Assisting Interns, Staff and Colleagues in
Detecting Secondary Traumatic Stress and
Vicarious Trauma
Sarah Hessenauer, PhD
University of Wisconsin – Whitewater
Rules for Self-Care
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When social workers are exposed to traumatic stories
and / or situations, it may cause uncomfortable thoughts
and responses.
If you start to feel uncomfortable, take care of yourself.
Stand up, take a walk, take deep breathes, employ
relaxation techniques, take a break, talk to others, or do
whatever works best for you! -Take care of yourself
Be mindful of your feelings
Be respectful to others
Examples
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
A colleague called to tell me about an incident where staff
were talking about a death of a client the night before.
Two students were in the room as the staff basically said
“too bad” and went about their meeting. The colleague
admitted they paid no attention to their co-worker who
had been the direct worker nor to the students involved
who may have never experienced this in their past.
A student in her internship called to state that the agency
had been put on alert due to a threatening call, but that
they told her to go ahead with her group. During her
group, an alarm sounded and she had no training on how
to handle the situation.

“Often we are not aware we have brought home an unwelcome visitor unless we notice that we are agitated
rather than relaxed, have trouble sleeping, or pick a
useless fight with our partner and make a connection”
(Rothschild & Rand, 2006)

“A profession cannot successfully retain its workforce
when issues of personal safety go unaddressed” (NASW
& University of Albany, 2006)
Social Workers and Trauma Work
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Social workers have higher rates of burnout than other
helping professionals, such as occupational therapists
(Brown, 2008).
In a study of British social workers 74% were
experiencing high levels of anxiety (Lloyd et al., 2002)
62% of experienced Child Protective Service workers
scored high on a measure of emotional exhaustion.
(Anderson, 2001)
In a study by Meyers & Cornille, (2002), of CPS workers
interviewed, 82% reported a trauma prior to working in
the CPS field, and 77% reported trauma while on job
(versus 76% of American adults).
Social Workers and Trauma Work Cont.
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In 1995, Beaton & Murphy reported social workers
experience physiological and physical symptoms, some
extending to serious illnesses, and ultimately a higher
mortality rate among controls (Figley, 1995).
In one study 17.7% of caseworkers suffered from
secondary traumatic stress, while only 15.2% of Vietnam
Vets reported post traumatic stress disorder (Kulka et al,
1990).
About 48% of the total workforce in the United States
experiences high levels of personal distress as a result of
their work (Strozier & Evans, 1998).
Self-Care

Social work self-care requires proper functioning at least
three neuropsychological symptoms:

Interpersonal empathy
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Rothschild and Rand (2006) cite Stern who said “we have the capacity
to experience what others experience” and “empathy is an integral,
necessary tool of our work” (p. 10).
Impact of motor neurons – brain cells reflect the activity of another’s
brain cells (p.42)
Balance in autonomic nervous system and arousal regulation
Clear thinking relying on the balanced functioning of all brain
structures
Stress
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Stressors are situations, conditions, people or things that
have the potential to trigger the stress response in us.
Stress can be protective; stress helps us adapt to
situations and is important for survival.
Impact of Stress
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If we allow stress reactions to build, they accumulate and
their impact spreads beyond our work life into home and
relationships.
Research shows that about 20% of professional helpers
are greatly impacted by taking on negative energy from
their clients or patients (Thivierge, 2011).
Top 10 Signs You Are Too Stressed
1.
You find yourself hoping to get the flu just so you can stay in bed for a day
2.
Your children shutter in fear when your bosses name is mentioned
3.
You have wondered if your cell phone would float when you hurled it into the
rive
4.
You start using a pencil instead of a pen to put dates with your partner in your
schedule
5.
Medical journals or case files have become “light bedtime readings”
6.
Your best friends think you have moved away since they have not hear from you
in so long
7.
You consider Red Bull a part of a balanced diet
8.
You fall asleep during trips to the dentist office, because it is the only time you
put your feet up
9.
You are too tired to remember the name of your dog
10.
It takes you six days of vacation to even begin to feel relaxed, and six minutes
back at your office to make you forget that you took a vacation
Volk, Guarino, Grandin & Clervil, 2008
Stress Reactions
Physical Stress Signs
Cognitive Stress Signs
Headaches
Exhaustion
Teeth grinding
Negative rumination
Insomnia
Inability to focus on a task
Irritability, anger
Reduced libido
Muscle tension
Reduction in joy
Gastric disturbance
Mental fatigue
High blood pressure
Feelings of futility
Rapid heartbeat
Devaluing of co-workers
How Is Your Life Affected By Stress?
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How does your body react to stress?
How is your personal life affected by stress?
How is your personal life affected by stress?
Student Specific Stressors
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Beginning workers
Role conflicts
Expectations of field and academic learning
Nature of field setting
Population served
Supervisors lack of attention to students’ emotional
reactions; current emphasis on an education model rather
than on a growth model (Litvack, Bogo, & Mishna, 2010)
Definitions
Trauma
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Exposure to a situation in which:
◦ The person experienced, witnessed, or was confronted with an
event or events that involved actual or threatened death or
serious injury, or a threat to the physical integrity of self or
others
◦ The person’s response involved intense fear, helplessness or
horror
PTSD (Post Traumatic Stress Disorder)
◦ An anxiety disorder in which one may experience nightmares,
flashbacks, heightened arousal, etc., related to a traumatic
event.
APA, 2000
Trauma

