Overcome Vicarious Trauma, Heal, and Grow!

79% of health care workers report secondary stress symptoms and vicarious post-traumatic growth1. So in this video, we’re going to talk about vicarious trauma and how to deal with it. Secondary stress is related to job burnout2 and compassion fatigue5, which has even been called secondary traumatization4. In other words, what increases compassion fatigue will also increase burnout, vicarious trauma, and PTSD-like symptoms2.

Both secondary stress and vicarious trauma come from secondary exposer to the survivor’s trauma and both display PSTD-like symptoms, but vicarious trauma also changes how you see the world6 and affects you emotionally7. It comes from continuous empathic engagement with the traumatized survivors7.

Basically, you’re constantly exposed to the survivors’ trauma-related imagery and intrusive thoughts, and these can stick with you well after you’re done interacting with the survivor8. Therapists who treat trauma often experience the same PTSD symptoms as their traumatized clients, even though they only hear about the secondhand trauma10,11, and for therapists, it can diminish their ability to provide treatment11. These PSTD symptoms might include flashbacks, nightmares, fatigue, and intrusive thoughts, all of which can impact your empathy12.

Emotionally, you end up feeling unsafe10,15. You can also feel a deep sense of helplessness and sadness, frustration with relationships19, anxiety20­, heaviness 22, physically and emotionally drained20, distress3, and detached15. In one therapist’s words:

“So then I get angry when I hear about what they’ve gone through in that moment or I get sad . . . it’s been hard . . . I would have trouble staying present, I would have trouble staying connected, I would get tired.”12

Experiencing shock is also a typical emotion that comes from listening to the traumatic events, and it comes up consistently in the research25,26 . Some therapists have even reported never hearing anything like the traumatic experience before27 and thinking that it couldn’t happen25. One therapist stated,

“And the more traumatic the story, the more tiring that is because you’re trying to empathize and also understand and not look horrified. I think that’s the other thing: you’re sort of trying to not sort of judge the patient.“ 12

However, the more experience and time you have, the less impact you’ll have from these overwhelming negative emotions and distress29.

New therapists tend to struggle with vicarious trauma more than experienced therapists do19. Therapists with a few years’ experience found the work extremely challenging and emotionally draining. They wanted to pull away from the survivors, establish boundaries, and avoid overidentifying themselves with the survivor.

The more experienced therapists, however, were able to engage in the trauma work without the emotional toll and were able to distinguish themselves from the vicarious trauma 19.

That is in fact one way to fight the detrimental emotional effects of vicarious trauma, which is being empathic without enmeshing yourself with the survivor, instead understanding that you’re two different people34. Basically, it protects you from the vicarious trauma35. Other ways to protect include feeling satisfied with your work34 and effective in helping the survivor10. Feeling grateful and appreciation for your own life will also help12

Mentally, vicarious trauma changes how you see the world 3,10,37, and it can change how you think about your psychological needs, which include safety, trust, esteem, intimacy, and control.

For example, we all have a psychological need to believe the world is safe7, but constant second-hand exposure to the trauma makes you view the world as unsafe3,38 and people as untrustworthy38.

The shifts in your worldview can come from the empathic engagement with the client39 and can affect how you view yourself40,41, your identity20, other people41 , and the population as a whole20. They can also lead to inappropriate therapeutic boundaries like missing appointments and inappropriate contact38. The survivors’ trauma can even permeate your memories37.

You want to fight the mental changes of vicarious trauma through different outlooks on life. Having a positive, optimistic, and hopeful outlook all will help3.

As one therapist stated,

“People who do trauma work have some sort of eternal hope. There are others who can’t find that and leave.”29

You want to see the world as a place of beauty and potential, while being optimistic that the therapeutic process is meaningful, that problems are solvable, and that people can only tackle what they can handle34. Just as important, you want to view the survivors as growing and the trauma as beneficial by seeing trauma work as planting seeds instead of looking for huge gains10,39. By accepting that there are no instant results, you’ll be able to appreciate the small changes:

“I think its small gains . . . where you see, the occasional resilient person that’s got through and made the best of what they’ve got and they’ve done really well and that, it’s like that’s worth three of the others.” 12

Self-care is a general but important activity that reduces vicarious trauma3,19,20,34, but just because you believe self-care is important doesn’t mean you’re likely to do it44. In fact, overworking, too much stress20 and having maladaptive beliefs44 lead to doing less self-care. Practicing therapists, however, report that not taking care of themselves puts them at risk for harming others. Self-care should be holistic and cover your physical, emotional, spiritual, and aesthetic needs34. So, check out my video on self-care for more tips on how to practice it.

