“The Only Way We’ll Be Successful”: Organizational Factors That Influence Psychosocial Well-Being and Self-Care Among Advocates Working to Address Gender-Based Violence

Abstract

Advocates who work for nonprofit organizations (NPOs) that address gender-based violence (GBV) experience a wide range of psychosocial health and well-being risks due to the emotionally demanding nature of the work they engage in. Most recommendations for advocates’ self-care focus on individual-level activities, failing to hold the NPOs accountable for creating workplace cultures and practices that foster psychosocial well-being, self-care, and resilience among the advocates. The aim of this qualitative research was to further our understanding of organizational-level factors that influence psychosocial well-being and self-care practices among advocates who work for GBV-specific NPOs in a metropolitan area in the southeastern United States. We conducted in-depth interviews with 25 GBV-specific advocates. Constructivist grounded theory methods were used in coding and analyzing the data. Sixteen advocates identified as White, followed by five Black, two Hispanic, and two mixed-race/ethnicity. Mean age was 36 years. Most participants had a master’s degree (n = 16). Analysis of the data resulted in three major themes: (a) Management and Leadership Style, (b) Interpersonal Relationship Dynamics, and (c) Culture of Self-Care. The ways in which leaders established relationships with other advocates to accomplish organizational goals, how advocates developed a sense of camaraderie with their coworkers, and shared norms around self-care shaped advocates’ willingness and ability to engage in individual and collective self-care. Findings of this study highlight the role of GBV-specific NPOs in creating workplace cultures and practices that are conducive to engaging in self-care and developing resilience among the advocates. By fulfilling this responsibility, organizations would enable the advocates to not only survive, but thrive in their work and make even greater strides in the overall mission of GBV prevention.

Keywords

gender-based violence prevention sexual assault vicarious trauma workplace violence mental health and violence reporting/disclosure

Introduction

Gender-based violence (GBV) has received increased attention in the United States, with more nonprofit organizations (NPOs) focused on preventing GBV and addressing its consequences (Inter-Agency Standing Committee, 2015). Advocates working for GBV-specific NPOs engage in micro-level (i.e., individual), meso-level (i.e., community), and macro-level (i.e., society) efforts to mitigate the impact of GBV. They support survivors¹ in reporting experiences of violence to law enforcement, connect them to health care, and provide direct services such as counseling, shelter services, and employment assistance (Globokar et al., 2019; Kulkarni et al., 2013). In addition, advocates engage in community outreach to raise awareness about and address the underlying causes of GBV such as patriarchal gender norms (Wood, 2014) and collaborate with public education to integrate GBV prevention curricula into programming at local, state, and national levels (Davies & Lyon, 2013). Finally, advocates lobby and run educational campaigns to address policies that shape the quality and accessibility of services for GBV survivors (Davies & Lyon, 2013).

GBV-specific advocates are often motivated by personal experiences and a desire to help survivors, be part of solutions, and affect social change (Homer, 2014). Contribution to a meaningful cause through advocacy fosters a sense of purpose in life and increases self-esteem (Klar & Kasser, 2009). Engagement in advocacy may also help survivors and their loved ones heal from traumatic experiences while making a change in others’ lives (Wood, 2017). Despite its rewards, the emotionally demanding nature of GBV-specific advocacy poses risks to psychosocial well-being. Chronic exposure to traumatic stories may cause a shift in how advocates see the world, other people, and their own safety, which can lead to feelings of distrust and withdrawal in personal relationships (Wu, 2008). Moreover, serving clients with limited organizational resources, working long and/or irregular hours, and receiving low salaries may intensify the emotional burden they experience (Kulkarni et al., 2013). As a result, burnout and secondary traumatic stress (STS) are common experiences among advocates who work with survivors of GBV (Skovholt & Trotter-Mathison, 2016). Burnout causes reduced work performance, absenteeism, and higher turnover rates, all of which compromise the quality of services organizations provide (Handran, 2015). Thus, it is in the best interest of organizations to foster advocates’ psychosocial well-being (Slattery & Goodman, 2009).

Defined as the “proactive strategies, or routines, that professionals use to offset the negative aspects of working with trauma victims and promote well-being” (Wasco & Campbell, 2002, p. 734), self-care is a critical component of GBV-specific advocates’ psychosocial well-being. Self-care practices help advocates better cope with work-related stress and enhance long-term psychosocial well-being by fostering a sustainable approach to advocacy. This in turn enables advocates to better care for survivors (Wasco & Campbell, 2002). Practicing self-care is a predictor of long-term work motivation, productivity, and organizational functioning (Choi, 2011; Maltzman, 2011). Most self-care recommendations have focused on individual activities, such as exercising, healthy eating, and maintaining a regular sleep schedule (Kulkarni et al., 2013). Although useful, such recommendations do not address the role of organizational structures and practices in shaping the advocates’ willingness and ability to engage in self-care. Focusing solely on individualized self-care to promote psychosocial well-being places all responsibility on the advocates and fails to recognize the important roles organizations play in creating supportive workplace environments (Bober & Regehr, 2006; Kulkarni et al., 2013).

The ability of an organization to fulfill its mission depends on the well-being and motivation of staff members (Maltzman, 2011). Therefore, studies have explored the ways in which organizational context shapes psychosocial well-being and self-care of staff members (Kulkarni et al., 2013; Maltzman, 2011; Quinn et al., 2019; Senreich et al., 2018; Slattery & Goodman, 2009). Feeling valued in the workplace, receipt of sufficient training (Senreich et al., 2018), concordance between personal and organizational values, job autonomy, workload control (Kulkarni et al., 2013), shared power to make decisions (Slattery & Goodman, 2009), quality of supervision, salary amount (Quinn et al., 2019), and workplace social support (Maltzman, 2011) are significant organizational factors that shape burnout and STS. These studies also revealed the need to further examine how organizational dynamics influence advocates’ psychosocial well-being and ability to thrive in their work (Bloomquist et al., 2015).