Figley (1995) suggested that PTSD should be called
primary post-traumatic stress disorder, whereas the same
symptoms appearing secondarily to the victim care in
helpers should be called secondary traumatic stress
disorder (exposure to the traumatized person rather
than to the traumatic event itself).
Re-Traumatization

The individual having experienced their own traumatic
event may develop symptoms that are reactivated by
hearing the client tell their story of trauma.
Secondary Traumatic Stress
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Zimering, Munroe, and Bird Gulliver (2003) identify
secondary traumatic stress as “indirect exposure to
trauma through a firsthand account or narrative of a
traumatic event” (n.p).
Bober and Regher (2005) stated that secondary
traumatic stress has symptoms similar to PTSD; however
the trauma is due to working with someone else who
has experienced the direct trauma and not the social
worker.
Secondary Trauma and the Brain
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1990’s, research began to look at the role of mirror neurons
in the brain and their association with Compassion Fatigue
(which will be discussed further). There is some speculation
that the contagiousness of laughter and yawning may be
connected to the function of the mirror neuron. There is a
mimicking response observed, that may be triggered by these
mirror neurons. The mirror neurons reflect the activity of
someone else’s brain cells (Rothschild, 2006).
Mimicking can work both ways.
The Brain and Countertransference
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“Unconscious attunement to and absorption of victims’
stresses and traumas” (Figley, 2002, p. 19)
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Not easily accessible via words
Intrusive type countertransference leads to loss of boundaries,
over-involvement, reciprocal dependency, and pathological
bonding
Avoidance type countertransference leads to withdrawal,
numbness, intellectualization, denial.
Vicarious Trauma

McCann and Pearlman (1995) identified vicarious
traumatization (VT) as the transformation that occurs
when an individual begins to change in a manner that
mimics a client’s trauma-related symptoms (experience in
social workers’ nervous systems).
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Vicarious traumatization tends to be the result of repeated
exposure to traumatic stories which results in a change in the
social workers thinking / core beliefs.
The social worker begins to interpret and relate to the world
in a new manner and his/her inner experience is altered by
exposure to trauma work (Figley, 2002, p. 157).
Vicarious Trauma
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VT emphasizes the way the therapist’s experience of the
self is altered in terms of identity, world view, spirituality,
self capacities, ego resources, psychological needs, and the
sensory system. Moreover,VT disrupts the therapist’s
sense of safety, trust, esteem, intimacy, and sense of
control (Pearlman & Saakvitne, 1995).
In effect,VT resembles the effects of trauma on the client.
Over time, the therapist is changed as a consequence of
empathic engagement in clients’ stories of sadism, cruelty,
betrayal, neglect, abandonment, and exploitation.
Vicarious Trauma

