Most people know that vicarious trauma is a problem that has a very high personal and organisational cost to human service providers and first responders – but it doesn’t have to be.
This article was first printed in Pro Bono news as part fo the "Ask Adam' Column. https://probonoaustralia.com.au/news/2018/03/preventing-vicarious-trauma/
Vicarious trauma is the term we have given to the traumatic impact that witnessing or hearing about the trauma of others can have on people.
It particularly affects first responders and those who work with traumatised people and populations. A 2013 study of workers found PTSD rates of 19.2 per cent, consistent across metal health workers, rescue workers and social workers, which is more than twice the rate for the general population (approximately 7.8 per cent). Approximately 80 per cent of workers report some symptoms of traumatic stress because of their job.
Anyone can suffer, from a frontline aid worker to the CEO thousands of miles away. Having strategies to deal with vicarious trauma should be part of any workplace that asks its people to work with traumatised individuals. But How?
Firstly, let’s make some distinctions. Vicarious Trauma is often mistaken for “burnout” or “compassion fatigue”, but they are importantly different.
Burnout is the result of overexposure to stress and results in exhaustion, fatigue and a reduced ability to cope with stressors and demands. Compassion fatigue is a slow hardening of empathy and emotional compartmentalisation, that functions as a protective mechanism against constant exposure to suffering. Both can be early warning signs of vicarious trauma but don’t necessarily lead to it.
For some people constant exposure to the trauma of others has a cumulative effect that results in the symptoms of Post-Traumatic Stress Disorder. Anxiety, depression, sleeplessness, intrusive memories, mood swings, intense emotions, drug and alcohol misuse and even suicidal ideation are common.
Who does it affect?
To prevent and respond to vicarious trauma it’s important to understand why it only affects some people. There are some key factors that can help us to predict the likelihood that someone will suffer from vicarious trauma. A history of trauma, particularly childhood trauma, is paramount among them. This is important because it is often those with childhood trauma that choose to enter the helping professions and to work with the most traumatised populations.
Other factors include being overworked, having too big a caseload, having inadequate resources, being in a toxic or neglectful work environment, being isolated, being insufficiently or badly supervised and not having positive protective relationships both inside and outside of work. Of course, this describes a great many work environments in the helping professions.
Underfunded and overloaded is just business as usual for many services, and stress has a way of rolling downhill in organisations.
How Does Trauma Work?
One of the earliest theories of trauma may provide the answer. Sigmund Freud originally suggested that trauma forms when the “ego” self-protectively rejects the emotional experience and impulses of the “Id” to maintain adaptation to its environment. In simpler terms, we repress experiences that we don’t know what to do with.
Brain imaging technology tends to support this by showing us that traumatised people have an imbalance of activity between the left and right hemisphere when recalling traumatic events, but non-traumatised people don’t. This means that the right hemisphere sensory memory is not being integrated with the left hemisphere “story” about the event. When trauma memories are properly processed and integrated most of the emotional information is discarded and the memory is “filed” into long-term memory. We remember the incident, but it doesn’t keep upsetting us.
Unprocessed trauma memories leave a person with a traumatic event on constant replay in their reticulating memory system, a full sensory experience that is felt as if the event was happening right now. This leads to the state of hyperarousal that we call PTSD.
Why do our brains do this?
Thirty years as a trauma therapist, and the research of a great many brilliant people, has led me to a theory about why this happens. The left brain is refusing to deal with the right brain sensory information because it represents a threat to our identity.
Identity is the description we give to our self-concept, a series of ideas we have about who we are. It encapsulates us and represents us to the world. Ultimately, its purpose is to help us meet our needs by having us believe that we are capable of meeting those needs. If we do believe this, we feel confident. If we don’t, we feel anxious.
Identity has structure to it. We need to believe that we have the power to protect and provide for ourselves, that we are loveable, that we are entitled to express our values, that we are valuable, that we are good and that we have the potential to grow. Traumatic events directly challenge our identity by challenging these beliefs. They can leave us feeling powerless, worthless, useless and even bad. Worse still, they can leave us with a vision of a future in which we will always be this way.
Why does vicarious exposure have the same effect?
Workers in the helping profession are almost constantly faced with situations in which they are helpless to create the outcome they would like, whether that is preventing a pointless death or saving a child from an abusive home environment. They are routinely presented with morally ambiguous situations that leave them wondering if they did the right thing, or did enough, or did too much.
Over time these unavoidable failures to successfully intervene and prevent suffering can wear down our belief in our power, our worth and even our goodness. So even though the violence and suffering didn’t happen to us directly, it can still diminish our belief in who we are.
This may be why those with an already impoverished identity from childhood trauma are especially vulnerable, as well as those workers who are not getting adequate support for their work and their self-esteem. Their identity is being compromised by their own past and their work environment.
Prevention – protecting our identity
Preventing vicarious trauma requires us to change the way we view our work, and what we think it means about us that we do not always have the power to get a good outcome. We must learn to “not take it personally” when things do not work out as we desperately wish they could. It also means understanding that we cannot save the world, but that does not mean that we do not make a valuable contribution to it.
Finally, we never really know the impact we may have in the future – a little bit of love in the middle of terrible suffering can ripple throughout time in ways we cannot predict and may never know of. Those in the helping professions have dedicated themselves to bringing light into the darkest moments of people’s lives, and they deserve to feel proud of their work and themselves.
Organisations can help by making sure that their workers have access to trauma informed supervisors and enjoy a supportive, positive and safe workplace that acknowledges their contribution.