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Abstract

Summary

Working with refugee-related trauma has been identified as one of the most challenging fields of social work practice. Self-care has been endorsed as the protection for practitioners against vicarious trauma and burnout, which have a high association when working with refugee-related trauma. This paper argues that social work must look beyond this perspective, towards more sophisticated comprehensions of care, which cultivate the ability to remain well in work for the longevity of careers. This is best described as sustainable practice. Through semistructured interviews practitioners working with refugee-related trauma were asked to reflect on how they had developed sustainability in their practice.

Findings

While each practitioner expressed unique perspectives and approaches that they drew on to form sustainability, there were common threads which wove through practitioners’ experiences. Sustainable practice was multifaceted, resting upon a foundation of connection, introspective awareness and processing, spirituality, ethics, learning, and growth.

Applications

This study provides insight into how these aspects of sustainable practice can be harnessed and taught, while offering opportunities for future research to continue to develop a sustainable model of care to support social workers in direct practice.

Keywords

Social work trauma social work practice refugees reflective practice therapeutic work

Introduction

During their careers social workers are inevitably exposed to various forms of oppression, injustice, discrimination, and trauma (McAuliffe et al., 2024). Working with refugee-related trauma has been described as a particularly challenging type of trauma work (Century et al., 2007). Practitioners working with clients who have experienced refugee-related trauma are inevitably confronted with the darkest side of humanity, demonstrated by the atrocities governments and groups inflict upon others (Engstrom et al., 2008). Personal stories of war, genocide, and organized violence transfer into the consciousness of the practitioner (Apostolidou, 2016; Woodcock, 2001). These narratives have been described as “so overwhelmingly forceful… that not only do they completely permeate the therapeutic space, but they shake its very foundational principles” (Apostolidou, 2016, p. 282). To illustrate this, Brahman (pseudonym), an Iranian man bravely shared an account of his experiences of torture, trauma, and acts of resistance through publication as “an enactment of solidarity and activism against disappearance” (Reynolds et al., 2014, p. 2). Brahman was imprisoned and brutally tortured for seven years in Iran before his escape. Reynolds et al., describe Brahman's story as a “horrific tale of experiences outside of human understanding” (2014, p. 2). He provides detailed insight into the political acts of violence and terror inflicted on individuals and groups. This trauma extended beyond the confines of his nation, accompanying him throughout his asylum seeking journey, refugee status attainment, and life in Canada (to read Brahman's account, see Reynolds et al., 2014).

Vicarious Trauma and Burnout

As practitioners bear witness to torture and trauma endured by clients they act as containers for this suffering, which becomes very alive through the sharing of narratives (Apostolidou, 2016; Glennon et al., 2019; Reynolds, 2008). It is perceived that through identifying with the trauma stories of clients, and the accumulation of this effect over time, practitioners may start to feel vicariously traumatized (Apostolidou, 2016; Puvimanasinghe et al., 2015). Extensively the literature speaks to the negative changes this can cause to the practitioner's emotions, thoughts, sense of self, worldview, memories, identity, beliefs, and perceptions of humanity (Apostolidou, 2016; Brockhouse et al., 2011; Butler et al., 2019; Mueller & Morley, 2020; Puvimanasinghe et al., 2015; Thompson et al., 2012). Cohen and Collens (2013) define this experience as a personal transformation, resulting from an accumulation of empathetic engagement with client's traumas (Butler et al., 2019; Cohen & Collens, 2013; Edelkott et al., 2016). Practitioners working with refugee-related trauma are known for their resilience, but can experience overwhelming stress due to the impact of intense suffering experienced by clients (Century et al., 2007; Glennon et al., 2019; Mueller & Morley, 2020; Thompson et al., 2012), or by helping suffering clients (Eaves, 2018). A commonly accepted interpretation of this is that it is through these experiences, and the associated vicarious trauma, that practitioners burn out (Mueller & Morley, 2020; Schaufeli & Greenglass, 2001; Thompson et al., 2012). The effect of working with refugee-related trauma on practitioners has been widely researched within social work and counselling literature, with the concepts of vicarious trauma and burnout being well developed (Apostolidou, 2016; Barrington & Shakespeare-Finch, 2013; Century et al., 2007; Gemignani & Giliberto, 2021; Guhan & Liebling-Kalifani, 2011; Killian et al., 2017; Long, 2020). These are understood as being high risk factors for practitioners working with refugee-related trauma (Century et al., 2007; Gemignani & Giliberto, 2021), with the dominant conceptions positioning vicarious trauma and burnout as experiences inflicted on practitioners by clients, however, in practice this is not the case.

An alternative understanding of burnout when working with refugee-related trauma was proposed by Reynolds (2008; 2010a, 2010b) who perceives burnout to be caused by working in systems which do not align with a person's ethics. Burnout arises when working with clients who have been subject to dehumanizing and inhumane treatment, such as torture, and clients are blamed for the injustices they are subject to; thus, political issues are considered private. Scant resources, funding, and organizational structures can inhibit practitioners’ ability for justice-doing. This leads to practitioners feeling ethically compromised. Reynolds (2008; 2010a, 2010b) describes this experience as “spiritual pain,” which can be so debilitating practitioners burn out.

