Vicarious traumatization
Encyclopedia
Vicarious traumatization (VT) is a transformation in the self of a trauma worker or helper that results from empathic
engagement with traumatized
clients and their reports of traumatic experiences. Its hallmark is disrupted spirituality
, or meaning and hope. McCann and Pearlman(1990a) coined this term specifically with reference to the experience of psychotherapists working with trauma survivor clients. Others, including Saakvitne, Gamble, Pearlman, and Lev (2000) have expanded its application to a wide range of persons who assist trauma survivors, including clergy
(Day, Vermilyea, Wilkerson, & Giller, 2006),front line social service workers (Pryce, Shackelford, & Pryce, 2007), justice system professionals (Levin & Greisberg, 2003; Peters, 2007), health care
providers (Madrid & Schacher, 2006; Shah, 2010a), humanitarian workers
(Shah, 2007; Pearlman & McKay, 2009), journalist
s, and first responders (Shah, 2010a).
, and support network, among other things, all interact with his or her situation (including work setting, the nature of the work s/he does, the specific clientele served, etc.), to give rise to individual expressions of vicarious trauma. This in turn implies the individual nature of responses or adaptations to VT as well as individual ways of coping with and transforming it.
Anything that interferes with the helper's ability to fulfill his/her responsibility to assist traumatized clients can contribute to vicarious trauma. Many social service workers report that they experience the demands of their agencies as the greatest impediment to their effectiveness
and work satisfaction (Pryce et al., 2007).
; greater sensitivity
to violence
; somatic symptoms; sleep difficulties; intrusive imagery
; cynicism
; sexual difficulties; difficulty managing boundaries with clients; and core beliefs and resulting difficulty in relationships reflecting problems with security, trust, esteem, intimacy, and control (Arvay & Uhlemann, 1996; Bober, Regehr,& Zhou, 2006; Brady, Guy, Poelstra, & Brokaw, 1999; Cunningham, 1999; Ghahramanlou & Brodbeck, 2000; Pearlman, 2003; Schauben & Frazier, 1995).
" [link] and "secondary traumatic stress disorder," "burnout
," and "countertransference
," [link] and "work-related stress," there are important differences. These include the following:
, feeling upset, worried, distressed. On the other hand, if helpers instead imagine what the client experienced, they may be more likely to feel compassion
and moved to help.
. More specifically, the aspects of VT that would need to be measured for a complete assessment include self capacities, ego resources, frame of reference
(identity, world view, and spirituality), psychological needs, and trauma symptoms (see McCann & Pearlman, 1990b, Pearlman, 2001, and Saakvitne et al., 2000 for discussions of these realms of the self). Measures of some of these elements of VT exist, including the following:
Psychological needs: Trauma and Attachment Belief Scale (Pearlman, 2003). This scale is available through Western Psychological Services, Inc. at www.wpspublish.com.
Self capacities: Inner Experience Questionnaire (Pearlman, 1995). Available from Laurie Anne Pearlman at lpearlmanphd@comcast.net
Inventory of Altered Self-Capacities (IASC, Briere, 2002). Available from Psychological Corporation.
Trauma symptoms:
World view: World Assumptions Scale (Janoff-Bulman, 1989)
s or system
s, although institutions that provide trauma-related services bear a responsibility to create policies and work settings that facilitate staff (and therefore client) well-being (Shah, 2008; Shah, 2010b). Each trauma worker is responsible for self-care (Saakvitne, Pearlman, and the Staff of the Traumatic Stress Institute, 1996), working reflectively (Pearlman & Caringi, 2009), and engaging in regular, frequent, trauma-informed professional confidential consultation
(Pearlman & Saakvitne, 1995).
There are many ways of addressing vicarious traumatization. All involve awareness, balance, and connection (Saakvitne et al., 1996). One set of approaches can be grouped together as coping strategies. These include, for example, self-care, rest, escape, and play. A second set of approaches can be grouped as transforming strategies. Transforming strategies aim to help workers create community
and find meaning through the work. Within each category, strategies may be applied in one's personal life (Saakvitne et al., 2000; Saakvitne et al., 1996) and professional life(Pearlman & Caringi, 2009). Organizations that provide trauma services can also play a role in mitigating vicarious trauma (Rosenbloom, Pratt, & Pearlman, 1995; Stamm, 1999).