In psychotherapy with traumatized individuals, it has to be
assumed that our subjectivity, including our organizing
principles, are altered by VT.
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First, vicarious trauma weakens the therapist’s capacity to be
emotionally flexible and available to the client’s emotional
needs, that is, to provide a holding environment and to sustain
affective attunement through empathic immersion in the
client’s subjective experience.
Second, the intersubjective field of the client–therapist is
always shaped by the therapist’s emotional experience of this
relational domain, in addition to the client’s experience.
Compassion Satisfaction
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Compassion satisfaction is about the pleasure you derive
from being able to do your work well.
For example, you may feel like it is a pleasure to help
others through your work and that we provide them with
some relief, growth or healing.
Compassion Fatigue
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The term compassion fatigue has been around since
1992, defined by both Johnson and Kottler (Figley, 2002).
Compassion fatigue is experienced by caregivers who
are overly focused and upset by the cumulative trauma
of those they are trying to help.
The symptoms are similar to those of post traumatic
stress disorder (PTSD).
Compassion Fatigue Defined
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
Compassion Fatigue is defined as the social workers decreased
ability to be empathic or able to “bear the suffering of clients”
and is “the natural consequent behaviors and emotions
resulting from knowing about a traumatizing event
experienced or suffered by a person” (Figley, 1995, p. 7).
Siegel, 2010, indicates it affects our ability to be fully “present”
with our clients. Our past, especially histories of trauma,
restrict our plateau’s and create valenced states that bias how
we will view certain situations. When we sense danger, we
cannot activate the social engagement system or selfengagement system. It will cause us to disengage from our
clients.
Compassion Fatigue Examples
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A female case manager working with women who have
been sexually assaulted assumes that all men she
encounters are unsafe
Staff working at an eating disorder center start to believe
that 100 lbs. is a good weight for an adult female
Someone you have supervised for years has developed a
recent habit of checking with you before making any
decisions, questioning whether his actions have any value
to the clients he once felt confident working with
Adapted from Volk, Guarino, Grandin & Clervil, 2008
Compassion Fatigue Symptoms
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Excessive Blaming
Bottled Up Emotions
Isolation from Others
Poor Self-Care
Diminished Sense of
Safety
Nightmare
Difficulty Maintaining
Boundaries
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Exhaustion
Apathy
Sadness / Depression
Aggression towards
Others
Decreasing Sense of
Competency
Questioning Personal
Values
Burnout
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The state which occurs when stress reactions reach a
crisis point. More commonly experienced by staff and
caregivers in response to continual exposure to other
peoples pain.
 Health may be suffering or outlook on life becomes
negative.
It grows over time and unlike Compassion Fatigue,
burnout is caused by stress and hassles, such as
paperwork/phone calls, rather than over-empathizing
with the trauma of those you work with.
It is the predictable, cumulative effect from the impact
or overload of their work.
Burnout
Unaddressed burnout can lead to compassion
fatigue.
 Remember the instructions from the flight
attendant, “If the cabin loses air pressure,
oxygen masks will drop from the ceiling. Please
put on your own mask before assisting others.”
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Help yourself before you can help others
Adapted from Volk, Guarino, Grandin & Clervil, 2008
Burnout
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Physical symptoms include:
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fatigue, low energy
poor sleep and headaches
irritability
Emotional symptoms include:
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anxiety and depression
hopelessness
aggression and cynicism
substance abuse
Other Warning Signs
Baranowsky (2002) identifies other warning signs as:
 Wishing the client would just get over it.
 Using anger or sarcasm with clients.
 Blaming a client for their problems.
 Fearing what the client will want to talk about.
 Using humor with a client to minimize his / her problems.
Organizational Symptoms of
Compassion Fatigue
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High absenteeism
Constant changes in co-workers relationships
Inability for teams to work well together
Desire among staff members to break company rules
Outbreaks of aggressive behaviors among staff
Inability of staff to complete assignments and tasks
Inability of staff to respect and meet deadlines
Lack of flexibility among staff members
Negativism towards management
Strong reluctance toward change
Inability of staff to believe improvement is possible
Lack of a vision for the future
Cost of Not Addressing
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Job performance decreases in terms of productivity
Mistakes increase
Office morale drops
Work relationships suffering
Personal life suffers, increased risk for substance abuse
Can lead to problems with health
Isolation from support networks
Decreased sense of self esteem and confidence
High staff turn over ($)
Increase use of sick leave ($)
Lack of collaboration with other offices
Risk Factors for Social Workers
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Caseload
History of personal trauma
Lower level of trauma training
Lack of control over work schedule
Lack of organizational support
Poor self-care
Evaluating
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Professional Quality of Life Scale:
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http://www.proqol.org/uploads/ProQOL_5_English_SelfScore_3-2012.pdf
Mean scores of PROQOL
Research
Prior BSW Study Participants
(Knight, 2010)
(Stamm, 2005)
N=42
N=1000 (Mental
health
professionals)
Subscale
UWW BSW
N=49
Compassion
Satisfaction
43.65/43.89
41.3
37
Secondary
Traumatic Stress
18.19/17.37
11.2
13
Burnout
19/17
18.5
22
NASW Code of Ethics
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We have an ethical responsibility to engage in appropriate
and responsible self-care.
The NASW Code of Ethics states that “a social worker’s
ethical behavior should result from their personal
commitment to engage in ethical practice.”
◦
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Ongoing self-care is the foundation of that “commitment” to
ethical practice.
We need to identify our secondary trauma and vicarious
trauma so that we can address to prevent related
negative consequences.
Protective Factors for Social Workers
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Job satisfaction and personal gratification protect us
Management of vital functions (sleep, food, recreation) (Yassen,
1995)
Proper training, including helpers’ ability to read and care for
their own stress responses
Training in safety/debriefing after “traumatic” event
Balanced number/level of trauma clients in your caseload
Relationships with others that convey cooperation and respect
Benefits that allow for time-off, vacation, and mental health
care
Good self-care
Good boundaries
Meyers & Cornille’s Study Recommends:
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Improved training
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Recognize and normalize secondary traumatic stress
Owning personal trauma history
Recognize gender differences (recognize how males and
females react differently after being exposed to abuse)
Coping strategies
Handling on-the-job victimization
Providing a supportive work environment
Limiting work hours
Personal care
Caregiving Organizations
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“Holding Fast” – Kahn (2005)
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What is Object Relations?
 How people internalize and externalize their relationships with
others.
 “Good enough” others.
What is a Caregiving Organization?
 Those agencies whose primary task is the effective providing for
people seeking healing, growth, learning or support form another.
 Relationships are based on premise that growth, healing, and learning
involves risk and vulnerability on part of those we treat.
 Caregivers must contain (absorb thoughts and feelings), provide
empathic acknowledgement, and provide an enabling perspective (take
over others ego functioning until they can do this on their own). Each
of these require a unique set of skill and sophistication, along with
stamina. Stress is an inevitable by product.
Caregiving Organizations (Cont.)
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Object Relations view of self-care in organizations
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“the quality of care given to care seekers depends on the extent to
which caregivers are emotionally ‘held’ within their own
organizations…the institution as a whole becomes therapeutic and its
members model caretaking behaviors toward one another”
“the extent to which caregivers are emotionally held within their own
organizations is related to their abilities to ‘hold’ others”
Leadership in Caregiving Organizations
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Create strong vision and mission which supports resiliency
Supervision is key – allow staff to explore issues
Leaders become ultimate attachment figures – contain emotion and
model appropriate behavior
Leaders must assist with change
“Leaders must hold lightly, hold firmly, and hold courageously”
Helping Student / Interns
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Discuss strategies to address any potential violence prior
to student starting: help student to potential situations,
teach safety education, help students understand rights,
and discuss fears
Address students over-identification (distorted reality)
and low sense of coherence (confidence) (Ying, 2009)
Offer agency debriefing and support to students after a
stressful situation
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Critical incident stress debriefing
Counseling referral as needed
Schools should provide training for field educators on
client violence issues
Self-Care Defined
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“A person’s emotional and psychological capacity to cope
with demands across time, circumstance, and setting’
(Ashford, Lecroy, & Lortie, 2006)
Self-care enhances well-being and involves purposeful and
continuous efforts that are undertaken to ensure that all
dimensions of self-care receive the attention that is
needed to make the person fit to assist others (Moore,
Bledsoe, Perry & Robinson, 2011)
Self-Care Strategies

