Chapter 6 Mental Health Needs

Section 2, Stress Management


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.

Learning Objectives

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


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.

Unique Sources of Stress in Working with Crime Victims

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:

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

Vicarious Trauma: Overview of Research and Terminology

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 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.


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).


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 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).

Understanding One's Ability to Tolerate Stress

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:

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

Manifestations of Stress: Recognizing the Signs

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:

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

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:


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:

Harmful Coping Mechanisms

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:

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).

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


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.

Recognizing Stress in One's Working Environment

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.

Techniques to Help Prevent Stress from Becoming Burnout

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:


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!


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).


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:

Taking Charge of Stress

(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.


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


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

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


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:

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.


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:

Conflict Management

"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.


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:

Promising Practices

Stress Management Self-Examination

1. Describe one intrinsic or personal characteristic that may contribute to stress among victim advocates.

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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