社會(huì)工作與替代性創(chuàng)傷：情感卷入的風(fēng)險(xiǎn)與機(jī)遇

理查德·英格拉姆（Richard Ingram） 伊恩·巴倫（Ian Barron）張驍健（譯） 邢朝國(guó)（校）

社會(huì)工作的一項(xiàng)關(guān)鍵工作在于建立關(guān)系和運(yùn)用同理心，在此背景下，考慮社工替代性創(chuàng)傷的普遍性及其影響變得尤為重要。盡管人們對(duì)實(shí)務(wù)過(guò)程中管理主義的主導(dǎo)地位和社工與服務(wù)對(duì)象關(guān)系的真誠(chéng)性存在很多爭(zhēng)議，但很顯然，在社會(huì)工作實(shí)務(wù)經(jīng)驗(yàn)中，社工的人際層面和自我層面都是極為重要的。

服務(wù)關(guān)系的建立要求社工全身心地關(guān)注那些希望與其提升信任、理解和洞察力的服務(wù)對(duì)象，并與之建立真誠(chéng)的聯(lián)系。這就要求社工用一種赫尼西（Hennessey. R）①Hennessey, R. Relationship skills in social work, London: Sage. 2011, p.8.所說(shuō)的同理心的方式來(lái)開(kāi)展工作，“一種在情感方面聆聽(tīng)他人通過(guò)口頭語(yǔ)言和非口頭語(yǔ)言表達(dá)出的內(nèi)容的方式，一種需要社工在與服務(wù)對(duì)象的關(guān)系之中投入自我的社工實(shí)務(wù)方式”。芬頓（Fenton.J）②Fenton, J. Values in social work: reconnecting with social justice. London: Palgrave. 2016.和英格拉姆（Ingram.R）③Ingram, R. Exploring emotions within formal and informal forums: messages from social work practitioners. British Journal of Social Work, 2013.45（3）.也提出這種實(shí)務(wù)方式要求建立情感層面的聯(lián)系，社工要具備情感上的反身性，同時(shí)還要具備理解他人情感世界的意愿。雖然這有時(shí)看起來(lái)像是社會(huì)工作者理所當(dāng)然的不可辯駁的特質(zhì)，但這也可能顯露或引發(fā)社工個(gè)人的復(fù)雜情感。

情感聯(lián)結(jié)對(duì)社工實(shí)務(wù)而言是重要的，也是必不可少的，但這也會(huì)對(duì)社工產(chǎn)生潛在危害。情感聯(lián)結(jié)的影響是多變的、多方面的?！皠?chuàng)傷事件”的本質(zhì)可以是社工親眼目睹或親身參與的直接經(jīng)驗(yàn)，也可以是在與他人交談過(guò)程中得來(lái)的間接經(jīng)驗(yàn)。另外，這種“事件”可能是單一的，也可能是由創(chuàng)傷性反應(yīng)引起的相關(guān)問(wèn)題的集合。當(dāng)把個(gè)人經(jīng)歷、創(chuàng)傷歷史和用來(lái)處理不幸的彈性因素考慮在內(nèi)時(shí)，情況就會(huì)變得更加多變。鑒于社工實(shí)務(wù)情境的豐富多樣性，把創(chuàng)傷作為一個(gè)重要議題來(lái)看待是至關(guān)重要的，以確保對(duì)創(chuàng)傷的警醒和預(yù)防。

麥卡恩（McCann.L）和皮爾曼（Pearlman.L）①M(fèi)cCann, L.and Pearlman, L. Vicarious traumatization: a framework for understanding the psychological effects of working with victims.Journal of Traumatic stress, 1990, 3（1）: 131-149.最先界定了替代性創(chuàng)傷這一概念，那時(shí)人們普遍認(rèn)為對(duì)創(chuàng)傷群體的研究有加劇創(chuàng)傷癥狀的風(fēng)險(xiǎn)。早期的研究聚焦于緊急救助和災(zāi)難援助，然而，由于研究多是描述性的而非實(shí)證的，證據(jù)的質(zhì)量受到了限制。②Sabin-Farrell, R. and Turpin, G. Vicarious traumatization: Implications for the mental health of workers. Clinical Psychology Review, 2003（23）: 32-36.近期的替代性創(chuàng)傷研究更多是由專業(yè)人員開(kāi)展的，如急救人員、災(zāi)難援助人員、護(hù)士、醫(yī)生、藥劑師、記者和熱線工作人員。③Nimmo, A. and Huggard, P. A systematic review of the measurement of compassion fatigue, vicarious trauma, and secondary traumatic stress in physicians. Australasian Journal of Disaster and Trauma Studies, 2013（1）: 37-44.一些研究已經(jīng)涉及與社工經(jīng)驗(yàn)相關(guān)的潛在性創(chuàng)傷，鑒于此，本文主要闡述替代性創(chuàng)傷的概念、不同職業(yè)群體的發(fā)病率、從業(yè)者患替代性創(chuàng)傷的風(fēng)險(xiǎn)以及預(yù)防。本文最后聚焦社工替代性創(chuàng)傷的最新研究。

