Vicarious traumatization explained

Vicarious trauma (VT) is a term invented by Irene Lisa McCann and Laurie Anne Pearlman that is used to describe how work with traumatized clients affects trauma therapists.[1] The phenomenon had been known as secondary traumatic stress, a term coined by Charles Figley.[2] In vicarious trauma, the therapist experiences a profound worldview change and is permanently altered by empathetic bonding with a client. This change is thought to have three requirements: empathic engagement and exposure to graphic, traumatizing material; exposure to human cruelty; and the reenactment of trauma in therapy. This can produce changes in a therapist's spirituality, worldview, and self-identity.

Vicarious trauma is a subject of debate by theorists, with some saying that it is based on the concepts of countertransference and compassion fatigue. McCann and Pearlman say that there is probably a relationship to these constructs, but vicarious trauma is distinct. Understanding of the phenomenon is evolving.

Signs and symptoms

Symptoms of vicarious trauma align with those of primary trauma. As professionals attempt to connect with their clients emotionally, the symptoms of vicarious trauma can create emotional disturbances such as sadness, grief, irritability, and mood swings.[3] Signs and symptoms of vicarious trauma parallel those of direct trauma, although they tend to be less intense. Workers with personal-trauma histories may be more vulnerable to VT, although research findings are mixed.[4] Common signs and symptoms include social withdrawal, mood swings, aggression, increased sensitivity to violence, somatic symptoms, sleep difficulties, intrusive imagery, cynicism, sexual difficulties, difficulty managing boundaries with clients, and relationship difficulties which reflect problems with security, trust, esteem, intimacy, and control.[5] [6] [7] [8] [9] [10] [11]

Contributing factors

Vicarious trauma, conceptually based in constructivism,[12] [13] [14] arises from interaction between individuals and their situations. A helper's personal history (including prior traumatic experiences), coping strategies, support network, and other things interact with his or her situation (including work setting, nature of the work, and clientele served) and may trigger vicarious trauma. Individuals respond and adapt to, and cope with, VT differently. It has been suggested that traumatization occurs when one's view of the world, or a feeling of safety, is shattered by hearing about the experiences of a client. This exposure to trauma can interrupt a clinician's daily functioning, reducing their effectiveness.[15]

Anything that interferes with a helper's ability to fulfill his or her responsibility to assist traumatized clients can contribute to vicarious trauma. Many human-service workers report that administrative and bureaucratic factors that are an impediment to their effectiveness influence work satisfaction.[16] Negative aspects of an organization such as reorganization, downsizing in the name of change management, and a lack of resources in the name of lean management contribute to burned-out workers.[17] [18] [19]

Vicarious trauma has also been attributed to the stigmatization of mental-health care by service providers. Stigma leads to an inability to engage in self-care; the service provider may reach burnout and become more likely to experience VT.[20] Research has begun to indicate that vicarious trauma is more prominent in those with a prior history of trauma and adversity.[20] A mental-health provider's defense style might pose a risk factor for vicarious traumatization; mental-health providers with self-sacrificing defense styles have been found to experience increased vicarious traumatization.[21] Among EMS personnel, previous-veteran status increased the likelihood of experiencing vicarious trauma. [22]

Related concepts

Although the term "vicarious trauma" has been used interchangeably with "compassion fatigue", "secondary traumatic stress disorder," "burnout," "countertransference" and "work-related stress," differences exist:

Mechanism

The posited mechanism for vicarious traumatization is empathy.[25] [26] Different forms of empathy may have different effects on helpers. Batson and his colleagues have conducted research that might aid trauma helpers in managing empathic connection constructively.[27] [28]

Measurement

VT has been measured in a variety of ways. Vicarious trauma is a multifaceted construct, requiring a multifaceted assessment. Aspects of VT that would need to be measured for a full assessment include self-capacities, ego resources, frame of reference (identity, world view, and spirituality), psychological needs, and trauma symptoms.[29] They include:

