Work

Working as a police officer involves regular exposure to events that can be violent or overwhelming, such as deaths, violence and traffic accidents. When these events occur repeatedly on the job, it can lead to the development of symptoms of mental illness and increased sickness absence for the individual officer. This will have consequences for both the individual officer and the entire department, as sick leave will increase overall task pressure.

Exposure to violent incidents in the work as a police officer can thus be a risk factor for the development of serious psychopathology, reduce the quality of daily work and lead to greater personal, organizational and financial costs over time. This project ARE YOU ALL RIGHT? will, in a solid research design and in close collaboration with the Danish National Police, ensure knowledge about key factors that may be crucial for the development of secondary and tertiary preventive measures when Danish police officers are exposed to stressful incidents at work.

Based on a prospective cohort study of Danish police officers, the project aims to 1) map the extent and nature of stressful incidents in daily work, 2) describe the psychological consequences of repeated stressful incidents at work, 3) uncover the relationship between stressful incidents at work and sick leave/ presenteeism, 4) identify key work environment factors that may be protective or aggravating for the development of mental disorders.

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Publications:

Møller, S. R., Hansen, N. B., Pihl-Thingvad, J., Hansen, A. S. F., Elklit, A. (2023). Critical incidents in police work: What incidents stay with Danish police officers? Journal of Police and Criminal Psychology. DOI: 10.1007/s11896-023-09593-3

Beck Hansen, N., Møller, S. R., Elklit, A., Brandt, L., Andersen, L. L. & Pihl-Thingvad, J., Are you all right (AYA)? (2022). Association of cumulative traumatic events among Danish police officers with mental health, work environment and sickness absenteeism: Protocol of a 3-year prospective cohort study. BMJ Open, 12:e049769. Doi:10.1136/bmjopen-2021-049769.

This PhD project investigates, in a prospective design, how different types and frequencies of violence affect mental health. The project also examines how different work environment factors either amplify or protect against the negative consequences of violence. Follow-up measurements will be made after 1, 2, 3, 4 and 5 years. The project is based on social pedagogues working with adults. The project is led by Jesper Pihl-Thingvad and is carried out in a collaboration between: The Department of Occupational and Environmental Medicine (Odense University Hospital), the National Centre for Psychotraumatology  (Department of Psychology, SDU), the National Research Centre for the Working Environment and the Danish Association of Social Educators. 
The PhD project was defended in June 2019, but work on the project continues.

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Publications:

Pihl-Thingvad, J., Andersen, L., Pihl-Thingvad, S., Elklit, A., Brandt, L., & Andersen, L. L. (2021). Can high workplace social capital buffer the negative effect of high work-load on patient-initiated violence? Prospective cohort study. International Journal of Nursing Studies, 120, 103971. Doi: 10.1016/j.ijnurstu.2021.103971

Pihl-Thingvad, J., Elklit, A., Brandt, L. P. A., & Andersen, L. L. (2019). Workplace violence and development of burnout symptoms: a prospective cohort study on 1823 social educators. International Archives of Occupational and Environmental Health, 92(6), 843-853. Doi: 10.1007/s00420-019-01424-5

Pihl-Thingvad, J., Elklit, A., Brandt, L.L.P. & Andersen, L.L.(2019) Occupational Violence and PTSD-Symptoms: A Prospective Study on the Indirect Effects of Violence Through Time Pressure and Nontraumatic Strains in the Occupational Context. Occupational and Environmental Medicine, 61(7), 572-583. Doi: 10.1097/JOM.0000000000001612.

Pihl-Thingvad, J., Andersen L.L., Brandt L.P.A. & Elklit, A.(2019) Are frequency and severity of workplace violence etiologic factors of posttraumatic stress disorder? A 1-year prospective study of 1,763 social educators. Journal of Occupational Health Psychology, 24(5), 543-555. Doi: 10.1037/ocp0000148.

