Vicarious Trauma

Adams, S. & Riggs, S. (2008). An exploratory study of vicarious trauma among therapist trainee. Training and Education in Professional Psychology, 2(1), 26-34

In the study, the authors explored vicarious trauma among therapist trainees. The researchers examined the history and type of trauma, levels of experience, trauma-specific training, and defense style (Adams & Riggs, 2008). The researchers also made sure to include other variables in the study. Psychological trainees are exposed to the same trauma as psychologists, but they do not have near the experience coping with trauma, and it can possibly affect the greater. During their training experiences, they provide mental health support to the first responder, disaster victims, and clients with different levels of trauma. In the research, 129 therapist trainees completed the Trauma Symptom Inventory and Defense Style Questionnaire (Adams & Riggs, 2008). According to the results, over half of the respondents were at a higher risk for vicarious trauma due to a self-sacrificing defense style. One-third of the sample had a past history with trauma.

The researchers concluded that trainees need trauma-specific training. This is needed as well as preparing the trainee to reduce their vicarious trauma vulnerability. Teaching the psychological trainee to recognize and address vicarious trauma will help reduce their risk when they become clinicians. Trauma-specific training should be provided within the context of defense style (Adams & Riggs, 2008). The training students need to be informed of the inherent occupational hazards and it is critical for preparing them to protect themselves. Intensive workshops and lectures will help with the training.

Bell, H., Kulkarni, S., & Dalton, L. (2003). Organizational prevention of vicarious trauma. Families in society, 84(4), 463-470.

This article discusses the idea that for too long the major concern for therapists was psychological burnout and that was the biggest concern for people in the mental health field. However, as this article points out it is vicarious trauma that is far more dangerous. The researchers have found that there are certain personal and organization factors that correlate with vicarious trauma.

Within a mental health organization, there are areas where the organization can improve to keep the therapists from developing vicarious trauma. This includes managing the workload. With each new patient, the therapist takes on, the potential for vicarious trauma increases. So the organization must make sure that therapist has a reasonable workload. Also, support groups have shown to have tremendous benefit. Therapists are not allowed to talk to anyone about their patients so a support group of other therapists is ideal. These factors, along with self-care guidelines, and good work environment, show which organizations are susceptible to vicarious trauma.

Bercier, M. (2013). Interventions that help the helpers: A systematic review and meta-analysis of interventions targeting compassion fatigue, secondary traumatic stress and vicarious traumatization in mental health workers. Chicago, IL: Loyola University

The researcher conducted a systematic review and meta-analysis to understand the effectiveness of current interventions. Self-care is the most prevalent suggestion in the research; this intervention involves the therapist taking time out of their lives to engage in enjoyable activities. Organizational support is another intervention suggested in the research. Supervisor support can help prepare and support the mental health worker to cope with exposure to their client’s trauma.

The research indicates social support is key to boosting the mental health workers’ coping skills. The literature review indicated there are large gaps in the data. Cognitive-behavioral therapy and Stress Inoculation Training were also suggested in the research for mental health professionals who have been negatively impacted by trauma exposure. If the mental health worker does not address their mental health needs, they cannot provide clients with the most competent care. In fact, it could become detrimental to both the therapist and patient. The therapist’s mental state is deteriorating. This causes them not to treat the patient as well. The patient gets worse and the therapist experiences more vicarious trauma. Then their treatment worsens and it becomes a vicious circle.

Branson, D. (2018). Vicarious trauma, themes in research, and terminology: A review of literature. Traumatology, 25(1), 2-10. https:// https://doi.org/10.1037/

In the systematic literature review, the authors examined the definition of vicarious, trauma, themes in the research and the terminology associated with the phenomena. Vicarious trauma is an emotional response to the exposure of the trauma of clients. Constant exposure to the pain of others while providing empathetic care results in an emotional residue of exposure leading to tension and preoccupation (Branson, 2015). The tension can lead to avoidance behaviors and a persistent arousal state (Branson, 2015). Commonalities found in the research include compassion fatigue, stress, burnout, and a loss of satisfaction.

The goal of the research is to identify a common definition and examine the implications of vicarious trauma on the mental health professional. An increase in the collective knowledge base helps in the development of effective prevention strategies. These strategies enhance clinical practice behaviors to improve patient outcomes. It also helps decreases research gaps and research inconsistencies.

Baum, N., Rahav, G. & Sharon. M. (2014). Heightened susceptibility to secondary traumatization: A meta-analysis of gender differences. American Journal ofOrthopsychiatry, 84(2), 111-122. Doi: 10.1037/h0099383.

