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.[1] Its hallmark is disrupted spirituality, or a disruption in the trauma workers' perceived meaning and hope. The term was coined specifically with reference to the experience of psychotherapists working with trauma survivor clients.[2] Others, including Saakvitne, Gamble, Pearlman, and Lev (2000) have expanded its application to a wide range of persons who assist trauma survivors, including clergy,[3] front-line social workers,[4] justice system professionals,[5][6] health care providers,[7][8] humanitarian workers,[9][10] journalists, and first responders.[8]

Signs and symptoms

The symptoms of vicarious trauma align with the symptoms of primary, actual trauma. When helping professionals attempt to connect with their clients/victims emotionally, the symptoms of vicarious trauma can create emotional disturbance such as feelings of sadness, grief, irritability and mood swings.[11] 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.[12] 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.[13][14][15][16][17][18][19]

Contributing factors

Vicarious trauma, conceptually based in constructivist self-development theory,[20][21][22] 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.[4] 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.[23][24][25]

Vicarious trauma has also been attributed to the stigmatization of mental health care among service providers. Stigma leads to an inability to engage in self care and eventually the service provider may reach burnout, and become more likely to experience VT.[26] The research has also begun to show that vicarious trauma is more prominent in those with a prior history of trauma and adversity.[26] Research indicates that a mental health provider's defense style might pose as a risk factor for vicarious traumatization. Mental health providers with self-sacrificing defense styles have been found to experience increased vicarious traumatization.[27]

While the term "vicarious trauma" has been used interchangeably with "compassion fatigue", "secondary traumatic stress disorder," "burnout," "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.[21] The burnout and vicarious traumatization constructs overlap, specifically regarding emotional exhaustion.[28] A worker may experience both VT and burnout, and each has its own remedies. VT and countertransference may also co-occur, intensifying each other.[21]
  • 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.[21]
  • Vicarious post-traumatic growth, unlike VTF, is not a theory-based construct but rather is based on self-reported signs.[29]
  • Body-centred countertransference

Mechanism

The posited mechanism for vicarious traumatization is empathy.[21][30][31] 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.[32][33] 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.[20][34][22] Measuring of some of these elements of VT exist, including the following:

  • Psychological needs, using the Trauma and Attachment Belief Scale[18]
  • Self capacities, using the Inner Experience Questionnaire[21] and/or the Inventory of Altered Self-Capacities[35]
  • Trauma symptoms, using the PTSD Checklist,[36] Impact of Events Scale,[37] Impact of Events Scale-Revised,[38] children's revised Impact of Events Scale (Arabic Version),[39] Trauma Symptom Inventory,[40] Detailed Assessment of Posttraumatic Stress,[41] and/or the World Assumptions Scale[42]

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.[43][44] Each trauma worker is responsible for self-care,[45] working reflectively,[46] and engaging in regular, frequent, trauma-informed professional confidential consultation.[21]

There are many ways of addressing vicarious traumatization. All involve awareness, balance, and connection.[45] 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[22][45] and professional life.[46] Organizations that provide trauma services can also play a role in mitigating vicarious trauma.[47][48]

Research shows that many simple things increase happiness and this aids to lessen the impact of vicarious traumatization. People who are more socially connected tend to be happier.[49] People who consciously practice gratitude are also shown happier.[50] Creative endeavours that are completely detached with work also increase happiness.[51] Self-care practices like yoga, qigong, and sitting meditation are found to be helpful for those who practice.[52][53][54] HBR in a case study regarding to traumatization stated that it is essential to create an organizational culture in which it is 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.[55]