Strategies that aim to counter the negative impact of work with trauma survivors and promote well-being of staff members should target organizational factors (i.e., policies, practices, resources) as well as strengthen individualized wellness efforts. Indeed, there are calls for shifting the focus of scholarship in this area from individual-level strategies to collective and organizational approaches (Hallinan et al., 2019; Wever & Zell, 2017). Such a shift could guide NPOs to support advocates more intentionally and systematically. The aim of this qualitative research was to further understanding of organizational-level factors that influence psychosocial well-being and self-care practices among advocates who work for GBV-specific NPOs in a metropolitan area in the southeastern United States.

Method

Recruitment and Participants

To be included in the study, we originally required that participants were fluent in English, 18 years or older, identified as a woman, and had engaged in paid GBV-specific advocacy while employed by an NPO or state-level agency for at least 1 year. After recruitment began, however, not all biologically female advocates who were recruited into the study identified as women. Therefore, we removed “identifying as a woman” from our inclusion criteria so that all who were originally recruited could participate.² To ensure a certain level of exposure to workloads, interpersonal relationships, and administrative dynamics within NPOs, we limited our sample to individuals who were paid staff members. Volunteers were not included. We also included advocates who were not currently working for GBV-specific NPOs in the state but did so during the 3 years preceding the data collection, to capture the reasons for quitting and/or transitioning to a new organization.

We recruited the first 10 participants through informal networking and snowball sampling (Denzin & Lincoln, 2011). After conducting the first 10 interviews and concurrently analyzing the data, we continued with a combination of purposive and theoretical sampling techniques (Breckenridge & Jones, 2009; Charmaz, 2006). We did this for two reasons: (a) to achieve diversity in the roles, positions, experience levels, and social locations (i.e., race, ethnicity, gender, sexual identity) of advocates, and (b) to reach saturation and refine the preliminary themes that emerged from the ongoing analysis (Breckenridge & Jones, 2009).

Participants included 25 advocates who worked for NPOs (n = 22) or government agencies (n = 3) that address GBV in the state. Three participants engaged in GBV-specific advocacy within the last 3 years and were currently working for other types of human service organizations. Sixteen advocates identified as White, five identified as African American, two identified as Hispanic, and two identified as mixed race/ethnicity (Arab-American and Middle Eastern-American; Table 1). Participant ages ranged from 23 to 64 years (M = 36). Most advocates had a master’s degree (n = 16), with common fields of study including social work, public health, clinical psychology, rehabilitation counseling, performance and pedagogy, and divinity. Three participants volunteered information about their sexual and/or gender identity during the interviews: one identified as gender nonconforming and bisexual, one identified as gender nonconforming and gay, and one identified as lesbian. The positions advocates held in their organizations are listed in Table 1. Advocates had varying levels of direct service experience. All advocates, including those who primarily engaged in community outreach and education, were responsible for answering crisis calls during weekly or monthly shifts.

Table 1.

Characteristics of the Study Participants.

	N (%)	M (Range)
Race/ethnicity
White	16 (64%)
African American	5 (20%)
Hispanic	2 (8%)
Mixed race/ethnicity^a	2 (8%)
Age		36 (23–64)
Educational status
Masters	16 (64%)
Bachelors	5 (20%)
Doctorate	4(16%)
Relationship status
Married	14 (56%)
Single	7 (28%)
In a relationship	3 (12%)
Separated	1 (4%)
Position in the organization^b
Community outreach/support and education director/coordinator	14 (56%)
Individual and/or group counselor	8 (32%)
Executive director/co-director	5 (20%)
Director of programs for survivors	4(16%)
Legal advocacy	2 (8%)

These participants identified as Arab-American and Middle Eastern-American. ^b Some participants held more than one position.

Materials and Data Collection

We developed a semi-structured interview guide based on the literature that focused on work experiences and well-being of caregiving professionals who serve people with a history of trauma (Figley, 2002; Skovholt & Trotter-Mathison, 2016), as well as the organizational context of GBV-specific advocacy (Homer, 2014; Kulkarni et al., 2013). Interview questions addressed advocates’ work roles, impact of their work on individual health and well-being, individual self-care practices, organizational culture and practices around self-care, and interpersonal relationships in the workplace. Participants were asked questions such as, “What are the major sources of stress that you experience due to your work?” “How would you describe your personal relationships with your coworkers?” and “Can you tell me about how you care for yourself?”

The first author conducted the 25 individual, in-depth interviews between October 2015 and September 2016. Participants provided written consent at the beginning of each interview. All interviews were recorded using a digital recorder. Twenty-one interviews were conducted in person, two via online video conference, and two by telephone. The interviews lasted between 65 and 124 min. Professional transcriptionists rendered the oral interviews into written format. To ensure confidentiality, no personal identifiers (e.g., individual’s names, organizational affiliation) were included in the transcripts. This study was approved by the University of South Carolina Institutional Review Board.

Data Analysis

We used a constructivist grounded theory (CGT) approach (Charmaz, 2006) to analyze the data. CGT methods are appropriate to examine social structures and processes that shape and are shaped by human agency and interactions (Charmaz, 2006). The first author led the coding process and worked collaboratively with other members of the research team (i.e., through peer debriefing and advisor consultations) to identify the core themes and subthemes and to discuss alternative interpretations of the data. We began initial coding by focusing on everyday work experiences of the study participants and used gerunds to code data as actions. Gerunds are “-ing” words—verbs that function as a noun—that reflect social processes (e.g., normalizing responses to trauma) in the data. Extracting initial codes in the form of gerunds provides a structured approach to identifying social processes and helps avoid development of early and immature themes (Charmaz, 2006; Saldaña, 2015). Using gerunds provided three distinct benefits to our analysis: (a) helped us pay close attention to the participants’ actions and their interactions within the organizations; (b) facilitated an emic approach by limiting us to participants’ own understandings of the workplace dynamics, reflected in their own words; and (c) allowed us to monitor the level of abstraction in the first stage of coding. In addition, we used versus coding, which is an affective coding technique, to uncover conflicting values, tensions, and competing interests among participants and within the organizations (Saldaña, 2015). We continued with focused coding and examined the frequency and significance of the initial codes. We then identified the relationships between these codes to form higher level categories. This process resulted in more conceptual and selective codes than would have otherwise been developed.

