What Is Vicarious Trauma?
If vicarious trauma goes unrecognised and unmitigated, helpers develop an entrenched sense of personal victimisation and globalised helplessness which can be difficult to reverse.
It is important to recognise that professional burnout is a phenomenon that can occur in most any professional work setting, while vicarious trauma, secondary traumatic stress, and compassion fatigue are unique to direct practice with crisis and trauma populations (McCann, Sakheim, & Abrahamson, 1998; Schauben & Frazier, 1995; Sexton, 1999).
Recognising and preventing vicarious trauma is the responsibility of both individual workers and organisations (SARC 2017). Whether or not an agency culture acknowledges the existence of VT, STS, and CF as normal reactions to client traumas may significantly contribute to the coping ability of individuals experiencing these conditions. However, there is much we can do as professionals to support ourselves when working with trauma narratives.
What’s the difference?
Burnout
There are three dimensions to the burnout syndrome: emotional exhaustion, depersonalisation and reduced personal accomplishment (Maslach et al. 1996). The dimension of emotional exhaustion refers to the depletion in emotional resources resulting in individuals feeling unable to contribute at a psychological level. Depersonalisation refers to the development of negative and cynical attitudes and feelings towards the client group, and a reduced sense of personal accomplishment involves negative self-evaluation and dissatisfaction with accomplishments within their role.
Compassion Fatigue
The cognitive dissonance caused by repeatedly seeing bad things happen to good people can cause practitioners to take on the view that clients are responsible for their own victimisation. This survivor-blaming reduces staff performance and efficacy, both because the worker’s negativity precludes them from establishing sufficient rapport with clients, and because their pessimistic view of the clients offers them little motivation to engage in objective and helpful dialogue and support with the client. They may, unknowingly, justify their unhelpful stance with thoughts of ‘the client should have known better’ or ‘the client deserved it’ (Figley, 2002).
Vicarious Trauma/Secondary Traumatic Stress
VT and STS are changes in the perceived realities of workers which occur as a result of working with traumatised clients and their stories. A helpful distinction between vicarious trauma and secondary traumatic stress is to conceptualise VT as the internal reactions resulting from a worker’s exposure to a client’s traumatic stories and experiences; while STS is the outward behavioural symptoms. Workers experiencing VT and STS have difficulty ridding themselves of the images and experiences shared by traumatised clients which can, overtime, alter the worker’s own thoughts and beliefs about the world in key areas such as safety, trust, esteem, intimacy and control.
Activated by mirror neurons (neurons which respond to the observed behaviours of others), the listener visualises/recreates the client’s story in their own mind, activating the autonomic nervous system and eliciting a fight/flight/freeze response. Given the role of the worker to remain composed and attentive to their client’s narrative, the worker is forced to ‘rev up’ their own internal resources so as not to act on their psychological responses, causing significant emotional and physical strain.
If vicarious trauma goes unrecognised and unmitigated, helpers develop an entrenched sense of personal victimisation and globalised helplessness which can be difficult to reverse.
Risk Factors
Professionals with high caseloads but minimal clinical experience with trauma clients are particularly vulnerable to vicarious trauma and secondary traumatic stress (Pearlman & Mac Ian, 1995). Similarly, clinicians early in their careers are often still developing their own effective coping strategies and thus are at higher risk of over-identifying with a client’s trauma narrative.
Many other factors, such as those listed below, also impact on a person’s specific vulnerability to developing secondary traumatic stress and vicarious trauma (Figley, 2002; Lerias & Byrne, 2003)
Personal risk factors
- Having personal history of traumatic experiences, particularly victimisation
- Overworking
- Ignoring/blurring client-worker boundaries
- Lack of experience and skill
- Limited personal supports
- Feelings of shame in regard to help-seeking
- Pre-existing mental health condition, predominantly anxiety, mood disorder or PTSD
- Elevated personal stress or distress ie loss, grief, change
- Poor self-care
- Limited self-reflection
Organisational risk factors
- Under-skilled supervisory support
- Stoic agency culture
- Institutionalised burnout or fatigue
- Dismissive culture regarding impact of trauma work on practitioners
- Solitary and isolating work environment
- Focus on outcomes over process
- Lack of policies and procedures regarding worker wellbeing and mental health
- Limited professional development and training opportunities
Client-based risk factors
- Trauma narratives, especially chronic or repeated trauma experiences
- Boundary violations
- Transference of feelings and experiences onto worker
- Pessimism regarding effectiveness of worker interventions
What Can Be Done?
Developing self-care strategies that increase connection, meaning, values-based living, safety, pleasure, and a sense of ease and excitement is the key to mitigating risks to your wellbeing. These activities provide a buffer and alternate view point to some of the more challenging aspects of human services work, whilst also energising practitioners so that they have more to offer to their clients, colleagues, communities and loved ones.
Depending on many individual factors, personal self-care strategies will vary from person to person. Whilst one person may find a sense of connection and inner-peace through meditation and yoga, another may feel invigorated and grounded by swimming in the ocean or walking in the bush. Depending on the reality of the time available, self-care may often involve just a 5 minute ‘time-out’ to ground and reset, or a quick Google search of something that creates joy or laughter.
When considering self-care strategies within the professional field, it is important to note that each workplace will have its own unique culture around self-care, and access and availability to particular professional self-care strategies will vary significantly. It would be a worthwhile activity for practitioners to familiarise themselves with the activities available to them within that realm, and considering their potential benefits.
Some workplaces may have specific policies and procedures which includes participation in regular supervision, access to Employee Assistance Programs (EAPs), mandated break times or social clubs. Some workplaces even offer free massages to employees!
Most importantly, any practitioner that is concerned for their mental health or the mental health of a colleague (or loved one) should seek professional support to work through the trauma and ameliorate the risk of it becoming a chronic disorder.