This project uses a cross-sectional design to investigate the prevalence of primary and secondary traumatisation and burnout among Danish prosecutors. The project also examines how different work environment factors, case-related conditions and support measures are related to traumatization and burnout.
The project was carried out from September 2019 to December 2021 and were based on a questionnaire survey among Danish prosecutors. The project were led by MSc in Psychology and PhD Maria Louison Vang, and were carried out in collaboration between the National Centre for Psychotraumatology, Department of Occupational and Environmental Medicine, Odense University Hospital, the HR department of the Danish Prosecution Service and Rikke Høgsted, MSc in Psychology.

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Publications:

Hovman, A.R., Pihl-Thingvad, J., Elklit, A., Roessler, K.K. & Vang, M.L (2024). Negative Acts in the Courtroom: Characteristics, Distribution, and Frequency among a National Cohort of Danish Prosecutors. Behavioral Sciences. 14(4). DOI: 10.3390/bs14040332

Vang, M. L., Hansen, N. B., Elklit, A., Thorsen, P. M., Høgsted, R., & Pihl-Thingvad, J. (2023). Prevalence and risk-factors for burnout, posttraumatic stress, and secondary traumatization among Danish prosecutors: Findings from a pilot-study. Psychology, Crime & Law, 1–21. DOI: 10.1080/1068316X.2023.2234543

 

Vang, M.L. & Pihl-Thingvad, J. (2020). Traumatisering og udbrændthed blandt anklagere: Resultater fra en spørgeskemaundersøgelse. Odense: Videnscenter for Psykotraumatologi To read the current issue in Danish, click here

Dealing with violent and tragic incidents in the work as a paramedic can be a risk factor for the development of serious mental illness, reduce the quality of daily work and lead to greater personal, organisational and financial costs over time. In violent incidents, it is natural to turn to support from various people around you, such as colleagues, managers, friends, family and professionals. However, there is a lack of knowledge about the use of multiple types of support over time and its effect on disease prevention.
Project No One Stands Alone, in collaboration with Ambulance South and with a strong research design, will ensure knowledge about factors that can contribute to the development of preventive measures when paramedics are exposed to stressful events at work.

Based on a prospective cohort study of paramedics in the Region of Southern Denmark, the project aims to answer the following questions:

1. Do patterns of support types used over the course of a year have an impact on the development of resilience, PTSD symptoms, and sick leave in the same and the following year?
2. Do pressure to drive and social capital have a moderating effect on the relationship between support and the development of PTSD symptoms and sick leave?
3. Do managers and employees who provide support to their colleagues, either in the form of trained support colleagues or informal support, have an increased degree of stress symptoms in the form of secondary traumatization?

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Publications:
Melander P, Vang ML, Lindekilde N, Andersen LPS, Elklit A and Pihl-Thingvad J (2024) Social support utilization’s effect on post-traumatic stress symptoms: a Danish cross-sectional study of 383 ambulance personnel. Front. Psychiatry 15:1425254. DOI: 10.3389/fpsyt.2024.1425254

Thorsen, P. M., Elklit, A., Hansen, N. B., Vang, M. L., Soenderbo Andersen, L. P., & Pihl-Thingvad, J. (2023). You Don’t Stand Alone: Preliminary results from a prospective cohort study on ambulance personnel. Poster session presented at Arbejdsmiljøforskningsfondens årskonference 3. maj 2023, Denmark.

Pihl-Thingvad, J., Vang, M. L., Møller, S. R., & Hansen, N. B. (2022). Critical Incidents Scale for Ambulance Work ‐ Denmark (CISAW-D): the development of a screening tool for work exposure to critical events in operative ambulance personnel. British Paramedic Journal, 7(3), 26-33(8). DOI: 10.29045/14784726.2022.12.7.3.26

 

The aim of the project was to examine the association between workplace sexual harassment and symptoms of PTSD in a sample of over 3000 social workers. The study also aimed to explore the effect of the frequency of sexual harassment, its source, and whether social capital in the workplace had a mitigating effect on the negative consequences of harassment.