The researchers conducted a meta-analysis to identify gender differences involving psychologists who experience vicarious trauma. Twelve peer-reviewed studies published between 1990 and 2012 with a total of 1,623 subjects (Baum, Rahav & Sharon, 2014). The statistical analysis of the collected data indicated women are more susceptible to vicarious trauma. They conducted gender difference studies to look at different variables including ways of caring and psychological boundaries. (Baum et al., 2014). The researchers found that the United States has the lowest gender.

The results of the research indicate women are more suspectable to vicarious trauma because of factors, such as heightened empathy, altruistic fear, and perceived vulnerabilities versus the male fender (Baum et al., 2014). Understanding this heightened susceptibility supports the creation of more effective interventions. The research suggests the use of a two-dimensional model should be used to address the gender factors increasing the psychologist’s risk.

Berscheit, K. (2013). A system’s view of early interventions for vicarious trauma: Managing secondary trauma stress. St. Paul, MN: St. Catherine University

In the heuristic study, the researcher examined the interventions used to address vicarious trauma. The goal of the study is to identify the best intervention for addressing this form of trauma. Data was collected using interviews to identify the best intervention approach. The findings of the research suggested trauma-informed clinical supervisors and a regime of self-care are the most effective ways to intervene before the clinician develops vicarious trauma. The researcher suggests the entire system must be shaped to support the mental health of the therapist.

The literature supports the use of self-care and supervisor support. The research backs this up. A trauma-informed clinical supervisor has the knowledge and skill to support the therapist in understanding and preventing vicarious trauma. They can also help the therapist develop a self-care regime. Creating a support team and encouraging the therapist to proactively engage in activities that support their physical, psychological, and spiritual health is the most effective way to cope with exposure to client trauma.

Brockhouse, R., Msetfi, R. M., Cohen, K., & Joseph, S. (2011). Vicarious exposure to trauma and growth in therapists: The moderating effects of sense of coherence, organizational support, and empathy. Journal of Traumatic Stress, 24, 735–742. doi:10.1002/jts.20704

The researchers conducted the study to understand the variables that moderate vicarious posttraumatic growth. The sample in the research included 118 therapists who work with clients exposed to vicarious trauma. Measures were taken on empathy, sense of coherence, and perceived organizational support (Brockhouse, Msetfi, Cohen & Joseph, 2011). The greatest factor predicted to contribute to vicarious trauma was a sense of coherence. Empathy had positive and negative effects. It helps in the establishment of interpersonal relationships but makes the therapist more vulnerable.

The research provides insight into the factors influencing the positive and negative growth of vicarious trauma. Understanding these variables helps supervisors predict the therapist's response and direct training (Brockhouse et al, 2011). Organizational support was identified as an important factor in preventing vicarious trauma. Using the insights gleaned from the research, measures can be taken to create a supportive environment to help avoid the growth of vicarious trauma.

Harrison, R. L., & Westwood, M. J. (2009). Preventing vicarious traumatization of mentalhealth therapists: Identifying protective practices. Psychotherapy Theory,Research, Practice, Training, 46(2), 203-219. doi:10.1037/a0016081

The qualitative study was “designed to identify protective practices that mitigate risks of Vicarious Traumatization (VT) among trauma therapists” (Harrison & Westwood, 2009, p. 2013). Six experienced psychotherapists were surveyed using interviews to understand how they manage and sustain their personal and professional wellbeing. A thematic content analysis was applied to analyze the results of the data. The twelve major themes identified in the research include countering the risk of isolation, self-awareness, hope, support, openness to the unknown, problem solving, optimism, holistic self-care; maintaining clear boundaries with clients, and empathy. The research recommends the development of individualized coping strategies, ethical responsibility, professional boundaries, and self-care was identified as the best way to avoid vicarious trauma.

Most of the sample discussed past experiences with vicarious trauma. Initially, the trauma of their clients resulted in added stress. The development of self-care strategies supported their ability to overcome stress and gain vicarious resilience. More research is needed to develop a deeper understanding of how experienced psychologist navigates the risk of vicarious trauma. The findings confirm the need to educate new psychologists before entering the field and the use of self-care strategies. New psychologists will face protective challenges because of the inexperienced. The participants recommended supportive supervision, support, and validation for supervisors and the team, self-care, and when necessary personal therapy. Although the research findings cannot be generalized to the entire population, the knowledge gained is helpful in educating the psychology field.

