Vicarious Trauma

Katie LonganeckerLisa Karch

Minnesota State University MoorheadCounseling and Student Affairs Graduate Program

“Our capacity to help others is greatest when we are willing, able, and even determined to be

helped ourselves.” - Van Dernoot Lipsky, 2009

“Just as no survivor can recover alone, no therapist can work with Trauma alone” - Herman

1992

Presentation Outline Define Vicarious Trauma Signs and Symptoms Impact on Counselors Prevention Coping Strategies

Definition• Trauma is defined as an actual or threatened death or injury to

ones self or others around which feeling of fear, helplessness, and horror were present

• Vicarious Trauma impacts the ways in which the world looks and feels like a different place to you as a result of your doing your work

• Refers to the cumulative effect of working with traumatized clients

Definition• Vicarious Trauma includes profound and permanent changes in

how counselors think, feel, and behave in relation to others and themselves as a result of their exposure to and empathic bonding with their clients' traumatic material

• Three conditions facilitate vicarious trauma:

– Empathic engagement and exposure of the therapist to graphic and traumatic material

– Empathic engagement and exposure of the therapist to the reality of human cruelty

– Therapists participation in traumatic re-enactments where client responses re-enact elements of their trauma within the therapy process

Definition• Vicarious trauma results in a reduced capacity or interest in

being empathic or “bearing the suffering of clients” and is “the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced or suffered by a person”

Signs and Symptoms• DSM – IV – TR acknowledges that learning about traumatic

events experienced others can contribute to symptoms of post-traumatic stress disorder (PTSD) and this may be particularly disturbing “when the stressor is of human design”

• Trauma reactions divided into three categories:

– Intrusive: persistent re-experiencing of the traumatic event (images and thoughts, physiological reactions, and dreams)

– Avoidant: general numbing in responsiveness and avoidance of trauma-related stimuli

– Arousal: hyper vigilance and difficulty concentrating

Signs and Symptoms• Symptoms of vicarious trauma closely resemble the signs and

symptoms of direct trauma and can by specific to the type of trauma being treated, ie. sexual assault counselors having nightmares about sexual assault

• Immediate Reactions include: intrusive imagery, nightmares, increased fears for the safety of oneself and loved ones, avoidance of violent stimuli in the media, difficulty listening to clients' accounts of events, irritability, emotional numbing

• Long-Term Reactions include: emotional and physical depletion, a sense of hopelessness, a changed world view in which others are viewed with suspicion and cynicism

Signs and Symptoms• Warning Signs:

– Feeling Helpless and Hopeless

– A sense that one can never do enough

– Hyper vigilance

– Diminished Creativity

– Inability to embrace complexity

– Minimizing

– Chronic Exhaustion/Physical Ailments

Signs and Symptoms• Warning Signs (continued):

– Dissociative Moments

– Sense of Persecution

– Guilt

– Anger and Cynicism

– Inability to Empathize/Numbing

– Addictions

– Inflated sense of importance related to one's work

– Inability to listen/Deliberate Avoidance

Impact on Counselors• Vicarious Trauma is most prevalent in counselors working with

victims of interpersonal violence such as domestic violence, child abuse, rape, and torture

– Also impacts counselors working with traumatic stressors unrelated to interpersonal violence such as cancer and death

• Primary predictor of developing vicarious trauma is the number of hours per week spent working with traumatized clients

• Higher incidences of vicarious trauma are associated with higher levels of exposure and lower levels of experienced working with traumatized clients

Impact on Counselors• Unresolved vicarious trauma may be one the causes of burnout

for counselors working with traumatized clients

• Vicarious trauma particularly impacts novice counselors or counselors new to the field of trauma work

Prevention• Lowered number or percentage of trauma cases on caseload

• Diversify caseload with not all trauma clients if possible

– If caseload is all trauma, counselors could benefit from participating in social change activities (foster a sense of hope and empowerment)

• Fostering a safe, comfortable, and private work environment if high trauma caseload

• Learning about vicarious trauma and accepting it as a normal part of doing trauma work

• Trauma specific education and trauma sensitive supervision

Prevention• Balance between life and work

• Self-care activities

• Hobbies, Leisure Activities

• Availability of social support, especially from others working in field of trauma work

• Any personal history of trauma dealt with through counseling

• Supervision and consultation

• Clear boundaries with clients

Prevention• PERCEIVED level of social support

• Sense of competence and coping

• Maintaining objective motivation

• Resolving any past personal traumas

• Drawing on positive role models for coping

Coping Strategies• Ask yourself these important questions:

– Why am I doing this work? What is my plan B?

• We choose the work we do, have options and knowing this may serve to re-motivate you

– Is this working for me? If not, what can I do to make it work for me?

– Where do I put my focus? Does this help me or make things harder for me?

Coping Strategies• Due to the confidential nature of work supervising and peer

consultation are key

– Develop a support system to help share the burden

• Practice Self Care

• Be patient and compassionate, with yourself, with your co-workers, and with your clients

• Building compassion and community

• Find a healthy balance for all areas of your life

• Practice compassion for myself and others

Coping Strategies• Personal psychotherapy for any past trauma and also any

impacts you are seeing from current work

• If caseload cannot be changed, leave at close to end of the day take regular breaks, full lunch hours, and regular vacations

• Know limits and be firm in keeping them

Resiliency• Trauma Stewardship is a daily practice through which

individuals, organizations, and societies tend to the hardship, pain, or trauma experienced by others. Belief that suffering can be transformed into meaningful growth and healing when a quality of presence is cultivated and maintained even in the face of great suffering

Resiliency• Foster Hope

– Focus on the positive, have confidence in yourself, put things in perspective

• Act with Purpose

– Make a plan, move toward goals, engage in active coping (not avoidance)

• Connect with Others

– Maintain relationships, give and receive help, spend time with others

Resiliency• Take Care of Yourself

– Take care of your body, take time to relax, nurture your spirituality

• Search for Meaning

– Find positive meaning, learn about yourself, look for personal growth

Review

• Vicarious Trauma is neither a reflection of inadequacy on the part of the therapist nor of toxicity or badness on the part of the client. It is best conceptualized as a sort of occupational hazard.

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