The results of the study indicated a statistical association between sexual harassment and symptoms of PTSD with a dose-response relationship. The more frequently employees experienced harassment, the more PTSD symptoms they exhibited. In addition, the study showed that every 5th social worker had been subjected to sexual harassment in their work. While social capital was a known protective factor in the development of PTSD in work with violence, the results of the study did not show this effect in sexual harassment. This was attributed to how feelings of shame and guilt might prevent some employees from disclosing their experiences to colleagues or managers, and thus seeking the support available in the workplace. They also considered that future studies should shed light on possible barriers that prevented victims of sexual harassment from seeking and taking advantage of the social support available in the workplace.

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Publications:

Hansen, N. B., Vang, M. L., Lichtenstein, M. B., & Pihl-Thingvad, J. (2022). Workplace Sexual Harassment Increases the Risk of PTSD Symptoms with Higher Frequency and Harassment Coming from a Colleague or Leader as Risk Factors. Scandinavian Journal of Work and Organizational Psychology, 7(1), 12. DOI: 10.16993/sjwop.174

A nationwide study of the effect of workplace violence conducted in collaboration with the Danish Victim Foundation (Offerfonden), the Department of Occupational and Environmental Medicine at Odense University Hospital and the Department of Occupational Medicine in Herning and safety representatives in the Region of Southern Denmark. The project has been running since 2011 and is currently led by PhD Sara Al Ali. The project were investigating whether there are specific risk factors, risk profiles and how symptoms develop over time. It is expected that the final results will eventually reveal how workplace safety culture is associated with employees' risk of developing psychological consequences. It is therefore also hoped that the results of the study can contribute to the implementation of preventive measures that can counteract the employee developing psychological problems as a result of the experience of violence.

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Publications:

Elklit, A. , Ali, S. and Pihl-Thingvad, J. (2023) Latent Growth Mixture Modeling to Estimate Differential PTSD Trajectories and Associated Risk Factors in Psychiatric Staff Following Workplace Violence. Open Journal of Epidemiology, 13, 360-371. DOI: 10.4236/ojepi.2023.134026

Al Ali, S., Pihl-Thingvad, J., & Elklit, A. (2022). The influence of coping and cognitive appraisal in predicting Posttraumatic Stress Disorder. Work, 71(3), 641-649. DOI: 10.3233/WOR-205177.

Andersen, L.P., Elklit, A. & Pihl-Thingvad, J. Crisis social support after work-related violence and threats and risk for depressive symptoms: a 3-months follow-up study. BMC Psychol 11, 42 (2023). Doi: 10.1186/s40359-023-01081-x

Al Ali, S., Pihl-Thingvad, J., & Elklit, A. (2022). The influence of coping and cogntive appraisal in predicting Posttraumatic Stress Disorder: A prospective study on psychiatric staff in Denmark following workplace violence. Work, 71(3), 641-649. Doi: 10.3233/WOR-205177.

Al Ali, S., Pihl-Thingvad, J., & Elklit, A. (2021). Does acute stress disorder predict posttraumatic stress disorder following workplace violence? A prospective study of psychiatric staff. International Archives of Occupational and Environmental Health, 94(3), 359–366. Doi:10.1007/s00420-020-01586-7

Andersen, L. P., Al Ali, S., Elklit, A., & Pihl-Thingvad, J. (2021) Betydningen af social støtte efter arbejdsrelateret vold. Herning: Universitetsklinikken Arbejdsmedicin, Regionshospitalet. (1-44)

Ali, S. A., Pihl-Thingvad, J. & Elklit, A. (2020). Does Acute Stress Disorder predict Posttraumatic Stress Disorder in psychiatric staff exposed to workplace violence? A prospective longitudinal study. International Archives of Occupational and Environmental Health. Doi:10.1007/s00420020-01586-7

The purpose of the project was to map the prevalence of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) after bank robbery and to investigate the possibility of predicting PTSD with a wide range of predictors not previously examined in the same study. The study found that bank robberies can be a traumatizing event for employees. A minority develop ASD and PTSD, while high subclinical prevalence show that a large proportion develop severe symptoms of both ASD and PTSD, even if they do not fulfil the criteria for full diagnoses. In particular, ASD severity and negative thoughts about self and abilities seem to predict PTSD severity after bank robbery.