Hayden, S., Williams, D., Canto, A. & Finklea, T. (2015). Shelter from the storm: Addressing vicarious traumatization through wellness-based clinical supervision. The Professional Counselor, 5(4), 529-542. doi:10.15241/scwh.5.4.529

Vicarious trauma is a well-known consequence of being exposed to the trauma of clients. Understanding the problem is the first step. The second step is the response. When psychologists are exposed to graphic descriptions of traumatic recollections, they risk a negative emotional response. The researchers suggest the application of a theoretical framework to shape interventions. The framework includes supervision from an experienced counselor for the first year the psychologist works on his or her own. The supervisor should be mindful of the signs of vicarious trauma and offer appropriate levels of support.

The inexperienced psychologist is most vulnerable to developing secondary trauma when they are not properly prepared for their emotional response to their client’s pain. The suggestion by the researchers to promote supervisor support is critical to promoting the mental health of the psychologist along with training the new psychologists on the symptoms, risk, preventative measures, and best interventions. Preparing the new psychologist to cope with the stressor of the job will help them mitigate the potential for a traumatic response.

Hunter, S. V. (2012). Walking in sacred spaces in the therapeutic bond: Therapists'experiences of compassion satisfaction coupled with the potential for vicarious traumatization. Family Process, 51(2), 179-192. doi:10.1111/j.1545-5300.2012.01393

The research examined the therapeutic bond and the risk of vicarious trauma. The research applied a grounded theory methodology to understand the opinion of experienced psychologists using in-depth interviews. The findings showed the therapeutic was bond was considered critical to the therapeutic relationship. The risk of vicarious trauma can be overcome through vicarious resilience and compassion satisfaction. Therapists must take steps to counterbalance the effect of being exposed to their client’s trauma. Sustaining a good relationship requires the theorist to be in good mental health.

The implication of the research is experienced psychologists have developed measures to overcome the stress of being exposed to the trauma of their clients. They understand and appreciate the therapeutic relationship. “The therapeutic bond gives therapists intense satisfaction and can reduce the risk of vicarious trauma” (Hunter, 2012, p. 179). Developing the therapeutic bond while understanding the challenges can support vicarious resilience. When psychologists feel extreme empathy for their clients, they are at a higher risk of becoming stressed when they are exposed to their trauma. This empathy can also be used to support vicarious resilience.

Kjellenberg, E., Nilsson, F., Daukantaite, D. & Cardena, E. (2013, May 6).Transformative narratives: The impact of working with war and torture survivors.Psychological Trauma: Theory, Research, Practice, and Policy, 1, 1-9.doi:10.1037/a0031966

Working with a torture victim can be painful for the psychologist. The recent wars have exposed psychologists to larger number of torture victims. In the research, 69 therapists were working with war and torture survivors. The research was designed to measure the attitudes of the therapist after they have been exposed to the trauma of clients. One of the most positive, protective factors was compassion satisfaction. Negative reactions to working with clients who have been torture can be hard on the emotional health of the psychologist. Compassion satisfaction helps the psychologist cope with this exposure. Self-care strategies were also necessary to help the psychologist separate themselves from the stories of the torture victims.

While there are fewer soldiers coming home from war currently, there is still a large population of soldiers who have scars from their time at war; the psychologist must be equipped to deal with the trauma they faced. Compassion satisfaction and vicarious resilience will support the psychologist in coping with these intensive stories. Along with developing these skills, the psychologist will need to take time to step away from the work to engage in activities to improve their emotional health. Without taking time away from the job, the stress of being exposed to the stories of torture victims can be harmful to the mental health of the psychologist. The experienced psychologist will be bettering quipped to address the stress of being exposed to extreme trauma by clients.

Lewis, M. & King, D. (2019). Teaching self-care: The utilization of self-care in social work practicum to prevent compassion fatigue, burnout, and vicarious trauma. Journal of Human Behavior in the Social Environment, 29(1), 96-106

The research examined field students who work directly with traumatized clients and have suffered from vicarious trauma. The training therapist experienced an intense emotional response to exposure to their clients resulting in distress. Integrating self-care skills were suggested along with techniques and strategies they can use during their daily work with clients. Self-care is effective for preventing trauma, but so is learning strategies to improve their educational experience. The student should receive professional self-care instructions and self-care education.