Self-Care

It has been proposed that self-care is the answer to avoiding vicarious trauma and burnout (Eaves, 2018; Lee & Miller, 2013). Having a self-care plan is perceived to create happiness and health (Eaves, 2018), and is considered an essential component of an individual's practice framework (Butler et al., 2019; Century et al., 2007; Lee & Miller, 2013). The dominant conception of self-care proposes that if you are successful in self-care practices your positive emotions will be enhanced and negative ones reduced (Butler et al., 2019). By eating healthily, meditating, resting, exercising, and spending time doing enjoyable activities, practitioners are able to regulate their emotions (Butler et al., 2019; Cohen & Collens, 2013; Lee & Miller, 2013; Thompson et al., 2012). Simply put, self-care directs you to find what makes you happy and to do more of it. Cohen and Collens (2013) while examining the impact of working with trauma on trauma practitioners recognized this self-care discourse as founded on the epicurean philosophy of hedonism. Hedonism considers wellbeing to be derived through pleasure attainment and pain avoidance (Cohen & Collens, 2013; Shmotkin, 2005). Feeling angry, frustrated, or sad are considered feelings which should be fixed and not acted upon (Butler et al., 2019; Michaeli, 2017). By adopting a self-care discourse which operates in binaries of positive/negative, or healthy/unhealthy a holistic understanding of what being well means for a person within a time and place cannot be achieved (Michaeli, 2017). This hedonistic interpretation of self-care also fails to articulate how self-care practices may support practitioners to learn and grow through their work with clients. Furthermore, healing is incorrectly defined as a linear process of positive feelings, which fails to acknowledge the whole range of human emotions which can be a part of the process, including sadness, depression, and even temporarily failing to function at all (Dutton, 2014).

In the context of working with refugee-related trauma it becomes apparent that such a discourse may serve a political agenda. The individualization of responsibility for wellbeing results in calming of the masses, and “obscuring” of the sociopolitical sources of distress, such as “war and violence; poverty and hunger; (and) failed social policies” (Michaeli, 2017, p. 53). By avoiding our full range of human emotions this narrow conception of self-care can be considered as primarily designed to calm oneself, resulting in the false and convincing illusion of wellbeing (Dutton, 2014). With this explanation it is evident why self-care is described as a preventative model for sustainable practice (Eaves, 2018; Lee & Miller, 2013), as it focusses on avoidance.

Vicarious Growth and Vicarious Resilience

More “positive outcomes” of working with trauma are well developed in the literature, such as vicarious growth (Barrington & Shakespeare-Finch, 2013; Brockhouse et al., 2011; Cohen & Collens, 2013; Guhan & Liebling-Kalifani, 2011; Long, 2020) and vicarious resilience (Apostolidou, 2016; Edelkott et al., 2016; Engstrom et al., 2008; Hernandez et al., 2007; Killian et al., 2017; Long, 2020; Nuttman-Shwartz, 2015). The more empathy and exposure to trauma a practitioner experiences has been found to result in greater levels of growth (Brockhouse et al., 2011). The most dominant theme of vicarious resilience is changes to practitioners’ perceptions of their own lives (Edelkott et al., 2016; Engstrom et al., 2008). This awareness occurs through discussing the client's resilience, and happens in conjunction with vicarious trauma (Edelkott et al., 2016; Engstrom et al., 2008; Hernandez-Wolfe et al., 2015). Hernandez-Wolfe et al., (2015) describe vicarious resilience as “profound ongoing experiences of intertwined pain, joy, and hope” (p. 153). Therefore, the binaries of trauma/growth or trauma/resilience which dichotomize the experience of the practitioner into “good” or “bad” in such a discourse may be unhelpful for the practitioner in making sense of their experience. Furthermore, there remains no specific theoretical model which explains how vicarious growth occurs (Cohen & Collens, 2013). Such a model may help to better understand how social workers and other practitioners working with refugee-related trauma are sustaining themselves in practice.

Sustainable Practice

Sustainable practice, this being the ongoing process of remaining well, capable, and ethical while working with refugee-related trauma throughout one's career, is a significantly underdeveloped concept within the literature. Reynolds assert that “a spirited presence and a genuine connectedness with others” (Reynolds, 2010a, p. 18; Richardson & Reynolds, 2012, p. 3) is required for sustainable practice. Bearing witness to the resistance of clients, such as Bahman's, can support the sustainability of practitioners through engaging in “hope-filled conversations, which can be transformative for both workers and clients” (Reynolds et al., 2014, p. 11). By maintaining hope, being relationally engaged, committed to social justice, and being open to being transformed by the work (vicarious growth and vicarious resilience), practitioners can be sustained beyond just warding off burnout. This requires a shared commitment to the ideology of collective action achieved through solidarity and shared ethics (Reynolds, 2010a; Richardson & Reynolds, 2012). It is evident with this description that the elements required to remain well when working with refugee-related trauma are not captured in a hedonistic interpretation of self-care. Beyond the work of Reynold's, no other literature has been found to discuss how practitioners working with refugee-related trauma are sustaining themselves.

With this understanding of the concepts of vicarious trauma, burnout, vicarious growth, vicarious resilience, and self-care, this research seeks to uncover greater understanding of how social workers and other practitioners working with refugee-related trauma are shaping sustainability in their practice by placing practitioners as experts for others to learn from.

Methodology

A hermeneutic phenomenological approach was used to guide this study. This allowed for greater depth in the concept of sustainable practice to be explored and new understanding and insight into sustainable practice to be examined within the context in which it occurs (Saldaña et al., 2011). This approach has been adopted by Barrington and Shakespeare-Finch (2013) to explore opportunities for vicarious growth in practitioners working with survivors of torture and trauma, and by Hernandez et al. (2007) to analyze the concept of vicarious resilience with trauma therapists. Bynum and Varpio (2018) suggest using a hermeneutic phenomenological approach for researching more complex phenomena, such as burnout. This research sought to answer the question “how are practitioners working with refugee-related trauma shaping sustainability in their practice?”

Following ethics approval, a purposive sampling approach was used to source participants with direct practice experience working therapeutically with refugee-related trauma at a specialized refugee-related trauma service in Australia. Seven female counsellors who identified with five nationalities took part in the study including four social workers. Everyone except for one participant had completed at least one postgraduate degree. Participants were aged between 28 and 50, with a median age of 38.5. Combined participants had 55.25 years of experience with a mean of 7.89. Informed written consent was obtained from all participants.

Participants engaged in semi-structured interviews which were held via Zoom and Teams. Interviews were recorded with the permission of the participants to ensure accuracy in data transcription. The decision to conduct interviews online was made to allow participation, regardless of participants location. This also kept consistency in the data collection process and provided participants more personal space for reflection.

