Alana Buller—Certified Canadian Counsellor and owner of Whole Heart Counselling Therapy in Winnipeg, Manitoba—shares her insights on how practitioners can tend to their emotional needs during this pandemic and continue offering high-quality care for their clients.
Vicarious trauma is an under-recognised health issue for a broad spectrum of health professionals, including those in allied health professions. Professionals who ignore their risk-exposure do so at their potential detriment. This article will review what vicarious trauma is, to whom and how it occurs, the warning signs, and most importantly, how its effects can be mitigated.
Brian (a pseudonym to preserve anonymity) told me: “as I listened to my client complain about her depression symptoms, I tried my best to maintain my empathic expression, but inside I felt like yelling, ‘I just don’t care’”. Brian was a marriage and family therapist, well-regarded in the community and someone I trusted as a sound practitioner. He came to see me because he had recognised some warning bells for himself that he was suffering from vicarious trauma. Cynicism, chronic fatigue and irritability were creeping into his daily life and he couldn’t remember the last time he had laughed out loud. It was a credit to him that he had the self-awareness and the courage to recognise and subsequently reach out to talk about what he was experiencing. His story is not unusual by any means.
What is vicarious traumatisation?
Vicarious traumatisation is specifically hearing about, witnessing or even imagining another’s trauma experience. Traumatisation itself occurs when a person experiences an event they perceive as life-threatening. Helpers of all sorts witness or experience second-hand those life-threatening events either through literally witnessing, or through the recounting of the experience. While the traumatised person is telling the story of the experience to the helper, the helper is imagining the experience in their mind.
Who is vulnerable to vicarious traumatisation?
Most of us understand that vicarious or secondary traumatisation is an issue for military personnel, first responders, and other professionals where the exposure to others’ trauma experiences is obvious. Research indicates that the list of vulnerable vocations is far broader than that. Many healthcare workers, including manual and counselling therapists, are also exposed to the trauma of others.
Vicarious trauma is distinct from and goes beyond the syndrome of burnout. Many jobs that have a high stress level and low level of gratification and meaning create a vulnerability to burnout. Burnout can be defined simply as “chronic workplace stress that has not been successfully managed”. Vicarious trauma also should be differentiated from compassion fatigue or empathic strain. Although compassion fatigue is definitely a liability for professional helpers, it is characterised by a “profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate”.
How does vicarious traumatisation occur?
The ironic part is that vicarious trauma stems from our capacity for empathy: the very quality that attracted many of us to our helping roles. Empathy is simply the ability to feel what another person is feeling. This is mediated by a region of the brain where mirror neurons fire ‘as if’ the empathising person is feeling what the other is feeling, or doing the behaviour the other is doing. This is likely the mechanism that makes a yawn in a staff meeting contagious, or a smile of a stranger on the street likely to be reciprocated. As a result, if the clinician is unmindfully empathising with the client or patient, they will be experiencing the trauma event internally. This is not healthy or sustainable.
What are the warning signs?
There are reliable indicators or warning signs for which helping professionals should monitor themselves. Laura Dernoot and Connie Burk, authors of Trauma Stewardship have compiled an insightful list of signs of what they label “trauma exposure response”. The term is to remind us that trauma exposure is inevitable–it is our response to our trauma exposure that needs to be monitored. The full list is available here.
I will highlight a few that I believe are particularly significant and/or subtle.
1Fight-flight-freeze immobility response
Unsurprisingly, vicarious traumatisation shows up with the same cardinal feature as trauma itself: a chronic hyper-activation of the nervous system. This hyper activation can be a fight, flight, or freeze response. Check yourself to see if you are having regular moments where you are responding more verbally aggressively to colleagues to “just get things done”. That may be a fight response. The flight response can show up in work as avoidance: for example, not returning phone messages, putting off required tasks, and important conversations.The freeze response appears as that sense of being overwhelmed and not knowing what to do next.
2Sense of persecution
This is related to a sense of powerlessness and helplessness. The clinician will feel they are not being paid, valued, or respected by leadership enough. Of course, sometimes these are objectively true and a healthy response would be to seek change in ethical and respectful ways. Alternatively, a professional can succumb to a sense of helplessness, persecution, and belief that we have no influence over our circumstances.
We all forget where we put our keys sometimes. However, when we are finding ourselves spacing out and forgetting what we were doing or saying a moment ago, that is a key indicator that our nervous system has been overloaded by trauma. Check yourself to see if you are more prone to space out and be gone for a few moments during interactions with colleagues. For many, those moments of spacing out are not empty moments, rather, our mind has gone to replay a story we heard or an event we witnessed as an intrusive thought. The essence of dissociation is that the person leaves the present and their perception goes elsewhere.
