Indirect Traumatization in Professionals Working with Trauma Survivors

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 difficult.

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 professional’s life.

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 cynical.

What can trauma workers do about indirect trauma?
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 humanity.

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.