(VTF). This is the process of transforming one's vicarious trauma, leading to spiritual growth. Vicarious transformation is a process of active engagement with the negative changes that come about through trauma work. It can be recognized by a deepened sense of connection with all living beings, a broader sense of moral inclusion, a greater appreciation of the gifts in one's life, and a greater sense of meaning and hope. Like VT, VTF is a process, not an endpoint or outcome. If we can embrace, rather than fending off, our clients’ extraordinary pain
, our humanity is expanded. In this receptive mode, our caring is deepened. Our clients feel that we are allowing them to affect us. This reciprocal process conveys respect
. We learn from our trauma survivor clients that people can endure horrible things and carry on. This knowledge is a gift we can pass along to others.
Empathy
Empathy is the capacity to recognize and, to some extent, share feelings that are being experienced by another sapient or semi-sapient being. Someone may need to have a certain amount of empathy before they are able to feel compassion. The English word was coined in 1909 by E.B...
engagement with traumatized
Psychological trauma
Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...
clients and their reports of traumatic experiences. Its hallmark is disrupted spirituality
Spirituality
Spirituality can refer to an ultimate or an alleged immaterial reality; an inner path enabling a person to discover the essence of his/her being; or the “deepest values and meanings by which people live.” Spiritual practices, including meditation, prayer and contemplation, are intended to develop...
, or meaning and hope. McCann and Pearlman(1990a) coined this term specifically with reference to the experience of psychotherapists working with trauma survivor clients. Others, including Saakvitne, Gamble, Pearlman, and Lev (2000) have expanded its application to a wide range of persons who assist trauma survivors, including clergy
Clergy
Clergy is the generic term used to describe the formal religious leadership within a given religion. A clergyman, churchman or cleric is a member of the clergy, especially one who is a priest, preacher, pastor, or other religious professional....
(Day, Vermilyea, Wilkerson, & Giller, 2006),front line social service workers (Pryce, Shackelford, & Pryce, 2007), justice system professionals (Levin & Greisberg, 2003; Peters, 2007), health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
providers (Madrid & Schacher, 2006; Shah, 2010a), humanitarian workers
Humanitarian aid
Humanitarian aid is material or logistical assistance provided for humanitarian purposes, typically in response to humanitarian crises including natural disaster and man-made disaster. The primary objective of humanitarian aid is to save lives, alleviate suffering, and maintain human dignity...
(Shah, 2007; Pearlman & McKay, 2009), journalist
Journalist
A journalist collects and distributes news and other information. A journalist's work is referred to as journalism.A reporter is a type of journalist who researchs, writes, and reports on information to be presented in mass media, including print media , electronic media , and digital media A...
s, and first responders (Shah, 2010a).
Contributing factors
Vicarious trauma, conceptually based in constructivist self-development theory (McCann & Pearlman, 1990b; Pearlman & Saakvitne, 1995; Saakvitne, et al., 2000), arises from an interaction between individuals and their situations. This means that the individual helper's personal history (including prior traumatic experiences), coping strategiesCoping Strategies
Coping Strategies is treatment designed for posttraumatic stress disorder within United States Armed Forces personnel and their families by the charitable organization Patriot Outreach...
, and support network, among other things, all interact with his or her situation (including work setting, the nature of the work s/he does, the specific clientele served, etc.), to give rise to individual expressions of vicarious trauma. This in turn implies the individual nature of responses or adaptations to VT as well as individual ways of coping with and transforming it.
Anything that interferes with the helper's ability to fulfill his/her responsibility to assist traumatized clients can contribute to vicarious trauma. Many social service workers report that they experience the demands of their agencies as the greatest impediment to their effectiveness
Effectiveness
Effectiveness is the capability of producing a desired result. When something is deemed effective, it means it has an intended or expected outcome, or produces a deep, vivid impression.-Etymology:...
and work satisfaction (Pryce et al., 2007).
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 (see Bride, 2004,for a review of this literature). Common signs and symptoms include, but are not limited to, social withdrawal; emotional lability; aggressionAggression
In psychology, as well as other social and behavioral sciences, aggression refers to behavior between members of the same species that is intended to cause humiliation, pain, or harm. Ferguson and Beaver defined aggressive behavior as "Behavior which is intended to increase the social dominance of...