The CGT approach included generating theoretical explanations of the organizational processes that related to advocates’ psychosocial health and well-being. During the final, theoretical coding stage, we assessed how these conceptual codes related to one another to form an analytic story and move toward an explanatory framework. We used qualitative data analysis software, NVivo 11 (QSR International Pty Ltd.), to manage the data and organize the codes, categories, and themes from transcripts. Example codes from each stage of coding and themes/subthemes are presented in Table 2.

Table 2.

Example Codes From Each Stage of Data Coding and Related Themes/Subthemes.

Initial Codes	Focused Codes	Theoretical Codes	Themes/Subthemes
● Feeling valued and appreciated● Receiving feedback● Rewarding for good work● Being treated as disposable	● Feeling valued and appreciated● Receiving feedback	● Sense of professional identity and organizational belonging● Being acknowledged for one’s work● A leadership approach that values staff	● Management and leadership style:● Appreciating staff and demonstrating their value
● Being micromanaged● Being open to feedback● Allowing autonomy● Participating in decision-making● Building trust-based relationships	Being micromanaged● Participating in decision-making● Building trust-based relationships	● Micromanagement	● Micromanagement versus leading nonhierarchically
● Professionalizing the field● Being a service profession● Adopting a business model● Working with wounded human beings● Securing funding	● Being a service profession● Adopting a business model	● Business oriented versus humanistic practice● Balancing business needs with service	● Adopting a business or service model of leadership
● Being emotionally abusive● Displaying the cycle of violence● Gossiping behind each other● Feeling mistrust	● Being emotionally abusive● Displaying the cycle of violence	● Abusive relationship patterns among staff members	● Interpersonal relationship dynamics:● Abuse of power
● Decompressing after a hard work day● Avoiding negativity● Seeking support from colleagues● Being vulnerable● Sharing laughter● Dealing with difficult stories	● Seeking support from colleagues● Being vulnerable● Sharing laughter	● Supporting each other during difficult times● Humor as a coping mechanism	● Spirit of camaraderie
● Recognizing vicarious trauma● Normalizing responses to working with trauma● Disclosing mental health issues● Feeling like a failure● Imposing stigma on self	● Normalizing responses to working with trauma● Disclosing mental health issues● Imposing stigma on self	● Stigma of receiving help imposed by others or self	● Culture of self-care● Reducing the stigma of “inevitable occupational hazards” and receiving help
● Paying lip service● Spending time together outside of work● Knowing what works for your staff● Encouraging staff to take mental health days● Providing resources for self-care● Incorporating collective self-care activities	● Paying lip service● Providing resources for self-care● Incorporating collective self-care activities	● Creating an organizational culture of self-care	● Making self-care a priority versus paying “lip service”

To address validity and credibility, we conducted member checks during the middle and late stages of the analysis (Creswell & Miller, 2000). Initial member checks took place in group settings, including a workshop delivered by the first author during the statewide sexual assault conference (May 2016) and an educational meeting organized by GBV-specific NPOs in the state (July 2016). On both occasions, the first author presented the emerging themes from our analysis and received feedback from the attendees, some of whom were study participants. Finally, the first author met in person with two of the study participants to receive feedback on the latest version of the themes and the analytical framework (May 2017). In presenting the data, we use pseudonyms to protect participant confidentiality. Professional role and years of experience are presented to contextualize the findings.

Findings

Our analysis resulted in three thematic areas which represent the organizational processes that shape advocates’ psychosocial health, well-being, and self-care: (a) Management and Leadership Style, (b) Interpersonal Relationship Dynamics, and (c) Culture of Self-Care. Data supporting each of these themes is presented and discussed below.

Management and Leadership Style

This theme captured the activities advocates engaged in to develop programs and oversight mechanisms, and the ways in which leaders interacted with other staff members to accomplish organizational goals. Three subthemes are presented below.

Appreciating staff and demonstrating their value

Advocates’ commitment to their organizations and work motivation were shaped by the extent to which leaders acknowledged and valued their efforts. Personal values and political worldviews also provided motivation. However, being recognized by the leadership for their efforts was essential to maintaining a strong sense of professional identity. Given the financial challenges that limited NPOs’ ability to provide a fair monetary compensation for the advocates’ labor, this was particularly important:

I know they can’t pay me well . . . They just don’t have the funds to do that. So finding what your, the currency is of your employees, right? If you can’t pay them well, then what can you do for them that would make them feel valued? Because I think if an employee feels valued and empowered and trusted, they’ll stay, and they’ll do great stuff. (River, Outreach and Education Director, 4 years)

Despite working long hours under stressful circumstances, advocates did not always feel appreciated by the leadership and had limited opportunities to participate in organizational decision-making. Sometimes these conditions contributed to the decision to leave the organization:

. . . new management was not receptive to feedback from employees of any level . . . and often statements of “you are disposable” were articulated out loud. So, I didn’t want to work in that, and also working 70 hours a week with no appreciation for what we were doing and no end in sight to that, was just like too much. It was very mentally taxing. So, I stepped away from that and actually, shortly thereafter three more of the therapists stepped away and took jobs elsewhere. (Joan, Prevention and Education Coordinator, 2 years)

Erin, a co-executive director with 30 years of experience in the field acknowledged the responsibility of not only valuing their staff members, but also putting this value into action by developing a caring relationship with them:

I think that you start with an attitude towards your staff, and the attitude is one of support and compassion that in what you say and what you do on a day-to-day basis, you give them the message that they’re valuable . . . It’s noble work and we can’t afford to lose you.

