Vicarious Trauma: How to Identify and Prevent It in Therapy

Vicarious trauma is a significant concern for counsellors working in close contact with traumatised individuals. Indeed, the Diagnostic and Statistical Manual of Mental Disorders (APA, 2013, p. 271) includes therapists working with trauma in its list of people who might develop post-traumatic stress disorder (PTSD).

This article explores the concept of vicarious trauma, its risk factors, symptoms, and the importance of self-care strategies for counsellors and psychotherapists in their practice.

Learning Outcomes

• Definition and impact: Vicarious trauma affects those working closely with traumatised individuals, leading to psychological effects that can persist for months or years.
• Risk factors: High empathy levels, unresolved personal issues and repeated exposure to trauma increase the risk of vicarious trauma.

• Signs and symptoms: Early signs include burnout, secondary trauma and compassion fatigue.
• Self-care strategies: Engaging in healthy behaviours, establishing routines and seeking support are crucial.
• Professional considerations: It is essential for counsellors to balance client loads and to recognise the need for breaks.

Vicarious Trauma: Definition and Impact

The term refers to the profound psychological impact experienced by those who work with victims of trauma. McCann and Pearlman (1990, p. 131) define vicarious traumatisation as follows:

Persons who work with victims may experience profound psychological effects, effects that can be disruptive and painful for the helper and can persist for months or years after work with traumatized persons. We term this process ‘vicarious traumatization’.

Vicarious trauma is not limited to therapists but includes a broad spectrum of professionals, e.g. police officers, paramedics, firefighters and doctors. These individuals may experience disruptive and painful psychological effects, which can last for extended periods.

Risk Factors for Vicarious Trauma

Several factors can increase the risk of vicarious trauma:

• Unexpected or repeated exposure to trauma: Frontline workers, especially those in high-stress environments (such as healthcare workers during the COVID-19 pandemic), are particularly susceptible.
• Empathy levels: High degrees of empathy for clients can amplify the risk.
• Unresolved personal issues: Personal emotional baggage can easily be triggered, exacerbating the effects of vicarious trauma.

Recognising Signs and Symptoms

Recognising the signs early is crucial for timely intervention. The key indicators include:

• Burnout: increasing pessimism about yourself, others and the world.
• Secondary trauma: symptoms similar to those experienced in PTSD, such as intrusive thoughts, withdrawal, and vivid flashbacks of clients’ experiences.
• Compassion fatigue: a disconnection from work and clients, viewing them more as cases than as individual humans.

Other symptoms can manifest as intrusions (e.g. flashbacks and nightmares), avoidance behaviours (e.g. avoiding clients and topics that trigger trauma) and hyperarousal (e.g. sleeplessness and hypervigilance).

Acknowledging and Addressing Vicarious Trauma

A critical step in managing vicarious trauma is acknowledging its presence. Often, those affected are the last to recognise it. Ethical frameworks in counselling highlight the importance of self-care, as an unwell therapist cannot support clients effectively. Feedback from colleagues and supervisors is invaluable, as they may notice the signs and symptoms before the individual does.

Professional Considerations for Managing Vicarious Trauma

If you are a counsellor in private practice, you must evaluate the number of traumatised clients that you can manage effectively. Overburdening yourself can lead to significant negative outcomes. Taking breaks and slowing down practice when necessary can help maintain balance and health.

For agency managers, thoughtful client allocation is crucial. Regular check-ins with counsellors to assess their wellbeing and client load can prevent burnout and promote longevity in the profession. Ensuring that the organisation supports staff dealing with high levels of trauma is also vital.

Final Remarks

Understanding and managing vicarious trauma is vital for the wellbeing of practitioners working with traumatised individuals. By recognising the signs early, implementing effective self-care strategies, and fostering supportive professional environments, counsellors and psychotherapists can mitigate its impact and continue to provide high-quality care to their clients.

References and Further Reading

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing.

McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131–149.

Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors. New York: W. W. Norton & Company.