Reflection Paper #2: “Self-Care”
Based on The Nadia Case Study
By: Rickard Jean-Noel
In the world today, it is almost impossible to avoid misfortunes. At times, they are self-inflicted, and other times they are caused by the people or the things around us. These unfortunate events that we go through in life often times leaves us scared and scarred. Some of the scars are visible and some are not. Regardless if others are able to see these scars, we often times carry them for our entire lives. These are often the results of trauma that life presents to us, however many see it as a curse, rather then a gift. As humans, our natural reaction to pain is to run as far away from it as possible. At times, this can seem like a viable alternative, particularly in the cases where your psychical might be at risk. However, when it is your mental that is the source of pain, plagued by memories of your past, there is nowhere that you can run to escape it.
In America, we often times see that many people immigrate to this country to escape the troubles and turmoil of their home country. They come to America searching for economical freedoms and the securities that the United States offers. They have escaped the war, famine, diseases, and political injustices that often took place in their homeland. To a certain degree, we can concede that they are “Immigrating from Trauma”. In the case study provided, we come across a young girl by the name of Nadia Tehran. Nadia is a 10-year-old Iranian immigrate girl that is currently experiencing issues in school. At first glance we might believe that she is simply a little girl that is behaving like a brat, but when we take a deeper look at her current life and things that have occurred to her, we can conclude that she has been through a great deal of trauma.
According to the case file, Nadia and her family immigrated to America from Iran about 6 years ago, when she was about 4 years of age. According to Nadia’s mother, Mrs. Jamila Tehran, they “grew up in a country devastated by war”. She also stated that her husband was imprisoned for about a year, leaving her to raise the children on her own. During this time there would often be violence in the neighborhood, which resulted in them having to move several times. She stated that “on occasions, artillery fire damaged their apartment”. They later escaped the horrors and chaos and immigrated to the United States. Upon coming to this country, they thought that they were in the clear, however death showed its ugly face and 3 ½ years ago, and unfortunate Nadia’s father died in an accident. This led Nadia’s mother to fall into depression, which had unknown effects on the children.
Given the facts presented in this case study thus far, I would say that many aspects of this story resonate with myself. I too immigrated to America from a country that was bombarded by violence, which was the island of Haiti. I came to America from Haiti at the age of 2, and my family as well lived in poverty when we first arrived here in America. We as well lived with family when we first arrived in America, and my parents worked low paying jobs in order to support us. My family were what you would describe as “political refugees”. My parents would often express that they feared for their lives in their home country because of all of the violence. I also lost a sister that died in Haiti, which caused a great deal of trauma to my family. This caused my mother to not return back to Haiti for over 20 years. The fear and trauma that my mother described to us cause none of us to every want to return back to our home country.
Growing up in school as a poor immigrant was not easy. At time’s I would feel outcasted because my family were not able to provide me with the expensive brand names and brand-new sneakers. This would cause me to distance myself from other students, similar to what Nadia had been doing. Because I came from Haiti, there were several stigmas attached to being Haitian. Stigmas such as: we do voodoo, we eat cats, we smell bad, etc. Therefore, I could understand the difficulties that Nadia and her family went through in their lives.
Another thought that came to mind when hearing this story was the political aspects that is connected to this. The family is from Iran and are Muslim and are currently living in America. Iran and America have been in conflict for a long time and have been really hostile towards each other. One of the reasons that there has been conflict is because of America recognizing Jerusalem as the capital of Israel. America also has a great deal of prejudice towards Muslim countries, especially after the 9/11 tourist attacks. I remember that I was in Junior High School during the 9/11 attacks. During that time, several Muslims were attacked, and their businesses were robbed and destroyed as well. Many of the students from Muslim countries stayed home several days afterwards out of fear. These stigma’s and ignorance are still practiced today. In 2017, after the inauguration of President Donald Trump, he signed and executive ordering banning several Muslim majority nations from coming into the U.S., and Iran was one of the countries included on that list. His justification for this was making America great again (Kaur, Kim, Sherman, & CNN 2020).
Given all of the current circumstances, along with the recent fire, we can conclude that this was a breaking point for Nadia and her mother. We can also conclude that they are experiencing something called “Intrusive Thoughts and Memories”. According to “Treatment Improvement Protocol (TIP) Series, No. 57. Center for Substance Abuse Treatment (US)” it is described as “Experiencing, without warning or desire, thoughts and memories associated with the trauma. These intrusive thoughts and memories can easily trigger strong emotional and behavioral reactions, as if the trauma were recurring in the present. The intrusive thoughts and memories can come rapidly, referred to as flooding, and can be disruptive at the time of their occurrence. If an individual experiences a trigger, he or she may have an increase in intrusive thoughts and memories for a while”. The article goes on to state that individuals that suffer from this illness “may have a surge of intrusive thoughts of past trauma, thus making it difficult for them to discern what is happening now versus what happened then” (Treatment Improvement Protocol (TIP) Series, No. 57.Center for Substance Abuse Treatment (US). Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014).