Erin noted that how leaders interacted with other advocates could have implications for the relationships between the advocates and their clients, alluding to the potential negative impacts on organizational functioning:

I believe that the way employees are treated translates to how they treat their clients. So, if they are being stressed, the demands are rigid and harsh and they are feeling unsupported and uncared for, that’s going to translate into poor service for the clients, no way around that in my opinion.

Adopting a business versus service model of leadership

With “business model,” advocates referred to the goal of “professionalizing the field” and drew attention to the hiring practices that were increasingly based on academic degree and advanced training requirements. On the contrary, participants’ references to a “service model” highlighted the humanistic values guiding their work and differentiating them from for-profit organizations. There were conflicting stances on hiring practices. One advocate questioned whether relying solely on a business model could ensure fit of staff to certain positions: “. . . sometimes we focus a little bit too much on somebody’s qualifications and their degrees and things like that, and that doesn’t always correlate with supervision skills either [laughs], so yeah” (Micah, Adult Education Coordinator, 9 years).

Advocates believed that achieving a certain level of business orientation was necessary to manage organizations’ finances with an efficient oversight system and secure funding for services. Yet, they advised to integrate business-oriented approaches into NPO management without forgetting about the goal of providing better services to the communities in need:

We don’t make tires. We don’t make furniture. We are working with human beings who are wounded. They are in pain, and so that really forms the basis of our philosophy here. We strongly believe in running the organization ethically and effectively managing the money that’s given into our care carefully, really keeping a close eye on the budget. And to that extent I think that we are a business, but on the other hand, we believe very strongly in a compassionate empowerment model, which means that we are not patriarchal. (Erin, Co-Executive Director, 30 years)

Erin noted that being guided by feminist and social justice-oriented values distinguished their organizations from for-profit businesses. Robin (Community Education Coordinator, 2 years), who identified as being “more on the service model side” in her practice, talked about the “muddling effect” of unclear roles within her organization and thought that several aspects of the business model, such as identifying clear individual work roles and having more efficient oversight systems could be helpful.

Advocates suggested creating “a mix” or “merging” the business and service models to resolve the dichotomy between these two. For a better NPO management approach, they called for the adoption of particular features from the business model in conjunction with keeping the focus on addressing the needs of individual clients and communities with compassion. Robin (Community Education Coordinator, 2 years) stated, “Merge the two. Yeah. There is much to be said about it being one over the other. I think there’s pros and cons to both. I prefer a model that’s kind of both.”

Micromanagement versus leading nonhierarchically

Advocates described nonhierarchical leaders as those who did not operate through authority and the exertion of power but rather, based their management style on competency, respect, and collaboration. In organizations with nonhierarchical leaders, advocates felt more driven in their work and had autonomy to manage their own time and responsibilities. Maintaining trust-based, egalitarian relationships with their leaders encouraged accountability among the advocates:

I love the management style where I’m at right now. It’s very much like here’s your responsibilities. Figure it out. If you have questions let me know, but I’m not going to micro-manage or dictate how or when you’re supposed to do something. (Joan, Prevention and Education Coordinator, 2 years)

Advocates struggled to be productive and feel connected to their work when a director or supervisor was micromanaging or overly critical about every step they took in fulfilling their responsibilities. They expected the leaders to understand that each advocate could adopt different approaches to complete a task, based on their previous experiences, training, and interests. When a leader intentionally used advocates’ unique skills and strengths in ways that were meaningful both to the advocates and the organization, it resulted in advocates’ enhanced sense of organizational belonging:

. . . empowering employees to be engaged and fulfilled by their work and trusting your employees. If you hire well, you just like wind them up and set them off and let them help brainstorm. Know what their strengths and powers are, and utilize that, instead of trying to push your employees into a little box. (River, Outreach and Education Director, 4 years)

Being involved in organizational decision-making was another important component of nonhierarchical leadership that participants clearly appreciated. For example, one advocate expressed excitement over a recently employed practice by her organization to facilitate advocates’ participation in program development. With this approach, the leadership had intentionally created a bridge between advocates’ interests, expertise, and the organization’s mission. Their leader took a collective approach to developing a strategic plan for each program and had approached the advocates with this proposition: “Let’s see what your position looks like . . . are there any areas you want to develop in, that we haven’t had that opportunity?” (Abbie, Community Education Director, 6 years). In response, advocates felt “like their voice (was) heard.” The leader’s proposition conveyed that their contribution was important to the overall mission of the agency.

Interpersonal Relationship Dynamics

Relationships with coworkers and leaders were influential in advocates’ sense of organizational belonging and overall psychosocial well-being. Two subthemes emerged under this category: abuse of power and spirit of camaraderie.

Abuse of power

Several advocates talked about feeling powerless and disappointed after observing abusive power dynamics within their organizations. River (Outreach and Education Director, 4 years) likened the abusive dynamics within their organization to the “Power and Control Wheel” (Dutton & Starzomski, 1997), a framework used to describe the relationships between survivors of violence and their perpetrators:

My boss was emotionally abusive. She was not emotionally abusive very much, to me, but she was a bully and would pick on, like find the weak link, and would pick on that person, or emotionally abuse them, and I felt very powerless to do anything to change that system within. I would go to presentations and present on like intimate partner violence and the cycle of violence, and the power and control wheel. And as I was presenting it to students, I’d be like, “Huh. That fits her. That fits her.”

Advocates alluded to “unchecked mental health issues” and “personal struggles” as potential reasons underlying abusive behaviors. These behaviors were often observed in situations where there were power differences between the advocates, such as the executive directors and staff they supervised. A shared belief among the participants was that most advocates in this field had a history of trauma, and this exposure, if not addressed, could adversely affect workplace relationships: “Hurting people hurt people” (River, Outreach and Education Director, 4 years). Being emotionally invested in their work and willing to do extra work for their clients sometimes made these advocates more vulnerable to the demands of an abusive supervisor or director. In these situations, advocates contemplated on how much they could withstand while “contributing to the cause”:

So, is this pain of this management situation worth this wonderful work that I feel like I’m doing, and I’m very fulfilled by? And I feel like someone who is a narcissist or a bully or an abuser can take advantage of that. Knowing that they can push you as far as they want, because you have that vested interest. (River, Outreach and Education Director, 4 years)

Advocates were concerned that abusive relationship patterns in their workplaces affected not only them but also the organization’s ability to help the survivors. Jamie (Director of Systems Advocacy and Prevention, 8 years) described these abusive relationship patterns among staff as “one of the biggest stumbling blocks to advancing this field.”