Pseudonyms were then developed to protect participants anonymity, followed by a thematic analysis of the data. Through an iterative process of analyzing, coding, and reanalyzing responses, the essence of sustainable practice was extracted. This proved to be a complex web of personal, environmental, and contextual factors to support practitioners within time and place. As such, maintaining sustainability was an ever evolving and developing practice. Findings were categorized into the following themes: importance of connection, maintaining sustainability through the darkness, spirituality in practice, the importance of ethics, the importance of learning and growth, and the complexity and interconnectedness of sustainability. Each theme will be reviewed and discussed below in the results.

Results

Importance of Connection

The element of sustainability with the strongest emphasis by all participants was the importance of connection. This was with clients, co-workers, the organization, and with oneself. Connection was emphasized as a core element of humanity, a necessity which existed beyond the confines of practice, yet of utmost importance for both practitioner and client to feel fulfilled, safe, and supported in the work. Audrey described this connection in her work by positioning herself as a piece of a puzzle among other practitioners:

Other people are out there doing really important, amazing work that's quite different to me, so we're all just pieces of the puzzle, like my way is not the best way… we’re connecting with each other… It is a nourishing connection… (a) very mindful, intentional direction of energy… because it doesn't just happen. (Audrey)

Sarina spoke of the importance of “holding onto magical moments of connection” with clients. She explained her work through a metaphor of a mandala, which depicts a web of interpersonal experiences and practices among co-workers, clients and oneself, centered in connection:

The concept of mandala, that it's kind of all in a circle but there is different patterns with different stories. People might interpret it differently. It's probably what my work is, cause I think the central point to me is connection, and I think that's why I'm in this job…The power of connection, and how fulfilling it is and also healing, and… how much you learn through that process… That sense of humility and learning from others all the time. So mandala, yeah, is probably a good description, cause you can give it any shape but it's still being held in a circle of connection. (Sarina)

Audrey also spoke of an undeniably close bond required between practitioner and client, wherein the practitioner is prepared and committed to sharing the experience of the client:

Touching the fire is when there is something that is too painful and too hot to manage that we need to find a way of touching it together. We need to give it space to understand it and to heal it… Because often what we need to look at and what we need to do is around something that has been too big and too unbearable and too painful for the world to hold, let alone an individual. (Audrey)

The importance of connection held a continuous presence in the narratives of participants, as demonstrated in the themes to follow.

Maintaining Sustainability Through the Darkness

The accumulative experience of constantly hearing the stories of pain inflicted on clients was seen as “a responsibility that weighs heavy” on practitioners, in terms of their sustainability. This could be draining or overwhelming at times.

Some stories… remind me of hope. Some stories make me so sad I'll actually cry for a few days…(and) some come back and haunt me. (Audrey)

All participants discussed strategies they had developed to process and integrate the ongoing exposure to refugee-related trauma. For Ari this was about sharing “the same… compassion… empathy, and kindness” with everybody she encountered, while Meera said, “it's also being aware of myself. What my emotional capacity is as well.” To address this Ari had developed a way of letting go of clients’ experiences:

I imagine I’m like a sponge and you kind of soak it up. But then I have to quite consciously kind of ring out the sponge so I'm not keeping it with me, not carrying it just longer than I should. It's hard to hear, but important to hear I think. (Ari)

Audrey spoke of needing to find a distinction between what was hers and the client's experiences, which she discussed as a “third space”:

I feel like the stories are woven into my stories and there's a real tension because they're not my stories… So for me, that's been probably the biggest thing that I think about… How do I truly honour them as not my story? But then we did share something together, because that person has shared that story with me. So, I try and visualise it in three ways. Their way, our way, and then what the stories have meant for me. (Audrey)

Participants spoke of ways their understanding of humanity had expanded or improved from working with survivors of refugee-related trauma. This included embracing and caring for humanity in all of its complexity.

That sense of just bearing witness to stories of both the best and absolute worst of humanity, and everything in between… I can't even articulate how I feel about the things that people are capable of doing to other people. It's so encouraging for humanity that people can be so beautiful, amazing, wonderful people after all they have been through. It's almost like something's being lifted and I just have a better understanding of what humanity is. (Ari)

Participants also expressed the importance of embodying love, compassion, humility, joy, and one's own values. This helped participants to “remain human” when faced with some of the world's worst crimes against humanity, such as genocide and forcible displacement of populations experienced by clients.

Spirituality in Practice

The importance of one's spirituality in practice was strongly expressed by participants. This shaped participants’ sense of meaning and purpose in their work, and supported their sustainability, whilst also providing a foundation through which hope could be maintained for the future:

Grace and magic and connection and love. That overarching sense that there are beings (who) are stronger, bigger than us. Your connection that goes beyond our colour skin or where we are born. I don’t think I would do this work, or I think I could become quickly cynical, because if you don’t believe in a higher power, it's really difficult to keep track of, keep hope, be hopeful for the future. (Sarina)

It was difficult then (I) changed the meaning making that I am doing… I am perceiving it as meant to be, I am meant to be here. Finding that purpose and meaning in the work… I try to be present… I try to stay at the centre of that inner self that I am connected with and its lifeline, it's anchor… receiving the light and spreading that or trying to help people… get connected to their inner self and getting energy and that guidance from that inner self. (Fatima)

The role of spirituality transcended the confines of traditional practice guidelines, with Audrey describing sustainable practice and spirituality as “one and the same.”

Connecting with some clients can be like communion. There's a depth to that that is spiritual. I can't quantify it. I can't put words to it…A wonder. A very deep and beautiful… wonder at what people can be in all of their humanity…Humanity is incredible. (Audrey)

Hannah expressed the importance of introspective awareness for her sustainability in practice, drawing on her three brains: her head, heart, and gut for guidance.

Being observant of myself, but also about others around me, and also about what's happening more globally… Trusting my intuition, which is… my head, my heart and my gut… to decide when to act. (Hannah)

By integrating experiences into the self, being self-aware, approaching life as an observer, and trusting one's own intuition participants were able to maintain sustainability in practice. It is evident that the spiritual perspective of practice protected participants from the darkest facets of the work, allowing them to remain purposeful, sustainable, and to find a sense of fulfilment in their work.

