Career Chat // Vicarious trauma // Friday 22 July, 10am AEST

Hi @NikNik and thanks for taking part in today's forum about vicarious trauma.

First a story ...

I was speaking with a young guy yesterday about his future career options, he commented with an exasperated look, "I could never do what you do, I'd get too involved with my clients, I'd take my client's problems home with me ... I'd want to fix them"

I thought about that and thought; no, I don't do that instead I journal, see a supervisor, meditate and have a creative outlet ... I try very hard to look after myself so that I'm not overly affected by my client's stories, and it helps.

As a counsellor I have to do those things because I work directly with people either in trauma or in 'story' about trauma.

Come to think of it all people in the helping industries do this - work with traumatic stories, if not the traumatic events themselves.

Some to a greater extent than others, for some it's colleague's stories that bring the trauma into the office ... That is also secondary exposure to trauma.

Even reading about trauma constantly still counts as exposure to trauma.

Ironically even the young man I was speaking to works with clients who have traumatic stories ... He's an employment consultant for the disability sector so although it's not obvious how he is exposed to trauma, he is - his clients are only too willing to share their life stories (often traumatic) with a friendly, helpful young man such as he.

Unfortunately he's one of the many who doesn't realise he's being exposed to secondhand trauma ... But we'll talk more about that later ....

So, what to make of all this? Is it true that all these people potentially take their work home with them (unwittingly sometimes)? And unless they are aware of it - do they really all become overly connected to their client's stories and maybe suffer for it?

According to research the answer is yes a very high proportion do - around 80% of helpers in fact, in some form or another suffer from secondary trauma syndrome ...

A pretty staggering number isn't it?

This type of trauma may be known as vicarious trauma or compassion fatigue or burnout ... To some degree the different words measure the grade to which you are affected (vicariously being the worst it seems).

Today's forum is about this phenomenon.

I will be discussing that the research shows it's seriously under reported but over represented amongst the helping professions ... many don't even know they have it.

How can you tell if you have some version of secondary trauma?

I'll go into more detail later but briefly ...

Unexplained anxiety, sleeplessness, flashbacks, depression, feeling of wanting to give up on the work ... Change in your world view (everything is bleak)

Those are just some of the signs and symptoms that may be related to secondary trauma...

Do any of these resonate with you? Have they become apparent since you began working in the helping sector? Do you know of anyone who may be affected?

I would love to hear from you today, this is an important issue that should be more openly discussed ....

So years ago I attended a writers conference and I had a question for the panel ...

My question to the panel of experienced writers was, "what do you do when you have seen many traumatic incidences over many years ... how do you deal with your feelings?"

No one said anything and suddenly one of the organisers who had been sitting at the front stood straight up, turned around (to the novice fool) and said with a disgusted tone "they just act professional ... !!!!!!!"

... I sat down like a scolded child (doh) but afterwards a young writer came up to me and said she was also wondering about that too and that actually, it had been a good question ... ha vindication!

Looking back it's obvious that for many years the issue of secondary trauma was being treated in a way that suggests it showed a lack of professionalism if you experienced it.

But research now tells us that post traumatic stress disorder (a form of vicarious trauma for some people) has become common amongst professionals exposed to traumatic events including but not limited to; writers photographers and all types of reporters and news people. Regardless of their professionalism, experience or age.

Wish I could tell that surly organiser!!

Although it should be said that those with more experience may have developed the resilience necessary to be able to cope to a greater extent, but more about resilience later ...

I guess that my story serves to highlight that in fact there is absolutely no shame in experiencing secondary trauma.

Not only is there no shame, but it is actually expected that you will experience secondary trauma to some degree unless you put measures in place that build your resilience and serve to inoculate against it.

In the last post I touched briefly on what it may look like to be experiencing secondary trauma in this post I also want to look at why we experience it ...

Why you may experience it:

According to researchers when we feel empathy for a client we are triggered and our limbic response is triggered, that is to say our fight or flight response causes our bodies to emit cortisol into our systems.

When cortisol is in our system and we don't eliminate it, it builds up and over a period of time it is the chemical most likely to cause stress in your body including anxiety, depression and even heart related issues.

We know that experiencing trauma including being exposed to trauma or hearing traumatic stories may or may not trigger us ... it is only when we feel and empathy towards the event or the story or the situation that we begin to experience the rising levels of cortisol within our bodies.

So a story that you hear which has no effect on you (no empathy) will not cause a rise in cortisol and therefore will likely not cause you any trauma ...

Unfortunately, or fortunately as the case may be, most people working in the helping industries have experienced trauma to some degree and therefore have excellent empathy which means of course they will often be triggered ... and therefore their cortisol will rise ...

But it is not your empathy that is the problem because after all that's what makes you good at your job and your ability to connect with others ...

Even if you are not on the front line and you hear your colleagues tell stories it's your connection to these colleagues which could also cause you to experience a rise in cortisol due to the empathy you feel ...

No it's not the empathy that is the issue ...