Spirit of camaraderie

In contrast to abuse of power, there was a spirit of camaraderie in some organizations, where advocates were able to share the challenges of trauma work and feelings of vulnerability with their coworkers. In these organizations, helping each other get through tough cases was a major source of support for the advocates: “for the most part, I really felt fairly equipped to handle the kind of stories that I was hearing. But only because I knew I had people that I could talk to” (Sam, Children’s Counselor, 5 years). They spoke of the unique and isolated world of GBV-specific advocacy as something they could only share with coworkers. Building a community of camaraderie was essential to fulfilling their responsibilities at work:

I do think it’s a family. And I think that’s the only way we’ll be successful, especially in a close-knit environment like that. Everything has to be confidential. So we don’t have anybody else to talk to about the problems we have going on . . . I’ll go talk to my coworker about it, get her view take, see what I should do to help them [clients], and then we’ll move forward. (Drew, Coordinator of Outreach Projects, 5 years)

A potential downside of developing close relationships in the workplace was the blurring of personal boundaries. Although relationships between the advocates were mostly supportive and nurturing, some advocates revealed that at times, they found themselves in the midst of a conversation that crossed their personal boundaries:

Many of the people in the office are very open about their intimate life, like sex life or whatever. I’m not . . . But because I may not volunteer information, then the joke is made well, you know, she won’t talk about it because she’s . . . And I know it’s a joke, and I know that it’s just meant to be all in good fun, but on the other hand, at the same time, it’s just, hmm, it’s uncomfortable. (Logan, Crisis Counselor, 6 years)

Making room for laughter in the face of hardship was as an important part of camaraderie. Weaving humor into their daily work helped them get through difficult times. The type of humor they shared was something that outsiders would not be able to understand:

. . . we make jokes that people outside of our work are like “that sounds horrible.” Like why are you joking about that? But it’s kind of the way that I feel like a lot of people process how terrible that is, whatever it is, because if you can’t laugh you’re just going to end up fetal in a corner and not accomplish anything. (Joan, Prevention and Education Coordinator, 2 years)

Embracing humorous moments and sharing laughter sometimes served as a collective self-care strategy:

. . . we can’t be serious all the time. We have to bring in some fun and laughter and, if it’s at the end of the day, everybody seems to pile into my office, and we have our talks . . . maybe I had an hour-long crisis call that just got me just in a tizzy and I’m just like, “OK, I need to go outside for a minute and blow some bubbles,” or “I need to go outside and hula hoop.” We have a cat outside that we go and talk to [laugh]. (Skyler, Program Director, 8 years)

Culture of Self-Care

Shared norms of self-care and tangible resources for self-care within the organizations shaped advocates’ willingness and ability to engage in self-care practices. Two subthemes were reducing the stigma of “inevitable occupational hazards” and receiving help, and making self-care a priority versus paying “lip service.”

Reducing the stigma of “inevitable occupational hazards” and receiving help

When they were first employed, most advocates had conversations with their executive director about how engaging in this work makes advocates vulnerable to burnout and STS. Advocates considered these experiences as a natural response to working with people’s trauma and suffering. Reflecting on how her recent work brought back some traumatic memories, Parker (Program and Outreach director, 8 years) said,

It’s an inevitable occupational hazard that you’re going to experience trauma doing this type of work. And so it’s not a matter of if you’re going to experience it. It’s just a matter of, it is a reality and then what are we going to do about it?

In some organizations, leaders endeavored to prevent such “occupational hazards” by embracing an open-door policy and inviting the advocates to come talk to them about their cases anytime they felt overwhelmed or needed guidance. Three advocates noted that trying to hide the signs of burnout was “hypocritical,” given the goals of their work. Working with supportive leaders enabled advocates to express and process negative emotions evoked by the trauma work. On the contrary, when advocates lacked this type of support, they were reluctant to be completely transparent about the emotional burden they were experiencing. For example, Harper (Outreach and Follow-up Coordinator, 3 years) voiced concerns about receiving judgmental responses from their colleagues if they were to disclose seeing a therapist:

I think there needs to be more of a culture of social service providers going to therapy themselves, and just like support around that . . . And if someone comes into work and they say, “Oh I went to therapy,” it’s still like oh that’s weird, even though we’re telling people to go to therapy, so it just doesn’t make sense . . . I do go to therapy and I don’t tell my colleagues, yeah.

The stigma of seeking mental health care was not always imposed by coworkers but rather was internalized and self-imposed at times. Skyler (Program Director, 8 years) reflected on the conflicted feelings among her colleagues about receiving professional help to better cope with stressful work experiences while being in the role of providing counseling to their own clients:

I think a lot of people are just kind of hesitant to utilize it [therapy], because they’re like, “Well, if I’m having to go talk to somebody, then I must not be any good if somebody comes and talks to me.” . . . They feel like a failure, I guess.

In some instances, intertwined layers of other and self-imposed stigma around burnout and seeking professional help led to a collective culture that was unsupportive of expressing vulnerability and addressing one’s emotional needs:

There’s also this really ironic sort of response to it [STS] in that like there was almost like a form of shame/pride of something getting to you. It kind of reminds me of like sort of like a tough man act, like punch me, that didn’t hurt. (April, Advocate Counselor/Group Services Coordinator, 4 years)

Making self-care a priority versus paying “lip service.”