The Importance of Ethics

It was important for participants to feel they could connect with and enact their values and remain ethical in their practice. Practitioners spoke of experiences where they had felt ethically compromised and expressed their inability to continue working in these situations.

It's exhausting working… (for) services that are designed to offer social justice and supports for all, and it's supposed to be non-judgmental, but staff don’t embody this. (Lucy)

When my values are not being considered or I cannot speak to my values then that (self) integrating would be shaking. (Fatima)

Through iterative reflective processes, and a deep connection and understanding of themselves, participants had developed an embodied understanding of ethical decision making. The process described by participants of ethics in sustainable practice is visualized in Figure 1.

Figure 1.

Embodies Ethical Processing in Practice.

The Importance of Learning and Growth

It is evident that one's practice cannot remain in a fixed state, but must evolve, change, and develop as the practitioner learns and grows. Likewise, practitioners were required to adapt and change with clients to support them best through their unique experiences, because “healing is not a linear thing” (Hannah). Participants explanations about sustainability in their work strongly emphasized the importance of growth.

Sustainability is being able to shed those things that don't serve me and my practice anymore, and just not being attached to things… Maybe I'm at deciduous tree and… (I’m) going through seasons and cycles… There's sunshine and there's rain, but the rain ultimately falls down near my roots and it's part of what goes back into that cycle of growth and learning. It's this sense of connection, the sense of growth, the sense of learning, and seasons, and change… (and) allowing myself to follow… my heart. (Ari)

Fatima also described her work metaphorically as the growth of a tree:

A tree, and there was the trunk outside of that… the tree had cracked through that trunk and a new tree had come up. It was just a new self that came… It needed to happen actually. (Fatima)

While Sarina focused on the nutrients required for growth:

Sustainability is not about just keeping the same thing going and keeping in your comfort zone, it's also about growing but also doing it mindfully and with love and care and not only for yourself but for others around you… It's that good soil, but also you keep growing… at the same time… (It's a) mix of values, and practice… (and the) concept of connection and love and growing. (Sarina)

Ari drew on a quote from Bruce Lee, “be like water,” meaning be formless.

This idea that, you pour water into a cup, and it becomes a cup. You pour water into a bottle, and it becomes a bottle. You pour it in a teapot, it becomes a tea pot… It's about flexibility and just being able to roll with the messiness of the work. (Ari)

The relationship between practitioner and client was one of shared learning and care. Approaching the work as a lesson of one's own privilege and not taking things for granted had helped participants find a greater appreciation and respect for people. Descriptions of the work as personal growth, and the constant need for adaptability in practice, demonstrate how working with survivors of refugee-related trauma is an ever-evolving journey of personal change and development.

I am trying to stay integrated and whatever experience I am learning from the environment I am integrating that to what I have. Having a new experience, making meaning of that, and adding to this integration that I have. My work life, my personal life, they are not separate. So whatever I am learning at work, I integrate to that, to this centre. (I am) making meaning of whatever that is happening. (Fatima)

It was evident that participants did not fear or attempt to block the emotions of clients. Instead they developed ways of releasing the difficult emotions involved in the work, through trauma integration, as they learnt and grew both as practitioners and people.

The Complexity and Interconnectedness of Sustainability

Each practitioner articulated a different interpretation and approach to the work they did. Within these differences were shared experiences of their perceptions of humanity being shifted and altered for the better to form a greater understanding of what humanity can be. It was important for participants to incorporate their experiences of client work into their understanding of themselves and the world. Through this, participants continuously grew and developed themselves. Through having a belief in a higher power and focusing on the human capacity to love, share joy, compassion, and resilience, participants were able to maintain a sense of hope for their clients, which was of utmost importance for both practitioner and client. Participants expressed a deep sense of gratitude to clients, and found purpose and meaning in their work. They explained how they had been changed by the work, and clients had helped them to become more caring and empathetic people, with greater acceptance and respect for people with different perspective to their own. An example of the web of interconnection required for sustainable practice was expressed by Audrey.

It is very much from that staying human space… Being really heart centred… I don't feel like I have to fix people… I feel like I can understand what I can understand, but if I don't understand it, that's OK. We're all important that we have really different pieces of the puzzle. (That) helps me sustain myself because I don't have to try and do it in another way… I need to keep humility and a sense of humour… joy and happiness outside of my work to keep nourishing me so work doesn't become my whole identity,… (and) a practical environment where I'm able to align my work with… my values.

Through an amalgamation of the elements described by participants as essential for sustainability in practice, a model for sustainable practice has been developed as represented in Figure 2.

Figure 2.

Model for Sustainable Practice.

Discussion

This research has explored how practitioners working with refugee-related trauma are shaping sustainability in practice throughout their careers. Through the narratives of participants, greater insight into the underdeveloped concept of sustainable practice has been provided, and a proposed model for sustainable practice has been developed. Participant explanations of sustainable practice explain how they learned to navigate the challenging elements of working with refugee-related trauma, such as vicarious trauma and burnout, while developing their resilience and growing alongside their clients. Participants articulated engaging in deep personal reflective processes as a way of caring for themselves. This was essential for them to understand themselves within the work and to process their experiences. The elements of sustainability identified by participants included emotional exploration and learning with clients, integration, and personal growth through these experiences. Critical self-reflection, introspective awareness, and the ability to practice one's values, ethics, and spirituality were key aspects of remaining well in work. This supported practitioners to maintain hope for clients and for themselves. Practice itself was articulated as being as much about oneself as it was about the client, to be of best service and support for the client. A consideration of this was the recognition and acceptance that the pain experienced in refugee-related trauma impacts everyone involved. Through this acceptance participants described how they were able to connect deeply with their clients; this connection being the heart and soul of their work.