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Related publications:

Hansen, M. & Elklit, A. (2014). Who Develops Posttraumatic Stress Symptoms Following a Bank Robbery? A National Cohort Study. In Simmons, J. P. (Ed.) Banking: Performance, Challenges and Prospects for Development (s. 25-62). NY: Nova Publishers.

Hansen, M., Armour, C., Shevlin, M., & Elklit, A. (2014). Investigating the Psychological Impact of Bank robbery: a Cohort Study. Journal of Anxiety Disorders, 28, 454-459. Doi 10.1016/j.janxdis.2014.04.0050887-6185

Hansen, M., Lasgaard, M. & Elklit, A. (2013). The Latent Factor Structure of Acute Stress Disorder following Bank Robbery: Testing Alternative Models in the light of the pending DSM-5. British Journal of Clinical Psychology, 52, 82-91.

Hansen, M. & Elklit, A. (2012): Does acute stress disorder predict posttraumatic stress disorder following bank robbery? Journal of Interpersonal Violence, 28 (1), 25-44. Doi: 10.1177/0886260512448848

Hansen, M. & Elklit, A.(2012): Et nationalt studie af bankrøveri – de psykologiske følgevirkninger og prædikatorer for PTSD. Odense: Videnscenter for Psykotraumatologi, Syddansk Universitet. 1-49

Hansen, M., Armour, C. & Elklit, A.(2012): Assessing a Dysphoric Arousal model of Acute Stress Disorder Symptoms in a Clinical Sample of Rape and Bank Robbery Victims. European Journal of Psychotraumatology, 3. Doi: 10.3402/ejpt.v3i0.18201

Are people who work in high-risk jobs more prone to certain mental and somatic disorders than others? Paramedics, firefighters, police officers, soldiers and rescue workers are exposed to repeated, violent incidents throughout their work and have to stay on top of things and act quickly despite this exposure. Many seem to be able to cope with multiple stressors due to education and training, as well as the motivation that presumably led them to choose the type of work involving saving other people. Personality and organisational factors play a significant role in the resilience of rescuers. The health consequences of having such a job have been studied by looking at acute stress, PTSD, anxiety and depression, as well as the following somatic disorders: high blood pressure, muscle and joint injuries and heart problems. 
Through our work on the project, we found that paramedics and firefighters are generally at higher risk of early retirement as a result of their workload. A search of 10 recent studies and a review revealed that around 20% of paramedics and 17% of firefighters are at risk of developing PTSD. In other words, there are significant physical and mental health issues associated with being a paramedic or firefighter.

If you're interested in learning more about responders and trauma, we recommend our research page on Disasters and Terror. 

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Publications:
Bonde, B., & Elklit, A. (2012). Psykiske og somatiske problemer hos mennesker med højrisiko jobs. Odense: Syddansk Universitet. Videnscenter for Psykotraumatologi.

Publications:

Elklit, A. (2013) Does Safety Training works? An Empirical Study. Odense: Syddansk Universitet. (1-18).

This project was about trauma reactions in police officers. The project was finalised with the creation of the book chapter below.
As a police officer, it is highly likely that you will, at some point, be exposed to potentially traumatic experiences in the course of your work. Most police officers do not develop serious reactions as a result of the traumatic event, but some do.
The chapter focuses on some of the factors, such as social support, job type and characteristics of the incident, that influence how traumatic experiences affect individual police officers
The chapter presents prevention and intervention strategies and how they can be used to minimize the negative consequences of traumatization in police officers.

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Publications:
Jørgensen, L. K. & Elklit A. (2021). Trauma and critical incident exposure in law enforcement (pp.87-112) in P. B. Marques. & M. Paulino (eds.), Police Psychology. New Trends in Forensic Psychological Science. Amsterdam: Elsevier. ISBN: 978-0-12-816544-7.

The project was a collaboration between Professor Ask Elklit, Hanne Søndergaard, psychologist at the Alcohol Counselling Service in Aarhus, and Helle Holmgren, psychologist at the Psychological & Educational Counselling Service in Blaabjerg. The trio studied 12 interpreters from Kosovo-Albania, who all reported a high workload. The interpreters also reported that the hardest part of the job was translating conversations between refugees and psychologists, as difficult topics such as torture and loss often came up. Interpreters experienced strong discrimination compared to other staff.