; greater sensitivity
Sensitivity
Stimulus|Sensitivity may refer to:* Sensitivity , the ability to react to a stimulus* Sensitivity , the strength of physical or emotional reaction in people* Sensitivity , variations in process dynamics and control systems...
to violence
Violence
Violence is the use of physical force to apply a state to others contrary to their wishes. violence, while often a stand-alone issue, is often the culmination of other kinds of conflict, e.g...
; somatic symptoms; sleep difficulties; intrusive imagery
Intrusive thoughts
Intrusive thoughts are unwelcome involuntary thoughts, images, or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to manage or eliminate. Most people experience these thoughts...
; cynicism
Cynicism
Cynicism , in its original form, refers to the beliefs of an ancient school of Greek philosophers known as the Cynics . Their philosophy was that the purpose of life was to live a life of Virtue in agreement with Nature. This meant rejecting all conventional desires for wealth, power, health, and...
; sexual difficulties; difficulty managing boundaries with clients; and core beliefs and resulting difficulty in relationships reflecting problems with security, trust, esteem, intimacy, and control (Arvay & Uhlemann, 1996; Bober, Regehr,& Zhou, 2006; Brady, Guy, Poelstra, & Brokaw, 1999; Cunningham, 1999; Ghahramanlou & Brodbeck, 2000; Pearlman, 2003; Schauben & Frazier, 1995).
Related concepts
While the term "vicarious trauma" has been used interchangeably with "compassion fatigueCompassion fatigue
Compassion fatigue is a condition characterised by a gradual lessening of compassion over time. It is common among trauma victims and individuals that work directly with trauma victims. It was first diagnosed in nurses in the 1950s...
" [link] and "secondary traumatic stress disorder," "burnout
Burnout (psychology)
Burnout is a psychological term for the experience of long-term exhaustion and diminished interest. Research indicates general practitioners have the highest proportion of burnout cases; according to a recent Dutch study in Psychological Reports, no less than 40% of these experienced high levels of...
," and "countertransference
Countertransference
Countertransferenceis defined as redirection of a psychotherapist's feelings toward a client—or, more generally, as a therapist's emotional entanglement with a client.-Early formulations:...
," [link] and "work-related stress," there are important differences. These include the following:
- Unlike compassion fatigue, VT is a theory-based construct. This means that observable symptomSymptomA symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s can serve as the starting for a process of discovering contributing factors and related signs, symptoms, and adaptations. VT also specifies psychological domains that can be affected, rather than specific symptoms that may arise. This specificity may more accurately guide preventive measures and interventionIntervention (counseling)An intervention is an orchestrated attempt by one, or often many, people to get someone to seek professional help with an addiction or some kind of traumatic event or crisis, or other serious problem. The term intervention is most often used when the traumatic event involves addiction to drugs...
s, and allow for the accurate development of interventions for multiple domains (such as changes in the balance between psychotherapyPsychotherapyPsychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
and other work-related tasks and changes in self-care practices). - Countertransference is the psychotherapist's response to a particular client. VT refers to responses across clients, across time.
- Unlike burnout, countertransference, and work-related stress, VT is specific to trauma workers. This means that the helper will experience trauma-specific difficulties, such as intrusive imagery, that are not part of burnout or countertransference (Pearlman & Saakvitne, 1995). The burnout and vicarious traumatization constructs overlap (specifically in the area of emotional exhaustionEmotional exhaustionEmotional exhaustion is a chronic state of physical and emotional depletion that results from excessive job demands and continuous stress. It describes a feeling of being emotionally overextended and exhausted by one's work...
[Gamble, Pearlman, Lucca, & Allen, 1994]). A worker may experience both VT and burnout, and each has its own remedies. VT and countertransference may also co-occur, intensifying each other (Pearlman & Saakvitne, 1995). - Unlike vicarious trauma, countertransference can be a very useful tool for psychotherapists, providing them with important information about their clients.
- Work-related stress is a generic term without a theoretical basis, specific signs and symptoms or contributing factors, or remedies. Burnout and vicarious trauma can co-exist. Countertransference responses may potentiate vicarious trauma (Pearlman & Saakvitne, 1995).
