Vicarious Traumatization: September 11th and Beyond
Hypervigilance. Irritability. Dreams with violent themes. Generalized feelings of hopelessness. Fluctuating symptoms of depression. All of these can be characteristic of clients coping with traumatic experiences. Unfortunately, the same symptoms are also sometimes found in those who treat them. Pearlman and MacIan (1995) describe this phenomenon as vicarious traumatization, or the effects of secondary exposure to traumatic events or material. After the events of last September 11th, most therapists, regardless of their training and areas of expertise, have been exposed to traumatic symptoms in their clients. Thus, more than ever, we need be aware of the risk of vicarious traumatization.
Therapists are at risk in several ways. First, bearing witness and being empathic to those who have been traumatized is, in effect, exposure to traumatic material. While a therapist may not develop full-blown posttraumatic stress disorder based on this type of exposure, sub threshold symptoms are not uncommon. Secondly, such exposure can also bring about changes in cognitive schemas and world views (McCann and Pearlman, 1990). Previously held beliefs about safety, fairness, justice and hope can be eroded or undermined by facing sobering traumatic material.
Mass exposure to the events of September 11th
Research in the area of vicarious traumatization suggests that cumulative exposure on the therapist’s part to traumatic material – multiple events in one person and/or work with more than one client – is a significant risk factor. Be aware of how much exposure to traumatic material is occurring, and what effect it may be having on you.
Psychologists’ personal reactions
To complicate matters, psychologists also have the added burden of managing their own personal experiences with the very public events of September 11th. Trauma therapists are already at higher risk for coping techniques that are more avoidant and escapist (Johnson and Hunter, 1997), rather than the active, approach coping more characteristic of better functioning. Focusing on one’s own reactions, and being aware of coping skills utilized, are important parts of personal self-care.
Another challenge facing therapists is a lack of training, experience, or interest in working with traumatized populations. Newer trauma therapists generally exhibit more distress and experience more difficulties than their more experienced counterparts, and thus therapists less familiar with trauma work may find themselves more vulnerable to secondary traumatization (Pearlman and MacIan, 1995). Seeking consultation or training is important if trauma issues begin to cause distress.
Now that nearly a year has passed, the anniversary of the events of September 11th may trigger a resurgence of symptoms in either clients or therapists. Being aware of this, and thus more prepared, is key.
It is unreasonable to expect that bearing witness and being empathic to the pain of others will not have an effect on therapist. However, being attuned to this risk and practicing professional and personal self-care can mediate this effect. Formal or informal debriefing with others is helpful (Everly, Boyle and Lating, 1999), but equally so are general stress reduction strategies, healthy lifestyle choices, and maintaining reinforcing pre-morbid positive cognitive schemas.
Please contact CLASP through our web site at hppt://www.cpaclasp.org or our email at firstname.lastname@example.org if you would like information, referrals or help in coping with personal stress and impairment.
Everly, G. S., Boyle, S. H., & Lating, J. M. (1999). The effectiveness of psychological debriefing with vicarious trauma: A meta-analysis. Stress Medicine, 15, 229-233.
Johnson, C. N. E. (1997). Vicarious traumatization in counselors working at the New South Wales sexual assault service: An exploratory study. Work and Stress, 11, 319-328.
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. & MacIan, P. S. (1995). Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Professional Psychology: Research and Practice, 26, 558-565.
Kasey Saltzman, PhD, is a practicing psychologist in Mountain View, CA, and a post-doctoral research fellow with the Stanford University Pediatric Anxiety and Posttraumatic Stress Disorder program. As column editor, she can be reached at 401 Quarry Road, MC 5719, Stanford, CA, 94305 or by email at Kasey.Saltzman@Stanford.edu.