Indirect Traumatization in Professionals Working with Trauma
Professionals and laypersons who work with trauma survivors often
have powerful reactions to hearing about the traumatic experiences of
others. In the professional literature, this is referred to by a variety
of labels, including “indirect trauma,”
“vicarious trauma,” or “compassion fatigue.” It
is almost inevitable that becoming professionally engaged in the process
of helping people who have survived traumatic events such as violent
assault, uncontrollable accidents or frightening disasters will affect
one’s emotional life and world view.
Thus, while helping people overcome the negative effects of trauma is
deeply meaningful and rewarding work, it also can be very taxing.
Working with trauma survivors requires specialized preparation,
extensive training and ongoing professional support that extends beyond
initial training years, spanning an entire career of trauma work.
Indirect or vicarious trauma can be thought of as a form of
occupational stress. It can be a cumulative response to working with
many trauma survivors over an extended period of time, or it may result
from reactions to a particular client’s traumatic experience. The
signs and symptoms of indirect trauma resemble those of direct trauma,
though they are not always a “mirror image” of the
client’s symptoms. There may be intrusions consisting of unwanted
thoughts or images of traumatic events the professional witnessed or
heard about: anxiety, excess vigilance (being on guard), avoidance of
people or activities, or persistent anger and sadness.
Professionals may also experience difficulties in their personal or
professional relationships, in managing boundaries and in dealing with
their emotions. They may withdraw from others, become hopeless, have
nightmares or difficulties sleeping, overeat and use too much alcohol.
Symptoms also can be specific to the kind of trauma being treated. For
example, those who work with sexual abuse survivors may have sexual
difficulties or nightmares about a sexual assault. Those working with
people after transportation accidents may find themselves increasingly
anxious about travel.
Who is affected?
Anyone who encounters trauma survivors in their work and approaches his
or her responsibility with empathy and sincerity may experience the
effects of indirect traumatization. Examples of professionals who may be
affected are psychotherapists, health care professionals, shelter staff,
attorneys, clergy, journalists, trauma researchers and emergency
responders—whether paid or volunteer.
How does indirect trauma come about?
Helping people who have been severely traumatized requires confronting
the tragedies of life and the worst of humanity—violence, torture,
senseless killing, disease, disaster and death. Because the professional
is committed to helping in some way; he or she cannot shy away from the
painful stories or allow a personal reaction to interfere with the job
at hand. Yet the emotions experienced by the helper are real, often
strong, and must be dealt with constructively. This is one of the most
challenging aspects of working with trauma survivors, and often the
professional training received does not provide enough preparation for
handling one’s own emotional reactions to the traumatic stories.
The need to understand, contain and even transform these reactions makes
the task of working with trauma survivors both very rewarding and
What factors contribute to indirect trauma?
For professionals new to this kind of work, the experience can be
particularly shocking and upsetting. Sometimes the trauma reminds the
professional of a personal experience, so that he or she has a reaction
to both the client and to his or her own past. Sometimes the
professional’s usual ways of coping are not particularly well
suited to the task, and new ways of coping need to be learned. Sometimes
the helper is so overwhelmed with personal stress or other problems that
he or she does not have the energy and capacity to manage these
emotions. This can be especially true when the helper also is a
survivor, as is often the case for disaster workers. And there are many
times when the job is simply too much for one person, no matter how
experienced and well trained—or the professional does not have
access to the necessary emotional and organizational support that is
needed to do the job well.
Aspects of the situation that can contribute to indirect trauma
include the confidential nature of trauma work; the difficulty forming
therapeutic relationships with people whose ability to trust has been
diminished by betrayal or abuse; problems with organizations and
institutions that fail to provide the necessary structural support for
working with trauma survivors; repetitive exposure to events that remind
one of the worst side of humanity; high clinical case loads of trauma
survivors; negative social attitudes toward trauma victims; and a lack
of balance between work, rest and play in the trauma
What is the cost of indirect trauma?
Indirect trauma can have multiple negative effects on the individual, as
well as on his or her family, friends and clients. If indirect trauma is
not recognized as a critical aspect of this kind of work, professionals
can become ineffective, have trouble with boundaries in helping
relationships, withdraw from friends, family, and colleagues, and make
bad judgments in their work. They may experience burnout and become a
burden to colleagues or leave the field prematurely, disheartened and
What can trauma workers do about indirect
It is the responsibility of those who train professionals to appreciate
and address this problem, given that adequate training for this work is
critical to its success. For the practicing professional, the first step
is to acknowledge and name the problem as an inevitable part of being
human and of trying to remain open to helping others. Often we can
address indirect trauma by attending to basic self-care: balancing work,
play and rest. Adequate diet and exercise are essential. Having a solid
connection with other colleagues and supervisors who can help with
indirect traumatization also is extremely helpful. Some professionals
find it necessary to balance their trauma work with other kinds of work,
or get more support for the work if this is not possible. Trauma
professionals can benefit from identifying specific difficulties,
assessing the contributing factors, targeting specific steps to take,
and getting support from friends or colleagues in taking those steps.
They also can find relief by engaging in activities or relationships
that restore hope and serve as reminders of the benevolent side of
Helping people deal with and overcome their traumatic experiences is
extraordinarily rewarding, and our work is motivated and sustained by
hope, compassion and knowledge. Indirect trauma can undercut our
effectiveness by reducing our ability to devote ourselves to the
client’s needs at hand. Even very experienced professionals who
are struggling with indirect traumatization will seek consultation from
trauma therapists or other supportive professionals. For more
information about traumatic stress or the International Society of
Traumatic Stress Studies, call 847-480-9028.
© 2005 International Society For Traumatic Stress Studies.
Indirect Traumatization-Revised. (RMMM) All rights reserved.