Vicarious traumatizationmay be addressed with awareness, balance, and connection.[40] One set of approaches is coping strategies, which include self-care, rest, escape, and play. A second set of approaches can be grouped as transforming strategies, which aim to help workers create community and find meaning through the work. Within each category, strategies may be applied in one's personal and professional lives.[41] Organizations that provide trauma services can also play a role in mitigating vicarious trauma.[42] [43]

Many simple things increase happiness, which lessens the impact of vicarious traumatization. People who are more socially connected tend to be happier.[44] People who consciously practice gratitude are also shown happier.[45] Creative endeavors that are detached from work also increase happiness.[46] Self-care practices such as yoga, qigong, and sitting meditation have been found helpful.[47] [48] [49] Harvard Business Review, in a case study of traumatization, noted the importance of an organizational culture which values social workers and counselors.[50] Research indicates that clinicians exposed to vicarious trauma need targeted interventions such as respite, increasing self-efficacy, and appropriate professional support increase their resilience and act as a buffer against vicarious trauma.[51]

Prognosis

Children have been found to experience vicarious trauma from trauma experienced by their caregivers and peers. Girls experience VT more than boys, and socioeconomic status and race have been found to predict vicarious trauma symptoms.

Counselors and other mental-health professionals have been found to experience vicarious trauma when working with veterans and others who have experienced trauma. Factors that predict vicarious-trauma severity include professional trauma, level of peer supervision, population served by the clinician,[52] defense mechanisms of the therapist,[53] emotional coping strategies, and social-support availability. Foster parents have also been found to experience vicarious trauma related to the trauma of their children. Several studies have found that foster parents experience vicarious trauma, burnout and compassion fatigue, and report emotional disengagement (a common symptom of VT) as a coping strategy.[54] [55]