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Publications: 
Holmgren, H., Søndergård, H., & Elklit, A.(2003). Stress and coping in traumatized inter-preters – a pilot study of refugee interpreters working for a humanitarian organization. Intervention – International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict, 1(3), 22-27.

Søndergaard, H., Holmgren, H., & Elklit, A.(2003). Tolkning i terapi: Problemer og kvalifikationskrav. Psyke & Logos, 24(1), 432-456.

This project deals with robberies committed in places other than a bank, such as petrol stations, supermarkets and shops.

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Publications: 
Elklit, A. & Brink, O.(2004) Acute stress disorder as a predictor of posttraumatic stress disorder in physical assault victims. Journal of Interpersonal Violence, 19(6), 709-726.

Elklit, A. (2000). Akutte følger af væbnet røveri. Forskningsnyt fra psykologien, 9(2), 1-3.

Elklit, A. (1999). Røveriofre—de psykologiske konsekvenser af et væbnet røveri. Psykologisk Skriftsserie, 24(5), 1-65.

Elklit, A. (2002). Acute stress disorder in victims of robbery and victims of assault. Journal of Interpersonal Violence, 17(8), 872-887.

 

Publications:

Pihl-Thingvad, J., Beck, N., Al Ali, S. & Elklit, A., (2019). Workplace Critical Incidents and Impact on Mental Health: Systematic Review of Longitudinal Studies on the Association between Critical Incident and Mental Health in Non-Military Work.
European Journal of Psychotraumatology. 10, Suppl. 1.

This multicentre study across 11 nations examines how regret in working with patients affects healthcare professionals in terms of sleep, burnout and turnover. The project also focuses on exposure to violence at work and reactions of a trauma-like nature. Based on newly qualified doctors and nurses, weekly measurements are made for a year, focusing on patient errors, the individual employee's experience and handling of regret, exposure to violence, as well as levels of burnout, sleep quality and intentions to leave their job. In addition, a larger questionnaire collection is conducted measuring demographic and lifestyle factors, general health, personality factors, work environment and sick leave. 
The Danish version of the RCS.HCP is a 10-item test that was found to be valid as a measuring instrument for addressing regret in healthcare work.
The project is led by Delphine Courvoisier who is affiliated with the Quality of care service (University Hospital of Geneva). The Danish participation is coordinated by Jesper Pihl-Thingvad in a collaboration between the Department of Occupational and Environmental Medicine (Odense University Hospital) and the National Centre for Psychotraumatology (Department of Psychology, SDU).

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Publications:
Cheval, B., Cullati, S., Mongin, D., Schmidt, R.E., Lauper, K., Pihl-Thingvad, J., Chopard, P. & Courvoisier, D.S.(2019) Associations of regrets and coping strategies with job satisfaction and turnover intention: international prospective cohort study of novice healthcare professionals. Swiss Medical Weekly. Doi: 10.4414/smw.2019.20074.

Pihl-Thingvad, J., Jacobsen, C. W., Brandt, L. P. A., Andersen, L. L., Elklit, A. & Courvoisier, D. (2018). The Regret Coping Scale for Health-Care Professionals (RCS-HCP): A validation study with Danish social educators. Work, 60(3), 401-410.

Cheval, B., Cullati, S., Pihl-Thingvad, J., Mongin, D., Von Arx, M., Chopard, P. & Courvoisier, D.S.(2018) Impact of CAre-related Regret Upon Sleep (ICARUS) cohort study: Protocol of a 3-year multicentre, international, prospective cohort study of novice healthcare professionals. BMJ Open, 27, 8(3). Doi: 10.1136/bmjopen-2018-022172.

