Secondary Trauma

Secondary trauma is the emotional spread of the effect of trauma symptoms as a result of close and extended contact with traumatized individuals. Generally, the traumatized person has close and extended contact with others, such as family members, friends, or mental health professionals. These individuals are at risk of experiencing psychological distress through direct exposure to the traumatized person. Symptoms of secondary trauma are similar to those of posttraumatic stress disorder (PTSD), but are less severe. Symptoms of secondary trauma include having unwanted thoughts or images about the trauma incident, persistent avoidance of places or activities related to the traumatic incident, detachment from others, and increased arousal indicated by sleep disturbances, irritability, concentration difficulties, or being overly vigilant.

The term secondary trauma has been used to encompass both vicarious trauma and compassion fatigue. Vicarious trauma, like secondary trauma, refers to the experiencing of trauma symptoms caused by close association with a traumatized person. Compassion fatigue, on the other hand, refers to the acquisition and development of symptoms by mental health professionals who are engaged in a therapeutic relationship with traumatized individuals.

Vicarious Trauma

Secondary trauma symptoms have been found in individuals who live with a traumatized family member, were raised by parents who were traumatized, or grew up with parents who were traumatized war veterans. Children of Holocaust survivors have been shown to acquire secondary trauma symptoms via intergenerational transmission; that is, the emotional and behavioral symptoms exhibited by family member(s) of one generation have been found to pass on to those of the next generation. Individuals in relationships with traumatized persons are also likely to acquire trauma reactions. It was found that when one partner reported a history of childhood physical or sexual abuse, the other partner reported significant symptoms of psychological distress. Research thus suggests that being in a family with someone who has been traumatized puts one at risk of developing vicarious trauma.

There are two hypotheses as to how exposure to a traumatized family member leads a person to acquire and experience vicarious trauma. The first suggests that the emotional bond between family members is the avenue through which the traumatized person’s symptoms are transmitted to others in the family. Underlying a caring relationship is sympathy and empathy. Empathy is similar to sympathy, but goes beyond sympathy in that empathy involves vicariously experiencing the thoughts, feelings, and experience of another. It is not surprising that individuals are vulnerable to acquiring and experiencing vicarious trauma from a family member, since being in the same family implies close and regular contact. In addition, family systems are usually one of the primary social support networks that individuals turn to for support and caring in times of difficulties and distress. Family members are likely to want to know what happened during the traumatic incident, how the traumatized person has been negatively affected, and what behavioral and emotional symptoms have developed. By virtue of being emotionally connected, a family member may feel the pain of the traumatized person to the extent of experiencing similar trauma symptoms.

Another hypothesis is that being exposed to a traumatized person can cause a family member to formulate beliefs about him- or herself, others, or the world in general that predisposes the family member to acquire and experience secondary trauma symptoms. For example, in incidents in which individuals are brought up by parents who have been traumatized by war or other atrocities, they may view the world as an unjust and unsafe place in which catastrophic and uncontrollable events can suddenly occur. These are similar beliefs often held by traumatized individuals that perpetuate trauma-related symptomology.

Compassion Fatigue

Working with individuals in a therapeutic relationship can be fulfilling and rewarding, as the therapist facilitates healing and recovery in clients who suffer from the psychological aftermath of having experienced a traumatic incident. However, being in such a helping role sometimes causes emotional pain due to direct exposure to the client’s traumatic material. Compassion fatigue is therefore an occupational hazard of being in the role of providing therapeutic help. Research has found that many sexual assault trauma counselors develop intrusive and unwanted images similar to those of their clients. Other research has indicated that female psychotherapists who work with large numbers of sexual abuse cases, or have seen a high number of sexual abuse survivors over the course of their careers, are more likely to develop and experience trauma symptoms than those who see fewer sexual abuse cases.

As to how or why psychotherapists who work with traumatized clients are vulnerable to develop symptoms of compassion fatigue, the first explanation, which involves empathy, is similar to the one mentioned for vicarious traumatization. Empathy is a major resource for psychotherapists in helping the traumatized, given its centrality in comprehending the experience and perspectives of clients. Empathy is indispensable in establishing rapport in a therapeutic relationship, assessing presenting problems, and formulating a treatment approach. While empathizing with a traumatized client helps the therapist to understand the client’s experience of being traumatized, the process may traumatize the therapist. Another reason why working with traumatized individuals can cause impairment in therapists is that exposure to clients’ trauma may provoke or reactivate unresolved issues from therapists’ own trauma histories.

Compassion Fatigue versus Burnout

Compassion fatigue is not to be confused with burnout. While these are both occupational hazards of being a psychotherapist, they are different from each other. Burnout is a process that begins gradually and gets worse over time. The literature on burnout supports the notion that the process is set in motion by gradual exposure to job strain, loss of idealism, a lack of sense of accomplishment, and accumulation of intensive contact with clients, particularly those whose problems are perceived as chronic, acute, complex, and require skills beyond what the therapist possesses. The causes and mechanisms leading to symptoms of compassion fatigue, as mentioned above, are quite different from those leading to burnout. Secondary trauma symptoms (STS) precipitated by compassion fatigue can emerge suddenly without warning. STS can happen to a psychotherapist at any point of his or her career. Additionally, STS also has a faster recovery rate than burnout.

Assessing Secondary Trauma

Despite the importance of studying secondary trauma, given its major impact on family members, close friends, and psychotherapists, there are few psychometrically sound instruments to assess this type of traumatization. Most of the existing instruments are designed for specific populations, such as mental health workers or children of Vietnam veterans who were diagnosed with PTSD. Another problem is that existing measures often lack reliable cutoff scores to facilitate clinical decision making. In some cases, both limitations are present. The Secondary Trauma Scale (STS) was developed to address these limitations. When the 18-item secondary trauma scale was administered to a university-age sample (along with other instruments to measure anxiety, depression, and symptoms of intrusiveness, avoidance, and dissociation), initial results indicated that higher scores on the scale were associated with emotional distress and intrusive and avoidance symptoms.

In summary, because most individuals turn to their existing social support networks in times of crises or distress, clinical attention should also be extended to those who provide care and support to those traumatized directly, such as family members. Given that compassion fatigue is a natural by-product of working with and caring for traumatized individuals, it should be recognized as the cost of caring for mental health professionals and addressed openly in training programs to prepare them to cope with these issues in the future. Secondary exposure to trauma may cause helpers to inflict additional pain on their clients, lose objectivity, or suffer negative impact on their own well-being. Treating and preventing such occupational hazards is important for sustaining helpers’ longevity and effectiveness. Given the impact of secondary trauma, more research attention should be directed at validating psychometric instruments to measure the severity of secondary trauma in order to facilitate appropriate intervention and treatment.

References:

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