Vicarious traumatization

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. It is a special form of countertransference stimulated by exposure to the client’s traumatic material (Courtois, 1993). Its hallmark is disrupted spirituality, or a disruption in the trauma workers' perceived 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 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), journalists, 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 strategies, 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 human service workers report that administrative and bureaucratic factors that impediment to their effectiveness influence work satisfaction (Pryce et al., 2007). Negative aspects of the organization as a whole, such as reorganization, downsizing in the name of change management and a lack of resources in the name of lean management, contribute to burned-out workers (Maslach, 2001 , 2003 ; Rupert & Morgan, 2005).

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; mood swings; aggression; 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).

Related concepts

While the term "vicarious trauma" has been used interchangeably with "compassion fatigue" and "secondary traumatic stress disorder," "burnout," and "countertransference," 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 symptoms 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 interventions, and allow for the accurate development of interventions for multiple domains (such as changes in the balance between psychotherapy 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 exhaustion [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 growth. 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 countertransference

Mechanism

The posited mechanism for vicarious traumatization is empathy (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 distress, 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.

Measurement

Over the years, people have measured VT in a wide variety of ways. Vicarious trauma is a multifaceted construct requiring a multifaceted assessment. 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 (McCann & Pearlman, 1990b, Pearlman, 2001, and Saakvitne et al., 2000) Measuring 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.(www.wpspublish.com)
Self capacities: Inner Experience Questionnaire (Pearlman, 1995). Available from Laurie Anne Pearlman(lpearlmanphd@comcast.net) and 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); Children's revised Impact of Events Scale - Arabic Version CR-IES13 (Veronese & Pepe, 2013); Trauma Symptom Inventory (Briere, 1996); Detailed Assessment of Posttraumatic Stress (DAPS, Briere, 2001) and World Assumptions Scale (Janoff-Bulman, 1989).

Addressing

Vicarious traumatization is not the responsibility of clients or systems, 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).

Research shows that many simple things increase happiness and this aids to lessen the impact of vicarious traumatization. People who are more socially connected (Kawachi & Berkman, 2001) tend to be happier. People who consciously practice gratitude are also shown happier (Seligman, Steen, Park, & Peterson, 2005). Experiences from active engagement with creative endeavours, music, sports, games, religious rituals...etc. from complete detachment with work are gauged to increase happiness (Csikszentmihalyi, American Psychologist ,10 ,821 – 827). Self-care practices like yoga, qigong, and sitting meditation are found to be helpful for those who practice(Christopher et al., 2011 ; Christopher, Christopher, Dunnagan, & Schure, 2006 ;Newsome, Christopher, Dahlen, & Christopher, 2006). HBR in a case study regarding to traumatization stated that it is essential to create an organizational culture in which it’s cool to be a social worker or a counselor, where these professionals are empowered to influence the workplace issues, the strategy of human services in both corporate and care services. (Mental Health and the American Workplace, John A. Quelch and Carin-Isabel)

Vicarious transformation

Beyond vicarious traumatization lies vicarious transformation (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 the clients’ extraordinary pain can be embraced instead of fended off, humanity is expanded. In this receptive mode, caring can be deepened. The clients feel that they are allowed to exert their influence, and this reciprocal process conveys respect. People can learn from trauma survivor clients that people can endure horrible things and show great resilience and strength. This knowledge that clients improve over time is gratifying and fulfilling the subsequent emotional healing brings ripple effects through the client’s family, friends, and off spring ...etc. this lived experience of survival would turn out as a gift that can be passed along to others.

References

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