Whenever I teach a course on Vicarious Trauma and Compassion Fatigue – I always begin by asking my students to consider a glass of water – not based on how empty or full, but how heavy they think it is. Some people respond in milliliters, others try to puzzle out the weight of the water versus the glass. After a few minutes of consideration, I give them the metric they are searching for:
The weight of the water changes depending on how long you hold onto it.
If I hold the glass for a minute, its fine. If I hold it for 5 minutes, my arm starts to tire, if I hold it for 15 minutes, my arm starts to hurt, If I hold it for an hour, that pain becomes paralysis.
Holding the stories of people affected by trauma works in the same way. The longer we bear the weight of trauma, the more we are affected by it. If we do not take restorative action when we become tired, that fatigue becomes pain, which leads to paralysis.
There are a number of terms that we hear when we begin to talk about the impact of trauma on the worker. While they are sometimes used interchangeably, there are significant and important distinctions:
Burnout is a condition that causes mental exhaustion, lethargy and depression and relates specifically to environmental factors in the work environment such as: high stress, long hours and lack of organizational support. A person in any high stress environment can suffer from burnout.
Compassion Fatigue is a state of emotional exhaustion affecting primarily professionals in the medical and social support professions and those who are full time carers for ill or disabled relatives. Although there are many symptoms of compassion fatigue, the tell- tale sign is an overwhelming sense of hopelessness and desensitization to the suffering of others.
Vicarious Trauma (or secondary traumatization) is a condition that affects those who are routinely exposed to stories of trauma and tragedy and their graphic details in the course of the job – medical professionals, therapists, police officers, addiction workers, social workers, shelter workers, intake workers, corrections officers. The impact of vicarious trauma on those who experience it are similar to burnout and compassion fatigue, but with additional symptoms such as: intrusive imagery, nightmares, negatively skewed worldview, inability to make decisions, workaholism, grandiosity, avoidance and loss of meaning.
A person who is experiencing Vicarious Trauma may also concurrently experience burnout and compassion fatigue. Recently, the Diagnostic and Statistics Manual have expanded to the definition of Post-Traumatic Stress Disorder to include Vicarious Trauma as a criteria for PTSD diagnosis “indirect exposure to aversive details of the trauma, usually in the course of professional duties.” Essentially this recognizes the insidious nature of trauma transmission and acknowledges that a professional who is routinely exposed to trauma narratives can develop PTSD as a result.
Strategies for Prevention
So, what can you do to prevent and manage these risks so that you can continue to do the work you love and support traumatized populations?
1) Recognize what your own red flags are in terms of being affected by the work. Do you notice yourself feeling relieved when a client cancels? Are you hiding in your office instead of engaging with coworkers? Do you feel responsible when a client makes unhealthy choices? Are you seeing abuse/neglect everywhere you look?
2)Once you have identified what the signs are for you personally – be authentic about how you are being affected with supervisor.
3)Utilize debriefing sessions with your supervisor or colleagues. If possible never do this work in isolation. An effective debrief or peer support session greatly reduces the likelihood of developing vicarious trauma
4) Develop a structured plan of self-care. This includes staggering peer support, supervision, and sessions with your own therapist, as well as defining strategies that help you to ‘shake off’ the details of graphic stories. Your plan should be highly personalized in order to accommodate what works for you.
5)Be intentional about creating personal/professional boundaries. Perhaps you create a self-care ritual that bookends your week – and marks the time going forward as the weekend.
6)Be mindful of your coping mechanisms and their relative health. Check in with yourself about your substance use. If you are making unhealthy choices – seek help.
7) Learn more about Vicarious Trauma and strategies for coping and prevention. There are many great resources on this topic, and I provide corporate workshops as well as individual support. Don’t hesitate to connect with me today if you want to learn more.
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Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
Harrison & Westwood. 2009. Preventing Vicarious Trauma of mental health therapists: Identifying Protective Practices. Psychotherapy Theory, Research, Practice, Training. Vol. 46, No. 2, 203–219
Lipsky, L. v. D., & Burk, C. (2009). Trauma stewardship [electronic book]: An everyday guide to caring for self while caring for others. San Francisco, CA: Berrett-Koehler Publishers.
Sunna Murphy, M.S.W., R.S.W. Sunna has specialized in the areas of trauma treatment, vicarious trauma, sexual abuse and domestic violence, borderline personality disorder and adolescent psychology for 5 years. She has over 10 years of experience working with diverse clients and communities on issues related to sexuality, gender, race, disability and equity. Sunna is passionate about helping people find their authentic voice and using creative pathways to healing. She is an eclectic practitioner that utilizes psychodynamic therapy, narrative therapy and dialectical behavioural therapy.