Advocates acknowledged self-care as an important strategy to cope with work stress and remain motivated; however, workplace structures and practices were not always conducive to practicing self-care.

For instance, in understaffed NPOs, advocates had to take on multiple responsibilities and worked irregular hours, making it difficult to invest time and energy in self-care:

There was a lot of lip service about self-care at the rape crisis center where I worked, and “make sure you take flex time if you work over your forty hours.” Like, “take time off.” But then you wouldn’t change any of the workload, and so you were expected to do forty hours of work in a shorter amount of time. So you could take care of yourself, and then you’d get in trouble if you didn’t do it, right? (River, Outreach and Education Director, 4 years)

Lack of practical support and enforcement by the leadership was an important barrier to self-care:

Well, part of the problem is, we all, in this field, have been taught what self-care is. But none of us have been taught or encouraged or checked in on the practical application of. I know exactly what I’m not doing. I have not practically applied very many of the self-care techniques because I’m exhausted. (Robin, Community Education Coordinator, 2 years)

Another barrier was assuming that mainstream self-care practices would work for all advocates and failing to take a personalized approach:

. . . we’re being given these ideas, but they don’t really fit my lifestyle, or my personality. They don’t really intrigue me, but we’re not getting any practical help in finding those things that do intrigue us, that do make us excited about, “Yay, I’m going to take care of me!” (Robin, Community Education Coordinator, 2 years)

Parker (Program and Outreach Director, 8 years) reflected on the lack of initiative in her organization for developing and promoting collective self-care practices and thought that the leaders sometimes “underestimate our organization’s ability to support staff, especially in this kind of work.” She stressed the link between being a trauma-informed agency and prioritizing the well-being of advocates:

. . . looking at it from a perspective of how we should be working with our clients, but not forgetting at all that it’s also, how do we practice this work, how do we let it influence how we treat our staff, too, and what kind of supports we have for them . . . I think being a trauma-informed approach agency means that we have to think about our staff within that realm too.

Advocates identified flexible work schedules and locations, more vacation time, and access to mental health services as resources that NPOs could provide to support the well-being of their staff. Collective self-care activities facilitated by the organizations included making lifestyle changes together to improve health, spending time together outside of work, formal and/or informal debriefing sessions, and providing retreats focusing on themes suggested by the advocates.

Discussion

Understanding the organizational dynamics that support helping professionals’ ability to maintain their well-being, develop a sustainable work practice, and experience job satisfaction is essential to creating workplace cultures that prioritize staff well-being. This is particularly true for GBV-specific advocates as they are constantly exposed to trauma and human suffering in their work. We found that advocates develop a stronger organizational identity and sense of belonging when their leaders recognize and appreciate their unique contributions to the organization’s mission. Feeling valued and supported by their supervisors enables advocates to experience greater fulfillment in their job and protects them from burnout and STS (Choi, 2011; Quinn et al., 2019). An important way of demonstrating each advocate’s value is to develop one’s job responsibilities with an awareness of individual strengths and interests. This may not always be possible to achieve since the material and human resources available to GBV-specific NPOs often do not correspond with the scope of their work. However, it is important for the leaders to know that tailoring job responsibilities to advocates’ skills and interests fosters a stronger alignment between personal and organizational values and promotes psychosocial well-being (Kulkarni et al., 2013; Schuler et al., 2016).

Echoing previous literature, we observed that a certain level of autonomy in managing their time and tasks increased advocates’ work motivation (Elpers & Westhuis, 2008; Kulkarni et al., 2013). This was an outcome of leadership approaches that value less hierarchy, which, in turn, supports advocates’ psychosocial well-being and leads to better organizational functioning (Bloom & Farragher, 2013; Slattery & Goodman, 2009). Unless it is balanced with collective, horizontal approaches to working together, workplace hierarchy can facilitate abuse of power and micromanagement (Hershcovis & Barling, 2011). Micromanagement can endanger the quality of relationships between leadership and staff, causing higher levels of distress in the workplace (Mcclusky, 2002; Rooney & Gottlieb, 2007). Although there is an inherent hierarchy between various staff positions in GBV-specific NPOs, leaders with an egalitarian approach recognize that organizations can benefit from different levels of expertise and various skills among the staff members. We found that leaders who strive to create a less hierarchical organizational culture share power with the staff members by creating mechanisms that allow staff members to have a voice in decision-making. Others have noted the association between advocates’ participation in organizational decision-making processes with greater commitment to the organizational goals and increased meaning in work (Choi, 2011; Slattery & Goodman, 2009). Organizing in horizontal ways that foster shared power has long been a core value in feminism(s). Our research highlights the historical situatedness of GBV-specific advocacy in the overall feminist movement and suggests that putting feminist values in practice makes a difference in advocates’ psychosocial well-being and, in turn, organizational functioning.

GBV-specific NPOs are not businesses in the traditional sense, but similar to for-profit businesses, financial security is essential to their ability to provide services (Walker & McCarthy, 2010). Although participants discussed “business” and “service” models of leadership as opposites, our findings suggest that these models are not mutually exclusive and may exist more on a continuum. Thus, NPO leaders may need to use business-oriented skills to secure and manage financial resources that are crucial to organizational survival. Given that most GBV-specific advocates have an educational background in fields such as social work, counseling, and public health, organizations would benefit from providing training opportunities to their management staff in nonprofit leadership and financial management. Future research is needed to gain an in-depth understanding of how a balance between the service and business dimensions could be achieved in GBV-specific NPO leadership and in other human service organizations.