See also

Further reading

External links

Notes and References

  1. McCann. Irene Lisa. Pearlman. Laurie Anne. 1990. Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress. 3. 131-149. 10.1007/BF00975140. 1 January 2024.
  2. Book: Russo. Chuck. Aukhojee. Prashant. McQuerrey Tuttle. Brooke. Johnson. Olivia. Davies. Mark. A. Chopko. Brian. Papazoglou. Konstantinos. 2020. POWER: Police Officer Wellness, Ethics, and Resilience. 7. Academic Press. 97-115. 978-0-12-817872-0. 10.1016/B978-0-12-817872-0.00007-0.
  3. Catanese. Shiloh A.. September 2010. Traumatized by association: The risk of working sex crimes.. Federal Probation. 74. 2. 1555-0303.
  4. For a review of this literature, see Bride. Brian E.. 1 January 2004. The Impact of Providing Psychosocial Services to Traumatized Populations. Stress, Trauma, and Crisis. 7. 1. 29–46. 10.1080/15434610490281101. 71313058. 1543-4613.
  5. Arvay. M.. Uhlemann. M.R.. 1996. Counsellor stress in the field of trauma: A preliminary study. Canadian Journal of Counselling. 30. 3. 193–210.
  6. Bober. Ted. Regehr. Cheryl. Zhou. Yanqiu Rachel. January 2006. Development of the Coping Strategies Inventory for Trauma Counselors. Journal of Loss and Trauma. 11. 1. 71–83. 10.1080/15325020500358225. 144405929. 1532-5024.
  7. Brady. Joan Laidig. Guy. James D.. Poelstra. Paul L.. Brokaw. Beth Fletcher. 1999. Vicarious traumatization, spirituality, and the treatment of sexual abuse survivors: A national survey of women psychotherapists.. Professional Psychology: Research and Practice. 30. 4. 386–393. 10.1037/0735-7028.30.4.386. 1939-1323.
  8. Cunningham. Maddy. 1 August 1999. The Impact of Sexual Abuse Treatment on the Social Work Clinician. Child and Adolescent Social Work Journal. 16. 4. 277–290. 10.1023/A:1022334911833. 140975279. 0738-0151.
  9. Ghahramanlou. M.. Brodbeck. C.. 2000. Predictors of secondary trauma in sexual assault trauma counselors. International Journal of Emergency Mental Health. 2. 4. 229–240. 1522-4821. 11217154.
  10. Book: Pearlman, Laurie A. Trauma and Attachment Belief Scale Manual. 2003. Western Psychological Services. Los Angeles. 828744792.
  11. Schauben. Laura J.. Frazier. Patricia A.. 1995. Vicarious Trauma: The Effects on Female Counselors of Working with Sexual Violence Survivors. Psychology of Women Quarterly. 19. 1. 49–64. 10.1111/j.1471-6402.1995.tb00278.x. 145635689. 0361-6843.
  12. Book: McCann, I. Lisa. Psychological trauma and the adult survivor: theory, therapy, and transformation. 1990. Brunner/Mazel. 978-0-87630-594-2. New York.
  13. Book: Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors. Pearlman. Laurie A.. Saakvitne. Karen W.. 1995. Norton. 978-0-393-70183-8.
  14. Book: Saakvitne, Karen W.. Risking Connection: A Training Curriculum for Working with Survivors of Childhood Abuse. 2000. Sidran Press. 978-1-886968-08-0.
  15. Foreman. Tamarine. 2018-04-01. Wellness, Exposure to Trauma, and Vicarious Traumatization: A Pilot Study. Journal of Mental Health Counseling. en. 40. 2. 142–155. 10.17744/mehc.40.2.04. 1040-2861.
  16. Book: Pryce. Josephine G. Secondary Traumatic Stress and the Child Welfare Professional. Shackelford. Kimberly K.. Pryce. David H.. 2007. Lyceum Books, Inc.. 978-0-19-061591-8. Chicago.
  17. Maslach. Christina. Schaufeli. Wilmar B.. Leiter. Michael P.. February 2001. Job Burnout. Annual Review of Psychology. 52. 1. 397–422. 10.1146/annurev.psych.52.1.397. 11148311. 42874270 . 0066-4308.
  18. Maslach. Christina. 1 October 2003. Job Burnout: New Directions in Research and Intervention. Current Directions in Psychological Science. 12. 5. 189–192. 10.1111/1467-8721.01258. 145581839. 0963-7214.
  19. Rupert. Patricia. Morgan. David. 1 October 2005. Work Setting and Burnout Among Professional Psychologists.. Professional Psychology: Research and Practice. 36. 5. 544–550. 10.1037/0735-7028.36.5.544.
  20. Newcomb. Michelle. Burton. Judith. Edwards. Niki. 2017-08-18. Service user or service provider? How social work and human services students integrate dual identities. Social Work Education. 36. 6. 678–689. 10.1080/02615479.2017.1327574. 149202002. 0261-5479.