一、替代性創(chuàng)傷的概念

在文獻(xiàn)綜述中，有一系列術(shù)語(yǔ)可以用來(lái)描述服務(wù)受創(chuàng)傷群體的專業(yè)人員的負(fù)面情緒，如繼發(fā)性創(chuàng)傷壓力、精疲力竭、替代性創(chuàng)傷和同情疲累。精疲力竭被認(rèn)為是“情緒超負(fù)荷和情緒耗竭，以人格解體④人格解體是個(gè)體實(shí)際存在的普通感覺(jué)處于喪失的狀態(tài)，表現(xiàn)為不現(xiàn)實(shí)或自我疏遠(yuǎn)，不能控制自己的動(dòng)作和言語(yǔ)的感覺(jué)——譯者注。、長(zhǎng)期情緒緊張和個(gè)人成就感降低為特征”。另一方面，繼發(fā)性創(chuàng)傷壓力指的是“因了解到重要的人所經(jīng)歷的創(chuàng)傷事件而引發(fā)的行為和情感，這是一種因幫助或希望幫助遭受了創(chuàng)傷或不幸的人而產(chǎn)生的壓力”。⑤Figley, C.R. Compassion fatigue: Toward a new understanding of the costs of caring. New York: Brunner/Mazel. 1995.相比之下，替代性創(chuàng)傷是一種更為嚴(yán)重的“因?qū)Π钢鳌畡?chuàng)傷材料’的移情投入而引發(fā)的社工個(gè)人的內(nèi)心體驗(yàn)”。⑥Pearlman, L.A. and Saakvitne, K.W. Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: WW Norton & Co.1995.無(wú)論是在專業(yè)領(lǐng)域還是在個(gè)人生活領(lǐng)域，替代性創(chuàng)傷都是累積、持久和明顯的。替代性創(chuàng)傷也被視為同情疲累，指的是因卷入案主的創(chuàng)傷經(jīng)歷而產(chǎn)生痛苦，進(jìn)而導(dǎo)致專業(yè)人員在情感層面和認(rèn)知層面出現(xiàn)反應(yīng)能力下降的現(xiàn)象。⑦Boscarino, J.A., Figley, C.R. and Adams, R.E. Compassion fatigue following the September 11 terrorist attacks: A study of secondary trauma among New York City social workers. International Journal of Emergency Mental Health, 2004, 6（2）: 57.雷（Ray, S.L）等人⑧Ray, S.L., Wong, C., White, D. and Heaslip, K. Compassion satisfaction, compassion fatigue, work life conditions, and burnout among frontline mental health care professionals. Traumatology, 2013, 19（4）:255-267.強(qiáng)調(diào)，服務(wù)創(chuàng)傷患者的專業(yè)人員需要具備較高的護(hù)理水平，但也可能會(huì)引發(fā)他們生理層面和心理層面的同情疲累。杜波依斯（Dubois.A.L）⑨DuBois, A.L. An inquiry of the lived experiences and contextual understandings of early childhood special educators related to children's trauma. Duquesne University. 2010.指出，如果沒(méi)有注意到替代性創(chuàng)傷的癥狀，替代性創(chuàng)傷對(duì)人的心理健康產(chǎn)生的影響會(huì)是長(zhǎng)期的。很明顯，回應(yīng)這些困難且復(fù)雜的情感層面的實(shí)務(wù)問(wèn)題，會(huì)使個(gè)別社工的健康受到嚴(yán)重?fù)p害，也會(huì)對(duì)從業(yè)者的功能和決策產(chǎn)生重大影響。

與此相反，有些研究者更加關(guān)注替代性創(chuàng)傷而非病理，關(guān)注什么是服務(wù)創(chuàng)傷群體之后引起的正常反應(yīng)和預(yù)期反應(yīng)。①Jenkins, S.R. and Baird, S.Secondary traumatic stress and vicarious trauma: A validational study. Journal of Traumatic Stress, 2002, 15（5）: 423-432. Bride, B.E. Prevalence of secondary traumatic stress among social workers. Social Work, 2007, 52（1）: 63-70.另外，不是所有研究者都將替代性創(chuàng)傷簡(jiǎn)單地看作是一種負(fù)面反應(yīng)。阿諾德（Arnold.D）等②Arnold, D., Calhoun, L.G., Tedeschi, R., &Cann, A. Vicarious Posttraumatic Growth in Psychotherapy. Journal of Humanistic Psychology,2005（43）: 239-263. Conrad, D. and Kellar-Guenther, Y. Compassion fatigue, burnout, and compassion satisfaction among Colorado child protection workers.Child Abuse & Neglect, 2006, 30（10）:1071-1080.認(rèn)為替代性創(chuàng)傷可能帶來(lái)替代性創(chuàng)傷后成長(zhǎng)，它能夠提高專業(yè)人員的洞察力和意志力，比如，赫爾南德斯（Hernandez.P）等③Hernández, P., Gangsei, D., & Engstrom, D. Vicarious resilience: A new concept in work with those who survive trauma. Family Process,2007, 46（2）: 229-241.把替代性創(chuàng)傷適應(yīng)力描述為社工在服務(wù)創(chuàng)傷人群時(shí)表現(xiàn)出的忍耐力和恢復(fù)力的提高。這表明，替代性創(chuàng)傷可能是實(shí)務(wù)中建立的情感關(guān)系的惡性后果，但它本身是極有價(jià)值的，如果運(yùn)用得當(dāng)，可以提高社工的實(shí)務(wù)能力。