See also

References
  1. Courtois, Christine A. (1993). "Vicarious traumatization of the therapist". NCP Clinical Newsletter. 3 (2).
  2. McCann, I. Lisa; Pearlman, Laurie Anne (1 January 1990). "Vicarious traumatization: A framework for understanding the psychological effects of working with victims". Journal of Traumatic Stress. 3 (1): 131–149. doi:10.1007/BF00975140. ISSN 0894-9867. S2CID 144560628.
  3. Day, Jackson H. (15 February 2006). Vermilyea, Elizabeth; Wilkerson; Giller (eds.). Risking Connection in Faith Communities: A Training Curriculum for Faith Leaders Supporting Trauma Survivors. Baltimore, Maryland: Sidran Press. ISBN 978-1-886968-16-5.
  4. Pryce, Josephine G; Shackelford, Kimberly K.; Pryce, David H. (2007). Secondary Traumatic Stress and the Child Welfare Professional. Chicago: Lyceum Books, Inc. ISBN 978-0-19-061591-8.
  5. Levin, Andrew; Greisberg, Scott (1 September 2003). "Vicarious Trauma in Attorneys". Pace Law Review. 24 (1): 245. ISSN 0272-2410.
  6. Peters, Jean Koh (1 November 2007). Representing Children in Child Protective Proceedings: Ethical and Practical Dimensions (3rd ed.). Lexis Nexis Matthew Bender. ISBN 978-0-8205-7581-0.
  7. Madrid, Paula A.; Schacher, Stephanie J. (May 2006). "A Critical Concern: Pediatrician Self-care After Disasters". Pediatrics. 117 (Supplement 4): S454–S457. doi:10.1542/peds.2006-0099V. ISSN 0031-4005. PMID 16735283.
  8. Shah, Siddharth Ashvin (2011). "Mental Health Emergencies and Post-traumatic Stress Disorder". In Kapur, G.; Smith (eds.). Emergency Public Health: Preparedness and Response. Sudbury, MA: Jones & Bartlett Learning. pp. 493–516. ISBN 978-0-7637-5870-7.
  9. Shah, Siddharth Ashvin; Garland, Elizabeth; Katz, Craig (2007). "Secondary traumatic stress: Prevalence in humanitarian aid workers in India". Traumatology. 13 (1): 59–70. doi:10.1177/1534765607299910. ISSN 1085-9373.
  10. Pearlman, Laurie Anne; McKay, Lisa (2009). "Understanding and addressing vicarious trauma" (PDF). Pasadena, CA: Headington Institute. Cite journal requires |journal= (help)
  11. Catanese, Shiloh A. (September 2010). "Traumatized by association: The risk of working sex crimes". Federal Probation. 74 (2). ISSN 1555-0303.
  12. For a review of this literature, see Bride, Brian E. (1 January 2004). "The Impact of Providing Psychosocial Services to Traumatized Populations". Stress, Trauma, and Crisis. 7 (1): 29–46. doi:10.1080/15434610490281101. ISSN 1543-4613. S2CID 71313058.
  13. Arvay, M.; Uhlemann, M.R. (1996). "Counsellor stress in the field of trauma: A preliminary study". Canadian Journal of Counselling. 30 (3): 193–210.
  14. Bober, Ted; Regehr, Cheryl; Zhou, Yanqiu Rachel (January 2006). "Development of the Coping Strategies Inventory for Trauma Counselors". Journal of Loss and Trauma. 11 (1): 71–83. doi:10.1080/15325020500358225. ISSN 1532-5024. S2CID 144405929.
  15. Brady, Joan Laidig; Guy, James D.; Poelstra, Paul L.; Brokaw, Beth Fletcher (1999). "Vicarious traumatization, spirituality, and the treatment of sexual abuse survivors: A national survey of women psychotherapists". Professional Psychology: Research and Practice. 30 (4): 386–393. doi:10.1037/0735-7028.30.4.386. ISSN 1939-1323.
  16. Cunningham, Maddy (1 August 1999). "The Impact of Sexual Abuse Treatment on the Social Work Clinician". Child and Adolescent Social Work Journal. 16 (4): 277–290. doi:10.1023/A:1022334911833. ISSN 0738-0151. S2CID 140975279.
  17. Ghahramanlou, M.; Brodbeck, C. (2000). "Predictors of secondary trauma in sexual assault trauma counselors". International Journal of Emergency Mental Health. 2 (4): 229–240. ISSN 1522-4821. PMID 11217154.
  18. Pearlman, Laurie A (2003). Trauma and Attachment Belief Scale Manual. Los Angeles: Western Psychological Services. OCLC 828744792.
  19. Schauben, Laura J.; Frazier, Patricia A. (1995). "Vicarious Trauma: The Effects on Female Counselors of Working with Sexual Violence Survivors". Psychology of Women Quarterly. 19 (1): 49–64. doi:10.1111/j.1471-6402.1995.tb00278.x. ISSN 0361-6843. S2CID 145635689.
