Vicarious Trauma Explained

What is Vicarious Trauma?

Empathy is the ability to engage with, understand and be sensitive to suffering. As therapists, listening to painful, distressing information in the most helpful way means being empathically supportive, fully engaged and connected to the person in crisis. This makes us vulnerable to vicarious trauma. Some therapists begin to experience symptoms associated with post-traumatic stress such as traumatic imagery, nightmares, anxiety, change in belief system, or a change in their behaviour.

The Cost of Caring for Others?

Sometimes vicarious trauma is associated with the ‘cost of caring’ for others (Figley, 1982). However, it shouldn’t be if the people caring are supported adequately to do their work. That said, if you’re delivering therapy to a wide range of people, you’re going to encounter situations that can test you emotionally. Showing compassion and caring for people in crisis means you’re likely to hear things that have the potential to create traumatic imagery in your own mind. You should be prepared for this and develop strategies to help you cope when it happens.

My Own Experience

Many years ago, I worked with someone whose home had been burgled. I soon noticed myself becoming more focused on the security of my own house. While this didn’t cause me distress, I did spend time reflecting on the situation with my clinical supervisor. I also took a break from working with anybody who had had a similar experience.

At the time, another trigger for me was that I had been burgled a number of years previously. My supervisor explained I was matching my world and personal experiences with those of the client. They encouraged me to focus on the differences between the two situations. I was also able to support myself by taking a break before and after each therapy session with the client. Implementing some CBT on myself helped me maintain a balanced belief system and I was able to approach the safety behaviours I wanted to put in place with curiosity.

Supervision and Self-Reflection

As you can see from my own experience, if you’re dealing with symptoms of vicarious trauma, it’s important to share this with your supervisor. Supervision is a reflective space where you can discuss your caseload and clinical practice with a trusted peer or colleague. It plays a key part in ensuring safe, effective practice and maintaining high standards of professional development. Thankfully, it is a requirement for every CBT therapist who is delivering therapy.

Journaling can also be a useful tool, especially if you have a difficult session and cannot see your supervisor right away. Focus on processing your emotional experience rather than writing out the traumatic content.

Self-Care for Therapists

Therapists use their mind and emotional landscape to be fully engaged and present with their clients and to listen in a compassionate, non- judgemental and supportive way. This is a huge honour and privilege. It’s also immensely rewarding. But we’re human too.

For me, the issue of vicarious trauma highlights the importance of self-care. Professor Paul Gilbert has written extensively about the need to create safeness in the therapeutic relationship (2014). Part of creating safeness for our clients is recognising our own wellbeing as part of the therapeutic relationship.

I believe one of the reasons people don’t always say what they need to in therapy is out of concern for therapists. Therapists who practice self-reflection and receive adequate support will project a sense of strength, confidence and resilience. This makes it easier for their clients to confidently share their traumatic experiences.

Unfortunately, supporting ourselves as therapists is somewhat overlooked in our training. This means many people only begin to understand how crucial self-care is when its absence begins to impact them. It’s important to remember there are two human minds in the room during therapy. Both need a great deal of care and support.

I’ve trained with Dr Deborah Lee a number of times and highly recommend her book ‘Recovering from Trauma using Compassion Focused Therapy’. Lee describes what we do as therapists as ‘humanitarian work’. I remember being very surprised the first time I heard this, but if you look at the definition of humanitarian work, she’s right. We are helping and supporting others in a time of need and crisis. When we see our work through this lens, we should feel more motivated to support ourselves. If we don’t, it’s likely there will come a time when we have to stop.

Protecting Yourself from Vicarious Trauma

Your mind is the tool you use for your work. How are you keeping it healthy? We maintain and update other tools in our practise, buy new books and upgrade computers, so we shouldn’t neglect our minds. Read Self-Care for Therapists for more advice.

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Sarah Rees

Sarah is a fully accredited Cognitive Behavioural Therapist and mental health writer delivering Modern Mental Health for you and with you in Mind. Sarah is the author of ‘The CBT Journal’ which helps you write for your wellbeing incorporating CBT techniques. For more information and to keep in touch have a look at