Compassion fatigue and burnout can be indicators of vicarious trauma. Students must be able to recognize the risk of vicarious to navigate the emotional response. Training, counseling practice, supervision, are the most common approaches used for retention strategies and to navigate the risk. To understand is these approaches are working more research is needed to understand how many students end up with vicarious trauma. Applying the strategies and measuring the response would alert the profession to the effectiveness of the approach.

McCann, I. L., & Pearlman, L. A. (1990). Vicarious trauma: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131–149. http://dx.doi.org/10.1007/

Authors McCann & Pearlman (1990) discuss a framework for understanding the psychological impact experienced by clinicians who work with clients who have experienced trauma. Psychologists work with clients who have experienced all types of trauma. Constant exposure to the painful experiences of clients can have a detrimental impact on their mental health. The goal of the framework is to help transform the experience of the psychologist to support productive interactions with clients even after being exposed to their graphic and painful traumas. When the psychologist is repeatedly exposed to the trauma of their clients, they develop protective factor they protective factors are not always healthy. The right framework will guide education and supervision.

Instead of allowing the traumatic experiences of the client to impact the psychologist, the framework would allow them to use the traumatic material to change their experience. When psychologists experience vicarious trauma, it can negatively impact their interaction with clients and harm their emotional and psychological health (McCann & Pearlman, 1990) The framework would support better professional performance by developing an understanding of the trauma and developing effective coping strategies. Training programs must be implemented in the mental health setting to support the effectiveness of the suggested framework.

Moulden, H. M., & Firestone, P. (2007). Vicarious traumatization: The impact on therapistswho work with sexual offenders. Trauma Violence Abuse, 8, 67–83. DOI: 10.1177/1524838006297729

Working with sexual offenders can be a stressful experience for the therapist. They must listen to the crimes of the client while keeping a professional demeanor. When the victim relays the same information, it is easy to sympathize with them even if their experiences can be hard to hear. The sexual offender is the perpetrator of heinous crimes against women and children. According to the findings of the research, therapists who work with these offenders are at risk of developing vicarious trauma. The protective factors identified through the research include professional experience, coping strategies, and the setting of the treatment.

The findings of the research have important implications. The results can be used to inform mental health professionals and policymakers. Vicarious trauma leads to occupational stress. Interventions to address the risks should take into account the heightened risk for the therapist who must counsel sex offenders. Therapists are in a unique position, as they must help treat perpetrators of terrible things without trying to judge them and provide the best care possible. Also, they must conduct therapy in places that show great potential to increase stress. Therapists in this situation are often not in offices or group homes. They are in prisons and jails which makes the potential for vicarious trauma even greater.

Myers, S. B., Sweeney, A. C., Popick, V., Wesley, K., Bordfeld, A., & Fingerhut, R.(2012). Self-care practices and perceived stress levels among psychology graduate140 students. Training and Education in Professional Psychology, 6(1), 55-66.doi:10.1037/a0026534

A survey of psychology graduate students found stress associated with being exposed to client trauma could be harmful to their experience. Psychology students are vulnerable to additional stress because they face multiple demands of including classwork, research requirements, clinical training, and the burden of financial constraints. They also face the additional stress of performance anxiety, institutional demands, and experience gaps (Myers et al., 2012). The current study suggests teaching the graduate student self-care strategies before they enter the field to give them the skills to cope with the multiple demands plus exposure to traumatized clients.

The research has identified an area of research needing further study. Supporting the graduate student in the development of alternative coping strategies will help them cope with the academic challenge as well as prepare them for working with clients. The application of self-care strategies will help reduce stress and support better mental health outcomes. The graduate student must be committed to engaging in these activities despite there many obligations. As the student gains experience, they will develop personal skills to cope with stress. Until they can develop these coping strategies, they will need supervisory support.

Owens-King, A. (2019). Secondary traumatic stress and self-care inextricably linked. Journal of Human Behavior in the Social Environment, 29, 37-47.https://doi.org/10.1080/10911359.2018.1472703

The current study examines the relationship between trauma-exposed clients and secondary traumatic stress among mental health workers. An online survey was used to gather data directly from the clinicians. The survey collected data on secondary trauma and self-care strategies. Based on the collected data, self-care strategies are beneficial to mitigating the impact of secondary trauma. The mental health worker who had the best outcomes received training on vicarious trauma prior to entering the profession. The research highlights that adding training about vicarious training will help to educate healthcare workers.

