Vicarious Traumatization

Vicarious traumatization, compassion fatigue, and secondary trauma all refer to the potentially negative impact of working with trauma survivors, including survivors of interpersonal violence, on caregivers, including therapists, counselors, advocates, and volunteers. Caregivers have described a range of responses to working with trauma survivors, including fear, feeling overwhelmed, anxiety, insomnia, physical ailments, emotional numbing, anger, hopelessness, vulnerability, grief, guilt, dread, horror, and over- or underidentification with survivors.

While some writers use the terms vicarious traumatization and compassion fatigue interchangeably, others have attempted to differentiate them. Vicarious traumatization focuses more on trauma work's capacity to create changes in a caregiver's cognitive schema, or underlying beliefs, about trust, safety, meaning, and self- and other esteem, and sense of meaning. Vicarious trauma can lead to increased fearfulness about one's own or loved ones' well-being, suspicion of others, a more negative view of personal and others' motives, [Page 732]social isolation, a lack of enjoyment of personal pleasures and pursuits, and attempts to either control others or surrender control to others. Finally, vicarious trauma can lead to transformations of the caregivers' worldview, spirituality, meaning, and sense of hope. Compassion fatigue focuses more on symptoms of posttraumatic stress, such as emotional numbing, intrusive images, and hyperarousal, agitation, and anxiety that are the result of a caregiver's interactions with trauma survivors. Research has also attempted to differentiate vicarious trauma and compassion fatigue from earlier conceptualizations of work stress such as burnout and countertransference.

Both compassion fatigue and vicarious trauma are thought to occur as a result of caregivers' empathic connection with survivors' intense feelings about and reactions to the traumatic event, overload of work demands, and the challenges to basic beliefs that traumatic events can present. Youth and inexperience, high caseloads of trauma survivors, lack of education (particularly trauma-specific education), and a personal history of trauma are thought to make caregivers more vulnerable to vicarious trauma-compassion fatigue, although findings on the impact of the therapist's own history of trauma on current report of vicarious trauma are equivocal. Numerous articles by caregivers have discussed possible approaches to preventing or mediating vicarious trauma or compassion fatigue, including limiting exposure to traumatized clients; taking care of one's body through rest, exercise, and healthy nutrition; developing personal and organizational support; maintaining good boundaries; obtaining trauma-specific education and supervision; and seeking help such as therapy or consultation as needed. However, there is little research to support any particular approach. It appears that at this time vicarious trauma, compassion fatigue, or secondary trauma are potential, though not inevitable, consequences of long-term work with trauma survivors.