Vicarious traumatization

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Vicarious trauma (VT) is a term invented by Irene Lisa McCann and Laurie Anne Pearlman that is used to describe how work with traumatized clients affects trauma therapists. [1] The phenomenon had been known as secondary traumatic stress, a term coined by Charles Figley. [2] In vicarious trauma, the therapist experiences a profound worldview change and is permanently altered by empathetic bonding with a client. This change is thought to have three requirements: empathic engagement and exposure to graphic, traumatizing material; exposure to human cruelty; and the reenactment of trauma in therapy. This can produce changes in a therapist's spirituality, worldview, and self-identity.

Contents

Vicarious trauma is a subject of debate by theorists, with some saying that it is based on the concepts of countertransference and compassion fatigue. McCann and Pearlman say that there is probably a relationship to these constructs, but vicarious trauma is distinct. Understanding of the phenomenon is evolving.

Signs and symptoms

Symptoms of vicarious trauma align with those of primary trauma. As professionals attempt to connect with their clients emotionally, the symptoms of vicarious trauma can create emotional disturbances such as sadness, grief, irritability, and mood swings. [3] Signs and symptoms of vicarious trauma parallel those of direct trauma, although they tend to be less intense. Workers with personal-trauma histories may be more vulnerable to VT, although research findings are mixed. [4] Common signs and symptoms include social withdrawal, mood swings, aggression, increased sensitivity to violence, somatic symptoms, sleep difficulties, intrusive imagery, cynicism, sexual difficulties, difficulty managing boundaries with clients, and relationship difficulties which reflect problems with security, trust, esteem, intimacy, and control. [5] [6] [7] [8] [9] [10] [11]

Contributing factors

Vicarious trauma, conceptually based in constructivism, [12] [13] [14] arises from interaction between individuals and their situations. A helper's personal history (including prior traumatic experiences), coping strategies, support network, and other things interact with his or her situation (including work setting, nature of the work, and clientele served) and may trigger vicarious trauma. Individuals respond and adapt to, and cope with, VT differently. It has been suggested that traumatization occurs when one's view of the world, or a feeling of safety, is shattered by hearing about the experiences of a client. This exposure to trauma can interrupt a clinician's daily functioning, reducing their effectiveness. [15]

Anything that interferes with a helper's ability to fulfill his or her responsibility to assist traumatized clients can contribute to vicarious trauma. Many human-service workers report that administrative and bureaucratic factors that are an impediment to their effectiveness influence work satisfaction. [16] Negative aspects of an organization such as reorganization, downsizing in the name of change management, and a lack of resources in the name of lean management contribute to burned-out workers. [17] [18] [19]

Vicarious trauma has also been attributed to the stigmatization of mental-health care by service providers. Stigma leads to an inability to engage in self-care; the service provider may reach burnout and become more likely to experience VT. [20] Research has begun to indicate that vicarious trauma is more prominent in those with a prior history of trauma and adversity. [20] A mental-health provider's defense style might pose a risk factor for vicarious traumatization; mental-health providers with self-sacrificing defense styles have been found to experience increased vicarious traumatization. [21] Among EMS personnel, previous-veteran status increased the likelihood of experiencing vicarious trauma. [22]

Although the term "vicarious trauma" has been used interchangeably with "compassion fatigue", "secondary traumatic stress disorder," "burnout," "countertransference" and "work-related stress," differences exist:

Mechanism

The posited mechanism for vicarious traumatization is empathy. [13] [25] [26] Different forms of empathy may have different effects on helpers. Batson and his colleagues have conducted research that might aid trauma helpers in managing empathic connection constructively. [27] [28]

Measurement

VT has been measured in a variety of ways. Vicarious trauma is a multifaceted construct, requiring a multifaceted assessment. Aspects of VT that would need to be measured for a full assessment include self-capacities, ego resources, frame of reference (identity, world view, and spirituality), psychological needs, and trauma symptoms. [12] [29] [14] They include:

Vicarious traumatizationmay be addressed with awareness, balance, and connection. [40] One set of approaches is coping strategies, which include self-care, rest, escape, and play. A second set of approaches can be grouped as transforming strategies, which aim to help workers create community and find meaning through the work. Within each category, strategies may be applied in one's personal [14] [40] and professional lives. [41] Organizations that provide trauma services can also play a role in mitigating vicarious trauma. [42] [43]

Many simple things increase happiness, which lessens the impact of vicarious traumatization. People who are more socially connected tend to be happier. [44] People who consciously practice gratitude are also shown happier. [45] Creative endeavors that are detached from work also increase happiness. [46] Self-care practices such as yoga, qigong, and sitting meditation have been found helpful. [47] [48] [49] Harvard Business Review , in a case study of traumatization, noted the importance of an organizational culture which values social workers and counselors. [50] Research indicates that clinicians exposed to vicarious trauma need targeted interventions such as respite, increasing self-efficacy, and appropriate professional support increase their resilience and act as a buffer against vicarious trauma. [51]

Prognosis

Children have been found to experience vicarious trauma from trauma experienced by their caregivers and peers. Girls experience VT more than boys, and socioeconomic status and race have been found to predict vicarious trauma symptoms.

Counselors and other mental-health professionals have been found to experience vicarious trauma when working with veterans and others who have experienced trauma. Factors that predict vicarious-trauma severity include professional trauma, level of peer supervision, population served by the clinician, [52] defense mechanisms of the therapist, [53] emotional coping strategies, and social-support availability. Foster parents have also been found to experience vicarious trauma related to the trauma of their children. Several studies have found that foster parents experience vicarious trauma, burnout and compassion fatigue, and report emotional disengagement (a common symptom of VT) as a coping strategy. [54] [55]

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Compassion fatigue is an evolving concept in the field of traumatology. The term has been used interchangeably with secondary traumatic stress (STS), which is sometimes simply described as the negative cost of caring. Secondary traumatic stress is the term commonly employed in academic literature, although recent assessments have identified certain distinctions between compassion fatigue and secondary traumatic stress (STS).

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

In psychology, posttraumatic growth (PTG) is positive psychological change experienced as a result of struggling with highly challenging, highly stressful life circumstances. These circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to the individual's way of understanding the world and their place in it. Posttraumatic growth involves "life-changing" psychological shifts in thinking and relating to the world and the self, that contribute to a personal process of change, that is deeply meaningful.

Body-centred countertransference involves a psychotherapist's experiencing the physical state of the patient in a clinical context. Also known as somatic countertransference, it can incorporate the therapist's gut feelings, as well as changes to breathing, to heart rate and to tension in muscles.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

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Compassion fatigue (CF) is an evolving concept in the field of traumatology. The term has been used interchangeably with secondary traumatic stress (STS)s. Secondary traumatic stress is the term commonly employed in academic literature, although recent assessments have identified certain distinctions between compassion fatigue and secondary traumatic stress (STS).

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<span class="mw-page-title-main">Trauma and first responders</span> Trauma experienced by first responders

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Over the last fifty years, there has been an increase in the different types of media that are accessible to the public. Most people use online search engines, social media, or other online news outlets to find out what is going on in the world. This increase can lead to people easily viewing negative images and stories about traumatic events that they would not have been exposed to otherwise. One thing to consider is how the dissemination of this information may be impacting the mental health of people who identify with the victims of the violence they hear and see through the media. The viewing of these traumatic videos and stories can lead to the vicarious traumatization of the viewers.  

References

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  2. ↑ Russo, Chuck; Aukhojee, Prashant; McQuerrey Tuttle, Brooke; Johnson, Olivia; Davies, Mark; A. Chopko, Brian; Papazoglou, Konstantinos (2020). "7". POWER: Police Officer Wellness, Ethics, and Resilience. Academic Press. pp. 97–115. doi:10.1016/B978-0-12-817872-0.00007-0. ISBN   978-0-12-817872-0.
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