Guided by social justice and feminist values, GBV-specific NPOs work toward eliminating the power differentials that underlie GBV. Despite having an increased awareness of the power and control dynamics in abusive relationships, advocates were not immune to the abuse of power within the workplace. Interviewing advocates with different levels of access to organizational power revealed that advocates in power positions were more likely to engage in abusive behaviors. Unhealthy relationship dynamics in the workplace such as bullying, emotional abuse, and creating rumors were discussed in relation to unmet recovery needs among the advocates who have a history of exposure to trauma. Similarly, Choi (2011) argued that “the unhealthy dynamics of trauma victims, such as denial, blaming, dominance and submission, could be transferred into the organizational culture and coworker relationships” (p. 228). Regular debriefing sessions and informal meetings may help advocates process difficult emotions rooted in past trauma so that they do not unintentionally carry their own psychological wounds into the workplace (Choi, 2011; Shier et al., 2018). Furthermore, organizations have the responsibility to provide mental health services and social support to advocates with a history of trauma, to prevent any unmet recovery needs from interfering with their relationships with clients and coworkers (Choi, 2011).

It is crucial for the organizations to detect and address dysfunctional and abusive leaders as their leadership style sets a precedent for staff, diminishes morale, and endangers the organization’s mission. Abusive leadership can perpetuate a toxic workplace culture in which absenteeism and diminished productivity are common (Estes & Wang, 2008). It is also necessary to note that advocates’ unmet recovery needs due to a history of trauma are not the only mechanism through which abuse of power can take place in these organizations. Horizontal hostility, discrimination, and prejudice in organizations can be rooted in broader social dynamics such as racism, ethnocentrism, and heterosexism (Okechukwu et al., 2014; Roscigno et al., 2009). Organizations may perpetuate these oppressive practices if they fail to create mechanisms that allow confidential reporting of abusive workplace experiences and enforce policies that prevent vertical violence and horizontal hostility. In addition, creating spaces in which staff members can give constructive feedback to their supervisors and managers can disrupt the traditionally one-directional accountability structures.

NPOs that address GBV are often isolated from the communities in which they reside and serve. Moreover, these organizations are “in conflict with the political status quo” (Kulkarni & Bell, 2011, p. 6) due to challenging traditional patriarchal and gender norms. The work of GBV-specific advocates brings up controversial sociocultural and political issues that others avoid discussing in daily conversations (Ganz, 2014). This might explain why advocates in our study felt hesitant to communicate about their work with people from outside their organizational networks and were concerned about being misunderstood or judged by others. The need for confidentiality further prevents them from talking about their work with other people (Ganz, 2014). In response, advocates developed “close-knit” communities and a sense of camaraderie within their workplaces which nurtured them in their personal and professional lives, also serving as a buffer against the “occupational hazards.”

A “close-knit” organizational culture may provide advocates with a reliable social support system and help them continue their work in the face of limited resources. However, these organizational cultures also run the risk of violating personal boundaries and diminishing independent thinking (Kulkarni & Bell, 2011). In this research, advocates reported experiencing the communities they built within their workplaces mostly as a supportive system. Yet, several advocates also mentioned blurring personal boundaries and the need for reserving some room for individuality. Individual advocates may have varying needs and preferences in terms of the interpersonal relationships within the workplace. It is important that all staff members are cognizant of these various needs and respect personal boundaries while maintaining the spirit of camaraderie.

An important finding of this study was that the incorporation of humor into the daily work of GBV advocacy served to balance the impact of constant exposure to human suffering. Advocates were able to excavate laughter out of even the most challenging aspects of their work. Constructive humor may act as a coping mechanism and self-care strategy, enhancing psychosocial well-being and resilience among helping professionals (Bloomquist et al., 2015; Moran, 2013). Others have noted the association of humor in the workplace with better performance, higher job satisfaction, lower levels of stress and burnout (Mesmer-Magnus et al., 2012), as well as increased creativity and group cohesiveness (Romero & Pescosolido, 2008).

It is essential to acknowledge STS and burnout as advocates’ natural responses to working with traumatized individuals so that NPOs can identify and avoid stigmatization of these experiences and move quickly toward developing solutions (Bell et al., 2003; Kulkarni et al., 2013). Advocates in our study perceived self-care as a prerequisite for maintaining their own well-being and doing their job efficiently. Yet, high levels of awareness around self-care did not always translate into practicing self-care. Similarly, one study documented that social workers were not engaging in self-care practices frequently, even though they valued self-care and acknowledged its benefits (Bloomquist et al., 2015).

We found that shared notions of self-care and organizational accountability for self-care were two influential factors that contributed to the incongruence between the conceptualization and enactment of self-care. Sharing their emotional responses to working with survivors and seeking outside psychological counseling are important self-care strategies for GBV-specific advocates. In workplaces where talking about challenging emotions is stigmatized, advocates may feel that taking on a professional caregiving role is in conflict with being the recipient of psychological care. Organizational stigma may perpetuate self-imposed stigma, making it harder for advocates to seek psychological support. GBV-specific advocates should have access to confidential and affordable counseling resources outside of their organizations through employee assistance programs. However, providing access to mental health services without creating an organizational culture that normalizes and encourages seeking help may not lead to greater use of those services by the advocates. Bloomquist et al. (2015) reported that one of the rarely practiced self-care activities among social workers was “negotiating one’s own needs within the workplace” (p. 303). Advocates’ perceptions of their rights to specific organizational self-care resources shape how much they actually engage in self-care. In our study, advocates from younger generations expressed more explicitly that they needed greater organizational support to maintain their psychosocial health and well-being. This may be due to an increased awareness around, and interest in, the concept of self-care among helping professionals over the years. At the same time, these young advocates experienced difficulties in communicating their well-being needs with their leaders. It is important for leaders to cultivate a culture that prioritizes advocates’ psychosocial well-being, invite the advocates to voice their self-care needs, and regularly involve them in the process of identifying organizational resources that support engagement in self-care.

These findings highlight the relationship between prioritizing self-care at the organizational level and being a trauma-informed agency. By taking a trauma-informed approach, GBV-specific NPOs not only resist re-traumatizing the clients they serve but also recognize the potential effects of trauma on their workforce (Bassuk et al., 2017). The provision of specialized trauma training is one organizational approach to ensuring that advocates gain the necessary skills to identify and respond to STS (Handran, 2015). Being a trauma-informed agency also requires investment of time and resources into collective self-care practices at the organizational level, such as sponsoring activities outside the workplace that are meaningful to the advocates, providing retreats, and offering training that covers diverse and practical ways of engaging in self-care.