This project studied the psychological and social consequences in the survivors and the bereaved after the train accident on the great Belt Bridge on 2th January 2019. Accidents and catastrophes influence many people, and some of them develop mental health symptoms. From the train accident in Sorø in 1989, we know that part of the rescue team developed PTSD. Catastrophe experiences after terror in Norway and England has shown, that many affected do not seek help, because they think their problems will disappear or that others are doing worse, and is in more need of the help than they are. To ensure that everyone who is in need of treatment gets the necessary help, and to be able to plan optimal initiatives in the future, we examined those who were directly affected. This project examines the rescue team’s reactions. If you are interested in the reactions of the passengers  bereaved family members, you can find our research project of the same name here.  The project started in 2019 and were led by PhD student Maria Louison Vang and PhD student Jesper Pihl-Thingvad. 

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Publications:

Elklit, A., Jørgensen, L. K. (2022). The Great Belt Bridge railway accident: Post-traumatic stress reactions among passengers and bereaved family members. American Journal of Disaster Medicine, 17(2) , 153-161. Doi: 10.5055/ajdm.2022.0429

This PhD project investigated, in a cross-sectional design, the prevalence of secondary traumatisation and burnout among Danish professionals working with children and youth exposed to violence or abuse. The project was conducted as a questionnaire survey among 97 different departments in the Danish child welfare system and includes Children's Centres employees, municipal social workers and police officers.
The project also examined how different work environment factors, case-related factors and individual factors either amplify the risk or protect against the development of secondary traumatisation and burnout. The results of the project are supplemented with group interviews with employees in the Danish Children's Centres, and together, the results from the questionnaire survey and the interview survey form the basis for recommendations for the prevention of secondary traumatisation and burnout among employees in the Danish Children's Centres. The project was carried out from March 2017 to February 2020.
The project is led by cand.psych. Maria Louison Vang under the supervision of Prof. Mark Shevlin, Associate Professor Maj Hansen and managers Ditte Askerod and Lane Lund at the Danish Children's Centres. The project is a collaboration between Ulster University, the Danish Children's Centres and the University of Southern Denmark as part of CONTEXT: The Collaborative Network for Training and Excellence in Psychotraumatology. 

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Publications:
Vang, M. L., Pihl-Thingvad, J., & Shevlin, M. (2022). Identifying child protection workers at risk for secondary traumatization: A latent class analysis of the Professional Quality of Life Scale-5. Journal of traumatic stress, 35(6), 1608–1619. Doi:10.1002/jts.22863

Vang, M.L. (2020). Occupational well-being among Danish child protection workers: Prevalence, predictors and prevention of secondary traumatisation and burnout. (Unpublished doctoral dissertation). Ulster University, Coleraine, Northern Ireland, United Kingdom.

Vang, M.L., Shevlin, M., Hansen, M. Askerod, D.K.K., Lund, L., & Flanagan, N. (2020). Secondary traumatisation, burnout and functional impairment among child protection workers: Findings from a Danish survey. European Journal of Psychotraumatology, special issue on CONTEXT.

Vang, M. L., Gleeson, C., Hansen, M., & Shevlin, M. (2020). Covariates of Burnout and Secondary Traumatisation in Professionals Working with Child Survivors of Trauma: A Research Synthesis. The British Journal of Social Work, 50(7), 1981–2001. Doi:10.1093/bjsw/bcz117

Vang, M.L., Pihl-Thingvad, J. & Shevlin, M. (2020, January) Screening for secondary traumatisation among Danish child protection workers: A latent variable approach. Poster presentation accepted at the 1st National Network Meeting for Trauma Researchers in Denmark, Odense, Denmark.

Vang, M.L., Hansen, M., Bramsen, R.H., Askerod, D., Lund, L., and Shevlin, M. (2017, October). Employee well-being in cross-sectoral child-protection -Operationalising the importance of cross-sectoral and multidisciplinary collaboration for employee well-being. Poster presented at the 15th ISPCAN European Regional Conference on Child Abuse & Neglect, The Hague, The Netherlands.

Vang, M.L., Hansen, M., Bramsen, R.H., Askerod, D., Lund, L., and Shevlin, M. (2017, June). Helping the Helpers: Preventing secondary traumatisation and burn-out amongst professionals working with survivors of child-abuse. Poster presented at the The 15th European Society for Traumatic Stress Studies Conference, Odense, Denmark