Day after day, many practicing psychologists treat people who have experienced severe trauma and loss, including survivors of abuse, victims of mass shootings and patients facing premature death.
While this work can be extremely rewarding, it can also take a toll, otherwise known as vicarious traumatization, compassion fatigue or secondary traumatic stress, says Janna Henning, PsyD, a professor of clinical psychology at Adler University in Chicago and founder of its traumatic stress psychology program. “I have come to believe there is an almost inevitable impact on therapists who regularly hear stories of human suffering,” she says.
Unfortunately, the mental health field has tended to underplay the impact this stress has on providers, adds Henning, who is also co-chair of the Education and Training Committee for APA Div. 56 (Trauma Psychology). Most training programs don’t delve into the issue, and few health-care systems attend sufficiently to provider wellbeing. Plus, there’s the false yet pervasive notion that good practitioners should be able to handle any traumatic material that clients may share.
To address this gap in traumaprovider care, Henning favors a comprehensive approach to vicarious traumatization—an approach she is taking as head of a new wellnessfocused program for practitioners, part of the Bridgepoint Psychology Center in Chicago. The program is helping mental health professionals develop more personalized and effective strategies to limit vicarious traumatization, and then build this support into their daily lives.
“We need to be healthy ourselves if we’re going to be able to provide safe and effective therapy to others,” Henning says.
The Monitor asked her about vicarious traumatization among providers and better ways to address it.
What is vicarious traumatization?
In therapy, providers who work with trauma survivors listen deeply and attempt to “feel with” our clients as they describe the details of terrible events, such as intentional human wrongdoing, hatred, violence, oppression, lifethreatening illnesses and more. In these moments of deep engagement, we let down our guard a little, and our own previously held beliefs and reactions are vulnerable to change.
The result can be vicarious traumatization, a term coined in the 1990s by psychologists Lisa McCann, PhD, Laurie Pearlman, PhD, and Karen Saakvitne, PhD. It refers to permanent changes in therapists that can result from chronic exposure to clients’ trauma narratives. While more research is needed to clearly define and document this phenomenon, it has been noted regularly in research and clinical reports. It is related to compassion fatigue, a type of clinical burnout that includes physical, emotional, and spiritual pain and exhaustion.
What are some symptoms of vicarious traumatization among therapists?
Therapists can experience changes on all levels—in their emotional states, meaning systems and behaviors. They may experience reduced feelings of trust, safety, hope, joy and self-esteem, as well as numbing or intense emotional reactions.
Because vicarious traumatization affects therapists’ beliefs, responses, insights and judgment, its negative effects are most often reflected in our personal and professional relationships. For example, emotional numbing may cause us to pull back from loved ones, feel diminished empathy for clients and colleagues, and even end or destroy relationships. These altered emotional responses and heightened feelings of vulnerability can lead to chronic illness or to abusive or unprofessional behavior with colleagues, students or clients—for example, lashing out or expecting them to help us meet our emotional needs. Understanding these issues matters a great deal if we want to help therapists preserve their health, avoid unethical behavior and stay in the field for as long as possible.
What are the gaps in addressing vicarious traumatization in training and practice?
The message we get in graduate school and in practice is that vicarious traumatization is preventable—that it probably won’t happen if you’re professionally competent. And if it does, it’s probably because you did something wrong as a therapist, such as being too empathically engaged with your clients.
Meanwhile, common recommendations for preventing or managing vicarious traumatization—like taking a vacation or getting a massage—tend to be geared toward those who are white, affluent, able-bodied and young or middleaged. These recommendations don’t necessarily fit well for people of differing cultural, ethnic or socioeconomic backgrounds, who might find it more restorative to engage in activities within their own spiritual, religious or cultural traditions.
Training may also neglect to foster our “compassion satisfaction,” or the joy and meaning derived from helping others. While we need to understand more about this phenomenon, research shows it can be fostered through social support, a sense of commitment and the ability to view change as an opportunity.
How do you think the psychology field can better address vicarious traumatization?
What’s missing is a spectrum of care to prevent and address vicarious traumatization. That’s the approach I’m taking with my program in Chicago for mental health professionals who work with clients who have survived trauma. It includes several components, including training in evidencebased approaches that providers may not have received in graduate school; access to individual therapy with therapists who understand trauma-related work and its effects; and consulting with heads of mental health agencies about how to make their practices healthier for providers, for instance, by creating practical, sustainable wellness initiatives and addressing workload concerns.
One novel aspect of the program is helping professionals determine their own self-care strategies and then create plans for repeatable activities that fit into their daily routines—activities such as focused journaling, restorative yoga or whatever they decide is beneficial for them. To help them with this, we provide one-on-one meetings to help them create and maintain these plans—as well as self-care workshops that provide support from other psychologists.
Although our field has known about vicarious traumatization for 25 years, we’re still telling students and clinicians that they need to take care of themselves, while adding increasingly demanding research projects, clinical experiences and caseloads to schedules that are already overloaded. We need to honestly address the systemic pressures that feed these issues—in academia, training agencies, at APA and at the political level.
The impact of trauma, stress and oppression on our clients is not likely to change. Our only option is to change the systems that surround us, which in turn will allow us to better serve our clients and keep ourselves healthy.
