In my humble opinion, helping people to live richer, fuller lives is such a privilege and incredibly rewarding. Sometimes, this is especially so when working with people who have experienced profound trauma. In my experience, sharing the therapeutic space with someone as they tell their story and process the impact it has had on them can alter you, as the therapist, in ways that enrich your experience of the world and adjust your perspective. But as we’ve discussed for the last few months, the downside of such emotionally-driven work is the risk of burnout when practicing as a psychologist.
What we’ve yet to discuss is when symptoms of burnout become even more problematic and result in “secondary traumatic stress” or “vicarious traumatisation”. Rather than get into an academic discussion of the nuances of difference between these two terms (an interesting article of the effects of trauma therapy on each of these concepts is here: http://www98.griffith.edu.au/dspace/bitstream/handle/10072/30406/62709_1.pdf?sequence=1 ), I think it is more helpful to acknowledge in a global way that in working with psychologically distressed people – especially traumatised individuals – there is a risk that the therapist may also become traumatised.
When people become traumatised, they experience intrusive, unwanted, distressing thoughts and images about the events or situations associated with the trauma, they become oversensitive or “hyperaroused” on both psychological and physical levels when they are reminded of, or think about the trauma, and they make significant efforts to avoid talking, thinking or feeling anything about the trauma, as well as avoiding situations, people and places that cue reminders of the trauma. When dealing with people who are traumatised, therapists can become affected in a similar way related to the trauma they have heard about through their client (rather than directly experienced themselves). Ultimately, the therapist may experience a profound change in the way they see the world including feeling hopeless about despairing.
If you work in private practice, you may rarely be able to control what kinds of referrals get sent your way (unless there is a population or type of therapy that your skills don’t cover e.g. children or specialised therapy such as Eye Movement Desensitisation and Reprocessing). This means that you will very likely see clients who are dealing with the effects of some kind of trauma. In order to treat those clients, you will likely conduct some kind of trauma-focused therapy where you will hear in great detail about the person’s trauma. If you specialise in treating certain populations that are more at risk of trauma (e.g. emergency services or defence personnel or veterans), you may do this kind of work regularly. It goes without saying then that you will be hearing some pretty horrific things.
I know I’ve said this before, but I feel the need to say it again in capitals this time: PSYCHOLOGISTS ARE HUMAN, TOO. And that means that like any normal person, you will probably have emotional and maybe physical reactions to what you hear. I remember once doing a session of imaginal exposure therapy right before lunch a few years ago. The colour of my lunch did nothing to launch my appetite after that particular session!
It goes without saying that there is no way we can turn off our emotional responses entirely, and nor should we want to. If we became robots, not only would that impair our ability to be empathic and connect with clients but it would likely be a sign of vicarious trauma in and of itself! So, how can we protect ourselves from becoming vicariously traumatised when working with traumatised people? Let’s review the strategies for helping ourselves while we help others:
1. Be informed
Understand the “occupational hazards” of working with psychologically distressed clients and get to know your early warning signs. Make sure you identify and manage those internal and external factors that make you more vulnerable to burnout and know and listen to your own limits.
2. Look after YOU
Walk the talk. We say it often but do we eat well, exercise regularly, get enough and good quality sleep, and take time for relaxation and fun for ourselves? Stay connected with family, friends and the community at large and remember that you’re human too. Get professional support and deal with your own “stuff” in personal therapy when required.
3. Work smart
Get supervision from someone you trust and respect on a regular basis (and this may be more regular than the 10 hours included in the CPD requirements), particularly if you have complex or at risk clients. Make sure your supervisor has extensive experience treating trauma so that he or she understands what you might be experiencing. Take regular holidays and arrange professional support to manage your caseload while you’re away so you can completely detach.
Take steps to manage your daily schedule in such a way as to utilise your energy when it’s strongest. If you’re a morning person, schedule the majority of your “heavy” work for the morning and ensure you have adequate breaks between clients. Eat regularly throughout the day rather than relying on caffeine to get you through (come on, we’ve all done it!). Don’t schedule clients outside of hours if you know this will negatively impact on your personal resources. Try to keep variety in your workload and consider granting yourself an extended break from clinical work once in awhile to fully recharge and get reconnected with yourself.
4. Stay grounded
Keep perspective through the use of humour, grounding techniques and/or mindfulness and spiritual connection. Remind yourself of the meaning in the work that you do and the things about the work for which you are grateful so that your satisfaction levels remain positive. Develop a ritual to help you detach from work when you are leaving for the day. Remind yourself of what you are doing well and where you are making a difference.
Consider where a few or many of these strategies might fit in with your own practice. If you are concerned that you may be suffering from vicarious trauma, prioritise yourself immediately and get supervision, and personal therapy if required. Look after yourself first because you can’t help anyone else unless you help yourself. And you’re awesome for what you do. Remember that.
Dr Rebecca Ray is a Clinical Psychologist and the founder of Happi Habits, a 12 week program that boosts happiness with scientifically proven positive psychology techniques. You can find the Happi Habits Community here: