Ethical Practice & The Challenge of Vicarious Trauma

By Suzanne G. Martin Psy.D., MPH
January 6, 2015



Ethical practice and the challenge of vicarious traumaPrinciple A: Beneficence and nonmaleficence: “Psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.” – American Psychological Association, 2014.

Current ethical guidelines require psychologists to selfassess competence and take steps to limit or discontinue clinical work when they can no longer provide competent care. Yet even in the best of circumstances, people – psychologists included – are not very good at evaluating their own performance.

Moreover, when psychologists work frequently with trauma patients, evidence suggests that they are at risk to develop vicarious trauma. Vicarious trauma (VT) occurs when a psychologist internalizes disturbing aspects of the traumatic experience of a patient into his or her own functioning.

Most psychologists in clinical practice work with individuals who seek treatment because of a past or recent trauma – survivors of child abuse, sexual assault, motor vehicle accidents, violent crime, combat trauma, domestic violence, terrorist attacks etc. – the list unfortunately is endless. Vicarious trauma can affect anyone who works closely with trauma including nurses, first responders, social workers, child abuse workers – even jurors. Psychologists are not exempt.

Treatments for Posttraumatic Stress Disorder (PTSD) often involve elements of exposure work. These therapies typically involve the patient describing their traumatic experience(s) and clinicians listening to the trauma narrative. This vicarious exposure to traumatic material can dramatically impact clinicians both personally and professionally.

Risk

Several factors, including theoretical orientation, training, supervision, military affiliation, personal trauma history, spiritual and religious views, level of social support and selfcare activities, may serve as either protective or risk factors in clinicians working with trauma patients. The risk is greater based on one’s own personal trauma history. So a psychologist with a personal history of trauma is at great risk of VT when working with trauma survivors.

Symptoms of Vicarious Trauma

There are several different signs and symptoms of VT that can occur in a psychologist working with trauma survivors. They include: canceling or being late for appointments, emotional exhaustion, inability to enjoy things you used to enjoy, hopelessness, addictive or compulsive behaviors and sleep disturbance. VT can also include many of the same symptoms as PTSD, including intrusive symptoms (nightmares), avoidant behavior (avoiding the topic) and hyperarousal (easily startled).

It can also include physical symptoms such as rapid heartbeat, dizziness, weakened immune system etc. These symptoms may adversely impact one’s clinical competence. What may begin as distress may quickly become impairment that all too often is seen only after an ethical incident has already occurred. VT can affect not only your professional practice but also your family, your organization and your patients.

Prevention

A primary predictor of VT is number of hours spent working with traumatized patients. Therefore, the best preventive measure against VT seems to be a balanced clinical workload. For some psychologists, particularly those working on military bases, Veterans Administration settings or exclusively with trauma populations (e.g. sexual abuse, domestic violence survivors), this may not be possible. In these situations, exceptional self-care skills are essential. Evidence suggests that coworker support is also very important.

Qualitative studies have shown that the most effective ways to moderate the complications from repeated exposure to VT are structured self-care practices that are incorporated into everyday life. Intervention may be as simple as taking some much needed time off. (When was the last time you took a vacation?).

Simple changes such as making time to do things you enjoy, turning down new obligations or trauma cases, addressing physical and spiritual needs are all important. Other healthy changes may include:

  • Reminding yourself of the importance and value of humanitarian work;
  • Staying connected with family, friends and colleagues; *Mindfulness: Noticing and deliberately paying attention to the “little things” – small moments such as sipping a cup of coffee, the sound of wind in the trees or brief connections with others;
  • Marking transitions, celebrating joys and mourning losses with people you care about through traditions, rituals or ceremonies;
  • Taking time to reflect (e.g., by reading, writing, prayer and meditation);
  • Identifying and challenging your own cynical beliefs, and *Undertaking growth-promoting activities (learning, writing in a journal, being creative and artistic).

Ironically, the characteristics that bring many of us into the field of psychology are the very factors that make us vulnerable to vicarious trauma. It is our professional and personal responsibility to ensure that these adverse outcomes are minimized.

Bottom line: Be aware of your risk and take proactive steps to stay emotionally healthy – for yourself and your patients.

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