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Therapist Self-Care Compassion Fatigue & Secondary Traumatic Stress
Domestic Violence continuing education social worker CEUs

Addendum A
Addendum A: Vicarious Trauma

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Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

Mental health care providers in the grief, loss and trauma fields often hear detailed and harrowing stories about the unfair, undeserved and often unimaginable traumatic experiences that their clients have endured. As a result, they are at risk for vicarious trauma, also known as secondary traumatization, secondary stress disorder, or insidious trauma. Vicarious trauma occurs when an individual who was not an immediate witness to the trauma absorbs and integrates disturbing aspects of the traumatic experience into his or her own functioning. Friends, family members and spiritual leaders who are providing support to the survivor are also at risk for vicarious trauma. Some precursors tvicarious trauma that you might hear about are compassion fatigue or burnout.

Vicarious trauma often carries many of the same symptoms as first-hand trauma or post-traumatic stress disorder. These symptoms are usually grouped into three broad categories:
• Intrusions, such as flashbacks, nightmares, intrusive thoughts
• Avoidance of situations, people or places that bring on the intrusions
• Hyperarousal, including hypervigilance, sleeplessness, and increased startle response ("jumpiness")

The following list provides a comprehensive picture of some of the specific symptoms you may experience.

Behavioral symptoms
• Sleep disturbances
• Nightmares
• Appetite changes
• Hypervigilance
• Exaggerated startle response, "jumpiness"
• Losing things
• Clumsiness
• Self-harm behaviors
• Negative coping – smoking, drinking, acting out

Physical symptoms
• Panic symptoms – sweating, rapid heartbeat, difficulty breathing, dizziness
• Aches and pains
• Weakened immune system

Cognitive symptoms
• Minimization of your vicarious trauma
• Lowered self-esteem and increased self-doubt
• Trouble concentrating
• Confusion/disorientation
• Perfectionism
• Racing thoughts
• Loss of interest in previously enjoyed activities
• Repetitive images of the trauma
• Lack of meaning in life
• Thoughts of harming yourself or others

Emotional symptoms
• Helplessness and powerlessness
• Survivor guilt
• Numbness
• Oversensitivity
• Emotional unpredictability
• Fear
• Anxiety
• Sadness and/or depression

Social symptoms
• Withdrawal and isolation
• Loneliness
• Irritability and intolerance
• Distrust
• Projection of blame and rage
• Decreased interest in intimacy
• Distrust
• Change in parenting style (e.g., becoming overprotective)

What you can do…
Monitor yourself. In order to stave off vicarious trauma, it is important to keep track of your levels of "burnout" or "compassion fatigue". There are several professional assessments aimed at these areas, including the ProQOL Professional Quality of Life Scale, which is available online free of charge. There are also many online self-care assessments, which will give you a sense of whether you are adequately engaging in self care (see below for more on self care).

Take care of yourself. Just as we tell our clients, it is important for us to get enough rest, eat balanced and healthy meals and maintain a regular physical exercise routine.

Take time for yourself. Resist the urge to work through the day without a break. Your mind and spirit need this respite. It is also critical that we take time outside of work to engage in enjoyable and restorative activities. Some popular self-care activities include: weekend getaways, yoga or meditation, attending religious or spiritual services, massage or other spa treatments, cooking, spending time with friends, going to sporting events, visiting museums, going to the movies, painting or drawing, sculpting, writing, swimming and hiking.

Separate yourself. As mental health professionals, we often provide a holding environment for our client’s pain in the counseling room. Remember to tell yourself, "This is not my pain. I am just holding it for a little while."

Limit yourself. Make sure you are maintaining proper boundaries not only with your clients, but also with your workplace. Consider limiting the number of trauma clients you see in one day, and try to vary the type of work you are doing (individual vs. group, direct vs. indirect, clinical vs. administrative). Be realistic about goals for your clients.

Help yourself. Many times, vicarious trauma takes such a toll on our lives that we need to seek professional help ourselves. Remember that you deserve this, and it will ultimately make you a better mental health care professional.

Be honest with yourself. Check in with yourself frequently to make sure you are still satisfied in your current job. Ask yourself the following questions to see what kind of mental health work you enjoy most, and to what you can to make sure you are doing what you find most rewarding.
• What kind of work do I find most stimulating? Therapy? Advocacy? Case management? Community outreach?
• What intervention model do I enjoy using? Crisis, short-term or long-term?
• DI prefer group or individual therapy work?
• What population do I enjoy working with?
• What kind of schedule is best for me and my family? Days? Nights? Weekends?

Empower yourself. Attend professional trainings regularly in order to keep your skills and knowledge as sharp and fresh as possible. Develop a specialty and learn the signs of burnout within that specialty.
Renew yourself. Explore your spirituality and look for ways that you can connect with yourself on a deeper level.

Wendt Center for Loss and Healing from http://www.wendtcenter.org/resources/for-professionals.html

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