Sustaining Oneself Through Embodiment in Practice

Introspection, self-awareness, and discovery of oneself were key aspects of sustainable practice for participants. Furthermore, this attunement to oneself often functioned as a guide in practice. Hannah articulated this through the concept of the three brains: the head, heart, and gut. The “head brain” is the domain for logic, reasoning, analytical thought, and cognition, which creates narratives and meaning (Soosalu et al., 2019). The “heart brain” holds emotions, values, desires, and is the source of wisdom (Alshami, 2019; Soosalu et al., 2019), while the “gut brain” is the domain for intuition, instinct, and a person's core sense of self (Soosalu et al., 2019). This brain guides both practitioners’ sense of safety for themselves, and the way practitioners practice with clients (Kolacz & Porges, 2018). This concept of somatic decision making or “embodied re-representation and interoceptive processing” (Soosalu et al., 2019, p. 2) has been well developed, with particular attention to the roles of cognition, emotions, and intuition (Soosalu et al., 2019). Barrett and Bar (2009) demonstrated that humans are constantly gathering information through somatic experiences as well as semantic knowledge. This experiential learning incorporates exteroceptive cues and interoceptive information in which the body is somatically communicating responses based off an accumulation of knowledge gathered through past experiences. Therefore, instinctual and emotional responses are intrinsically a part of decision-making processes, or how a practitioner will respond to any given situation. This brings scientific insight into participants embodied ethical decision making resembled in Figure 1, and the concept of “spiritual pain” discussed by Reynolds (2008, 2010b). When participants felt ethically compromised in their work environment they experienced an embodied reaction, which could lead to burnout. This was articulated as feelings of exhaustion or feeling “shaky” within themself caused by their inability to enact their values. Through ethical practice practitioners were able to maintain a sense of sustainability.

Working with survivors of refugee-related trauma has been described as “messy work” (Participant Ari; Reynolds et al., 2014). Practitioners need to learn how to sit in places of discomfort with clients, adapt to client's needs, and as such reinvent themselves as practitioners for each client that they see. This was clearly articulated by participants, particularly through Audrey's description of “touching the fire” and the adaptivity that Ari expressed in her Bruce Lee quote to “be like water.” Participants drew on their intuition to guide their practice and their instincts to know where it was safe to go with clients. This was not a process of playing a role for clients. There was an ingrained need for authenticity in practitioners practice, with the inability for this to be enacted leading to burnout. This corresponds to similar findings by Nielsen et al. (2023) in the relationship between emotional dissonance and burnout among child welfare workers.

The Importance of Spirituality for Sustainability

Spiritual beliefs served as an anchor and a guide for participants. Through their beliefs they developed a sense of purpose in the work and were able to maintain hope for their clients and the future. Connection as a central component of practice, personal growth, creativity, a strong understanding of one's values, and being able to enact these values, all correspond with the definition of spirituality provided by The Association for Spiritual, Ethical and Religious Values in Counselling (as cited in Steen et al., 2006). There was a need for participants to be connected with their inner self to be able to support and guide clients in their own connection with self. This suggests that educating practitioners in how to harness their spirituality or beliefs as a foundation of practice would support their development of sustainability.

Ghaderi et al. (2018) identified a distinct difference between spirituality and spiritual health. Spirituality was perceived as a potential state of being, which is comprehensive and dynamic, and differs around the globe. Spiritual health is understood as a sub-category of spirituality. According to Ghaderi et al. (2018), “the basic characteristics of spiritual health are as follows: proper lifestyle, connection with others, asking about the meaning and purpose of life, and transcendence” (p. 2). Practitioners discussed all of these elements in their approach to supporting clients. Here the necessity for practitioners to harness and actively engage in their spirituality, while maintaining their spiritual health becomes apparent. It also becomes clear that for sustainability in practice practitioners must work within relational boundaries. They can then embark on transformative learning journeys with their clients through a spiritual health perspective, and ward off the crippling effects that trauma can inflict.

Redefining Boundaries in Practice for Sustainability

The connectedness participants expressed with clients, and their willingness to engage with the emotional impact of hearing client's stories of torture and trauma, speak to a form of boundaries contrary to those in traditional practice. O’Leary et al. (2013) considered traditional boundaries to have the ability to inhibit connection as they focus on separation, professional distance, and the disempowerment of clients. Audrey's description of “the third space” helped her maintain her emotional boundaries, to value the privacy of clients, and remain ethical in her practice in order to sustain herself. Power within the practitioner client relationship was distributed as two equal participants of a shared experience, each bringing their own knowledge, wisdom, and insight. Together they learnt and grew with each other and took away their own experience of the session.

The concept of a “third space,” such as this, has been developed within grey literature as a shared communal space for relaxation and wellbeing (Tahmaseb-McConatha, 2015). The Trust (2020) speak of the “third space” within the context of practitioner and client relationship. They perceive this as a shared space between client and practitioner to describe the concepts of transference and countertransference. The “third space,” however, remains underdeveloped in the literature. Through the experiences expressed by participants it is evident that to sustainably work with refugee-related trauma a change in the conception of professional boundaries is needed. A different approach to boundary setting which intentionally places the social worker alongside the client was proposed by O'Leary et al. (2013). Their proposed model enables the effective use of self and promotes connection within the relationship. This type of boundary setting requires transparency and reciprocity as the client and social worker together move towards the desired outcome. A need for redefining professional boundaries is supported by Herlihy and Dufrene (2011) who expressed that to effectively and ethically work with diverse populations, and to advocate for social justice, a shift in boundaries is required.

Vicarious Growth Through Transformative Learning

Emphasized among participants was the importance of ongoing learning and growth. Sustainable practice could not be achieved by remaining in a fixed state, rather, this was a process of continuously being open to being changed by the work and to learn alongside clients. Individuals learn through their relationships with others (Taylor & Cranton, 2012). Therefore, it is not surprising that each client's story will gradually change a practitioner's schema (Brockhouse et al., 2011; McCann & Pearlman, 1990). People uncritically integrate information from their environment, which guides their decisions and actions until meeting a perspective that contradicts their expectations (Cohen & Heinecke, 2018; Eaves, 2018; Taylor & Cranton, 2012). This discrepancy can either be rejected, or a process of transformative learning occurs (Taylor & Cranton, 2012).

