Secondary Traumatic Stress

Terminology

Compassion fatigue (CF) is used as an alternative term to refer to the phenomena of STS and was introduced in an effort to lessen the stigma of experiencing STS. Though not always reported as such, STS (i.e., secondary trauma) and CF are interchangeable terms. In addition to these, several other terms are used to refer to the impact of repeated exposure to traumatized persons. The reported changes that occur in individuals who come into contact with traumatized persons have also been termed vicarious traumatization (VT), which refers to a transformation in cognitive schemas and belief systems as a result of exposure to another's traumatic experiences. VT is believed to cause significant changes in the person's sense of meaning, connection, identity, and worldview. As with STS, VT parallels the experiences of those who are directly traumatized. Some experts consider VT to be the same as STS, with a focus on cognitive changes in addition to the classic trauma response, but others consider it to be a separate, albeit related, phenomenon.

The negative impact of secondary exposure to trauma has also been described as a countertransference reaction. The classic definition of countertransference refers to a distortion by a therapist resulting from the therapist's life experiences and associated with her or his unconscious, neurotic reaction to the client's transference. This traditional view of counter-transference specifically refers to the activation of the therapist's unresolved or unconscious conflicts or concerns. More contemporary views suggest that counter-transference is all of the caregiver's emotional reactions toward the client, regardless of the source. Even the broadest definition of countertransference refers to the therapist's emotional and behavioral responses to the client and is thus restricted to what is taking place in the therapeutic relationship. STS affects the professional's work with the client as well as interpersonal relationships outside of the professional setting, and in this way is distinct from countertransference. Further, STS is limited to work with traumatized clients whereas countertransference can occur with any client population. Lastly, countertransference is a phenomenon that occurs only in therapeutic relationships and thus does not account for the experiences of family members and friends of traumatized individuals.

Burnout is another term that has been used to refer to the negative impact of exposure with traumatized individuals. Burnout is a syndrome of emotional exhaustion and cynicism that occurs frequently among individuals who do people work of some kind—for example, social workers. A key aspect of the burnout syndrome is increased feelings of emotional exhaustion, which may also occur with STS. However, although burnout is a function of the work context, it fails to incorporate the interaction of the context of trauma work with the individual. With burnout, increased workload and institutional stress, not trauma, are the precipitating factors, whereas STS arises as a result of exposure to a client's traumatic material.

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