  20. McCann, I. Lisa (1990). Psychological trauma and the adult survivor: theory, therapy, and transformation. New York: Brunner/Mazel. ISBN 978-0-87630-594-2.
  21. Pearlman, Laurie A.; Saakvitne, Karen W. (1995). Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors. Norton. ISBN 978-0-393-70183-8.
  22. Saakvitne, Karen W. (2000). Risking Connection: A Training Curriculum for Working with Survivors of Childhood Abuse. Sidran Press. ISBN 978-1-886968-08-0.
  23. Maslach, Christina; Schaufeli, Wilmar B.; Leiter, Michael P. (February 2001). "Job Burnout". Annual Review of Psychology. 52 (1): 397–422. doi:10.1146/annurev.psych.52.1.397. ISSN 0066-4308. PMID 11148311.
  24. Maslach, Christina (1 October 2003). "Job Burnout: New Directions in Research and Intervention". Current Directions in Psychological Science. 12 (5): 189–192. doi:10.1111/1467-8721.01258. ISSN 0963-7214. S2CID 145581839.
  25. Rupert, Patricia; Morgan, David (1 October 2005). "Work Setting and Burnout Among Professional Psychologists". Professional Psychology: Research and Practice. 36 (5): 544–550. doi:10.1037/0735-7028.36.5.544.
  26. Newcomb, Michelle; Burton, Judith; Edwards, Niki (2017-08-18). "Service user or service provider? How social work and human services students integrate dual identities". Social Work Education. 36 (6): 678–689. doi:10.1080/02615479.2017.1327574. ISSN 0261-5479. S2CID 149202002.
  27. Adams, Shelah A.; Riggs, Shelley A. (2008). "An exploratory study of vicarious trauma among therapist trainees". Training and Education in Professional Psychology. 2 (1): 26–34. doi:10.1037/1931-3918.2.1.26. ISSN 1931-3926.
  28. Gamble, SJ; Pearlman, LA; Lucca, AM; Allen, GJ (1994). Vicarious traumatization and burnout among Connecticut psychologists: Empirical findings. Annual meeting of the Connecticut Psychological Association. Waterbury, CT.
  29. Arnold, Debora; Calhoun, Lawrence G.; Tedeschi, Richard; Cann, Arnie (1 April 2005). "Vicarious Posttraumatic Growth in Psychotherapy". Journal of Humanistic Psychology. 45 (2): 239–263. doi:10.1177/0022167805274729. ISSN 0022-1678. S2CID 145618063.
  30. Rothschild, Babette; Rand, Marjorie L. (2006). Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma. Norton. ISBN 978-0-393-70422-8.
  31. Wilson, John P.; Thomas, Rhiannon Brywnn (23 November 2004). Empathy in the Treatment of Trauma and PTSD. Routledge. ISBN 978-1-135-93746-1.
  32. Batson, C. Daniel; Fultz, Jim; Schoenrade, Patricia A. (1 March 1987). "Distress and Empathy: Two Qualitatively Distinct Vicarious Emotions with Different Motivational Consequences". Journal of Personality. 55 (1): 19–39. doi:10.1111/j.1467-6494.1987.tb00426.x. ISSN 1467-6494. PMID 3572705.
  33. Lamm, Claus; Batson, C. Daniel; Decety, Jean (1 January 2007). "The Neural Substrate of Human Empathy: Effects of Perspective-taking and Cognitive Appraisal" (PDF). Journal of Cognitive Neuroscience. 19 (1): 42–58. CiteSeerX 10.1.1.511.3950. doi:10.1162/jocn.2007.19.1.42. ISSN 0898-929X. PMID 17214562. S2CID 2828843.
  34. Pearlman, Laurie Anne (2001). "The treatment of persons with complex PTSD and other trauma-related disruptions of the self". In Wilson, J.P.; Friedman; Lindy (eds.). Treating psychological trauma & PTSD. New York: Guilford Press. pp. 205–236.
  35. Briere, John; Runtz, Marsha (1 September 2002). "The Inventory of Altered Self-Capacities (IASC): A Standardized Measure of Identity, Affect Regulation, and Relationship Disturbance" (PDF). Assessment. 9 (3): 230–239. doi:10.1177/1073191102009003002. ISSN 1073-1911. PMID 12216780. S2CID 14719358.
  36. Weathers, Frank W; Litz, Brett T; Herman, Debra S; Huska, Jennifer A; Keane, Terence M (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Annual convention of the International Society for Traumatic Stress Studies. 462. San Antonio, Texas.
  37. Horowitz, M.; Wilner, N.; Alvarez, W. (May 1979). "Impact of Event Scale: a measure of subjective stress" (PDF). Psychosomatic Medicine. 41 (3): 209–218. doi:10.1097/00006842-197905000-00004. ISSN 0033-3174. PMID 472086. S2CID 4506565.
