Every single day, behavioral health professionals interact with people who have experienced trauma. We care for them and hope to provide healthy pathways for them to thrive and recover from the events and relationships that have hurt them.
However, one of the perils of the job is identifying so strongly with the plight of our clients that we absorb their trauma. It’s called vicarious trauma.Vicarious trauma exists on a spectrum with another occupational hazard known as compassion fatigue. But there are key differences.
What is vicarious trauma? How is it different from compassion fatigue? And how can behavioral health professionals learn to protect themselves from trauma’s tentacles?
We are all touched by trauma as it takes root in families and communities. So it’s no wonder that behavioral health professionals, working on the front lines with people affected by trauma, are experiencing its effects.
When we come into contact with people who have experienced trauma, we are also exposed to that trauma. In fact, the definition of post-traumatic stress includes “experiencing repeated or extreme exposure to aversive details of the traumatic event(s).”
In a virtual training for the COVID-19 Assistance for Community Health (COACH) staff training enhancement series, instructor Eileen M. Russo, MA, LADC, explores the topics of compassion fatigue and vicarious trauma. “It won’t be a matter of if, it will be a matter of when,” says Russo of human services professionals.
Russo’s training begins with a quote from Rachel Naomi Remen’s Kitchen Table Wisdom:
“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to walk through water without getting wet.”
“If somebody has told you that you are too emotional about your work, or that you have to develop a thick skin, or you’re not going to survive—or that you need to leave work at work, then they’ve never worked in human services,” says Russo.
However, boundaries and self-care are critical to avoiding occupational hazards like burnout, compassion fatigue, and vicarious trauma.
Human beings are affected by the suffering of other people, and people in the helping professions have chosen to work with people who have been hurt. It’s normal to ruminate about what we experience in our day-to-day work, or even to have dreams—even disturbing ones—that are related to our occupations.
There’s nothing wrong with having strong feelings about your work, or identifying with clients. But behavioral health professionals are not indestructible. Yes, we are helping people, and we need trauma-informed support at work to do effective work with clients.
Compassion fatigue is defined as “a deep erosion of our compassion, of our ability to tolerate strong emotions/difficult stories in others.” It’s when you’re tired of caring. There are days, times, and moments when it all feels like too much.
The pandemic has complicated this. For example, working at home can make it challenging to create emotional boundaries to move out of these feelings.
How do you know if you are experiencing compassion fatigue? It’s different for everyone, but some folks make errors in judgment, or feel detached. Some people feel angry or sad most of the time, and they don’t have access to their typical range of emotions.
Detachment can be a helpful strategy to protect ourselves, but it also deprives us of things that bring us pleasure.
Other signs of compassion fatigue are closely related to post-traumatic stress: intrusion (uninvited, unexpected thoughts), avoidance (avoiding work or colleagues, not wanting to turn your computer on), and hypervigilance (a high level of anxiety or being on guard).
The opposite of compassion fatigue is compassion satisfaction. Many people working in supportive, trauma-informed environments find ways to achieve satisfaction and to feed and sustain their energy. They also work to balance out their work and personal lives, and they care for themselves in ways that sustain their personal and professional lives.
Another occupational reality for many people in helping professions, including behavioral health professionals, is vicarious trauma, a concept explored by Laurie Anne Pearlman, PhD, head of the Trauma Research, Education, and Training Institute.
The Department of Justice’s Office for Victims of Crime defines vicarious trauma as “a negative reaction to trauma exposure and includes a range of psychosocial symptoms.” The department’s Vicarious Trauma Toolkit uses the term to include:
Secondary traumatic stress
Compassion fatigue
Critical incident stress
There is not always a clean line between these symptoms.
Vicarious trauma develops over time and arises from listening to stories of pain and trauma. It runs deeper than compassion fatigue because it can change who we are by shifting our world view. As Pearlman and Saakvitne write, “When we open our hearts to someone’s stories of devastation or betrayal, our cherished beliefs are challenged and we are changed.”
Anyone who works with survivors of trauma and violence is at risk. However, certain factors increase the likelihood of vicarious trauma.
Prior traumatic experiences
Social isolation, at work or at home
A tendency toward avoidance or having trouble expressing feelings
Being new to a job or not having enough preparation or supervision
The lack of a process that helps them discuss the trauma they are witnessing from clients
We are so used to stepping in to try to intervene and interrupt the effects of trauma that we have trouble shutting it off.
The Vicarious Trauma Toolkit includes a list of possible negative reactions to vicarious trauma. They are similar to the compassion fatigue symptoms, and they can have a serious impact on day-to-day work and life. For example, vicarious trauma can cause sleep difficulties or physical problems. It may lead to distractibility or a feeling of hopelessness. Some people lash out because they feel irritable, aggressive, or angry. And still others engage in coping or addictive behaviors like over- or under-eating, substance abuse, or taking risks.
Vicarious trauma requires intervention, just like trauma itself. If you or someone you care about is showing signs of vicarious trauma, reach out to them and offer to help them navigate toward resources and tools designed to address it.
The Vicarious Trauma Toolkit is a great place to start. It has tools designed for specific occupations and related resources that remind us that we are all in this together.
Self-care is important for everyone, and it is essential for people in the helping professions.
Caring for ourselves—physically and emotionally—is not selfish. Behavioral health professionals need to care for their own physical, emotional, and mental health in order to be effective.
This article in Betterhelp.com has some simple suggestions for preventing vicarious trauma. For example:
Making sure you have supervision and training to handle the trauma you encounter
Journaling
Creative pursuits like art and music
Taking time off work
Seeking counseling for yourself
The Connecticut Women’s Consortium has a number of trainings related to self-care.
Our executive director, Colette Anderson, LCSW, has a YouTube video titled “Trauma-Informed Care 101,” which provides a great introduction to the impact of trauma on the lives of clients and clinicians.
As Russo says in the COACH video, “Self-care is a key way to protect yourself from predators such as vicarious trauma and compassion fatigue. It is how you keep your humanity.”