Transformative learning is based on three key domains: dialogue, praxis, and conscientization (Eaves, 2018). The learner engages in dialogue which challenges existing assumptions and perspectives, placing the learner in a disorientating dilemma. The learner then critically reflects on that experience and how it conflicts with the learner's existing meaning structures (Praxis). Through rational exploration of existing meaning structures and taking action on contexts which influence and shape their life, they engage in conscientization (Cohen & Heinecke, 2018; Eaves, 2018). The learner then applies this new knowledge, building competence and confidence (Cohen & Heinecke, 2018). Transformative learning, therefore, essentially changes a person through personal growth (Christopher et al., 2001). Participants expressed bearing witness to the atrocities clients had experiences (dialogue), which disrupted their understanding of humanity (praxis). They then integrated this newfound information into their understanding of the world (conscientization). These experiences of connection and joint learning were what Sarina described as “magical moments.”

The conditions participants spoke of to facilitate growth resemble the conditions identified by Robertson (1996, as cited in Christopher et al., 2001) for transformative learning to occur. The need for an authentic, empathetic, and caring relationship between practitioner and client, a sense of safety and trust, and engagement in a collaborative process of equal participation and joint reflection were required. Findings from Brockhouse et al. (2011) support this proposition. They found that the more comprehensible and manageable practitioners perceived the world to be reduced opportunities for vicarious growth. This suggests that it is the practitioner's willingness to engage in a shared learning experience with their client that leads to growth. Through this growth participants discussed how their perceptions of humanity had, for the most part, changed for the better. This process of continuously learning with clients may also shed some light on Henriques et al.'s (2024) findings to why older practitioners experience lower levels of burnout. Cohen and Collens (2013) identified that there remains no specific theoretical model of explanation for how vicarious growth occurs. Based on the accounts of participants, transformative learning theory could provide the answer.

Self-Care and Sustainable Practice

It is evident that a hedonistic interpretation of self-care in which pain should be avoided does not align with the processes participants undertook to remain well in their practice. While participants expressed sometimes feeling sadness, a shared grief with clients, or being overwhelmed by the atrocities in the world, a sense of awe, compassion, gratitude, and inspiration from their clients could simultaneously be experienced. Vicarious trauma was experienced with vicarious growth. It was through embracing this complexity, or “the messiness” of the work, that participants were able to continuously integrate their experiences, grow, and sustain themselves. As such, the experience of sustaining oneself while working with refugee-related trauma does not align with a model of self-care which is focused solely on making oneself feel better (Butler et al., 2019; Michaeli, 2017).

Self-care processes articulated by participants more closely resemble a eudaimonic understanding of self-care: care of oneself derived through self-realization (Cohen & Collens, 2013; Ryan & Deci, 2001; Shmotkin, 2005) and self-assessment of personal functioning (Ryan & Deci, 2001), and the concept of sustainable practice developed by Reynolds (2010a; Reynolds et al., 2014; Richardson & Reynolds, 2012). Through an ongoing process of introspective interrogation of oneself, a conscious exploration of one's own experience and reaction to the work, and integration of the stories of refugee-related trauma that participants bore witness to, they were able to remain well in their work. Rather than trying to avoid painful experiences they sat in these places of discomfort with clients, and through this gained greater understanding of themselves. By centering connection and allowing oneself to be transformed through a shared learning experience with clients, practitioners are able to remain well, capable and ethical in practice throughout their careers.

Limitations

This study offers significant insight into sustainable practice when working with refugee-related trauma, however, it was limited by a small sample size of seven participants from one organization. As such, findings may not be representative of how practitioners working with refugee-related trauma are shaping sustainability across the broader sector. The unique challenges of working with refugee-related trauma may also limit the applicability of this study to different forms of trauma work.

Conclusion

This research has demonstrated that while each practitioner has unique qualities and approaches that they draw on to form sustainability in their practice, there are common threads which weave through practitioners’ experiences. Essential elements such as connection, shared learning, spirituality, and growth demonstrate there is greater depth to sustaining oneself in practice than can be offered through a hedonistic interpretation of self-care. Within the complex interplay of the client practitioner relationship working with refugee-related trauma, practitioners engaged in self-care practices which can be considered eudaimonic. Concepts such as the “three brains,” or the head, heart and gut, introspective processing and integration, ethical practice, and transformative learning offer insight into how sustainability occurs. These aspects also shed light on the transformative experience of vicarious trauma to growth, and have the potential to support social workers and other practitioners through the challenges of working with refugee-related trauma. It is evident that sustainable practice when working with refugee-related trauma is not only achievable, as depicted in Figure 2 Model for Sustainable Practice, but can be a source of purpose and fulfillment for practitioners. This study provides the foundations for further research to continue to develop an educational model of sustainability to support practitioners when working with complex trauma, such as refugee-related trauma.

Footnotes

ORCID iD

Amanda Rose Collins

Ethics Approval

Ethics approval for this project was given by The Griffith University Ethics Review Committee (approval: CC: Postgraduate Dissertation Course 8200HSV GU Ref No: 2021/825). Ethics approval was also received by the affiliated organization.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

Alshami

A. M.

(2019). Pain: Is it all in the brain or the heart? Current Pain and Headache Reports, 23(12), 88. https://doi.org/10.1007/s11916-019-0827-4

Apostolidou

(2016). Constructions of emotional impact, risk and meaning among practitioners working with asylum seekers and refugees. Counselling and Psychotherapy Research, 16(4), 277–287. https://doi.org/10.1002/capr.12087

Barrett

L. F.

Bar

(2009). See it with feeling: Affective predictions during object perception. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 364(1521), 1325–1334. https://doi.org/10.1098/rstb.2008.0312