Collecting data directly from mental health workers on how they have navigated vicarious trauma is important to developing educational approaches to supporting them in overcoming the stressor associated with the job. Similar to other research, the evidence supported the use of self-care strategies. Training would prepare the therapist to understand the need for self-care before the trauma of their clients causes an emotional toll. Experienced psychologists understand the demands of the job and take the septs to prevent mental health consequences from interacting with traumatized clients.

Shannon, P. J., Simmelink-McCleary, J., Im, H., Becher, E., Crook-Lyon, R. E. (2014).Developing self-care practices in a trauma treatment course. Journal of SocialWork Education, 50(3), 440-453. doi:10.1080/10437797.2014.917932

A large swathe of the research supports the use of self-care strategies to avoid the development of vicarious trauma. Students receive education on self-care while training but they do not have the knowledge to apply these skills once they enter the workforce. The research examined ways to better improve the student’s skill before they enter the profession. The findings of the research indicated evidence-based practices are essential for mediating the stress of being exposed to the client’s trauma. Students must be encouraged to adopt effective self-care strategies before they enter the profession to develop appropriate protective factors. The research is important to the profession because it has identified areas where student education is lacking.

Sui, X & Padmanabhanunni, A. (2016). Vicarious trauma: The psychological impact of working with survivors of trauma for South African psychologists. Journal of Psychology in Africa, 26(2), 127-133. http://dx.doi.org/10.1177/0022167805274729.

In the journal article, the authors discuss the risk of the adverse effect of working with traumatized clients. Psychologists in South African are exposed to a large number of clients who have experienced horrific life events. The goal of the study was to examine the experience of six psychologists who work with clients who have been exposed to physical and sexual abuse (Sui & Padmanabhanunni, 2016). Data collected were analyzed using thematic analysis to identify the symptoms of the sample including “cognitive schemas, symptoms characteristic of post-traumatic stress disorder, and somatic symptoms” (Sui & Padmanabhanunni, 2016, p. 128). Along with reporting negative symptoms, the sample claimed they have also experience vicarious growth through the application of coping strategies.

Understanding the symptoms of vicarious trauma helps in the development of protective factors to enhance the efficiency of psychological services and support a more effective response when delivering care to traumatized patients. When psychologists experience vicarious post-traumatic growth, they are better equipped to manage their emotional response to the trauma. To enhance the efficiency of psychological services, psychologists must be prepared to recognize and address vicarious trauma.

Trippany, R., White, V. & Wilcoxon, S. A. (2004). Preventing vicarious trauma: What counselors should know when working with trauma survivors. Journal of Counseling & Development, 82, 31–37. doi:10.1002/j.1556-6678.2004.tb00283.x

In the article, the author examines important information involving vicarious trauma and discusses what counselors need to know. Members of the mental health field are exposed to the traumatic experiences of their clients. This includes sexual and physical abuse, domestic violence, natural disasters, school shootings and other school-related violence, and war experiences (Trippany, White & Wilcoxon, 2004). Exposure to trauma can cause cognitive dysfunction. The most common response is burnout and countertransference. While burnout and vicarious trauma differ, burnout is a symptom.

The Constructivist Self-Development Theory (CSDT) is used to explain the progression of vicarious trauma (Trippany et al., 2004). Applying this approach, the cognitive schemas or perceptions of the counselor interact with personal characteristics making some people more vulnerable to developing this kind of trauma. How the counselor adapts is dependent on different contextual factors. Addressing the safety, esteem, trust, control, and intimacy needs of the counselor provide the protective factors for preventing vicarious trauma (Trippany et al., 2004). The implications for the counselor are they must adapt their own experiences and engage in self-care.

Zaccari, A. (2017). Vicarious trauma coping and self-care practices among trauma therapists. Minneapolis, MN: Walden University

Effective coping strategies have been identified as the best way to cope with the risk of vicarious trauma. The research study involved a quantitative approach to measure the role of Trauma therapists in developed coping skills. Using the framework of the self-development theory, a sample of therapists with over ten experiences treating clients was surveyed to learn their opinion on the best coping strategies and self-care approaches. The findings showed the experience psychologists overcome the risk of vicarious trauma through awareness. Psychologists with experience can teach these skills to more inexperienced clinicians.

The relevance of this research is overtime; the psychologist learns how to overcome the risk of vicarious trauma. They use their experience and understanding of the risk to develop coping strategies. Through the research, it was clear; the sample used different self-care and coping strategies to support their positive mental health. While self-care is critical, the therapist will develop a personalized strategy to cope with exposure to client trauma.