4Pulled toward confirmation bias and away from critical thinking
Traumatisation takes away openness and creativity and that all-important ability to look at problems in different ways and “think outside the box”. We can find ourselves creating premature closure on an issue or a problem because creative problem-solving is too taxing. Check your engagement with your work to see if you are lapsing into rigid thinking patterns and “hard” responses to co-workers. Check to see if you still have the creativity you brought into your profession.
What can a professional helper do to prevent vicarious traumatisation?
Fortunately, there are also a number of reliable and effective strategies to prevent and mitigate the effects of vicarious trauma. These can be broken down into two categories: individual and organisational. In a subsequent blog, I will outline organisational strategies. For now, let’s talk about how a clinician can help themselves.
- I believe the most important tool to prevent or mitigate vicarious trauma is a close and trusted friend or colleague who is committed to giving you feedback when they recognise some of these signs. I recommend printing out Dernoot and Burk’s diagram (linked) and sharing it with your trusted friend or colleague, asking them to care for your well-being enough to flag the early-warning signs.
- Know your own trauma map. We all need to know our own personal hot buttons. We all have a certain set of circumstances or kinds of stories that resonate a little too close to home, triggering our own sense of victimhood. That is inevitable. When that happens, our own sense of powerlessness, or alternately our sense of rage and injustice will get activated. If we are staying conscious of our own hot buttons we have a much greater capacity to create a healthy empathic distance from the material we witness in our work.
- Use dual awareness to attend to the client/patient and one’s own internal experience simultaneously. As described above, getting too empathically absorbed in the experience of the other is the essence of vicarious trauma. We can manage this risk by maintaining dual attention. Think of this as having one foot in the story we are witnessing and one foot in our own experience, in the present moment: “I am watching my client be terribly upset by her recent loss AND I am noticing that I am remembering how much I miss my mother”. Observing both allows us to protect ourselves from being absorbed in the other’s experience.
- Learn how to mentally and somatically break the “empathy trance”. Babette Rothschild, author of Help For The Helper writes, “when unchecked, somatic empathy can be problematic […] unconscious somatic empathy may be a major factor underlying your risk for compassion fatigue, vicarious traumatisation and burnout”. Breaking the empathy trance is deliberately un-mirroring by taking a sip of water, shifting posture, changing your breathing, blinking eyes or even taking a deep breath. All of these micro-activities momentarily break the clinician free from over-empathising with the client.
- Create your unique ritual of disconnection from work. This may be a cleansing prayer ritual, or a mindful moment or two before you leave your place of work. If you are working remotely, it may be deliberately closing the door to the home work-space, or closing the laptop mindfully. The key is to show your subconscious that you are leaving your work at work so that you can protect your home and family from the work strain. For example, a few years ago I noticed that I was unconsciously washing my hands as soon as I got home from my therapy office. Of course hand washing is a good idea always, and especially in these times of COVID-19. As I reflected on this behaviour, I discovered that I was unconsciously cleansing myself from the conversations and emotional strain that I had been participating in through the day.
- Maintain activities and a friendship circle outside of work that allows you to shift fully out of your work identity. I treasure my circle of friends that are in a completely different line of work and don’t really understand what I do. When I am with them, I can’t be tempted to talk shop with them and I naturally shift from my professional identity to “just a normal guy”.
- Continue to grow professionally. When we stimulate ourselves with professional development we inevitably feel more empowered, creative, and forward-looking. These are antidotes to vicarious traumatisation.
- Finally, don’t wait to seek out professional help for yourself with a therapist trained in trauma treatment and familiar with treating vicarious traumatisation. Heed the first warning signs and commit to doing something about it so that you are able to practice the work you love for as long as you wish. Your local association of counselling therapy, psychology, psychotherapy or similar will have a searchable database to locate a practitioner well-versed in vicarious trauma treatment.
For further reading
Gentry, E., Dietz, J. (2020). Professional Resilience. Outskirts Press.
Mathieu, F. ( 2012). The Compassion Fatigue Workbook. Routledge.
Rothschild, B. (2006). Help for the Helper. W.W. Norton.
Steele, W. (2020). Reducing Compassion Fatigue, Secondary Traumatic Stress and Burnout. Routledge.
Van Dernoot, L., Burk, C. ( 2009). Trauma Stewardship. Burrett-Kooehler.
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