It's the rise of cortisol in your body that without proper attention builds to a toxic level causing you to experience anxiety, stress, depression, confusion, sleeplessness, irritability or anger ...

Which when taking singularly or individually may not appear to be related to your work but when put into the context of your 'helper work' (or work that exposes you to trauma) could be diagnosed as compassion fatigue, burnout or even vicarious trauma.

Do you connect with any of this information? does this resonate with you? Were you also at that writer's conference?

Next up what we can do to eliminate the stress ..

---

@Renstar wrote:

Why you may experience it:

According to researchers when we feel empathy for a client we are triggered and our limbic response is triggered, that is to say our fight or flight response causes our bodies to emit cortisol into our systems.

When cortisol is in our system and we don't eliminate it, it builds up and over a period of time it is the chemical most likely to cause stress in your body including anxiety, depression and even heart related issues.

We know that experiencing trauma including being exposed to trauma or hearing traumatic stories may or may not trigger us ... it is only when we feel and empathy towards the event or the story or the situation that we begin to experience the rising levels of cortisol within our bodies.

So a story that you hear which has no effect on you (no empathy) will not cause a rise in cortisol and therefore will likely not cause you any trauma ...

Unfortunately, or fortunately as the case may be, most people working in the helping industries have experienced trauma to some degree and therefore have excellent empathy which means of course they will often be triggered ... and therefore their cortisol will rise ...

But it is not your empathy that is the problem because after all that's what makes you good at your job and your ability to connect with others ...

Even if you are not on the front line and you hear your colleagues tell stories it's your connection to these colleagues which could also cause you to experience a rise in cortisol due to the empathy you feel ...

No it's not the empathy that is the issue ...

It's the rise of cortisol in your body that without proper attention builds to a toxic level causing you to experience anxiety, stress, depression, confusion, sleeplessness, irritability or anger ...

Which when taking singularly or individually may not appear to be related to your work but when put into the context of your 'helper work' (or work that exposes you to trauma) could be diagnosed as compassion fatigue, burnout or even vicarious trauma.

Do you connect with any of this information? does this resonate with you? Were you also at that writer's conference?

Next up what we can do to eliminate the stress ..

---

Hi @Renstar,

A call out to people who RSVPd @JM-Addiction @Sonya76 and @utopia.

What strike me about what you mentioned above is that it vicarious trauma might be relevant for people on here on the Forums. As members, we help each other and empathetic to each other, listening to other people's experiences. It make me realise that both 'helpers' in general also need to take care of themselves too.

Anybody relate to this?

Earlier on in life, I completed an inpatient rehabilitation stay recovering from a Drug and Gambling addiction. I attended all groups and formed some really strong relationships during my stay.

I built a solid friendship with another bloke which continued after discharge, the first six months we had some great times, Coffee, beach, shopping. Things to keep us distracted.

However, unfortunately, my mate had lapsed, I was his primary support network which I have driven and assisted him three times to agree on further hospitalisations.

One evening I received a phone call from him, he was suicidal; I live an hour’s drive from his location. Conveying immediate action when necessary, I managed to contact both ambulance and police services to arrive successfully confirming his safety.

My position and educations involve both Counselling Therapy and Family Support Facilitating. Exceptional circumstances Mandatory reporting may arise which give the counsellor good grounds for believing that serious harm may occur to the client or to other people. I spoke directly to the ambulance officer and provided in-depth detail concerning his psychiatric history of, previous hospitalisations.

Acknowledging limitations and Ethical Responsibilities, through conveying the ability to acknowledge capabilities and recognise when it’s appropriate to refer clients to alternative treatment.

That evening was the day our friendship sadly ended. Unfortunately, I have had to block all contact and communication with him. As our, once a friendship had now become an unethical relationship and broken professional boundaries.

It is apparent that client’s motivation throughout the recovery process can produce inconsistencies towards changeability.

Boundaries are a crucial feature towards maintaining an active client-counsellor relationship. Sustaining a structure to provide a consistent framework.

Hi @CherryBomb, @JM-Addiction

Yes that's absolutely correct ... And in this context it's even more insidious because often we post something without giving much thought to a follow-up in terms of how we feel about the situation and what the other person on the forum is going through

You think about their situation in that moment, you relate to it and then respond but the risk is that it may then trigger all sorts of empathic feelings which you do nothing with - after all it's a simple 'post' isn't it ?

But is it ?

Maybe it is and nothing more comes of it however if what you have written then stirs up all sorts of feelings inside of you and you do nothing about it a one off experience may not cause an issue but if you continue to do that and don't eliminate your cortisol in other words build resilience, de-stress or talk to someone etc etc ( I will go through these in the next post in more detail) ...

Then yes you may be putting yourself at risk.

Thank you @CherryBomb ... This is a very real hazard for your forum writers but providing they become aware of the risk then much can be done ...