  21. Adams. Shelah A.. Riggs. Shelley A.. 2008. An exploratory study of vicarious trauma among therapist trainees.. Training and Education in Professional Psychology. en. 2. 1. 26–34. 10.1037/1931-3918.2.1.26. 1931-3926.
  22. Renkiewicz. Ginny K.. Hubble. Michael W.. 2021-06-15. Secondary Traumatic Stress in Emergency Services Systems (STRESS) Project: Quantifying and Predicting Compassion Fatigue in Emergency Medical Services Personnel. Prehospital Emergency Care. 26 . 5 . 652–663. 10.1080/10903127.2021.1943578. 34128453. 235439364. 1090-3127.
  23. Gamble. SJ. Pearlman. LA. Lucca. AM. Allen. GJ. 1994. Vicarious traumatization and burnout among Connecticut psychologists: Empirical findings. Annual meeting of the Connecticut Psychological Association. Waterbury, CT.
  24. Arnold. Debora. Calhoun. Lawrence G.. Tedeschi. Richard. Cann. Arnie. 1 April 2005. Vicarious Posttraumatic Growth in Psychotherapy. Journal of Humanistic Psychology. 45. 2. 239–263. 10.1177/0022167805274729. 145618063. 0022-1678.
  25. Book: Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma. Rothschild. Babette. Rand. Marjorie L.. 2006. Norton. 978-0-393-70422-8.
  26. Book: Empathy in the Treatment of Trauma and PTSD. Wilson. John P.. Thomas. Rhiannon Brywnn. 23 November 2004. Routledge. 978-1-135-93746-1.
  27. Batson. C. Daniel. Fultz. Jim. Schoenrade. Patricia A.. 1 March 1987. Distress and Empathy: Two Qualitatively Distinct Vicarious Emotions with Different Motivational Consequences. Journal of Personality. 55. 1. 19–39. 10.1111/j.1467-6494.1987.tb00426.x. 3572705. 1467-6494.
  28. Lamm. Claus. Batson. C. Daniel. Decety. Jean. 1 January 2007. The Neural Substrate of Human Empathy: Effects of Perspective-taking and Cognitive Appraisal. Journal of Cognitive Neuroscience. 19. 1. 42–58. 10.1162/jocn.2007.19.1.42. 17214562. 0898-929X. 10.1.1.511.3950. 2828843.
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  31. Weathers. Frank W. Litz. Brett T. Herman. Debra S. Huska. Jennifer A. Keane. Terence M. 1993. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Annual convention of the International Society for Traumatic Stress Studies. San Antonio, Texas. 462.
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  42. Book: Secondary traumatic stress: self-care issues for clinicians, researchers, and educators. Rosenbloom. D.J.. Pratt. A.C.. Pearlman. Laurie A.. 1995. Sidran Press. 978-0-9629164-9-6. Stamm. B.. 66–79. Helpers' responses to trauma work: Understanding and intervening in an organization.
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  44. Kawachi. Ichiro. Berkman. Lisa F.. 1 September 2001. Social ties and mental health. Journal of Urban Health. 78. 3. 458–467. 10.1093/jurban/78.3.458. 11564849. 1099-3460. 3455910.
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  47. Christopher. John Chambers. Chrisman. Jennifer A.. Trotter-Mathison. Michelle J.. Schure. Marc B.. Dahlen. Penny. Christopher. Suzanne B.. 1 July 2011. Perceptions of the Long-Term Influence of Mindfulness Training on Counselors and Psychotherapists: A Qualitative Inquiry. Journal of Humanistic Psychology. 51. 3. 318–349. 10.1177/0022167810381471. 145411787. 0022-1678.
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  52. Helpingstine . Claire . Kenny . Maureen C. . Malik . Fayeza . 2021-06-17 . Vicarious Traumatization and Burnout among Service Providers for Victims of Commercial Sexual Exploitation . Journal of Child Sexual Abuse . 30 . 6 . 722–745 . 10.1080/10538712.2021.1938771 . 1053-8712 . 34137346 . 235460538.
  53. Aafjes-Van Doorn . Katie . Békés . Vera . Luo . Xiaochen . Prout . Tracy A. . Hoffman . Leon . 2021-07-30 . What Do Therapist Defense Mechanisms Have to Do With Their Experience of Professional Self-Doubt and Vicarious Trauma During the COVID-19 Pandemic? . Frontiers in Psychology . 12 . 647503 . 10.3389/fpsyg.2021.647503 . 1664-1078 . 8363079 . 34393887 . free.
  54. K. B. McLain. The impact of burnout, compassion fatigue, and compassion satisfaction on foster parenting. Unpublished PhD dissertation. State University of New York (2008)
  55. Blanchette, J. A. (2011). Compassion Fatigue, Forgiveness, and Empathy in Foster Parents (Order No. 3442295). Available from

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