How to spot vicarious trauma and what to do about it
Counsellors and therapists are arguably at high risk of vicarious trauma as they are frequently exposed to the traumatic stories of their clients. A survey of 253 trauma therapists in the UK found that 70% of therapists were at high risk of secondary traumatic stress (Sodeke-Gregson, Holttum & Billings, 2013).
Sadly, however, many counsellors may not even realise they are experiencing vicarious trauma or may feel that what they are experiencing is ‘par for the course’ in being a counsellor. There may even be shame or embarrassment about being impacted by client work, which of course, shouldn’t be the case. Unfortunately, as counsellors or therapists we may not afford ourselves the same compassion we show to our clients.
As many will be aware, vicarious trauma can influence quality of life and relationships as well as mental and physical health. A poll in the Counsellors Therapy Pot Facebook group showed that well over half respondents fell they received adequate training around counsellor self-care and wellbeing before they qualified. So, it isn’t surprising that there are some counsellors who aren’t even aware that they are experiencing the effects of vicarious trauma.
In this blog I will highlight some of the differences between vicarious trauma, burnout, compassion fatigue and moral injury. It can be the case, for instance, that people don’t realise that they are experiencing the effects of vicarious trauma, they think that they have burnout. But it is really important to be able to tell the difference. This is probably exacerbated by the fact that burnout, vicarious trauma, compassion fatigue and even moral injury can all go hand in hand.
Photograph by Savannah B. from Unsplash
Vicarious trauma and compassion fatigue seem to have the most in common because they can both alter the individuals' world view. They are more complicated than being very tired or overworked and can often caused by a conflict between our deepest values and the work that we are required to do, a phenomenon which is called moral distress. Burnout, unlike VT, CF and MI can be treated by taking time out or resting. Whilst this may help those with the other issues mentioned, rest and recuperation will not ease the symptoms entirely.
Some signs and symptoms of Vicarious Trauma include:
Experiencing lingering feelings of anger and / or sadness about the client’s situation.
Becoming overly involved emotionally with the client.
Experiencing bystander guilt, shame, feelings of self-doubt. This may be similar to survivor's guilt.
Being preoccupied with thoughts of clients outside of the work situation.
Over identification with the client or intrusive imagery.
Loss of hope, pessimism, or cynicism
Nightmares and / or lack of sleep.
Avoiding traumatic disclosures from clients, leading to subpar clinical services. The counsellor's experience is what we are concerned about at T-pot but it is also very important to note that addressing VT isn't just important for ourselves, it is important for our clients too.
Negative coping skills, both personally and professionally. This may include reliance on food, alcohol or shopping outside of work or inside work it could look like checking notes over and over again or taking more on than you should because, somehow, you think it will help.
Hyperarousal to your safety and the safety of loved ones. This may be a general feeling or it may be specifically related to issues that your client has brought (for example, if they talk about a traumatic burglary you may worry unhealthily that this will happen to you or loved ones).
Increasingly pessimistic worldview. This can be heightened by national and international news stories.
Loss of work-related motivation.
Distancing from spiritual beliefs.
Thinking about a career change.
Stress-related medical conditions.
Resenting the ‘extra mile’ you go for the job. Some people might be proud of going that extra mile to start with (for instance, seeing more clients in a day than is advisable, not taking holiday or just generally living and breathing their work) but over time this may turn to resentment, grumpiness and irritability which may seep into their personal life. Amy Cunningham talks about this in her TED talk: The Cost of Vicarious Trauma.
Exhaustion and irritability. This is how VT can be mistaken for burnout. If you feel you have burnout do check in and see if symptoms more aligned with VT are also present.
Ways of preventing or easing the impact of vicarious trauma include:
Check in with yourself regularly: learn the signs your body gives you to let you know if client work is getting too much.
Balance your caseload - mix of more and less traumatised clients.
Take regular breaks, take time off when you need to.
Consider setting up a buddy system with colleagues or other counsellors that you know.
Ensure that you use supervision effectively. Consider if some extra supervision might be helpful, such as peer supervision for instance.
Consider having your own therapy if you do have a lot of traumatised clients or if there is a particular case playing on your mind. Don't forget that we offer affordable counselling for counsellors at T-pot.
Ask yourself if there are personal factors that may increase your risk of Vicarious Trauma or Compassion Fatigue. For instance, if you have a lot of caring responsibilities such as caring for elderly parents you may be more prone to vicarious trauma. If you have a lot on your plate outside work it is important to check in and see if you need to make some changes to mitigate that.
Say no when necessary and communicating your limits to avoid becoming overwhelmed.
Ensure that you have a support network of friends, family members, or colleagues who can provide emotional support and understanding. Share your experiences and feelings with trusted individuals who can offer empathy and validation. Take time to find a ‘tribe’ that you feel comfortable with if necessary. Your connection and wellbeing is important!
Incorporate mindful practices into your daily routine to stay grounded and present. Mindfulness techniques, including deep breathing and meditation, can help reduce stress and promote emotional resilience.
Limit the amount of exposure you have to traumatic material, whether it’s through news or TV programmes.
Find ways of externalising the feelings through creative media - using the sandtray (if you have the equipment), drawing, painting, writing, composing poetry or songs.
Wellbeing of counsellors is our prime concern at Counsellors Therapy Pot so in the new year we will be launching Self-care CPD online workshops which will include sessions on vicarious trauma and compassion fatigue as well as burnout and moral injury. Please let us know if you have any thoughts about what you’d like us to include in the training. We’d also like to hear from anyone who has been impacted by any of these topics who would be willing to talk about their experiences in a case study. In return we would give you free access to the workshops.
Take care all.
Photograph by Kelly Sikkema on Unsplash