Vicarious Trauma Among Helpers

Vicarious Trauma Management and Self-Care

An article by Secure Start Intern, Tara Hearne

Vicarious trauma is a term used to describe the reaction of those who work in a helping role in response to hearing their clients’ trauma stories. Also known as secondary traumatisation or compassion fatigue, vicarious trauma changes a helper’s view about themselves, others and the world via alteration of cognitive schemas of identity, memory systems and belief systems. Cognitive schemas that are commonly impacted by vicarious trauma can be broken down into five psychological needs:

  1. Safety needs – an individual’s sense of security. Individuals experiencing vicarious trauma lose their sense of security and feel as if their personal safety is compromised due to real or imagined threats. When cognitive schemas of safety needs are distorted it manifests as increased levels of feeling vulnerable and fearful, as well as behaviours that may be overly cautious.
  2. Trust needs – an individual’s capacity to trust that their emotional, physical and psychological needs will be met by others, as well as the ability to trust their own perceptions and beliefs. Shifts in cognitive schemas of basic trust present as suspiciousness of others, even in once trustworthy relationships, and stifled self-trust leading to self-doubt.
  3. Esteem needs – an individual’s inherent value for self and others. Changes in cognitive schemas of esteem needs can cause feelings of inadequacy, doubt in own abilities and reduced esteem for others as the likelihood of seeing others and the world as cruel is amplified.
  4. Intimacy needs – an individual’s innate need to feel connected to others and self. Disruptions in cognitive schemas of intimacy needs produce chronic feelings of emptiness when alone which can cause either increased dependence on others or an increased independence from others.
  5. Control needs – an individual’s ability to self-manage and confidence in their own agency in the world. Alterations in cognitive schemas of control needs produce a diminished sense of freedom resulting in behaviours consistent with being either helpless or over-controlling.

Changes in cognitive schemas can be negative but can also be positive and adaptive. With every experience people are exposed to, cognitive schemas are altered. People who are exposed to trauma stories may experience changes in their cognitive schemas but this will not always result in a vicarious traumatisation response; just as with those who experience trauma, not all will develop symptoms of a post-traumatic disorder. When cognitive schemas change in maladaptive ways, as described above, vicarious traumatisation can result, producing symptoms which are much like the symptoms seen in trauma survivors but not as severe. The symptoms include intrusive re-experiencing of the trauma story, avoidance of being exposed to trauma stimuli, depressed mood and heightened startle response, which affect the helper’s personal and professional lives.

Exposure to trauma stories can produce a number of responses which can be thought of on a continuum. On one end, as mentioned above, exposure to stories of trauma can result in a change in cognitive schemas that are positive and adaptive. This response, sometimes referred to as vicarious transformation, can result in the development of personal and professional perspective and growth; the opposite of the effects of vicarious traumatisation. Self-care can help promote vicarious transformation and reduce vicarious traumatisation, therefore self-care is vital for those in a helping role that are exposed to trauma stories. On the other end of the continuum is vicarious traumatisation, as described above. Without some form of management strategy or treatment, vicarious traumatisation can lead to a full posttraumatic stress disorder response.

Vicarious trauma can be similar to, but is distinct from, burnout and counter transference, but these can co-occur. Burnout and vicarious trauma share similar symptoms, but are different. Burnout can happen in any profession due to emotional exhaustion, with onset being gradual, whereas vicarious trauma is the result of being exposed to traumatic stories, with onset generally being sudden or abrupt. Counter transference is the emotional reaction to client’s stories which relate to the helpers life experience and is relevant in sessions or within the context of sessions whereas vicarious traumatisation affects all aspects of the helper’s life.

The impact of vicarious trauma can be significant, changing a helper’s beliefs and realities in the context of interpersonal, intrapsychic, familial, cultural and social aspects of their lives. The adjustment of beliefs causes posttraumatic stress like symptoms to become present. The symptoms are pervasive, meaning they permeate all aspects of the helper’s life and are cumulative, meaning with each exposure to trauma stories changes in beliefs and realities are reinforced, thereby exacerbating symptoms.

Because vicarious trauma can have such a big impact on all aspects of helper’s lives, it also influences their ability to appropriately assist those they are trying to help. Helpers may become less emotionally accessible or show anger toward those they are trying to help. They may avoid trauma stories or become intrusive in the exploration of trauma memories. Helpers may begin to doubt their ability to help thus impacting those they are trying to assist.

Given the impact of vicarious trauma on helpers, and the potential impact helpers behaviour can have on those that they are trying to help, it is important for those in a helping role to take steps to prevent or manage any symptoms related to vicarious trauma.

Management and Self-Care

Peer supervision has been reported as the most common method of dealing with vicarious trauma. Peer supervision provides the chance to debrief, is helpful in providing support and validation while also decreasing feelings of isolation and increasing objectivity, empathy and compassion. Confidentiality barriers make seeking support from regular social networks inappropriate, therefore peer supervision is essential as it facilitates debriefing while adhering to ethical constraints.

Education regarding working with clients with a history of trauma and how this may affect those in a caring role is beneficial in reducing the effect of vicarious trauma. Ongoing training and information has also been shown to decrease trauma related symptomatology. Being made aware of vicarious trauma is in itself a way of preventing and managing trauma reactions.

Maintaining work-life balance in an important aspect of self-care in any profession and particularly so for those who work with trauma clients. To protect a sense of personal identity, having positives in personal life is important, things such as socialising with friends and family, doing creative activities, being physically active, journaling, seeking personal counselling and engaging in meditation and relaxation. Because vicarious trauma can affect a helper’s sense of trust, maintaining a strong social support network is of particular importance in preventing and reducing the effects of vicarious trauma.

Helpers may also benefit from using whatever means that gives them a sense of spirituality. These could include, but not limited to, participating in organised religions, meditations and doing volunteer work. Having a sense of spirituality gives a sense of meaning and connection which can be a protective factor against developing vicarious trauma.

In the case of therapists, counsellors and social workers, vicarious trauma has been found to be greater in prevalence in those who have a high caseload of trauma clients compared to those with only a few. It is therefore beneficial to actively limit, where possible, the number of trauma cases taken on. With trauma clients taken on, it is also important to maintain clear boundaries.

 

Main reference:

Trippany, R. L., White Kress, V. E., & Wilcoxon, S. A. (2004). Preventing vicarious trauma: What counsellors should know when working with trauma survivors. Journal of Counseling and Develpoment, 82, 31-37.

See also:

Courtois, C. A., Ford, J. D., Herman, J. L., & van der Kolk, B. A. (2009). Treating complex traumatic stress disorders: An evidence-based guide. New York: Guilford Press.

Harrison, R. L., & Westwood, M. J. (2009). Preventing vicarious traumatization of mental health therapists: Identifying protective practices. Psychotherapy: Theory, Research, Practice, Training, 46, 203–219.

Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: A review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. Best Practice in Mental Health, 6,(2) 57-68.