Is vicarious traumatisation something clinicians treating trauma need to be concerned about, what should they do about it?
The notion of vicarious trauma was initially introduced by McCann and Pearlman (1990) in their article, Vicarious Traumatization: A Framework for Understanding the Psychological Effects of Working with Victims. The framework indicated that this was a phenomenon that was specific to those who work with traumatised individuals.
Over time it seems to have gone from a framework to a disorder and diagnosis. This is despite several researchers (Hafkenscheid, 2005; Sabin-Farell & Turpin, 2003) concluding that there is insufficient evidence to support the construct. It has even expanded to other professions such as humanitarian aid workers (Shah, Garland, & Katz, 2007), lawyers (Levin & Greisberg, 2003) and many more.
Popular media has supported the concept. There are many different websites discussing vicarious trauma, some of them even offering courses on managing vicarious traumatisation. A google search (23rd Jan 2018) resulted in 418,000 hits for the term vicarious trauma.
If it is not a disorder what is it?
The literature reflects multiple overlap for stress related constructs such as
- vicarious trauma
- burnout
- compassion fatigue
- empathic strain
- event countertransference
- secondary-traumatic stress
Phelps, et.al (2009) suggested that vicarious traumatization like other stress-related conditions, such as burnout and compassion fatigue are dimensional constructs of distress rather than distinct disorders.
Like first responders, some psychologists are exposed to traumatic material during their work. Other psychologist may work in areas supporting clients with personality disorder, psychosis and other severe mental health problems which are equally stressful. The stressors associated with role of psychologist are distinct compared with other occupations, but the research does not support that they are unique to any one client group. The research indicates that like other stressful jobs, stress should be managed to prevent it becoming distress.
How should we mange stress or distress
Just like first responders and stress in general, self-care is important for all mental health clinicians. For psychologists it includes factors like placing limits around yourself, placing limits around your clients, maintaining social connections, regular exercise, good nutrition, good sleep, and time out. Similarly, regular supervision where you process the information and emotions related to your clients’ report of traumatic experience is also important.
Summary
Vicarious trauma is not a diagnosis, nor is it inevitable. However, the persistence of the (ill defined) construct serves to remind those in the helping professions about the importance of self-care. This is important for all clinicians, not just those working in the trauma field.
References
Hafkenscheid., A. (2005). Event countertransference and vicarious traumatization: Theoretically valid and clinically useful concepts? European Journal of Psychotherapy, Counselling and Health, 7, (3), 159–168.
Levin A., P. & Greisberg, S. (2003) Vicarious Trauma in Attorneys, 24 Pace Law Review, 245. Available at: http://digitalcommons.pace.edu/plr/vol24/iss1/11
McCann, L., and Pearlman, L. (1990) Vicarious Traumatization: A Framework for Understanding the Psychological Effects of Working with Victims, Journal of Traumatic Stress, 3, 1, 139-141.
Phelps, A., Lloyd, D., Creamer, M., Forbes, D. (2009) Caring for Carers in the Aftermath of Trauma; Australian Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, VIC, Australia. Journal of Aggression, Maltreatment & Trauma, 18, 313–330.
Sabin-Farrell, R., Turpin, G. (2003) Vicarious traumatization: implications for the mental health of health workers? Clinical Psychology Review, 23, 449–480.
Shah, S. A., Garland, E., & Katz, C. (2007) Secondary Traumatic Stress: Prevalence in Humanitarian Aid Workers in India. Traumatology, 13, 1, 59-70.