In the reading Nadia is described as appearing “restless, distracted, or zoned out”. She is also described as becoming “very agitated”, “particularly toward the end of the school day”. Nadia is also requesting to take lunch on her own. Nadia’s mother is concerned that Nadia is “not sleeping, hardly talking, and not eating well”. She is also performing poorly in class and is not paying attention. The common event that continues to be repeated as the trigger is the fire that occurred at the home. Nadia is described as “moody and uncooperative; daydreaming when she should be concentrating on schoolwork or on tasks that she must do around the home”. The common event that seems to be the trigger in this case would be the fire. The fire was described as upsetting to Nadia and when she is asked to provide the source of her troubles, she answers by stating that “I don’t know, I don’t know”. This is all proof that Nadia is suffering from intrusive thoughts of past trauma. Even though the fire was 3 months ago, and no one was hurt, Nadia continues to relive this event and possibility other traumatic events in her life over and over in her mind.
One thing that we must consider is the fact that there several children that are involved in this case. The children include Nadia (10), Daquan(brother) (9), Sabina(sister) (7). When providing care to the children, we must be reminded that they began to experience trauma at an incredibly young age. Their father was imprisoned for close to a year when they were young. They also often moved because they lived in a dangerous environment and would often times barely escape death. About 3 ½ after coming to America, their father died in an accident and they were left with their bipolar depressive mother. If we refer to “The 12 Core Concepts”, specifically number 4, we see that the following 3 points apply to the children and are the direct symptoms that Nadia is displaying. These include:
- “Posttraumatic stress and grief reactions can develop over time into psychiatric disorders, including posttraumatic stress disorder (PTSD), separation anxiety, and depression.”
- “Posttraumatic stress and grief reactions can also disrupt major domains of child development, including attachment relationships, peer relationships, and emotional regulation, and can reduce children’s level of functioning at home, at school, and in the community.”
- “Children’s post trauma distress reactions can also exacerbate preexisting mental health problems including depression and anxiety. Awareness of the broad range of children’s potential reactions to trauma and loss is essential to competent assessment, accurate diagnosis, and effective intervention.”
(“The 12 Core Concepts” Concepts for Understanding Traumatic Stress Responses in Children and Families)
Given the severity of the level of trauma that these children are dealing with, we would
tread lightly when providing care. I would honestly sympathize with them and try to be as delicate as possible when providing care. As someone that has been through trauma as a child, who has moved often as a child, and that grew up in poverty as a child, I would be able provide a better understanding. As an immigrant I would also understand the stigmas attached. I would attempt to collaborate with other healthcare providers that share the same culture and/or religion as the children to provide a higher level of cultural respect to the children, specifically Nadia.
The main caregiver for Nadia and her siblings is her mother Mrs. Jamila Tehrani. Her mother’s sister, Yasmin Amirpour, severs as support and a translator for Nadia’s mother. Their extended family also helps to provides Mrs. Tehrani with “groceries, transportation, and childcare”. Given the fact that Mrs. Tehrani suffers from Bipolar, depression, and perhaps PTSD. though it is mentioned that she is taking medication “to help her function”, we believe that it would be best that she continues to seek therapy for herself and takes courses to help her to better assist her children, particularly Nadia. We would have to be very sympathetic towards Mrs. Tehrani because she comes from poverty, had to deal with her husband incarceration and eventually his death, and currently living a country foreign to her. She is also a struggling single mother in a country that is not her homeland that has social biases towards Muslim people and her home country of Iran. When working with the mother, we must keep in consideration all that she has been throughand everything that she is currently going through. A translator such as her sister,Mrs. Amirpour, would be extremely helpful in helping her, particular with the language barrier. Growing up with immigrant parents, I was able to witness the differences between when they were dealing with individuals that spoke their language and shared the same culture, compared to those that did not. They were often times more comfortable with those that had similarities with themselves, language playing a huge part in this. I would keep the language barrier in mind and attempt to always have a translator on hand when providing care to Nadia’s mother or whenever she is present.
Referencing the Article entitled “Preventing Vicarious Trauma (VT), Compassion Fatigue (CF), and Burnout (BO) in Forensic Mental Health: Forensic Psychology as Exemplar. Professional Psychology: Research and Practice”, it describes Vicarious Trauma as the following: “VT can develop when a practitioner is exposed to the retelling of a traumatic event by a client. Much like the experience of a direct trauma, VT may affect a practitioner’s worldview or primary belief system, cognitions, and emotional needs (Hatcher & Noakes, 2010; Pearlman & Saakvitne, 1995a). Symptoms can also mirror those of direct trauma exposure, such as disturbances in mood, self-identity, spirituality, and cognitive frame of reference as well as intrusion symptoms (Pearlman & Saakvitne, 1995b). Long-term sequelae of VT may include problematic interpersonal and romantic relationships as well as decreased sexual desire (Branson, Weigand, & Keller, 2014). Practitioners are at higher risk for developing VT if they have experienced direct trauma exposure, have had less exposure to trauma in their practice or training, or if they have experienced the same traumatic event as the client, as in the case of a sudden, widespread crisis such as a mass shooting or natural disaster (Day, Lawson, & Burge, 2017; Finklestein, Stein, Greene, Bronstein, & Solomon, 2015; Pearlman & Mac Ian, 1995” (Pirelli, G., D.L. Formon, and K. Maloney. 2020).