You also want to make sure you have a support network 19,34 and a supportive work environment 3,10,20,34. This work environment should give you a varied caseload 19,34, clear boundaries34, and supervision 38,44, because it provides resources48, validation, and support49.

Religious and spiritual practices are also important10,19,34, because they will reinforce that people are resilient, that there’s more to life than suffering, that your work is meaningful, and that people can grow even through trauma34.

In fact, you can experience post-traumatic growth from indirect trauma55 and you can experience both vicarious trauma and vicarious post-traumatic growth at the same time10,19.

“I feel very sad, very sorry, but I feel very. . .empowered. I feel very honored that I am asked to assist people. And that for me is something that I can grab like — you know — a real light switch.”34

Both vicarious trauma and vicarious post-traumatic growth come from your empathy with the traumatized survivor, but which one you experience is based on your worldview3.

“It’s also a beautiful and inspiring time as a clinician because you’re holding, you’re sitting in this darkness with them, but you’re seeing their strength and courage which is so beautiful and it’s often stronger than the trauma. “19

To put yourself in a state of post-traumatic growth, you need to see the survivors’ growth10,25, and it can be shocking to see them cope and grow25

“I have follow up with some of my clients and I’m reminded that. . .women learn how to laugh and be silly again. . .I truly feel it’s watching a rebirth of a human being.” 10

You also want to see them as resilient19

“I’ve learnt how strong and resilient people are, and how much inner resources and strengths people have.” 26

Distracting yourself to get distance from the situation and reframing the trauma in a positive light lead to more vicarious post-traumatic growth12. However, it’s also strongly suggested that you can benefit from embracing the trauma rather than distancing yourself from it34, as secondary stress provides the fertile ground for vicarious post-traumatic growth to occur50. Traumas cause psychological pain, which bring about mental restructuring like more wisdom, stronger relationships, and more acceptance, and it leads to being open to new experiences51. But, you want to use your coping skills to promote vicarious post-traumatic growth52. Vicarious trauma does change you, but the positive changes mean you will value your profession more53, trust in the therapeutic process more, and become better therapists29. Thankfully, these positive changes you’ll experience to your worldviews are permanent54

REFERENCES

1. Kalaitzaki, Tamiolaki, & Tsouvela (2021) From Secondary Traumatic Stress to Vicarious Posttraumatic Growth Amid COVID-19 Lockdown in Greece: The Role of Health Care Workers’ Coping Strategies https://pubmed.ncbi.nlm.nih.gov/33759805/

2. Cieslak et al. (2014) A meta-analysis of the relationship between job burnout and secondary traumatic stress among workers with indirect exposure to trauma. https://pubmed.ncbi.nlm.nih.gov/23937082/

3. Cohen & Collens (2013) The Impact of Trauma Work on Trauma Workers: A Metasynthesis on Vicarious Trauma and Vicarious Posttraumatic Growth https://psycnet.apa.org/record/2012-30277-001

4. Figley (1995) Compassion fatigue: Coping with secondary traumatic stress disorder https://psycnet.apa.org/record/1995-97891-000

5. Bride, Radey, & Figley (2007) Prevalence of secondary traumatic stress among social workers https://pubmed.ncbi.nlm.nih.gov/17388084/

6. Sabin-Farrell & Turpin (2003) Vicarious traumatization: Implications for the mental health of health workers. https://pubmed.ncbi.nlm.nih.gov/12729680/

7. Pearlman & Saakvitne (1995) Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors https://psycnet.apa.org/record/1995-97990-000

8. Hesse (2002) Secondary trauma: How working with trauma survivors affects therapists https://psycnet.apa.org/record/2002-15763-006

10. Bell et al. (2003) Strengths and secondary trauma in family violence work https://pubmed.ncbi.nlm.nih.gov/14620108/

11. Bride (2004) The impact of providing psychosocial services to traumatized populations https://psycnet.apa.org/record/2004-11905-003

12. McCormak & Adams, (2016) Therapists, Complex Trauma, and the Medical Model: Making Meaning of Vicarious Distress from Complex Trauma in the Inpatient Setting https://psycnet.apa.org/record/2015-12656-001

15. Clemans (2004) Life changing: The experience of rape-crisis work https://journals.sagepub.com/doi/abs/10.1177/0886109903262758?journalCode=affa

19. Wang & Park-Taylor (2021) Therapists’ Experiences of Counseling Foreign-National Sex-Trafficking Survivors in the U.S. and the Impact of COVID-19 https://tinyurl.com/yfzhutty

20. James (2014) Addressing Secondary Trauma in Social Workers Counseling Trauma Survivors https://sophia.stkate.edu/cgi/viewcontent.cgi?article=1335&context=msw_papers