- Vicarious post-traumatic growthPost-traumatic growthPosttraumatic growth refers to positive psychological change experienced as a result of the struggle with highly challenging life circumstances . These sets of circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to...
. Arnold, Tedeschi, Calhoun, and Cann, 2005) reported this phenomenon after interviews with 21 psychotherapists who were asked about the effects their work had on them. Unlike VTF, VPG is not a theory-based construct, but based on self-reported signs. - Body-centred countertransferenceBody-centred countertransferenceBody-centred countertransference or 'somatic countertransference refers to feelings that a psychological practitioner has about a client. Referring to the psychologists sensation in the gut, changes to breathing, to heart rate and to tension in muscles'....
Mechanism
The posited mechanism for vicarious traumatization is empathy [link](Pearlman & Saakvitne, 1995; Rothschild, 2006; Wilson & Thomas, 2004). Different forms of empathy may result in different effects on helpers. Batson and colleagues have conducted research that might inform trauma helpers about ways to manage empathic connection constructively (Batson, Fultz, & Schoenrade, 1987; Lamm, Batson, & Decety, 2007). If helpers identify with their trauma survivor clients and immerse themselves in thinking about what it would be like if these events happened to them, they are likely to experience personal distressDistress
Distress may refer to:*Distress , occurring when an individual cannot adapt to stress*Suffering*Distress signal, an internationally recognized means for obtaining help...
, feeling upset, worried, distressed. On the other hand, if helpers instead imagine what the client experienced, they may be more likely to feel compassion
Compassion
Compassion is a virtue — one in which the emotional capacities of empathy and sympathy are regarded as a part of love itself, and a cornerstone of greater social interconnection and humanism — foundational to the highest principles in philosophy, society, and personhood.There is an aspect of...
and moved to help.
Measurement of VT
Over the years, people have measured VT in a wide variety of ways. Vicarious trauma is a multifaceted construct requiring a multifaceted assessmentEvaluation
Evaluation is systematic determination of merit, worth, and significance of something or someone using criteria against a set of standards.Evaluation often is used to characterize and appraise subjects of interest in a wide range of human enterprises, including the arts, criminal justice,...
. More specifically, the aspects of VT that would need to be measured for a complete assessment include self capacities, ego resources, frame of reference
Frame of reference
A frame of reference in physics, may refer to a coordinate system or set of axes within which to measure the position, orientation, and other properties of objects in it, or it may refer to an observational reference frame tied to the state of motion of an observer.It may also refer to both an...
(identity, world view, and spirituality), psychological needs, and trauma symptoms (see McCann & Pearlman, 1990b, Pearlman, 2001, and Saakvitne et al., 2000 for discussions of these realms of the self). Measures of some of these elements of VT exist, including the following:
Psychological needs: Trauma and Attachment Belief Scale (Pearlman, 2003). This scale is available through Western Psychological Services, Inc. at www.wpspublish.com.
Self capacities: Inner Experience Questionnaire (Pearlman, 1995). Available from Laurie Anne Pearlman at lpearlmanphd@comcast.net
Inventory of Altered Self-Capacities (IASC, Briere, 2002). Available from Psychological Corporation.
Trauma symptoms:
- PTSD Checklist (PCL, Weathers et al., 1993)
- Impact of Events Scale (IES, Horowitz, 1979)
- Impact of Events Scale-Revised (IES-R; Weiss & Marmar, 1996)
- Trauma Symptom Inventory (Briere, 1996)
- Detailed Assessment of Posttraumatic Stress (DAPS, Briere, 2001)
World view: World Assumptions Scale (Janoff-Bulman, 1989)
Addressing VT
Vicarious traumatization is not the responsibility of clientClient
Client may refer to:* Customer, someone who purchases or hires something from someone else* Client , software that accesses a remote service on another computer* The client who received patronage in ancient Rome...
s or system
System
System is a set of interacting or interdependent components forming an integrated whole....
s, although institutions that provide trauma-related services bear a responsibility to create policies and work settings that facilitate staff (and therefore client) well-being (Shah, 2008; Shah, 2010b). Each trauma worker is responsible for self-care (Saakvitne, Pearlman, and the Staff of the Traumatic Stress Institute, 1996), working reflectively (Pearlman & Caringi, 2009), and engaging in regular, frequent, trauma-informed professional confidential consultation
Consultation
The Consultation served as the provisional government of Mexican Texas from November 1835 through March 1836 during the Texas Revolution. Tensions rose in Texas during early 1835 as throughout Mexico federalists began to oppose the increasingly centralist policies of the government. In the...
