Vicarious Trauma
Care for the Caregiver
Dan L. Petersen, Ph.D.
“You cannot describe it unless you have
seen it,
you cannot explain it unless you have done
it,
you cannot imagine it unless you have been
there,
then it never goes away”
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Bill Bessington, Retired Reporter, Chugiak, Alaska
Stress
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Distress and Eustress
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Biological and Psychological stress
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Trauma
Burnout
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Burnout is not vicarious trauma
Burnout refers to a response to the work
environment which may be too demanding,
stressful, or unrewarding.
Behaviors characteristic of burnout include lack
of motivation, poor work performance, time
problems, and general dissatisfaction with the
job.
Vicarious trauma
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Terms: secondary trauma, compassion
fatigue (Figley), PTSD, secondary
traumatic stress, indirect victimization and
traumatic countertransference.
Vicarious trauma
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“The transformation that occurs within the
trauma worker as a result of empathetic
engagement with the client’s trauma
experiences. Such engagement includes
listening to graphic descriptions of horrific
events, bearing witness to peoples’ cruelty
to one another, and witnessing and
participating in traumatic reenactments”
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Pearlman & Saakvitne, 1995
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Studies have shown that approximately 24
to 38% of professionals who work with
clients who have experienced trauma
experience moderate to high levels of
traumatic stress.
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(Dalton, 2001; Cornille & Meyers, 1999; Johnson &
Hunter, 1997; Reghr & Cadell, 1999; Chrestman,
1995; Pearlman & Mac Ian, 1995)
McCann and Pearlman’s Schema
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Personal frame of reference
Safety
Dependency and trust
Power
Esteem
Independence
Intimacy
Cognitive Alterations
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Feelings and statements of
despair/hopelessness
Cynicism
Anger
Withdrawal and numbness
Irrational cognitions
Common cognitive coping
mechanisms that often are
problematic
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Comparing one’s self with those less fortunate
Selectively focusing on the positive attributes of
one’s self to feel advantaged
Imagining a potentially worse situation
Construing benefits from the crash victim’s
experience
Manufacturing normative standards that make
one’s adjustment seem normal
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Taylor, Wood and Lechtman, 1999
Victim advocates may
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Withdraw
Have boundary violations
Become controlling and intrusive
Deny the victim’s reality
Minimize the victim’s experiences
Refocusing (“how did you survive” as
opposed to “what happened to you” or
“what did you go through”
Risk Factors
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Helper’s personal history
Type of client/victim
Level of trauma experienced by the victim
Helper’s attempts to cope
Environment
Supportive or non-supportive
 High traffic with high pressure
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Symptoms of vicarious trauma
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No time, no energy
Disconnection (depersonalization)
Social withdrawal
Sensitivity to violence
Cynicism
Despair and hopelessness
Sleep problems
Disrupted frame of reference
Diminished self-efficacy (e.g., inability to trust your own
decisions)
Alterations in sensory experiences
Scenario
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Jane has been working at the center for about four months. Jane applied
for the position because as she indicated in her interview for the job:
“I want to give back. I want to help others as I was helped. I know what it
is like to be a victim of a crime and I know in my heart that I can help
others.”
Jane’s supervisor upon entering the break room sees Jane with her head
down on the table crying. The supervisor asks Jane if she is alright and
Jane responds that she will be okay and that it is just that she feels so bad
sometimes after working with a client. Then she looks up at the supervisor
and earnestly asks, “It will get better, won’t it?” Then she says that she use
to talk to her friends about her feelings after the crime and that it helped a
lot but lately talking about it seems to maker her feel worse rather than
better. The supervisor consoles Jane by gently touching her on the
shoulder. “I know we are all busy and I have a client waiting right now, but
if you want to talk about it stop by some day when we are both free. Come
on, let’s get back to work.”
Protective Factors
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Social support
Supervision/consultation
Competence
Self-awareness
Ethics or moral sense
Number of personal issues resolved with a
success strategy
Defined boundaries
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Personal limitation
Ability to be a resource for others
Framework for health
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Physical health
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Body/exercise
Disease
Nutrition/food intake
Psychological
Professional
Organizational
Community/family
Actions to prevent or assist in
reducing vicarious trauma
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Journaling
Develop personal rituals/routines
Mindfulness
Find balance (work, play, family, others)
Extend identity beyond work
Diversify caseload
Seek consultation on difficult cases
Take breaks during the day
Gain competence
Modify work schedule as needed with case severity/load
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Be curious
Self-reflect, notice your inner experiences
Read literature unrelated to work
Practice receiving from others
Wear clothes you like
Eat healthily
Take time off when sick
Exercise
Get regular care
Get enough sleep
Take day trips or mini vacations
Spend time with others whose company you enjoy
Learn to say “no” to extra responsibilities sometimes
Find things that make you laugh
Spiritual self-care
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Make time for reflection
Spend time in nature
Find spiritual connection or community
Be open to inspiration
Cherish your optimism and hope
Be aware of the non material aspects of life
Try at times not to be in charge or the expert
Meditate
Pray
Sing
Contribute to causes in which you believe
Read inspirational literature
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Saakvitne & Pearlman; 1996 excerpted
Autogenic Relaxation
History
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Johannes Schulz published “Autogenic
Therapy in 1932
Based on passive concentration and body
awareness
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Detached but alert state of mind
Requires no equipment and takes only
about 10 to 15 minutes per session
Can be practiced anywhere
Is similar to many meditative techniques
Schulz’s six autogenic “states”
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Heaviness in the arms and legs
Warmth in the arms and legs
Warmth and heaviness in the heart area
Focus on breathing
Focus on warmth in the abdomen
Focus on coolness in the forehead
Breathing
Slow breathing
“Breathe in, 1 2 3; Breathe out, 1 2 3”
Deep breathing
Stomach expands as diaphragm moves to pull in
more air
Let your body breathe (the air is breathing me)
Breathe in through the nose and out through the mouth
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I feel quiet
My feet feel heavy, heavy and relaxed
My calves, my knees, thighs and hips feel heavy,
relaxed and comfortable
My stomach feels relaxed and quiet
My hands are heavy
My arms and shoulders are relaxed.
My arms are heavy and warm.
I feel quiet