Vicarious Traumatization

• What is it?

• Who gets it?

• What causes it?

• Do I have it?

• What can be done about it?

Definition: The cumulative transformative effect on the helper of working with survivors of traumatic life events, both positive and negative.

Saakvitne & Pearlman, 1996

Description: Vicarious Traumatization - (Saakvitne & Pearlman, 1996)

• No time, no energy

• Disconnection

• Social withdrawal

• Sensitivity to violence

• Cynicism

• Despair and hopelessness

• Nightmares

• Disrupted frame of reference

  • Changes in identity, worldview, spirituality

  • identity: less effective, helpless

  • Worldview: more dangerous, less hope,other people as malevolent and evil

  • Spirituality: loss of good, higher power

• Diminished self-efficacy

• Impaired ego resources

• Disrupted schemas

• Alterations in sensory experiences

• May include typical symptoms of PTSD

  • Hyperarousal

  • Emotional numbing

  • Avoidance

  • Intrusive experiences

• Impacts on psychological need areas

  • Safety: Increased fear and vulnerability, excessive security concerns

  • Trust: No one can be trusted, not even the self

  • Esteem: Decreased re: self and others

  • Intimacy: Isolation, addictions, withdrawal

  • Control: Increased control maneuvers, narrowing scope of one’s world

Also Known As . . . .

• Secondary traumatic stress

• Compassion fatigue

• Co-victimization

• Contact victimization

• Indirect trauma

 If it goes on too long . . . . . BURNOUT!!!

Relationship to Countertransference

• Specific form of countertransference

• But not necessarily specific to or tied to an individual patient

• Can continue to affect our lives long after relationship with patient has ceased

Who Gets It? Some Examples

• 20% - 80% of rescue workers show prolonged stress responses, often short-lived

• Trauma therapists:

  • ISTSS study, 27% substantially distressed (n=214)

  • Trauma counselors: 24% high levels of general life stress; 16% high levels emotional exhaustion, 26% felt ineffective at work; 14% high traumatic stress levels similar to clients with PTSD

  • Rape counselors: 82% and 78-93% had a history of personal sexual abuse

  • Domestic violence counselors, other sexually traumatized clients

• Child protection workers

  • Study one: high level of symptoms, correlated with length on job, longer hours and being female

  • Study two: veterans, 2+ years – 62% high on emotional exhaustion.

• Sexual offender counselors

• Hospital personnel:

  • Pediatric intensive care

  • Neonatal intensive care

• AIDS workersLaw enforcement

• Homicide

• Researchers

• Museum workers working on Holocaust Museum exhibits

• Jurors

• Clergy

• Media eyewitnesses to execution

Risk Factors for V.T.

• Past history of trauma

• Overwork

• Poor respect for boundaries

• Too high caseload of trauma survivors

• Less experience

• Too much exposure

• High % traumatized children, particularly sexually abused children

• Too many negative clinical outcomes

• Protective Factors Against VT

• Social support

• Supervision and consultation

• Resolution of one’s personal issues

• Strong ethical principles of practice

• Knowledge of theory

• On-going training

• Competence in practice strategies

• Awareness of the potential and impact of VT

Protective Factors Against VT

• Social support

• Supervision and consultation

• Resolution of one’s personal issues

• Strong ethical principles of practice

• Knowledge of theory

• On-going training

• Competence in practice strategies

• Awareness of the potential and impact of VT

What Causes It?

• Biological causality

  • Emotional contagion

• Psychological causality

  • Loss of positive illusions

• Social causality

  • Inability to use "normal" social obstacles

• Organizational causality

  • Sick systems

• Moral/Spiritual/Philosophical causality

  • Profound Theoretical Conflicts

Biological causality

• Susceptibility To Contagion (Hatfield et al., 1991)

  • If attention is riveted on others

  • If construe themselves in terms of their interrelatedness to others

  • Are able to read others nonverbal cues

  • Tend to mimic facial, vocal, & postural cue

  • Aware of their own emotional responses

  • Are emotionally reactive

  • Good caregiving requires that the caregiver respond to the state of emotional contagion in certain limited and prescribed ways, forced to contain, rather than express, their own physiologically-based states of hyperarousal, fear, anger, and grief.