(Pearlman & Saakvitne, 1995).
There are many ways of addressing vicarious traumatization. All involve awareness, balance, and connection (Saakvitne et al., 1996). One set of approaches can be grouped together as coping strategies. These include, for example, self-care, rest, escape, and play. A second set of approaches can be grouped as transforming strategies. Transforming strategies aim to help workers create community
Community
The term community has two distinct meanings:*a group of interacting people, possibly living in close proximity, and often refers to a group that shares some common values, and is attributed with social cohesion within a shared geographical location, generally in social units larger than a household...
and find meaning through the work. Within each category, strategies may be applied in one's personal life (Saakvitne et al., 2000; Saakvitne et al., 1996) and professional life(Pearlman & Caringi, 2009). Organizations that provide trauma services can also play a role in mitigating vicarious trauma (Rosenbloom, Pratt, & Pearlman, 1995; Stamm, 1999).
Vicarious transformation
Beyond vicarious traumatization lies vicarious transformationSpiritual transformation
Spiritual transformation has a variety of overlapping meanings that carry distinct connotations:*In psychology, spiritual transformation is understood within the context of an individual's meaning system, especially in relation to concepts of the sacred or ultimate concern...
(VTF). This is the process of transforming one's vicarious trauma, leading to spiritual growth. Vicarious transformation is a process of active engagement with the negative changes that come about through trauma work. It can be recognized by a deepened sense of connection with all living beings, a broader sense of moral inclusion, a greater appreciation of the gifts in one's life, and a greater sense of meaning and hope. Like VT, VTF is a process, not an endpoint or outcome. If we can embrace, rather than fending off, our clients’ extraordinary pain
Suffering
Suffering, or pain in a broad sense, is an individual's basic affective experience of unpleasantness and aversion associated with harm or threat of harm. Suffering may be qualified as physical or mental. It may come in all degrees of intensity, from mild to intolerable. Factors of duration and...
, our humanity is expanded. In this receptive mode, our caring is deepened. Our clients feel that we are allowing them to affect us. This reciprocal process conveys respect
Respect
Respect denotes both a positive feeling of esteem for a person or other entity , and also specific actions and conduct representative of that esteem. Respect can be a specific feeling of regard for the actual qualities of the one respected...
. We learn from our trauma survivor clients that people can endure horrible things and carry on. This knowledge is a gift we can pass along to others.
Further reading
- Hernandez, P., Gangsei, D., & Engstrom, D. (2007). Vicarious resilience: A new concept in work with those who survive trauma. Family Process, 46(2), 229-241.
- Kearney, M.K., Weininger, R.B., Vachon, M.L.S., Harrison, R.L., & Mount, B.M. (2009). Self-care of physicns caring for patients at the end of life. Journal of the American Medical Association, 301(11), 1155-1164.
- Meadors, P.,& Lamson, A. (2009). Compassion fatigue and secondary traumatization: Provider self care on intensive care units for children.
- Journal of Pediatric Health Care, (22)1, 24-34.
- Norcross, J.C., & Guy, J.D. (2007). Leaving it at the office: A guide to psychotherapist self-care. New York: Guilford Press.
- Peters, J.K. (2007). Representing children in child protective proceedings 2007: Ethical and practical dimensions(3rd ed.). LexisNexis Matthew Bender.
- Shah, S.A. (2009). “To do no harm,” Spiritual Care and Ethnomedical Competence: Four cases of Psychosocial Trauma Recovery for the 2004 Tsunami and 2005 Earthquake in South Asia. In G.H. Brenner, D.H. Bush, & J. Moses (Eds.) Creating Spiritual and Psychological Resilience Integrating Care In Disaster Relief Work, 157-178. New York: Routledge.
- Wicks, R.J.J. (2007). The resilient clinician. New York: Oxford University Press.