二、替代性創(chuàng)傷的職業(yè)患病率

學(xué)者們研究不同職業(yè)領(lǐng)域中替代性創(chuàng)傷的性質(zhì)和范圍。范斯坦（Feinstein.A）等④Feinstein, A., Owen, J. and Blair, N. A hazardous profession: war, journalists, and psychopathology. American Journal of Psychiatry, 2002, 159（9）: 1570-1575.發(fā)現(xiàn)近1/5的戰(zhàn)地記者都有抑郁癥狀，他們大多用酒精進(jìn)行自我治療。同樣程度的繼發(fā)性創(chuàng)傷壓力也出現(xiàn)在服務(wù)精神病患者的工作人員身上。⑤Kulka, R.A., Schlenger, W.E., Fairbank, J.A., Hough, R.L., Jordan, B.K., Marmar, C.R. and Weiss, D.S. Trauma and the Vietnam war generation: Report of findings from the National Vietnam Veterans Readjustment Study. NewYork:Brunner/Mazel.1990.法拉（Farrar AR）⑥Farrar AR: Vicarious Traumatization MentalHealth Professional. APAGS Newsletter. 2002.發(fā)現(xiàn)10%的災(zāi)難救援人員都表現(xiàn)出替代性創(chuàng)傷癥狀。同樣地，12%的急救服務(wù)人員都經(jīng)歷過(guò)臨床水平的創(chuàng)傷后應(yīng)激障礙。⑦Van Der Ploeg, E. and Kleber, R.J. Acute and chronic job stressors among ambulance personnel: predictors of health symptoms. Occupational and Environmental Medicine, 2003, 60（1）: 140-146.與心理治療師相比，警察的創(chuàng)傷性應(yīng)激障礙癥狀要更明顯一些。⑧Follette, V.M., Polusny, M.M. and Milbeck, K. Mental health and law enforcement professionals: Trauma history, psychological symptoms, and impact of providing services to child sexual abuse survivors. Professional psychology: Research and practice, 1994, 25（3）: 275.目前少量的研究對(duì)社會(huì)工作者的替代性創(chuàng)傷進(jìn)行評(píng)估。梅爾德倫（Meldrum.L）⑨Meldrum, L., King, R. and Spooner, D. Secondary traumatic stress in case managers working in community mental health services. In: Figley C.R,（Ed）. Treating compassion fatigue. New York, NY: Routledge. 2002: 85-106.發(fā)現(xiàn)澳大利亞的社區(qū)心理輔導(dǎo)人員，包括社會(huì)工作者在內(nèi)，都經(jīng)歷過(guò)繼發(fā)性創(chuàng)傷障礙，一直從事創(chuàng)傷人群服務(wù)會(huì)使社工變得習(xí)慣和麻木，這反過(guò)來(lái)會(huì)導(dǎo)致社工在情感上更為脆弱。⑩Glover, H. Emotional numbing: A possible endorphin-mediated phenomenon associated with post-traumatic stress disorders and other allied psychopathologic states. Journal of Traumatic Stress, 1992, 5（4）:643-675.布萊德（Bride.B.E）①Jenkins, S.R. and Baird, S.Secondary traumatic stress and vicarious trauma: A validational study. Journal of Traumatic Stress, 2002, 15（5）: 423-432. Bride, B.E. Prevalence of secondary traumatic stress among social workers. Social Work, 2007, 52（1）: 63-70.對(duì)282名碩士學(xué)位層次的社會(huì)工作者進(jìn)行了繼發(fā)性創(chuàng)傷壓力調(diào)查，結(jié)果顯示，他們之中有28%的社工有輕生的念頭，25%的社工表現(xiàn)出情感麻木，14%的社工沒(méi)法回想起服務(wù)案主的過(guò)程，還有5%的人從他們所經(jīng)歷的創(chuàng)傷中恢復(fù)過(guò)來(lái)?？道拢–onrad.D）和凱勒（Kellar-Guenthar.Y）②Arnold, D., Calhoun, L.G., Tedeschi, R., &Cann, A. Vicarious Posttraumatic Growth in Psychotherapy. Journal of Humanistic Psychology,2005（43）: 239-263. Conrad, D. and Kellar-Guenther, Y. Compassion fatigue, burnout, and compassion satisfaction among Colorado child protection workers.Child Abuse & Neglect, 2006, 30（10）:1071-1080.發(fā)現(xiàn)在科羅拉多州的363名兒童保護(hù)工作者（也是社會(huì)工作者）中，有約一半的人經(jīng)歷過(guò)同情疲累，然而，他們中的70%仍然有較高的職業(yè)滿意度。