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How do you care for yourself?
What are the benefits?
Tools
Self-Care Assessment Tool: Self-Care
 Organizational Self-Care Checklist
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Self-Care Strategies at Work
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Seek supervision and guidance
Peer consultation about clients
Regular lunch breaks
Taking short breaks at work
Utilize Employee Assistance Programs
(Eastwood, C.D. & Ecklund, K, 2008)
General Self-Care Strategies
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Acknowledge your work will affect you
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Obtain trauma training
Learn about burnout
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Mixed literature on this however, many of us know the fact but do
not live it.
Seek consultation and supervision
Seek professional help when needed
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“Know thyself”
“Heal old pain”
Get proper nutrition, sleep, and exercise
Use humor to relieve tension
Develop realistic expectations about your role
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Examine self-talk
General Self-Care Cont.
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Build a strong support network
Balance between personal and professional life
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“Sick days versus wellness days”
Pursue leisure activities
Moderate caffeine / alcohol use
Maintain professional contacts
Meditation and body therapy (yoga, massages, etc.)
Reflect
Evaluate and set new goals
Be kind to yourself
Other Ideas
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Attending cultural events
Hobbies
Take medications as prescribed
Take trips for pleasure
Volunteer
Journal
Church / worship services
How to Help Others
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When approaching your colleagues about their stress,
compassion fatigue or burnout---make sure to have this
conversation while they are not distracted or overly
stressed.
Identify stress-relief solutions such as retreats and
workshops.
Resources

Baird, K. & Kracken, A. (2006). Vicarious traumatization and secondary traumatic
stress: A research synthesis. Counseling Psychology Quarterly, 19(2): 181–188.

