Examining Self-Care As a Moderator of Secondary Traumatic Stress and Functional Impairment in Clinical Social Workers

Background and Purpose

Social workers are regularly exposed to the traumatic experiences of clients, and thus are at risk for secondary traumatic stress (STS). Indeed research has demonstrated a high prevalence of STS in social workers. As with traumatic stress resulting from direct exposure, STS may result in significant distress or impairment in various psychosocial domains. Self-care is believed to protect against the development of STS and mitigate its impact on functioning, however little research exists examining such relationships. Recently, Lee and Miller (2013) offered a conceptual definition of self-care that distinguishes personal self-care from self-care practices. The purpose of this study was to investigate whether personal and professional self-care, moderate STS and its relationship with functional impairment.

 Methods

The present study used a cross-sectional, mailed survey of a random sample of masters-level NASW members. 731 responses were returned, a response rate of 29% consistent with other studies of NASW members. These analyses were limited to 539 respondents involved direct practice at the time of the survey. Exposure to traumatized clients was operationalized as the percentage of respondents’ caseload that met the criteria for PTSD. Secondary traumatic stress, functional impairment, and self-care were measured with the Secondary Traumatic Stress Scale (17-items; alpha = .92), Functional Impairment from Secondary Trauma Scale (7-items; alpha = .92), and the personal and professional subscales of the Self Care Practices Scale (9 items each alpha = .80 and .76), respectively. Hayes’ PROCESS macro for SPSS was used to conduct four moderation analyses examining: (1) personal self-care as a moderator of the association between secondary exposure to trauma and STS; (2) professional self-care as a moderator of the association between secondary exposure to trauma and STS; (3) personal self-care as a moderator of the relationship between STS and functional impairment; and (4) professional self-care as a moderator of the relationship between STS and functional impairment. Age, gender, and experience were included as covariates due to known associations with STS.

 Results

Both personal self-care and professional self-care moderated the relationship between secondary exposure to trauma and STS. Higher levels of secondary exposure was associated with higher levels of STS at lower levels of personal and professional self-care, but at higher levels of personal and professional self-care secondary exposure was not associated with STS. Only professional self-care was found to moderate the relationship between STS and functional impairment, with higher levels of STS associated with higher levels of functional impairment, with the strength of the relationship diminishing with higher levels of professional self-care. Personal self-care did not moderate the relationship between STS and functional impairment. Higher STS was associated with more functional impairment at all levels of personal self-care.

 Conclusions and Implications

Our results support the notion that self-care can prevent the development of STS and mitigate its effect of the functioning of social workers. Self-care, particularly of the professional variety, should be utilized by social workers working with the traumatized.