三、替代性創(chuàng)傷的風(fēng)險(xiǎn)因素

替代性創(chuàng)傷的風(fēng)險(xiǎn)因素一方面包含了專業(yè)同理①Wasco, S.M., Campbell, R. and Clark, M. A Multiple Case Study of Rape Victim Advocates' Self-Care Routines: The Influence of Organizational Context. American Journal of Community Psychology, 2002, 30（5）: 731-760.iMorrison, Z. 'Feeling Heavy': Vicarious Trauma and Other Issues Facing Those who Work in the Sexual Assault Field. Australian Institute of Family Studies, 2007（4）: 1-13.，另一方面又包含了與創(chuàng)傷患者或創(chuàng)傷資料的長(zhǎng)期接觸。②Dunkley, J. and Whelan, T.A. Vicarious traumatisation: Current status and future directions. British Journal of Guidance & Counselling, 2006,34（1）: 107-116.Bober, T. and Regehr, C. Strategies for reducing secondary or vicarious trauma: Do they work? Brief Treatment and Crisis Intervention, 2006, 6（1）: 1.例如，專業(yè)人員通過(guò)反思自己的悲傷、恐懼和其他強(qiáng)烈的情緒來(lái)適應(yīng)創(chuàng)傷者的痛苦，這就會(huì)在個(gè)人層面影響到專業(yè)人員。看令人震驚的圖片、聆聽(tīng)和目睹服務(wù)對(duì)象支離破碎的信仰，這可能會(huì)導(dǎo)致服務(wù)者的自我認(rèn)同、世界觀和精神發(fā)生變化。③Janoff-Bulman, R. Shattered assumptions: Towards a new psychology of trauma. New York: The Free Press. 1992; Cunningham, M. Impact of trauma work on social work clinicians: Empirical findings. Social Work, 2003, 48（4）: 451-459.Iliffe, G. and Steed, L.G. Exploring the counselor's experience of working with perpetrators and survivors of domestic violence. Journal of Interpersonal Violence, 2000, 15（4）: 393-412.就服務(wù)者自身創(chuàng)傷經(jīng)歷對(duì)其替代性創(chuàng)傷形成的影響而言，相關(guān)證據(jù)是混亂的。④Morrison, Z. 'Feeling Heavy': Vicarious Trauma and Other Issues Facing Those who Work in the Sexual Assault Field. Australian Institute of Family Studies, 2007（4）: 1-13.DeAngelis, T. Normalizing practitioners’ stress. Monitor on Psychology, 2002: 7.鮑勃（Bober.T）和雷格爾（Regehr.C）認(rèn)為有創(chuàng)傷病史并且仍在服務(wù)創(chuàng)傷人群的社工應(yīng)該尋求支持，以在早期階段對(duì)這些創(chuàng)傷病史進(jìn)行反思和討論。⑤Bober, T. and Regehr, C. Strategies for reducing secondary or vicarious trauma: Do they work? Brief Treatment and Crisis Intervention, 2006, 6（1）: 1.

替代性創(chuàng)傷的一個(gè)風(fēng)險(xiǎn)因素是專業(yè)人員所服務(wù)個(gè)案的創(chuàng)傷程度。在工作中，更多地接觸性虐待個(gè)案的專業(yè)人員⑥Schauben, L.J. and Frazier, P.A. Vicarious trauma the effects on female counselors of working with sexual violence survivors. Psychology of Women Quarterly, 19951, 9（1）: 49-64.，尤其是在接觸兒童性虐待⑦Cunningham, M. Impact of trauma work on social work clinicians: Empirical findings. Social Work, 2003, 48（4）: 451-459.、性犯罪者⑧Moulden, H.M. and Firestone, P. Vicarious traumatization: The impact on therapists who work with sexual offenders. Trauma, Violence, &Abuse, 2007, 8（1）: 67-83.或曾有過(guò)創(chuàng)傷經(jīng)歷的案主時(shí)，專業(yè)人員患替代性創(chuàng)傷的幾率更高。服務(wù)創(chuàng)傷個(gè)體的時(shí)間長(zhǎng)短是預(yù)測(cè)替代性創(chuàng)傷的因素。⑨Bober, T. and Regehr, C. Strategies for reducing secondary or vicarious trauma: Do they work? Brief Treatment and Crisis Intervention, 2006, 6（1）: 1.但是貝爾德和詹金斯發(fā)現(xiàn)從業(yè)者的精神痛苦與其服務(wù)的創(chuàng)傷個(gè)數(shù)之間無(wú)相關(guān)性。⑩Baird, S. and Jenkins, S.R. Vicarious traumatization, secondary traumatic stress, and burnout in sexual assault and domestic violence agency staff. Violence and Victims, 2003, 18（1）: 71.有關(guān)專業(yè)人士從業(yè)年限的研究也提供了一些相反的證據(jù)。①Wasco, S.M., Campbell, R. and Clark, M. A Multiple Case Study of Rape Victim Advocates' Self-Care Routines: The Influence of Organizational Context. American Journal of Community Psychology, 2002, 30（5）: 731-760.iMorrison, Z. 'Feeling Heavy': Vicarious Trauma and Other Issues Facing Those who Work in the Sexual Assault Field. Australian Institute of Family Studies, 2007（4）: 1-13.鮑勃和雷格爾發(fā)現(xiàn)工作年限與對(duì)親密關(guān)系的消極信念呈正相關(guān)。②Dunkley, J. and Whelan, T.A. Vicarious traumatisation: Current status and future directions. British Journal of Guidance & Counselling, 2006,34（1）: 107-116.Bober, T. and Regehr, C. Strategies for reducing secondary or vicarious trauma: Do they work? Brief Treatment and Crisis Intervention, 2006, 6（1）: 1.與此相反，艾利夫（Iliffe.G）和斯蒂德（Steed.L.G）③Janoff-Bulman, R. Shattered assumptions: Towards a new psychology of trauma. New York: The Free Press. 1992; Cunningham, M. Impact of trauma work on social work clinicians: Empirical findings. Social Work, 2003, 48（4）: 451-459.Iliffe, G. and Steed, L.G. Exploring the counselor's experience of working with perpetrators and survivors of domestic violence. Journal of Interpersonal Violence, 2000, 15（4）: 393-412.發(fā)現(xiàn)服務(wù)家庭暴力的社工很難有替代性創(chuàng)傷的征兆，因?yàn)殡S著時(shí)間的增長(zhǎng)，他們?cè)缫褜?duì)此習(xí)以為常。另外，德安吉利斯（DeAngelis.T）④Morrison, Z. 'Feeling Heavy': Vicarious Trauma and Other Issues Facing Those who Work in the Sexual Assault Field. Australian Institute of Family Studies, 2007（4）: 1-13.DeAngelis, T. Normalizing practitioners’ stress. Monitor on Psychology, 2002: 7.提出，替代性創(chuàng)傷的風(fēng)險(xiǎn)在于沒(méi)有認(rèn)識(shí)到專業(yè)人員因服務(wù)痛苦情緒的案主而產(chǎn)生的情緒波動(dòng)。

