Experiencing Secondary Trauma
Therapists, carers, blue light service first responders, nurses, family members of trauma survivors, doctors, surgeons, teachers, and anyone who has ever helped someone through a traumatic experience; this may be of interest to you. Vicarious trauma, secondary traumatic stress, compassion fatigue, and burnout are all terms that are often incorrectly used interchangeably. You may be familiar with them, but you may not be entirely sure how they differ or who might be affected by them. Some of these terms are used exclusively for those people working in helping roles, but the aim of this article is to help you to discern what you may be experiencing, no matter what your job might be. This is because we are more than just what we do; we are also what we experience individually and as a global community.
Defined in 1990, Vicarious trauma (VT) was originally used to describe the process by which a therapist or helping professional is profoundly and permanently changed through the holding of traumatic material brought by clients and the unique, negative changes to the therapist that can occur. Importantly, it is specifically related to empathic exposure, within a therapeutic relationship, to detailed disclosure of traumatic experiences. VT is differentiated from other forms of secondary stress by the negative cognitive shifts within the therapist that occur on repeated exposure to this material. In other words, it has an impact on the therapist’s worldview, sense of self, emotional behaviour, self-esteem and the way they think, feel and relate to themselves and to others. While the original definition may have been aimed at therapists, terrorist activities in the last few decades, global warming, and most recently the Covid pandemic and Ukraine war shine a light on how everybody might experience vicarious trauma by way of living in a global community filled with unrelenting imagery of death, destruction and existential fear. Vicarious trauma is particularly damaging as it negatively impacts what are called cognitive schemas. These are our core beliefs about, among other things, the safety and trustworthiness of the world or people around us. Many of the symptoms of VT overlap with those of PTSD, such as cynicism, anger, emotional detachment, changes in worldviews or spiritual beliefs, increased physical ailments and illnesses, intrusive imagery, arousal and avoidance behaviours. It is for this reason that PTSD is considered to be an element of vicarious trauma.
People at risk of vicarious trauma include mental health professionals, charity workers and researchers who spend time in empathic engagement with others, listening to trauma stories. It also includes family members living with trauma victims but can arguably include anyone who empathically engages consistently over a long period with trauma stories via the news or documentaries having never personally experienced the trauma. The Covid pandemic and terrorist attacks around the world are a good example, and while not necessarily the result of trauma, the enormous increase in acute anxiety over the past few years is a testament to the kind of impact these direct and indirect threats can have.
Secondary traumatic stress
Similar to the above distinction, secondary traumatic stress (STS) is specifically characterised by symptomology nearly identical to that of PTSD following indirect exposure to single or multiple traumas. It is also characterised by an overwhelming desire to provide help or comfort to those who have suffered, while not always being able to do so. First responders and medical practitioners are examples of professionals who are at risk of STS. Symptoms include avoidance, disturbing images, hypervigilance, and hypersensitivity to related stimuli well as physical symptoms with no obvious medical cause and other PTSD symptoms. However, STS does not rise to the level of VT because an empathic relationship has not been developed over time between the person observing the effects of the trauma and those who have experienced it. It is also not considered to result in a permanent change to the helper’s cognitive schemas/world views.
At risk of STS are mental health professionals, police officers, firefighters, paramedics and other first responders and A&E personnel. STS can occur after a single indirect exposure to trauma. It differs from vicarious trauma because no empathic long-term relationship is established with the trauma survivor.
If you are unsure about the symptoms you may experience, then have a look at my trauma quick guide published a few months ago. The symptoms for VT and STS may align with those of PTSD.
Compassion fatigue, like STS, is represented by an overwhelming desire to assist someone and is often accompanied by a sense of helplessness and an eventual diminished capacity for empathy. The two terms are often used interchangeably, but there is no evidence that someone suffering from compassion fatigue has the same symptoms of secondary traumatic stress, other than that of a decrease in the quality of care that is provided due to empathic fatigue. A carer, for example, may feel a diminished capacity for empathy toward his or her clients over time if the effects of compassion fatigue are not recognised or managed.
Those at risk of compassion fatigue include anyone who is working in an environment that requires a continued output of care and attention. Examples are carers (professional or family), nurses, pastoral staff and the like.
Unlike the other terms Burnout can occur in any profession and does not require exposure to traumatic material. It is associated with isolation, continual output of empathy, a sense of overwhelm with the workload and importantly, is differentiated from the other terms mainly by a lack of social or workplace support. While burnout includes symptoms common to STS, VT and compassion fatigue, such as emotional exhaustion, a disconnect and diminished empathy and quality of care for clients, and self-doubt with regard to professional efficacy, burnout is considered to be transient. It is also limited to the workplace, and not a cause of permanent cognitive shifts in the person experiencing it.
As mentioned above, burnout can happen to anyone but is punctuated mainly by a lack of organisational support and consequent overwhelm with the workload.
While these conditions may feel daunting, there is growing evidence that those who are most at risk, are also able to experience vicarious resilience. Engaging with and journeying with someone who has survived a trauma, can be a healing experience for both parties. Watching someone work towards a sense of wholeness and restoration can have a positive impact on those helping them, leading to positive shifts in their world views rather than negative ones.
Managing the Risk Somatic Experiencing, or similar resiliency-based and self-awareness therapies have shown to be effective in increasing resiliency and reducing symptoms of PTSD in people who assist both in the immediate aftermath of trauma and in post trauma therapy. It is particularly effective as an early intervention but has also been shown to consistently produce a lasting reduction in PTSD symptoms from as little as one or two sessions, with follow ups at eight months and one year. These benefits extend to those training in the modality. In measuring anxiety and somatic symptoms, research shows that trainees going through the SE program show a significant decrease in physical symptoms and general anxiety falls well below the clinical range. A large component of the SE training is teaching and encouraging an increased self-awareness of the trainee’s internal processes. Studies report significant improvement in physical symptoms, quality of life, post-traumatic stress symptoms, depression and anxiety, for both one to one SE client sessions and participants of SE training modules when compared to a control group. It is therefore suggested in the research that self-awareness, mindfulness, meditation and skilled, trauma informed supervision or therapy are very effective ways of not just managing the risks, but decreasing the chances of being impacted negatively by exposure to indirect trauma. If you feel that you are experiencing indirect trauma in your workplace and do not have the support you feel you need, reach out to the organisation and request trauma informed supervision or therapy to help mitigate the risk of experiencing similar symptoms to those whom you are helping. Trauma informed therapists who are aware of the risks and symptoms of secondary trauma can be found on counselling directory and may also be of help.