Vicarious trauma for helping professionals – tips for organisations
In a follow-up from his previous post, guest author Dr. Don Russell discusses how vicarious traumatisation also affects organisations and gives some practical strategies to create a healthy, resilient and compassionate workplace.
Vicarious trauma is an under-recognised health issue for a broad spectrum of health professionals. Professionals who ignore their risk of exposure do so at their peril. In an earlier blog entry I discussed what vicarious trauma is, how it develops from a neuroscience perspective, and what an individual can do to prevent and mitigate its effects. In this blog, let’s address how an organisation or agency can create cultural strategies to immunise the whole organisation against vicarious trauma.
Mary-Beth shifted uneasily in her seat at the Tuesday morning staff meeting at the Child Protection Agency where she had been working for the past eight months. She listened as the manager talked disparagingly about the parents in a case where two children needed to be apprehended for their protection. The manager used demeaning and objectifying language to describe the parents and their addiction problems that had prompted the intervention. This was a casual aside to making another point, but it was jarring to Mary-Beth. She scanned around the table to see if others found the comments as incongruous and unsettling as she did. She grew even more uncomfortable as she realised the others were apparently oblivious to the disrespect and perhaps shared the manager’s attitude.
The dissonance that (the fictitious) Mary-Beth experienced suggests two conclusions. Firstly, that Mary-Beth is working in an organisational culture that has been impaired by collective vicarious trauma and, secondly, that she may want to update her resume and move on if she wants to maintain her well-being and passion for her work.
This might sound harsh, but the reality is that organisations suffer from vicarious trauma just as individuals do. Those effects, if unmanaged, will create a culture in the organisation that propagates and reinforces the vicarious traumatisation at an individual level. Fortunately, organisational culture can work in a constructive and uplifting way too. An organisation that is collectively mindful of vicarious traumatisation and actively manages its trauma response can actually be protective to the staff.
What makes an organisation vulnerable?
As we discussed in the previous blog on individual traumatisation, it is the human capacity for empathy that sets us up for vicarious traumatisation. We have the innate ability to feel what another person is feeling. If the other person is experiencing trauma or recounting a traumatic event, then our “empathy circuit” has us feeling traumatised as well.
Beyond that simple equation, we also need to recognise that some organisations and agencies have a culture that makes vicarious traumatisation more likely — and it’s important to look at those factors. Of course, we must also carefully examine how we can create an organisational culture that protects its staff members from the effects.
It can help to think of your workplace as a system, and to draw comparisons and contrasts between a healthy family system and a healthy workplace. Take a look at the following four characteristics of an unhealthy culture and notice how they promote helplessness, isolation, invalidation, and lack of safety within the individual:
Some organisations have created a culture of hyper-independence, in which staff are expected to handle their caseloads without guidance or oversight. This might be unconsciously intentional by leadership, or the result of limited staffing. While staff autonomy is mostly a good thing, it can have the unfortunate by-product of creating an unspoken agreement that a staff member should only reach out for support or to debrief in extreme situations. The effect is creating silos where staff aren’t fully aware of others’ work and creates isolation. Shame can also creep in alongside the isolation, because there isn’t the opportunity for validation among staff.
2Prioritising the mission over the people
Many organisations have their origins in humanitarian missions and that ethos continues to the present. The focus on the mission (for example “serving the disenfranchised in the inner city”) can easily cause the staff serving toward the delivery of that mission to feel that they are mere cogs in the wheel. If an individual is distressed and not effective in their role, they get left on the sidelines and replaced with a new person with a fresh enthusiasm for the mission.
3Compliance over conversation
The concept of group-think is well-understood, but continues to be a hazard to organisational effectiveness. It happens primarily because of a culture that does not actively foster diversity of opinion or trust that the liberal exchange of ideas will lead to the best thinking. In an organisation or agency, the use of power to achieve conformity and compliance has the effect of silencing staff members’ voices.
4Performance over presence
The corporate world is dominated by “outcomes”, “deliverables”, and performance reviews. But the value system signified by those terms has begun to leak into other professions, including healthcare. While it’s important to be effective as individuals and organisations,, if those metrics are the primary way of evaluating success, we are liable to inadvertently dehumanise staff.
These are a few of the characteristics of an organisation that is likely to create vicarious trauma. Now, if you review the list above again, notice these are also markers of a dysfunctional family system.
What can an organisation do to prevent and mitigate the effects of vicarious traumatisation?
“Binge watching”, presidents tweeting, the gig economy, and BLM are all new cultural phenomena in the last ten years. These are proof that culture can change. In fact, culture will always evolve. A workplace culture can also change, and change for the better using intentional strategies and a vision.
Intentional strategising to avoid the “family dysfunctions” listed above will go a long way to immunising your organisation against vicarious traumatisation.. Here are some practical steps an organisation could take to achieve this goal — think of these as organisational resilience strategies or stress-hardiness strategies:
Make sure all members of staff are trauma-informed, even if they are not engaging directly with clients/patients. It is helpful for each person to understand their role in the larger system.
Empower staff by establishing clear expectations and clear boundaries i.e. who is responsible for what. Clarity around this provides psychological containment and reduces general anxiety and fear.
Create a culture of psychological safety, which allows staff to be comfortable enough with vulnerability to ask for help. Even the most competent staff member needs assistance from time to time. It must be acceptable for them to reach out and ask for what they need.
Teach front-line service providers “low-impact debriefing”. I am indebted to Laura van Dernoot Lipsky and Connie Burk, authors of Trauma Stewardship for this wise advice. To give a brief summary, low-impact debriefing starts with asking for consent. This gives the hearer an opportunity to say, “no, I am just between meetings, I can’t give you my full attention, but how about at 3:30?” Or if the answer is affirmative, the speaker also gives fair warning that what follows may be heavy, which prevents the “ambushing” effect that is a key component of trauma. Any disclosure should be limited to only what is necessary without including graphic details An example of an appropriate level of disclosure might be something along the following lines: “I was just in an appointment with a person who experienced an assault, and it left me rattled because they reminded me of my mother who might experience the same thing and it left me feeling so vulnerable.”
Finally, one of the most powerful strategies an organisation can implement is intentionally building a culture of empathy and self-compassion, modelled from the top down. It only takes a moment to reframe a conversation marked by victim-blaming, judgment, and shaming, to a conversation characterised by compassion and understanding. If this becomes typical, it will change the cultural DNA of an organisation to be more resistant to the effects of vicarious traumatisation.
For further reading
Conn, S. (2018). Increasing Resilience in Police and Emergency Personnel: Strengthening Your Mental Armor. Routledge.
Gentry, J. & Dietz, J. (2020). Professional Resilience. Outskirts Press.
Luthans, F. & Yousef-Morgan, C. (2009). “Positive Workplaces,” in Oxford Handbook of Positive Psychology. 3rd ed. Edited by C. Snyder. Oxford University Press.
Mathieu, F. ( 2012). The Compassion Fatigue Workbook. Routledge.
Rothschild, B. (2006). Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma. W.W. Norton.
Steele, W. (2020). Reducing Compassion Fatigue, Secondary Traumatic Stress and Burnout: A Trauma Sensitive Workbook. Routledge.
Van Dernoot Lipsky, L.& Burk, C. (2009). Trauma Stewardship. Burrett-Kooehler.
As a clinician, you may be vulnerable to taking on the trauma of your patients or experiencing what's known as vicarious traumatisation. Learn some of the warning signs and ways to avoid it in this guest post from Dr. Donald Russell.
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