在組織層面也已經(jīng)確認(rèn)了一系列風(fēng)險(xiǎn)因素。非支持性管理、低薪資水平和提供服務(wù)的挑戰(zhàn)都是精疲力竭率較高的預(yù)測(cè)因素。①Bell, H., Kulkarni, S. and Dalton, L. Organizational prevention of vicarious trauma. Families in Society: The Journal of Contemporary Social Services, 2003, 84（4）: 463-470.Bober, T. and Regehr, C. Strategies for reducing secondary or vicarious trauma: Do they work? Brief Treatment and Crisis Intervention,2006, 6（1）: 1.鮑勃和雷格爾②Bober, T. and Regehr, C. Strategies for reducing secondary or vicarious trauma: Do they work? Brief Treatment and Crisis Intervention,2006, 6（1）: 1.確認(rèn)了組織因素的影響，反對(duì)把討論重點(diǎn)放在專業(yè)性應(yīng)對(duì)策略上，因?yàn)檫@可能會(huì)導(dǎo)致把替代性創(chuàng)傷的發(fā)生歸責(zé)于個(gè)人，從而導(dǎo)致專業(yè)人士更不可能主動(dòng)尋求幫助。

四、預(yù) 防

一系列保護(hù)因素都可以用來(lái)預(yù)防替代性創(chuàng)傷。埃德?tīng)柹‥idelson.R.J）③Eidelson, R.J., D'alessio, G.R. and Eidelson, J.I. The impact of September 11 on psychologists. Professional Psychology: Research and Practice, 2003, 34（2）: 144.和他的同事認(rèn)為高度的使命感是一種可以預(yù)防替代性創(chuàng)傷的保護(hù)因素，對(duì)于志愿者來(lái)說(shuō)尤其適用。受過(guò)良好訓(xùn)練的專業(yè)人員，尤其是接受過(guò)創(chuàng)傷知情方面訓(xùn)練的專業(yè)人員和有穩(wěn)定的高質(zhì)量的督導(dǎo)的專業(yè)人員，知道如何更好地預(yù)計(jì)和處理替代性創(chuàng)傷。④Barron, I., Abdallah, G. and Heltne, U. Randomized control trial of Teaching Recovery Techniques in rural occupied Palestine: effect on adolescent dissociation. Journal of Aggression, Maltreatment & Trauma, 2006, 25（9）: 955-973.

自我關(guān)懷、自我培養(yǎng)、身體健康、休閑活動(dòng)以及知道何時(shí)應(yīng)該尋求幫助都是有助于降低替代性創(chuàng)傷風(fēng)險(xiǎn)的因素。保持工作之外的興趣愛(ài)好可以降低專業(yè)人員的壓力水平，有計(jì)劃的休息和調(diào)整能夠?yàn)閷I(yè)人士灌輸希望、明晰生活和工作的界限，這些都可以增加專業(yè)人士的適應(yīng)力。⑤Bell, H., Kulkarni, S. and Dalton, L. Organizational prevention of vicarious trauma. Families in Society: The Journal of Contemporary Social Services, 2003, 84（4）: 463-470.自我關(guān)懷的關(guān)鍵在于：改變社工對(duì)自己經(jīng)歷的看法，把緊張的情緒表達(dá)出來(lái)，了解自己的身體和生理感覺(jué)，與別人進(jìn)行心靈交流，獲得家庭支持，參加娛樂(lè)活動(dòng)。社工還需要避免在工作之余接觸創(chuàng)傷資料，比如創(chuàng)傷的電影和書(shū)籍。⑥Wasco, S.M. and Campbell, R. Emotional reactions of rape victim advocates: A multiple case study of anger and fear. Psychology of Women Quarterly, 2002（26）: 120-130.

很重要的一點(diǎn)是，若預(yù)防的責(zé)任完全落在個(gè)人身上，可能會(huì)使個(gè)體從業(yè)者遭受成為“問(wèn)題人”的病態(tài)化風(fēng)險(xiǎn)。例如，有研究發(fā)現(xiàn)，組織層面的支持有助于促進(jìn)工作人員給遭受性侵害者提供持久的服務(wù)。⑦Wasco, S.M., Campbell, R. and Clark, M. A Multiple Case Study of Rape Victim Advocates' Self-Care Routines: The Influence of Organizational Context. American Journal of Community Psychology, 2002, 30（5）: 731-760.支持性的組織環(huán)境包括工作之余的空間、持續(xù)的專業(yè)提升和專業(yè)督導(dǎo)。⑧Bell, H., Kulkarni, S. and Dalton, L. Organizational prevention of vicarious trauma. Families in Society: The Journal of Contemporary Social Services, 2003, 84（4）: 463-470.替代性創(chuàng)傷被視為一種職業(yè)風(fēng)險(xiǎn)，因此社工應(yīng)當(dāng)有機(jī)會(huì)去宣泄和訴說(shuō)自己的創(chuàng)傷經(jīng)歷。⑨Wasco, S.M. and Campbell, R. Emotional reactions of rape victim advocates: A multiple case study of anger and fear. Psychology of Women Quarterly, 2002（26）: 120-130.莫里森（Morrison.T）⑩Morrison, T. Emotional Intelligence, Emotion and Social Work: Context, Characteristics, Complications and Contribution. The British Journal of Social Work, 2007（37）: 245-263.強(qiáng)調(diào)了工作場(chǎng)所的政策是怎樣提升或抑制了這些因素。鮑勃和雷格爾①Bell, H., Kulkarni, S. and Dalton, L. Organizational prevention of vicarious trauma. Families in Society: The Journal of Contemporary Social Services, 2003, 84（4）: 463-470.Bober, T. and Regehr, C. Strategies for reducing secondary or vicarious trauma: Do they work? Brief Treatment and Crisis Intervention,2006, 6（1）: 1.指出預(yù)防替代性創(chuàng)傷的重點(diǎn)是機(jī)構(gòu)提供具有安全性和支持性的工作環(huán)境。