When dealing with vicarious trauma, it is important to identify and understand the potential risk factors that could develop. The article states that “Vicarious trauma is considered an inevitable part of the helping relationship that facilitates changes in cognitive schemes and worldview for the clinician exclusively (Iqbal, 2015). (p. 4) “(Pirelli, G., D.L. Formon, and K. Maloney. 2020).One of the many ways that we can deal with vicarious trauma is by utilizing the support systems around you. Support systems such as the organizational job support for the company in which you might be working for, as well as supervision with a supervisor that you might be training and working with. All are way in which you can apply to help reduce VT (Almond, 2014; Bonach & Heckert, 2012; Collins & Long, 2003; Harrison & Westwood, 2009). In the article “Vicarious trauma, themes in research, and terminology: A review of literature” it states that “specific recommendations to decrease the development of VT include making supervision available on a regular basis, reflection time, trainings on VT and VTG, supporting clinicians in taking time off or mental health days, meaningful appreciation, offer opportunities for upward advancement, provide examples of positive approach to challenges through role modeling and leadership, and balancing client caseloads to help ensure a variety of presenting problems” (Branson, D. C. .2019).
All of which that was previously discussed in this writing could prove to be useful if applied in the case of Nadia correctly. It is a case in which there are several family members that are being affected by trauma and there are small children involved. Since I have children of my own, I might feel the need to be more involved in order to assist the children. This is something that I can discuss with a supervisor in order to assist in protecting boundaries. Training would be very beneficial in this case in the sense that it would help with the cultural differences and providing with information on preventing VT. Mental health days are always good because they help to “take a break” and provide a “mini vacation” from cases. Given the fact that they are an immigrant family that are dealing with trauma, if proper boundaries are not put into place, the family could grow overly attached and become needy.
According to the article entitled “Teaching self-care: The utilization of self-care in social work practicum to prevent compassion fatigue, burnout, and vicarious trauma “ it states that “Self-care for social workers is an integral part of professionalism and is intricately tied to our ability to be fully present for our clients in order to deliver quality services. So important is the concept of self-care, that it is featured prominently in Council on Social Work Education (CSWE) Educational Policy and Standard (EPAS) Competency 1” (Lewis, Melinda L., and Dione M. King. 2019). This translate to me that you must be at your best in order to best help others. This helps brings the importance of self-care full circle. For self-care I often times exercise, go for long walks, listen to music and motivational tapes, and I pray. I believe prayer is especially important and it provides you with inner peace. The fact that the family are also a religious family that believes in a higher power, allows us to connect on a spiritual level. The body and the spirit work best when they are working in harmony and in unity. If there is not a war within, then the war outside can not defeat us.
In conclusion, we can all say that this is not an easy case. There are several layers that affect everyone from the children to the caregivers. We also foresee the language barriers as well as the cultural barriers. One thing that is for certain is that we will provide the best quality and ethical care for the clients. We will also apply the proper self-care actions, as well as the proper principles to avoid or at best minimalize Vicarious Trauma. With all things considered, we believe that if every principle is applied correctly, the clients will receive the best care and the social worker will be protected as well.
- Kaur, H., Kim, A., & Sherman, I. (2020). The US-Iran conflict: A timeline of how we got here. Retrieved September 28, 2020, from https://www.cnn.com/interactive/2020/01/world/us-iran-conflict-timeline-trnd/
- Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/
- “The 12 Core Concepts”; Concepts for Understanding Traumatic Stress Responses in Children and Families
- Pirelli, G., Formon, D. L., & Maloney, K. (n.d.). Preventing Vicarious Trauma (VT), Compassion Fatigue (CF), and Burnout (BO) in Forensic Mental Health: Forensic Psychology as Exemplar. Professional Psychology: Research and Practice. https://doi-org.avoserv2.library.fordham.edu/10.1037/pro0000293
- Harrison, R. L., & Westwood, M. J. (2009). Preventing vicarious traumatization of mental health therapists: Identifying protective practices. Psychotherapy, 46, 203–219. 10.1037/a0016081
- Lewis, M. L., & King, D. M. (2019). Teaching self-care: The utilization of self-care in social work practicum to prevent compassion fatigue, burnout, and vicarious trauma. Journal of Human Behavior in the Social Environment, 29(1), 96–106. https://doi-org.avoserv2.library.fordham.edu/10.1080/10911359.2018.1482482
- Branson, D. C. (2019). Vicarious trauma, themes in research, and terminology: A review of literature. Traumatology, 25(1), 2–10. https://doi-org.avoserv2.library.fordham.edu/10.1037/trm0000161