  38. "Impact of Event Scale – Revised (IES-R)". PTSD: National Center for PTSD. US Department of Veterans' Affairs.
  39. Veronese, Guido; Pepe, Alessandro (1 November 2013). "Psychometric Properties of IES-R, Short Arabic Version in Contexts of Military Violence". Research on Social Work Practice. 23 (6): 710–718. CiteSeerX 10.1.1.951.5841. doi:10.1177/1049731513486360. ISSN 1049-7315. S2CID 144835107.
  40. Briere 1996.
  41. Briere, John (2001). Detailed Assessment of Posttraumatic Stress: DAPS: Professional Manual. Psychological Assessment Resources Lutz, FL.
  42. Janoff-Bulman, Ronnie (1 June 1989). "Assumptive Worlds and the Stress of Traumatic Events: Applications of the Schema Construct". Social Cognition. 7 (2): 113–136. doi:10.1521/soco.1989.7.2.113. ISSN 0278-016X.
  43. Shah, Siddharth Ashvin (September 2008). "Addressing Stress in National Staff" (PDF). Monday Developments: The Latest Issues and Trends in International Development and Humanitarian Assistance. 26 (9): 21–22.
  44. Shah, Siddharth Ashvin (December 2010). "Three Principles of Effective Staff Care: Differentiation, Diversity and Diffusion" (PDF). Monday Developments: The Latest Issues and Trends in International Development and Humanitarian Assistance. 28 (12): 8–10, 30.
  45. Saakvitne, Karen W.; Pearlman, Laurie A. (1996). Transforming the Pain: A Workbook on Vicarious Traumatization. W.W. Norton. ISBN 978-0-393-70233-0.
  46. Pearlman, Laurie A.; Caringi, J. (2009). "Living and working self-reflectively to address vicarious trauma". In Courtois, Christine; Ford (eds.). Treating complex traumatic stress disorders: an evidence-based guide. New York: Guilford Press. pp. 202–224. ISBN 978-1-60623-039-8.
  47. Rosenbloom, D.J.; Pratt, A.C.; Pearlman, Laurie A. (1995). "Helpers' responses to trauma work: Understanding and intervening in an organization". In Stamm, B. (ed.). Secondary traumatic stress: self-care issues for clinicians, researchers, and educators. Sidran Press. pp. 66–79. ISBN 978-0-9629164-9-6.
  48. Stamm, B., ed. (1999). Secondary Traumatic Stress: Self-care Issues for Clinicians, Researchers, and Educators. Sidran Press. ISBN 978-1-886968-07-3.
  49. Kawachi, Ichiro; Berkman, Lisa F. (1 September 2001). "Social ties and mental health". Journal of Urban Health. 78 (3): 458–467. doi:10.1093/jurban/78.3.458. ISSN 1099-3460. PMC 3455910. PMID 11564849.
  50. Seligman, Martin E. P.; Steen, Tracy A.; Park, Nansook; Peterson, Christopher (2005). "Positive Psychology Progress: Empirical Validation of Interventions" (PDF). American Psychologist. 60 (5): 410–421. CiteSeerX 10.1.1.465.7003. doi:10.1037/0003-066X.60.5.410. ISSN 1935-990X. PMID 16045394.
  51. Csikszentmihalyi, Mihaly (1999). "If we are so rich, why aren't we happy?". American Psychologist. 54 (10): 821–827. doi:10.1037/0003-066X.54.10.821. ISSN 1935-990X.
  52. Christopher, John Chambers; Chrisman, Jennifer A.; Trotter-Mathison, Michelle J.; Schure, Marc B.; Dahlen, Penny; Christopher, Suzanne B. (1 July 2011). "Perceptions of the Long-Term Influence of Mindfulness Training on Counselors and Psychotherapists: A Qualitative Inquiry". Journal of Humanistic Psychology. 51 (3): 318–349. doi:10.1177/0022167810381471. ISSN 0022-1678. S2CID 145411787.
  53. Christopher, John Chambers; Christopher, Suzanne E.; Dunnagan, Tim; Schure, Marc (1 October 2006). "Teaching Self-Care Through Mindfulness Practices: The Application of Yoga, Meditation, and Qigong to Counselor Training". Journal of Humanistic Psychology. 46 (4): 494–509. doi:10.1177/0022167806290215. ISSN 0022-1678. S2CID 143592253.
  54. Newsome, Sandy; Christopher, John; Dahlen, Penny; Christopher, Suzanne (1 September 2006). "Teaching Counselors Self-Care Through Mindfulness Practices". Teachers College Record. 108 (9): 1881–1900. doi:10.1111/j.1467-9620.2006.00766.x.
  55. Quelch, John A.; Knoop, Carin-Isabel (6 November 2014). "Mental Health and the American Workplace". Cite journal requires |journal= (help)

Further reading
This article is issued from Wikipedia. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.