五、社會(huì)工作與替代性創(chuàng)傷

盡管替代性創(chuàng)傷在社會(huì)工作者中的潛在發(fā)生率較高，但是應(yīng)只有少量文獻(xiàn)明確探討了這一議題?？伎怂梗–ox.K）和斯坦納（Steiner.S）①Cox, K., amd Steiner, S. Preserving commitment to social work service through the prevention of vicarious trauma. Journal of Social Work Values and Ethics, 2013, 10（1）: 52-60.探討了社工應(yīng)對(duì)替代性創(chuàng)傷的策略，這些策略可以緩解替代性創(chuàng)傷的癥狀、減輕替代性創(chuàng)傷的影響，他們強(qiáng)調(diào)接觸創(chuàng)傷事件和創(chuàng)傷資料會(huì)使社工產(chǎn)生自我懷疑感和憤怒感。齊格弗里德（Siegfried.）②Siegfried, C. Child Welfare Work and Secondary Traumatic Stress. National Child Traumatic Stress Network. 2008.也再次確認(rèn)了與繼發(fā)性創(chuàng)傷壓力有關(guān)的癥狀，提出同理心是一種關(guān)鍵性風(fēng)險(xiǎn)因素，因?yàn)樗股绻け┞对诎钢鞯膭?chuàng)傷事件和敘述中，導(dǎo)致社工士氣低落、健康不佳、缺席會(huì)談。尼莫（Nimmo.A）和哈格德（Haggard.P）③Nimmo, A. and Huggard, P. A systematic review of the measurement of compassionfatigue, vicarious trauma, and secondary traumatic stress in physicians. Australasian Journalof Disaster and Trauma Studies, 2013, 2013（1）: 37-44.在文獻(xiàn)綜述中比較了同情疲勞、繼發(fā)性創(chuàng)傷壓力和替代性創(chuàng)傷，特別強(qiáng)調(diào)了替代性創(chuàng)傷與實(shí)務(wù)中常見(jiàn)的復(fù)雜情感反應(yīng)不同，并提出了它們相似的癥狀可能會(huì)使人們難以意識(shí)到替代性創(chuàng)傷的出現(xiàn)。烏略亞（Ulloa.I）和羅斯（Rose.J）④Ulloa, I,. and Rose, J. Perceptions of social worker professionals with regards to the prevalence of vicarious trauma among social workers in the child welfare field. California State University.2011.關(guān)注兒童福利工作者對(duì)替代性創(chuàng)傷流行程度的認(rèn)知，并歸納了替代性創(chuàng)傷的影響，如健忘、攻擊性、夢(mèng)魘、疲勞、動(dòng)機(jī)缺乏和頭痛。

雖然替代性創(chuàng)傷對(duì)社工個(gè)人的影響是非常明顯和深刻的，但是對(duì)社工的替代性創(chuàng)傷也有一些有效的支持。英格拉姆（Ingram.R）⑤Ingram, R, Exploring Emotions within Formal and Informal Forums: Messages from Social Work Practitioners. The British Journal of Social Work, 2015, 45（3）: 896-913,提到，在情感支持和情感反應(yīng)方面，督導(dǎo)可以起到廣泛的治療作用。曼寧·瓊斯（Manning-Jones.S）等⑥Manning-Jones, S., Terte, I., and Stephens, C. Vicarious posttraumatic growth: a systematic literature review. International Journal of Wellbeing, 2015, 5（2）: 125-139.提出督導(dǎo)可以減輕與替代性創(chuàng)傷有關(guān)的孤立感和其他嚴(yán)重的負(fù)面情緒。齊格弗里德⑦Siegfried, C. Child Welfare Work and Secondary Traumatic Stress. National Child Traumatic Stress Network. 2008.也承認(rèn)在治療方面，督導(dǎo)起到了至關(guān)重要的作用，但同時(shí)也提出了更多建議和策略以強(qiáng)調(diào)在不同領(lǐng)域給予社工支持的必要性：（1）職業(yè)層面：服務(wù)的個(gè)案數(shù)和常規(guī)的高質(zhì)量督導(dǎo);（2）機(jī)構(gòu)層面：定期休息、年假以及來(lái)自同事的支持;（3）個(gè)人層面：自我關(guān)懷（健康、鍛煉、反思和精神活動(dòng)）以及保持工作和生活平衡的能力;（4）應(yīng)對(duì)策略：對(duì)實(shí)務(wù)的情感層面進(jìn)行自我反思。