Barrington

A. J.

Shakespeare-Finch

(2013). Working with refugee survivors of torture and trauma: An opportunity for vicarious post-traumatic growth. Counselling Psychology Quarterly, 26(1), 89–105. https://doi.org/10.1080/09515070.2012.727553

Brockhouse

Msetfi

R. M.

Cohen

Joseph

(2011). Vicarious exposure to trauma and growth in therapists: The moderating effects of sense of coherence, organizational support, and empathy. Journal of Traumatic Stress, 24(6), 735–742. https://doi.org/10.1002/jts.20704

Butler

L. D.

Mercer

K. A.

McClain-Meeder

Horne

D. M.

Dudley

(2019). Six domains of self-care: Attending to the whole person. Journal of Human Behavior in the Social Environment, 29(1), 107–124. https://doi.org/10.1080/10911359.2018.1482483

Bynum

Varpio

(2018). When I say … hermeneutic phenomenology. Medical Education, 52(3), 252–253. https://doi.org/10.1111/medu.13414

Century

Leavey

Payne

(2007). The experience of working with refugees: Counsellors in primary care. British Journal of Guidance & Counselling, 35(1), 23–40. https://doi.org/10.1080/03069880601106765

Christopher

Dunnagan

Duncan

S. F.

Paul

(2001). Education for self-support: Evaluating outcomes using transformative learning theory. Family Relations, 50(2), 134–134. https://www.jstor.org/stable/585855 https://doi.org/10.1111/j.1741-3729.2001.00134.x

10.

Cohen

Collens

(2013). The impact of trauma work on trauma workers: A metasynthesis on vicarious trauma and vicarious posttraumatic growth. Psychological Trauma, 5(6), 570–580. https://doi.org/10.1037/a0030388

11.

Cohen

Heinecke

(2018). Dialogue exhibitions: Putting transformative learning theory into practice. Curator: The Museum Journal, 61(2), 269–283. https://doi.org/10.1111/cura.12254

12.

Dutton

(2014). Queering self-care: Reimagining the radical possibilities of self-care in healing from sexual assault. Spaces Between: An Undergraduate Feminist Journal, 2, 1–10.

13.

Eaves

(2018). Self-Care: A Model of Prevention & Sustainability in Social Work Practice (Doctoral dissertation). University of St. Thomas School of Social Work. https://researchonline.stthomas.edu/esploro/outputs/991015131535903691

14.

Edelkott

Engstrom

D. W.

Hernandez-Wolfe

Gangsei

(2016). Vicarious resilience: Complexities and variations. American Journal of Orthopsychiatry, 86(6), 713–724. https://doi.org/10.1037/ort0000180

15.

Engstrom

Hernandez

Gangsei

(2008). Vicarious resilience: A qualitative investigation into its description. Traumatology, 14(3), 13–21. https://doi.org/10.1177/1534765608319323

16.

Gemignani

Giliberto

(2021). Constructions of burnout, identity, and self-care in professionals working toward the psychosocial care of refugees and asylum seekers in Italy. Journal of Constructivist Psychology, 34(1), 56–78. https://doi.org/10.1080/10720537.2019.1700853

17.

Ghaderi

Tabatabaei

S. M.

Nedjat

Javadi

Larijani

(2018). Explanatory definition of the concept of spiritual health: A qualitative study in Iran. Journal of Medical Ethics and History of Medicine, 11(3), 1–7. https://pmc.ncbi.nlm.nih.gov/articles/PMC6150917/

18.

Glennon

Pruitt

D. K.

Rouland Polmanteer

R. S.

(2019). Integrating self-care into clinical practice with trauma clients. Journal of Human Behavior in the Social Environment, 29(1), 48–56. https://doi.org/10.1080/10911359.2018.1473189

19.

Guhan

Liebling-Kalifani

(2011). The experiences of staff working with refugees and asylum seekers in the United Kingdom: A grounded theory exploration. Journal of Immigrant & Refugee Studies, 9(3), 205–228. https://doi.org/10.1080/15562948.2011.592804

20.

Henriques

Luís

Rivero

Gonçalves

S. P.

Tavares

L. P.

Marujo

HÁ

(2024). The impact of community resilience, well-being, and community attachment on human service workers’ burnout. Journal of Social Work, 24(3), 322–338. https://doi.org/10.1177/14680173231225113

21.

Herlihy

Dufrene

R. L.

(2011). Current and emerging ethical issues in counseling: A delphi study of expert opinions. Counseling and Values, 56(1-2), 10–24. https://doi.org/10.1002/j.2161-007X.2011.tb01028.x

22.

Hernandez

Gangsei

Engstrom

(2007). Vicarious resilience: A new concept in work with those who survive trauma. Family Process, 46(2), 229–241. https://doi.org/10.1111/j.1545-5300.2007.00206.x

23.

Hernandez-Wolfe

Killian

Engstrom

Gangsei

(2015). Vicarious resilience, vicarious trauma, and awareness of equity in trauma work. The Journal of Humanistic Psychology, 55(2), 153–172. https://doi.org/10.1177/0022167814534322

24.

Killian

Hernandez-Wolfe

Engstrom

Gangsei

(2017). Development of the vicarious resilience scale (VRS): A measure of positive effects of working with trauma survivors. Psychological Trauma, 9(1), 23–31. https://doi.org/10.1037/tra0000199

25.

Kolacz

Porges

S. W.

(2018). Chronic diffuse pain and functional gastrointestinal disorders after traumatic stress: Pathophysiology through a polyvagal perspective. Frontiers in Medicine, 5, 145. https://doi.org/10.3389/fmed.2018.00145

26.

Lee

J. J.

Miller

S. E.

(2013). A self-care framework for social workers: Building a strong foundation for practice. Families in Society, 94(2), 96–103. https://doi.org/10.1606/1044-3894.4289

27.

Long

(2020). Supervisors’ perception of vicarious trauma and growth in Australian refugee trauma counsellors. Australian Social Work, 73(1), 105–117. https://doi.org/10.1080/0312407X.2018.1501587

28.

