to develop a model training program to serve victim care providers experiencing secondary traumatic stress. This project will address the impact of the huge emotional demands that can be experienced by victim service providers who assist victims of crime. In addition to developing a training program for the purpose of assisting individual victim service providers, the project will also identify organizational practices that appear effective at supporting the well being of care providers. Grant products will include a curriculum development manual and a trainer's manual.

Stress Management Self-Examination

2. Describe one external or organizational factor that may contribute to stress among victim advocates.

3. Describe one harmful mechanism that is used to cope with stress.

4. Describe three ways to reduce stress (either as described in this section or from personal experience).

5. Name the six ways that people generally manage conflict.

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