Psychological causality

• Loss of positive illusions

  • As we replace reality with bias and distortion, we buffer the nervous system and safeguard psychological intactness . . . . A considerable amount of insanity, in the sense of being out of touch with reality, is requisite to optimal mental health. (Schumaker, 1995)

  • Increasingly we must view the psychologically healthy person not as someone who sees things as they are but as someone who sees things as he or she would like them to be.(Taylor, 1989)

Social causality
 

• Inability to use "normal" social obstacles (Coates et al, 1979)

  • As bearers of disturbing thoughts and negative emotions, victims are suppressed

  • Listeners switch topic away from trauma

  • They attempt to press their own perspective of the trauma upon victim

  • Exaggerate victims’ personal responsibility

  • Avoid contact with victim altogether

Organizational causality - Sick Systems

• Continuous culture of crisis

• Long-term and preventative solutions are never formulated

• Democratic processes give way to authoritarianism

• Rigid hierarchies

• Culture of shaming and blaming

• Conflicts never addressed or resolved

• Order maintained through isolation, splitting, overcontrol, manipulation, deceit

• Mistrust grows

• Individualism increases

• Little humor

• Positive emotions are discouraged

• Negative emotions are supported

• Culture of toughness and meanness develops

• Threat of violence used to control others

• If threats do not work, actual violence will be used

• Denial of any real problems

• Tolerance for a high level of hypocrisy

• Confrontation with reality is discouraged

In the caregiver context, the helper can at least feel capable of providing some meaningful assistance to the victim.

But the caregiver, embedded in a situation of powerlessness and lack of social support may find that all efforts to bring assistance to bear are foiled by the institutional setting within which he or she is practicing.

Moral/Spiritual/Philosophical causality
 

• There are Profound Ethical and Theoretical Conflicts in Present Day Caregiving

  • Desacralization of healing

    • Psychotherapy is the profession responsible for treating the unfortunate personal effects of the empty self without disrupting the economic arrangements of consumerism. (Cushman, 1995)

    • Practitioners...are placed in the position of being responsible for guiding and/or healing the empty self without being allowed to address the historical causes of the emptiness.(Cushman, 1995)

  • The commodification of health care

    • Compassionate listening has been traded away.

    • Caregivers treated like assembly line workers, keep the line going, regardless

    • Increasing caseloads

    • Increasing paperwork

    • Decreases in staffing and resources

    • Caregivers must decide daily who they are going to hurt – themselves and their own family by not living up to the financial expectations of the companies that employ them, their patients who continue to expect a healing response, or the institutions whose survival is ever more critically dependent on fast-paced performance.

    • Demeaning of any form of critical human intervention not dependent on drugs/restraint

  • Shortcomings of the medical model

    • Patient is passive

    • Patient is helpless

    • Expert is in charge, has control

    • The social context matters little

  • Individualism

    • Individual violence embedded within a culture of violence – confrontation with “the perpetrator”

    • All of American psychology (with some notable exceptions) has been quintessentially a psychology of individuals. (Sarason, 1981)

    • The actions dictated by those who focus on individual pathology are carefully claimed to derive from no moral or political base; ordered to no social goal beyond that of patching the wounded. (Armstrong, Rocking the Cradle of Sexual Politics)

  • Culture of Violence

    • If they attempt to stay politically disengaged, or “scientifically neutral” caregivers may find themselves medicalizing or pathologizing disorders that are actually a result not of a medical problem, but a social, political, or economic problem.

    • Caregivers, schooled in individualism, tend not to turn to others in any organized fashion in order to protect themselves, and therefore must contain the overwhelming emotions they have been exposed to without protest and alone.

    • And they must accept the recurrent and penetrating messages from the society that their work is not valued, and their witness not sought despite the fact that they may recognize that most of the pathology they are asked to “treat” is entirely preventable if the society would only choose to withdraw support for violence.

     

	The Germ Theory of Trauma: The Impossibility of Ethical Neutrality
	Caring for the Caregiver: Avoiding and Treating Vicarious Traumatization
	Sanctuary Model of Organizational Change
	Components of the Sanctuary Model
	Social Legacy of Trauma
	Trauma Theory
	Seven Commitments of Sanctuary

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Last modified: 05/23/08