22. Betts Adams et al. (2001) The traumatic stress institute belief scale as a measure of vicarious trauma in a national sample of clinical social workers https://psycnet.apa.org/record/2001-01705-002

24. Smith, Kleijn, Trijsburg, & Hutschemaekers (2007) How therapists cope with clients’ traumatic experiences https://pubmed.ncbi.nlm.nih.gov/19289893/

25. Splevins et al. (2010) Vicarious posttraumatic growth among interpreters https://pubmed.ncbi.nlm.nih.gov/20663936/

26. Steed & Downing (1998) A phenomenological study of vicarious traumatization amongst psychologists and professional counsellors working in the field of sexual abuse/assault https://psycnet.apa.org/record/2001-03472-003

29. Lonergan et al. (2004) The development of the trauma therapist: A qualitative study of the child therapist’s perspectives and experiences https://psycnet.apa.org/record/2005-02600-004

31. Neumann & Gamble (1995) Issues in the professional development of psychotherapists: Countertransference and vicarious traumatization in the new trauma therapist https://psycnet.apa.org/record/1996-12134-001

34. Harrison & Westwood (2009) Preventing vicarious traumatization of mental health therapists: Identifying protective practices https://pubmed.ncbi.nlm.nih.gov/22122619/

35. Halevi & Idisis (2018) Who helps the helper? Differentiation of self as an indicator for resisting vicarious traumatization https://pubmed.ncbi.nlm.nih.gov/29016154/

37. Baird & Jenkins (2003) Vicarious traumatization, secondary traumatic stress, and burnout in sexual assault and domestic violence agency staff https://pubmed.ncbi.nlm.nih.gov/12733620/

38. Trippany, Kress, & Wilcoxon (2004) Preventing Vicarious Trauma: What Counselors Should Know When Working With Trauma Survivors https://ovc.ojp.gov/sites/g/files/xyckuh226/files/media/document/vt_summary_and_a_new_theory-508.pdf

39. Adams et al. (2008) The compassion fatigue scale: Its use with social workers following urban disasters https://journals.sagepub.com/doi/abs/10.1177/1049731507310190

40. Pearlman (1996) Psychometric review of TSI Belief Scale, Revision-L In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaptation (pp. 415–417) https://www.amazon.com/Measurement-Stress-Trauma-Adaptation-Hudnall/dp/1886968020

41. Buchananm, Anderson, Uhlemann, & Horwitz (2006) Secondary Traumatic Stress:
An Investigation of Canadian Mental Health Workers https://psycnet.apa.org/record/2011-14494-003

42. Pearlman & MacIan (1995) Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists https://psycnet.apa.org/record/1996-15656-001

45. Bride & Figley (2009) Secondary Trauma and Military Veteran Caregivers https://psycnet.apa.org/record/2009-22348-009

46. Bober & Regehr (2005) Strategies for Reducing Secondary or Vicarious Trauma: Do They Work? https://psycnet.apa.org/record/2006-01882-001

48. Catherall (1995) Coping with secondary traumatic stress: The importance of the therapist’s professional peer group. In B. H. Stamm (Ed.) Secondary traumatic stress: Self-care issues for clinicians, re- searchers, and educators https://www.amazon.com/Secondary-Traumatic-Stress-Clinicians-Researchers/dp/1886968071

49. Oliveri & Waterman (1993) Impact on therapists. In J. Waterman, R. J. Kelly, M. K. Oliveri, & J. McCord (Eds.), Behind the playground walls: Sexual abuse in preschools https://www.ojp.gov/ncjrs/virtual-library/abstracts/behind-playground-walls-sexual-abuse-preschools

50. Joseph (2011) What doesn’t kill us: The new psychology of posttraumatic growth https://tinyurl.com/53bfpcba

51. Tedeschi and Calhoun (2004) Target article: “Posttraumatic growth: Conceptual foundations and empirical evidence https://psycnet.apa.org/record/2004-11807-003

52. Rodríguez-Rey et al. (2017) Posttraumatic growth in pediatric intensive care personnel: Dependence on resilience and coping strategies https://pubmed.ncbi.nlm.nih.gov/27929306/

53. Shamai & Ron (2009) Helping direct and indirect victims of national terror: Experiences of Israeli social workers https://journals.sagepub.com/doi/10.1177/1049732308327350

54. Arnold et al. (2005) Vicarious posttraumatic growth in psychotherapy https://psycnet.apa.org/record/2005-02539-007

55. Manning-Jones et al. (2015) Secondary traumatic stress, vicarious posttraumatic growth, and coping among health professionals; A comparison study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7747932/