McAuliffe

Boddy

Chenoweth

(2024). The Road to Social Work and Human Service Practice (7th Ed.). Cengage Learning.

29.

McCann

I. L.

Pearlman

L. A.

(1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3(1), 131–149. https://doi.org/10.1007/BF00975140

30.

Michaeli

(2017). Self-care: An act of political warfare or a neoliberal trap? Development (Society for International Development), 60(1-2), 50–56. https://doi.org/10.1057/s41301-017-0131-8

31.

Mueller

Morley

(2020). Blaming individuals for burnout: Developing critical practice responses to workplace stress. Social Alternatives, 39(3), 20–28. https://research.usc.edu.au/esploro/outputs/99511206902621

32.

Nielsen

M. B.

Johannessen

H. A.

Christensen

J. O.

Finne

L. B.

(2023). Emotional dissonance and burnout among child welfare workers: The moderating role of social support from colleagues, supervisors, and organization. Journal of Social Work, 23(4), 615–635. https://doi.org/10.1177/14680173221143649

33.

Nuttman-Shwartz

(2015). Shared resilience in a traumatic reality: A new concept for trauma workers exposed personally and professionally to collective disaster. Trauma, Violence & Abuse, 16(4), 466–475. https://doi.org/10.1177/1524838014557287

34.

O’Leary

Tsui

M.-S.

Ruch

(2013). The boundaries of the social work relationship revisited: Towards a connected, inclusive and dynamic conceptualisation. British Journal of Social Work, 43(1), 135–153. https://doi.org/10.1093/bjsw/bcr181

35.

Puvimanasinghe

Denson

L. A.

Augoustinos

Somasundaram

(2015). Vicarious resilience and vicarious traumatisation: Experiences of working with refugees and asylum seekers in South Australia. Transcultural Psychiatry, 52(6), 743–765. https://doi.org/10.1177/1363461515577289

36.

Reynolds

(2008). An ethic of resistance: Frontline worker as activist. Women Making Waves, 19(1), 5.

37.

Reynolds

(2010a). Doing Justice as a path to sustainable community work [Doctoral Dissertation]. The Taos Institute. https://www.taosinstitute.net/education/taos-phd-program/completed-dissertations/vikki-reynolds-dissertation

38.

Reynolds

(2010b). A supervision of solidarity. Canadian Journal of Counselling, 44(3), 246–257.

39.

Reynolds

Hammoud-Beckett

Sanders

C. J.

Haworth

(2014). Poetic resistance: Witnessing Brahman’s resistance to torture and political violence. International Journal of Narrative Therapy and Community Work, 2, 1–15.

40.

Richardson

Reynolds

(2012). Here we are amazingly alive: Holding ourselves together with an ethic of social justice in community work. International Journal of Child, Youth and Family Studies, 1, 1–19. https://doi.org/10.18357/ijcyfs31201210471

41.

Ryan

R. M.

Deci

E. L.

(2001). On happiness and human potentials: A review of research on hedonic and eudaimonic well-being. Annual Review of Psychology, 52, 141–166. https://doi.org/10.1146/annurev.psych.52.1.141

42.

Saldaña

Leavy

Beretvas

(2011). Fundamentals of qualitative research. Oxford University Press.

43.

Schaufeli

W. B.

Greenglass

E. R.

(2001). Introduction to special issue on burnout and health. Psychology & Health, 16(5), 501–510. https://doi.org/10.1080/08870440108405523

44.

Shmotkin

(2005). Happiness in the face of adversity: Reformulating the dynamic and modular bases of subjective well-being. Review of General Psychology, 9(4), 291–325. https://doi.org/10.1037/1089-2680.9.4.291

45.

Soosalu

Henwood

Deo

(2019). Head, heart, and gut in decision making: Development of a multiple brain preference questionnaire. SAGE Open, 9(1), 1–17. https://doi.org/10.1177/2158244019837439

46.

Steen

R. L. A.

Engels

Thweatt

W. T.,

III . (2006). Ethical aspects of spirituality in counseling. Counseling and Values, 50(2), 108–118. https://doi.org/10.1002/j.2161-007X.2006.tb00047.x

47.

Tahmaseb-McConatha

(2015). Comforting third spaces access to “third spaces” can promote health and well-being. Psychology Today. https://www.psychologytoday.com/us/blog/live-long-and-prosper/201503/comforting-third-spaces

48.

Taylor

E. W.

Cranton

(2012). The handbook of transformative learning: theory, research, and practice. John Wiley & Sons.

49.

The Trust . (2020). The space between: Transference & countertransference. Psychosynthesis Trust. https://psychosynthesistrust.org.uk/the-space-between-transference-countertransference/

50.

Thompson

E. H.

Frick

M. H.

Trice-Black

(2012). Counselor-in-training perceptions of supervision practices related to self-care and burnout. The Professional Counselor, 1(3), 152–162. https://doi.org/10.15241/eht.1.3.152

51.

Woodcock

(2001). Threads from the labyrinth: Therapy with survivors of war and political oppression. Journal of Family Therapy, 23(2), 136–154. https://doi.org/10.1111/joft.2001.23.issue-2

Conceptualizing Sustainable Practice in Trauma-Related Work: Reflections From the Field

Abstract

Summary

Findings

Applications

Keywords

Introduction

Vicarious Trauma and Burnout

Self-Care

Vicarious Growth and Vicarious Resilience

Sustainable Practice

Methodology

Results

Importance of Connection

Maintaining Sustainability Through the Darkness

Spirituality in Practice

The Importance of Ethics

The Importance of Learning and Growth

The Complexity and Interconnectedness of Sustainability

Discussion

Sustaining Oneself Through Embodiment in Practice

The Importance of Spirituality for Sustainability

Redefining Boundaries in Practice for Sustainability

Vicarious Growth Through Transformative Learning

Self-Care and Sustainable Practice

Limitations

Conclusion

Footnotes

ORCID iD

Ethics Approval

Funding

Declaration of Conflicting Interests

References