It is crucial to extend the notion of self-care beyond the individual-level practices that advocates engage in, to collective practices and values that are promoted at the organizational level. Wever and Zell (2017) argued that when individual self-care is proposed as “an antidote” for the negative impacts of the work within human service organizations, it “places the responsibility of managing the effects of social, cultural and organizational injustices squarely on the individual worker” (p. 210). Without ignoring the necessity for each advocate to be cognizant of their own well-being needs and to be proactive, they called “for a movement of caring for and acknowledging each other in human service organizations” (Wever & Zell, 2017, p. 211). Similarly, in a manual developed to provide tools and skills for facilitators who work with women survivors of family-level violence, Billings (2018) argued,

. . . the work of facilitating support groups with women victims and survivors of violence also requires the construction of mutual care processes among the facilitators. Seeing itself as a team of facilitators that share experiences and energies, mistakes and successes, and mutually counting on each other for the renewal of ideas, approaches and new forces is key to the continuity of the work.

Advocates are often unable to invest in time, energy, and financial resources to improving their well-being due to being overworked, underpaid, and physically and emotionally exhausted. A culture of individual responsibility and blame exacerbates the emotional burden they experience and places them at a greater risk for negative mental health outcomes. Cultivating an organizational culture in which advocates care for each other and feel responsible for each other’s well-being would provide greater health benefits and capture the communal aspect and relational ethics of engaging in anti-GBV work.

Limitations and Implications for Future Research

Due to the sensitive nature of the issues we examined (e.g., organizational support for self-care, interpersonal relationships, power relations), it is possible that advocates who felt comfortable about commenting on these issues self-selected into the study. Organizational resources for self-care vary across different contexts and our findings may not reflect the experiences of all advocates working in the GBV field. Yet, they offer insight into the common organizational dimensions of advocates’ psychosocial well-being and self-care. Some of our findings may also be relevant to the work experiences of other helping professionals, such as social workers, nurses, and first responders. Newer generations of advocates are increasingly aware that their ability to care for themselves, their colleagues, and their clients while being fulfilled in their work depends on the organizational resources. Future research needs to address the generational differences in advocates’ perspectives and experiences around self-care and collective care within the NPOs. In addition, research is needed to identify new collective approaches that GBV-specific NPOs can use in supporting advocates’ psychosocial well-being, resilience, and work engagement. Finally, this study did not address work experiences, self-care, and collective care practices of male advocates or volunteers, which could be the focus of future studies.

Conclusion

GBV-specific advocates serve a crucial role in the recovery of survivors, as well as transforming sociocultural structures that underlie GBV. Engaging in this important but challenging work takes a toll on their psychosocial well-being. Our results emphasize the role of GBV-specific NPOs in creating workplace cultures that are conducive to engaging in self-care and collective care, developing resilience and a sustainable approach to advocacy. Organizational policies and practices need to be at the forefront of strategies that are adopted to promote advocates’ psychosocial well-being. By fulfilling this responsibility, organizations will enable advocates to thrive in their work and make even greater strides in the overall mission of GBV prevention.

Footnotes

Acknowledgments

The authors would like to thank the GBV-specific advocates who generously shared their time and experiences for the purposes of this study. The knowledge produced by this study would not be possible without their support and participation.

Authors’ Note

Dr. Tim Cunningham is now also affiliated with the Nell Hodgson Woodruff School of Nursing at Emory University.

Declaration of Conflicting Interests

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

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by an Olga I. Ogousson Doctoral Research Award from the Department of Health Promotion, Education, and Behavior at the University of South Carolina.

ORCID iD

Ebru Cayir

Notes

Author Biographies

Ebru Cayir is a postdoctoral research associate with the Compassionate Care Initiative at the University of Virginia, School of Nursing. Her research focuses on promoting mental health, well-being and resilience among caregiving professionals by adopting collective, diverse and inclusive approaches. She also examines how social identity categories such as race, ethnicity, gender, and sexuality shape work experiences, well-being, and belongingness among these professionals.

Mindi Spencer is an associate professor in the Department of Health Promotion, Education, and Behavior at the Arnold School of Public Health, University of South Carolina. Her research and teaching focuses on health disparities among minority and/or lesbian, gay, bisexual, and transgender (LGBT) older adults, cultural context and health impacts of caregiving, and health disparities in the South.

Deborah Billings is an adjunct associate professor in the Department of Health Promotion, Education, and Behavior at the Arnold School of Public Health, University of South Carolina, and at the Gillings School of Global Public Health, University of North Carolina. She also serves as a senior advisor for Group Care Global. She conducts research and programmatic work in the areas of sexual and reproductive health, rights, and justice, with particular emphasis on contraceptive access, safe abortion, and prevention of gender-based violence.

DeAnne K. Hilfinger Messias is Emily Myrtle Smith Professor of Community Nursing Emerita in the College of Nursing at the University of South Carolina. She has conducted community-engaged research, implemented and evaluated community-based programs aimed at improving immigrants’ access to culturally and linguistically appropriate health services and promoting the health of immigrant women and their families.

Alyssa Robillard is an associate professor in the Department of Health Promotion, Education, and Behavior at the Arnold School of Public Health, University of South Carolina. Her research focuses primarily on HIV prevention, care, and treatment among youth, women, African Americans, and incarcerated populations. She also examines the role of storytelling approach in protecting the cultural integrity of messaging to promote behavior change.

Tim Cunningham is the previous director of the Compassionate Care Initiative and an adjunct assistant professor in the School of Nursing at the University of Virginia. He also serves as an adjunct assistant professor in the Nell Hodgson Woodruff School of Nursing at Emory University. His research focuses on psychosocial support and resilience among health care providers, artistic interventions in hospital settings, and the role of contemplative practices in health care provider well-being.

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