Research indicates that service providers often find treating survivors of childhood abuse stressful, because of survivors' resistance to change, their ways of relating to helpers, and the nature of the work (Palmer et al., 2001). The nature of the work is particularly stressful when it involves listening to detailed descriptions of very painful, often horrific events; it may also involve helpers re-enacting survivors' early experiences of trauma and betrayal with them (Palmer et al., 2001). There is no doubt that hearing and thinking about the stories one hears can continue well after the client has left the therapeutic interaction.
Historically, therapists' reactions to client traumas were regarded as either burnout or countertransference. These days, the term vicarious traumatisation (VT) is used to describe therapists' trauma reactions resulting from exposure to clients' traumatic experiences (Figley, 1995; Pearlman & Maclan, 1995; Trippany, White Kress, & Wilcoxon, 2004).
VT is defined by Saakvitne et al. (2000) as the cumulative transformative effect on the helper of working with survivors of traumatic life events, both positive and negative. VT recognises that working with trauma survivors greatly affects the helper and that we must address the effects in order to protect both helper and clients. VT is unavoidable and is the natural consequence of being human, connecting to and caring about our clients as we see the effects of trauma on their lives (Saakvitne, Gamble, Pearlman, & Tabor, 2000). According to Saakvitne et al. (2000) the single most important factor in the success or failure of trauma work relates to the attention paid to the experience and the needs of the helper. We cannot meet the needs of our clients when we are overriding our own.
Saakvitne et al (2000) explain that inevitably trauma therapists will develop an increased awareness of the reality and occurrence of traumatic events, and this makes therapists more aware of their vulnerability. Safety and security are threatened when therapists become aware of the frequency of traumas, often leading to feelings of loss of control and helplessness. VT can affect how therapists relate to their families, friends, and partners. Furthermore, the therapist may experience changes in esteem for themselves and for others.
Signs and symptoms of vicarious traumatisation (Saakvitne et al., 2000).
VT impacts on areas of psychological need including: safety, trust, esteem, intimacy and control.
Signs and symptoms of VT include:
- Emotional numbing
- Social withdrawal
- Work-related nightmares
- Feelings of despair and hopelessness
- Loss of sense of spirituality
- More negative view of the world
- Reduced sense of respect for your clients
- Loss of enjoyment of sexual activity
- No time or energy for yourself
- Feeling that you can't discuss work with family or friends
- Finding that you talk about work all the time (can't escape)
- Sense of disconnection from your loved ones
- Increased sense of danger (reduced sense of safety)
- Increased fear for safety of children or loved ones
- Sense of cynicism or pessimism
- Increased illness or fatigue
- Increased absenteeism
- Greater problems with boundaries
- Difficulties making decisions
- Reduced productivity
- Reduced motivation for your work
- Loss of sense of control over your work and your life
- Lowered self esteem, lowered sense of competence in your work
- Difficulties trusting others
- Lessened interest in spending time alone
- Less time spent reflecting on your experiences
Managing vicarious traumatisation
The trauma model CSDT (constructive self development theory) for working with survivors of childhood trauma outlined previously, is also a useful model for assisting therapists and trauma counsellors to manage their VT experiences. CSDT suggests that changes in the perceived realities of therapists occur as a result of working with traumatised clients and their stories (Saakvitne et al., 2000). Strategies to manage VT as suggested by Saakvitne et al. (2000) include:
1. Anticipating VT and protecting oneself:
Protecting yourself includes arranging things ahead of time to anticipate the stress of your work and its impact on you. Strategies include:
A sense of balance is considered to be one of the key components to preserving a sense of identity and overall wellbeing. A healthy balance of work, rest, play, including socialisation with friends and family is important in decreasing the effects of VT. Furthermore, any activities which assist the individual's personal tolerance levels, for example; journal writing; personal counselling; emotional support from partners, will assist the individual to reconnect to emotions (Trippany et al., 2004).
2. Addressing signs of VT
Addressing VT includes those things you do for self-care. Strategies include:
- Self nurturing
3. Transforming the pain of VT
Transforming VT includes things you do to transform the negative impact of the work into a connection with some positive aspects of meaning and community. Strategies include:
- Create meaning
- Infuse meaning in current activities
- Challenge negative beliefs
- Participate in community building