Baranowsky, Anna B.; In: Treating compassion fatigue. Figley, Charles R. (Ed.); New
York, NY, US: Brunner-Routledge, 2002. pp. 155-170.

Bober, T. & Regehr, C. (2006). Strategies for Reducing Secondary or Vicarious
Trauma. Brief Treatment and Crisis Intervention 6 (1); 1-9.

Criss, P. (2010). Effects of client violence on social work students: a national study.
Journal of Social Work Education, 46 (3), 371-389.

Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic
stress disorder in those who treat the traumatized. NY: Brunner/Mazel.

Figley, C. R. (2001). Renewing Spirits: Lessons From Thirty Years of Trauma Work,
Invited keynote address to the William Wendt Center for Loss and Health
Conference on Illness, Grief & Trauma, Washington, DC, October 6.

Figley, C. R. (Ed.) (2002). Treating Compassion Fatigue. New York: BrunnerRoutledge.

Harr, C. & Moore, B. (2011) Compassion fatigue among social work students in
field placements. Journal of Teaching in Social Work, 31(3), 350-363.
Resources
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Kabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness
Meditation in Everyday Life, New York: Hyperion
Knight, C. (2010).Indirect trauma in the field practicum: Secondary traumatic
stress, vicarious trauma, and compassion fatigue among social work students
and their field instructors. Journal of Baccalaureate Social Work, 15(1), 3152.
Kulka, R. A.,Schlenger, W. E.,Fairbank, J. A.,Hough, R. L.,Jordan, B. K., Marmar, C.
R.,Weiss, Daniel S. (1990). Trauma and the Vietnam war generation: report of
findings from the National Vietnam Veterans readjustment study. Philadelphia,
PA, US.
Litvak, A., Bogo, M., & Mishna, F. (2010). Emotional reactions of student in
field education: an exploratory study. Journal of Social Work Education,
46(2), 227-243.
Maslach, C. and Jackson, S. E. (1981). The measurement of burnout. Journal of
Occupational Behavior, 2, 99-113.
Maslach, C. (1976). Burn-out. Human Behavior, 5 (9), 16-22.
McCann, I. L. and Pearlman, L. A. (1990).Vicarious traumatization: A
framework for understanding the psychological effects of working with
victims. Journal of Traumatic Stress, 3:2, 131-149.
Resources
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Miller, K. I., Stiff, J. B., & Ellis, B. H. (1988). Communication and empathy as
precursors to burnout among human service workers. Communication
Monographs, 55(9), 336-341.
Moore, S.E., Bledsoe, L.K., Perry, A.R., Robinson, M.A. (2011) Social work
students and self-care. Journal of Social Work Education, 47 (3), 545-553.
Morrisette, P. J. (2004). The Pain of Helping: Psychological Injury of Helping
Professionals. NY: Brunner-Routledge.
Pearlman, L A. & Saakvitne, K. W. (1995). Treating therapists with vicarious
traumatization and secondary traumatic stress disorders. In C. R. Figley (Ed.),
Compassion fatigue: Coping with secondary traumatic stress disorders in
those who treat the traumatized, 150-177. NY: Brunner/Mazel.
Pierson, J.E. Vicarious Trauma and Self-Care. Retrieved from:
dhss.delaware.gov/si08/files/si09_1314_vicarioustrauma_selfcare.pdf, April 10,
2011.
Rothschild, B. & Rand, M. (2006). Help for Helpers. NY: W.W. Norton &
Company, Inc.
Resources
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Siegel, D. (2010). The mindful therapist: a clinician's guide to mindsight and neural
Integration (1st ed). New York: W. W. Norton & Company.
Stamm, B.H. (2005) The ProQol Manual. Lutherville, MD: Sidran Press.
Thivierge, R. (2001). Healing from Secondary Trauma and Vicarious Trauma.
Retrieved from: www.dynamicharmony.com on April 5, 2011.
van der Kolk, B. (2005). Traumatic Stress: The Effects of Overwhelming
Experience on Mind, Body, and Society (1st ed). Guildord Press. New York:
New York.
Ying, Y (2009). Contribution of self-compassion to competence and mental
health in social work students. Journal of Social Work Education, 45(2), 309323.
Zimering, R., Gulliver, S.B.; Knight, Jeffrey; Munroe, James; Keane, Terence M.;
Journal of Traumatic Stress,Vol 19(4), Aug, 2006. pp. 553-557.
Web Resources
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Websites on CF
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http://www.breathofrelief.com/
http://www.compassionfatigue.org/
http://www.headington-institute.org/Default.aspx?tabid=2648