曼寧·瓊斯等⑧Manning-Jones, S., Terte, I., and Stephens, C. Vicarious posttraumatic growth: a systematic literature review. International Journal of Wellbeing, 2015, 5（2）: 125-139.對(duì)多個(gè)領(lǐng)域的替代性創(chuàng)傷后成長(zhǎng)進(jìn)行了文獻(xiàn)梳理，如社會(huì)工作、心理治療、葬禮主持和醫(yī)務(wù)人員。齊格弗里德指出，通過(guò)反思和自我關(guān)懷，社工有機(jī)會(huì)辨識(shí)自己的優(yōu)勢(shì)，幫助別人獲得希望。斯普萊文斯（Splevins.K）等⑨Splevins K, Mireskandari S, Clayton K, Blaszczynski A: Prevalence of adolescent problem gambling, related harms and help-seeking behaviors among an Australian population. Journal of Gambling Studies. 2010,（ 26）: 189-204.提出，如果同理心能夠用來(lái)突出我們自己的優(yōu)勢(shì)，進(jìn)而成為未來(lái)實(shí)務(wù)工作的動(dòng)力，那么同理心實(shí)際上就成為了一個(gè)保護(hù)性因素。⑩Cox, K., amd Steiner, S. Preserving commitment to social work service through the prevention of vicarious trauma. Journal of Social Work Values and Ethics, 2013, 10（1）: 52-60.另外，巴林頓（Barrington.A.J）和莎士比亞·芬奇（Shakespeare-Finch.J）①Barrington, A. J., & Shakespeare-Finch, J. Working with refugee survivors of torture and trauma: an opportunity for vicarious posttraumatic growth. Counseling Psychology Quarterly, 2013, 26（1）: 89-105.以及烏達(dá)克（Hudek.C）②Hudek, C. Dealing with vicarious trauma in the context of global fear. The Folio, 2007, p95-101.注意到社工與服務(wù)對(duì)象之間的關(guān)系質(zhì)量可以作為社工在創(chuàng)傷事件后獲得康復(fù)和成長(zhǎng)能力的標(biāo)識(shí)，他們認(rèn)為這是正能量和支持的來(lái)源。

社工在工作中經(jīng)常接觸有過(guò)創(chuàng)傷經(jīng)歷的案主，并且要在同理心關(guān)系中把這些創(chuàng)傷事件表達(dá)出來(lái)。出于實(shí)務(wù)工作的需要，社工應(yīng)該獲得支持和機(jī)會(huì)去反思和處理他們實(shí)務(wù)中的情感內(nèi)容。③Ruch, G. The contemporary context of relationship based practice. In Ruch, G., Turney, D. & Ward, A.（Eds.） Relationship based social work: getting to the heart ofpractice.London:Jessica Kingsley. 2010.督導(dǎo)就是一種可以提供這樣支持的重要形式，它需要識(shí)別由實(shí)務(wù)引起的有意或無(wú)意的情緒活動(dòng)和情緒反應(yīng)，這對(duì)提升社工決的策質(zhì)量和幸福感起著重要作用。④Hair, H. The Purpose and Duration of Supervision, and the Training and Discipline of Supervisors: What Social Workers Say They Need to Provide Effective Services. British Journal of Social Work, 2012, 43（8）: 1562-1588.這就要求督導(dǎo)通過(guò)“消極感受力”過(guò)程來(lái)“把握”社工，在這個(gè)過(guò)程中，實(shí)務(wù)中復(fù)雜而未解決的情感問(wèn)題被允許和合法化，而不是暫時(shí)擱置或草草解決。

柯林斯（Collins.S）⑤Collins, S. Social workers, resilience, positive emotions and optimism. Practice, 2007, 19（4）: 255-269.提醒我們，在復(fù)雜的實(shí)務(wù)環(huán)境中，社會(huì)工作者處理問(wèn)題、得到成長(zhǎng)的抗逆力與社工的樂(lè)觀態(tài)度以及進(jìn)行反思的動(dòng)機(jī)密不可分。這些樂(lè)觀態(tài)度和反思動(dòng)機(jī)為社工自身提供了部分保護(hù)因素，使社工努力與希望、自豪和自省等積極情緒聯(lián)系起來(lái)，這正是社工解決棘手問(wèn)題、得到解決方案和把握機(jī)遇所需要的。杜牙地（Tugade.M.M）和弗雷德里克森（Frederickson.B.L）⑥Tugade, M.M& Frederickson, B.L. Resilient individuals use positive emotions to bounce back from negative emotional experiences. Journal Personality and Social Psychology, 2004, p320-333.提出這些屬性可以提高創(chuàng)造力和注意力，但是社工需要依靠組織結(jié)構(gòu)和組織支持來(lái)提升這些屬性。

六、角色卷入和認(rèn)同

社會(huì)工作作為一種職業(yè)，需要對(duì)替代性創(chuàng)傷卷入有明確認(rèn)知，需要采取措施以落實(shí)必要的支持來(lái)預(yù)防替代性創(chuàng)傷或適當(dāng)控制其影響。在實(shí)務(wù)過(guò)程中，社工產(chǎn)生情感反應(yīng)和情感聯(lián)結(jié)是不可避免的，這在決策制定、關(guān)系建立和評(píng)估方面都是至關(guān)重要的。這種情感知覺(jué)使得社工能夠在不同領(lǐng)域中做出判斷。例如，只有當(dāng)社工可以利用他的經(jīng)驗(yàn)、知識(shí)和情感反應(yīng)去確定“公正”的界限，對(duì)“公正”形成理解，他對(duì)社會(huì)公正的追求才是有意義的。如果我們認(rèn)同在社會(huì)工作領(lǐng)域的諸多情境中，實(shí)務(wù)工作的人際層面和自我層面都是至關(guān)重要的，那么有關(guān)同理心和情感聯(lián)結(jié)的風(fēng)險(xiǎn)和機(jī)遇都是不可避免的。