Hi and thanks @JM-Addiction for sharing that story

It's an excellent examples of transgressing boundaries

I supposed to some degree it relates back to the idea of being professional ... From my previous post

Of course part of being a professional therapist is understanding that there are boundaries and certainly boundaries are taught to us and reinforced by our supervisors and our ethical standards ...

But what about those people working in other situations ( forums writers, employment consultants, reception staff of hospitals or crisis centres ...) mainly those who have no training ... who are not even aware they are being exposed to secondary trauma, yet who are also working in a helping environment.

I hope that you will help me to help these people with suggestions for how they may build resilience and inoculate themselves against the invisible wounds created by secondary trauma

• How does this problem typically make you feel?

• What do you think may make the problem better?

• Do you have an idea about why this keeps happening?

• What would you like to see different about your current situation?”

• Focus on how you react and respond in certain situations

• Your Thoughts are only thoughts. Don’t believe everything you Think.

W-WHAT IS IT YOU REALLY WANT?

D -DOING, WHAT ARE YOU CURRENTLY DOING?

E -EVALUATE, IS WHAT YOUR DOING, GETTING YOU WHAT YOUR WANT?

P-PLAN

So we have covered the reasons why you may experience secondary trauma

Let's ts look at the way in which secondary trauma reveals itself ... it varies from person to person ...

Findings from a recent study mentioned the following physical symptoms :

• Compassion fatigue may be characterised by physical fatigue, Gastro intestinal issues, feelings of exhaustion, hyper arousal, rapid pulse hypertension and increase in physical ailments

• Psychological symptoms might include anxiety, depression, sleep disturbance flashbacks, thoughts and dreams related to the clients trauma

• There are also social impacts and these have been reported; as doubting or changing one's values and beliefs, changing one's views of the world, isolation with drawing from social activities with family and friends, interpersonal disruption, unable to feel a sense of happiness or enjoyment and a reduction self-esteem and feelings of guilt and cynicism ...

The above-mentioned symptoms obviously are higher amongst people working very closely with trauma but don't be surprised if even casual or inadvertent exposure to trauma causes at least some of these symptoms.

Sadly I can think of more than one friend who works in a helping environment who has inadvertently been the victim of secondary trauma, but is probably not even aware of it ...

Please remember that the experience of secondary trauma is often invisible...

... it's like smoke in the air ... You can't help but become affected by it ... it's in the stories that you here, it's in the ambience and environment ... they can get you down and you didn't even know it was happening ...

I hope this forum is able to shed some light and maybe alert you to your own secondary trauma symptoms - you may be realising right at this moment that yes this is talking about you ...

If that is the case then please contact either your employment assistance program (EAP) or your GP or a psychologist or counsellor ... As has been said before getting back on track can be achieved and soon we'll discuss how.

Feel free to share your experiences

The big question in regards to secondary trauma then becomes how do we avoid developing it?

Vicarious trauma is the most serious types of secondary trauma as it involves a complete change in one's outlook on life and can lead to some fairly serious depression and anxiety.

And there are a number of factors that contribute to the risk of developing this and other types of secondary trauma ...

The absence of self care is really a strong determinant ,,, so too is a lower level of experience in working with clients who have experienced trauma that was found to increase stress and vulnerability.

Also caseload intensity and the absence of social support and supervision which leads us back to people who are in the helping professions and who do have training tend to be aware of maintaining their boundaries and upholding ethical standards and of course ensuring they have adequate resources ...

It can be shown that even professionals are exposed if they don't utilise all the proper resources.

However for those of us not in a position to have access to pre arranged support such as a volunteer for example there are ways that you can alleviate symptoms and manage the risk of developing secondary trauma (including vicarious trauma, compassion fatigue and burnout) ...

So as an organisation it's important to make sure that there are larger structures in place for volunteers, for example; make sure to build awareness about secondary trauma, also offer education that informs people for how to manage and reduce the risk of secondary trauma. Such as this forum !

When it comes to you as an individual you need to make sure that you accept you might be in a situation where you are exposed to secondary trauma

According to the research you should then try to develop a high level of emotional awareness, that is ensure you're able to draw on strategies to handle your emotions ... This might include journaling, talking to a professional or a supportive helper and also maintain regular activities that decrease the cortisol in your body, such as walking or swimming or actually anything that involves the movement of your body, even deep breathing and relaxation .

Positive results were seen in a study which showed a decline in compassion fatigue amongst nurses when an intervention program was used ...

This program included; group workshops, person centred therapy, experiential learning and education about secondary trauma.

The program also included fostering resilience amongst the nurses through the development of self care, emotional awareness, emotional management and problem-solving capability. It was delivered in small groups ...

In organisations where there is a risk of compassion fatigue such small groups and such interventions foster support and re-iterate the idea that there is nothing to be ashamed off with secondary trauma ...

One of the things that I note to come out of that study is the importance of emotional intelligence and resilience, we might have that as a topic for a future forum but I would also like to expand on it in the next post

Has any of what has been shared today raised a flag for you? does any of this resonate or do you know of anybody who might benefit from this information ?

If so ... Hope you're doing well today !!