Vicarious Trauma

Contributing Factors

VT, conceptually based in constructivist self-development theory, arises from an interaction between individuals and their situations. This means that the individual helper's work style (boundary management, for example), personal history (including prior traumatic experiences), coping strategies, and use of support network, among other things, all interact with his or her situation (including work setting, the nature of the work she or he does, the specific clientele served, etc.) to give rise to individual expressions of vicarious trauma. This in turn determines the individual nature of responses or adaptations to VT as well as suggesting individual ways of coping with and transforming it.

Anything that interferes with the helper's ability to fulfill his or her responsibility to assist traumatized clients can contribute to vicarious trauma. Many social service workers, for example, report that they experience the demands of their agencies as the greatest impediment to their effectiveness and work satisfaction.

Signs and Symptoms

The signs and symptoms of vicarious trauma parallel those of direct trauma, although they tend to be less intense. Workers who have personal trauma histories may be more vulnerable to VT, although the research findings on this point are mixed. Common signs and symptoms include, but are not limited to, social withdrawal, emotional dysregulation, aggression, greater sensitivity to violence, somatic symptoms, sleep difficulties, intrusive imagery, cynicism, anxiety, depression, substance overuse, sexual difficulties, difficulty managing boundaries with clients, and disruptions in core beliefs and resulting difficulty in relationships reflecting problems with security, trust, esteem, intimacy, and control.

Related Concepts

Although the term vicarious trauma has been used interchangeably with compassion fatigue, secondary traumatic stress disorder, burnout, work-related stress, and secondary trauma, there are important differences, including the following:

• 1.
  Unlike compassion fatigue, VT is a theory-based construct. This means that observable symptoms can serve as the starting point for a process of systematically identifying contributing factors and related signs, symptoms, and adaptations. VT also specifies psychological domains that can be affected and that underlie particular symptoms that may arise. This level of analysis may more accurately guide preventive measures and interventions and allow for the accurate development of interventions for multiple domains (such as addressing aspects of the helper's work style and her work environment).
• 2.
  Countertransference is the psychotherapist's response to a particular client. Unlike vicarious trauma, countertransference can be a very useful tool for psychotherapists, providing them with important information about their clients.
• 3.
  Unlike burnout, countertransference, and work-related stress, VT is specific to trauma workers. This means that the helper may experience trauma-specific difficulties, such as intrusive imagery, that are not part of burnout or countertransference. The burnout and vicarious traumatization constructs overlap in the area of emotional exhaustion. A worker may experience both VT and burnout, and each has its own remedies. VT and countertransference may also co-occur, intensifying each other. Burnout and vicarious trauma can also coexist.
• 4.
  Work-related stress is a generic term without a theoretical basis, specific signs and symptoms or contributing factors, or remedies.
• 5.
  Secondary trauma can be conceptualized as trauma one may experience when a friend or loved one is victimized. This is different from VT in that the secondary trauma victim has a personal, rather than a professional, role with the primary survivor. That implies very different effects, in nature, extent, and intensity. It also requires different interventions.
• 6.
  Debora Arnold and colleagues described v icarious posttraumatic growth (VPG) after interviews with 21 psychotherapists who were asked about the effects their work had on them. Unlike VT, VPG is not a theory-based construct but, rather, is based on self-reported signs.
• 7.
  Pilar Hernandez and colleagues reported results of interviews with 12 clinicians who worked with survivors of political violence and torture. Their construct, vicarious resilience (VR), is based on lessons clinicians learned from working with survivors. Although a valuable construct, VR is not rooted in theory but rather in clinical observation.

Mechanism

The posited mechanism for VT is empathy. Different forms of empathy may result in different effects on helpers. C. Daniel Batson and colleagues have conducted research that might inform trauma helpers about ways to manage empathic connections constructively. If helpers identify with their trauma survivor clients and immerse themselves in thinking about what it would be like if these terrible events happened to them, they are likely to experience personal distress, feeling upset, worried, distressed. Conversely, if helpers instead imagine what the client experienced, they may more likely feel compassion and be moved to help. Babette Rothschild has also suggested specific ways of managing empathy with the goal of reducing vicarious trauma while remaining attuned and connected to the client. She focuses on the neurobiology of empathy.

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