這就引出了職業(yè)認(rèn)同的概念，雖然這一點(diǎn)在職業(yè)規(guī)范、職業(yè)標(biāo)準(zhǔn)和專業(yè)知識(shí)中也有所表現(xiàn)，⑦Ingram, R. Understanding Emotions in Social Work: theory, practice and reflection. Maidenhead: Open University Press,2015.但是它也存在于“自我意識(shí)”之中。⑧Ibarra, H. Provisional selves: Experimenting with image and identity in professionaladaptation. Administrative Science Quarterly, 1999, 44（4）: 764-791.這種“自我意識(shí)”植根于個(gè)人或職業(yè)的道德、知識(shí)、角色和經(jīng)歷中。既然社會(huì)工作者與創(chuàng)傷事件的接觸難以避免，我們要做的不是逃避創(chuàng)傷，而是要認(rèn)識(shí)創(chuàng)傷并加強(qiáng)對(duì)它的安全防范和警惕。誠(chéng)然，對(duì)于社工來(lái)說(shuō)，創(chuàng)傷的觸發(fā)和閾值是難以估摸的，這更加突顯了社工職業(yè)認(rèn)同的必要性，而這種認(rèn)同包含了每個(gè)社工在實(shí)務(wù)中的體驗(yàn)和經(jīng)歷。

圖1 一種系統(tǒng)的情感卷入性實(shí)務(wù)方法與替代性創(chuàng)傷

圖1從預(yù)防、應(yīng)對(duì)、干預(yù)三個(gè)關(guān)鍵階段構(gòu)建了替代性創(chuàng)傷的防治模式。需要強(qiáng)調(diào)的是，個(gè)人層面、組織層面與專業(yè)層面在每個(gè)階段的行為都不同，但它們可以互補(bǔ)。在每個(gè)階段中，不同層面之間都存在聯(lián)系。

七、結(jié) 論

本文強(qiáng)調(diào)，在社會(huì)工作中，需要在承認(rèn)實(shí)務(wù)中情感卷入的重要性與對(duì)替代性創(chuàng)傷的跡象和影響有所警覺(jué)之間保持平衡。這是一個(gè)復(fù)雜的過(guò)程，它會(huì)受到充滿相互作用的環(huán)境的影響，包括創(chuàng)傷顯露的程度和性質(zhì)，社會(huì)工作者的知識(shí)、技巧和態(tài)度，組織文化和組織支持，對(duì)服務(wù)對(duì)象情感卷入的職業(yè)期望等。本文為專業(yè)社工、社工機(jī)構(gòu)和社工職業(yè)提供了一個(gè)模式，幫助其面對(duì)替代性創(chuàng)傷的挑戰(zhàn)。作者認(rèn)為，該模式可適用于國(guó)內(nèi)外的諸多職業(yè)。

社工實(shí)務(wù)建議

1.社會(huì)工作者與服務(wù)對(duì)象之間的情感聯(lián)結(jié)為社工的專業(yè)判斷提供了重要信息（替代性創(chuàng)傷的風(fēng)險(xiǎn)與情感顯露的平衡）。

2.社會(huì)工作者應(yīng)當(dāng)接受有關(guān)創(chuàng)傷知識(shí)的專業(yè)訓(xùn)練，使他們更好地理解服務(wù)群體和自身反應(yīng)。

3.替代性創(chuàng)傷需要被納入社會(huì)工作者的風(fēng)險(xiǎn)因素，社工所在組織更應(yīng)該承認(rèn)這一點(diǎn)。

4.社工組織需要對(duì)模式的使用進(jìn)行探索，建立組織文化，提供實(shí)務(wù)支持，保護(hù)社會(huì)工作者。

研究建議

需要在以下幾個(gè)方面進(jìn)行實(shí)證研究：

1.評(píng)估模式應(yīng)用于社工組織和類似職業(yè)的有效性。

2.識(shí)別社會(huì)工作者患替代性創(chuàng)傷的性質(zhì)和程度。

3.對(duì)社會(huì)工作實(shí)務(wù)的情感維度進(jìn)行定性研究。

4.對(duì)國(guó)際社會(huì)工作實(shí)務(wù)的情感維度進(jìn)行跨文化分析。

Social Work and Vicarious Trauma: Risks and Opportunities of Emotional Engagement Richard Ingram, Ian Barron

Abstract: The current paper aims to encourage discussion of the potential impact of vicarious trauma for social workers.The paper locates this knowledge in the context of relationship based practice and the significance of emotional engagement and exposure across practice contexts. The paper draws from literature specific to the social work profession as well as other human services in a range of international contexts. Implications are explored for prevention, ways of coping, and intervention of vicarious trauma at the level of practitioners, services and the social work profession. The key finding from this paper is that there is a balance to be struck between acknowledging the importance of emotional engagement in social work practice and the need for awareness of signs and impact of various trauma. A model is provided to enable practitioners, organisations and the social work profession to address the emotional dimensions of social work practice within contexts of vicarious trauma. This model is applicable to social workers in national and international contexts. Recommendations for practice suggest a range of opportunities to manage the aforementioned balancing act through awareness training, supervision, self-care, organisational culture and personal/professional identity.Recommendations are made future research including assessing the nature and extent of traumatisation of social workers and strategies for prevention, coping and intervention.

Keywords: vicarious trauma; emotions; social work; professionalism; supervision