UNDERSTANDING SECONDARY TRAUMA

What is considered secondary trauma?

Defined by Dr. Charles Figley, Secondary Traumatic Stress Disorder is “the natural consequent behaviors, resulting from knowledge about a traumatizing event experienced by a significant other. It is. the stress resulting from helping or wanting to help a traumatized or suffering person”. Secondary trauma can be incurred when an individual is exposed to people who have been traumatized themselves, disturbing descriptions of traumatic events by a survivor, or others inflicting cruelty on one another. Symptoms of secondary trauma are similar to those of PTSD.

Otherwise known as compassion fatigue, second-hand PTSD, and secondary traumatic stress disorder, secondary trauma refers to a form of distress or trauma that’s experienced indirectly by hearing details of or witnessing the aftermath of a traumatic experience by another person. The term secondary traumatic stress disorder was a concept developed by trauma specialists Beth Stamm, Charles Figley, and others in the early 1990s to better understand and explain why service providers exhibited symptoms of PTSD without having experienced trauma first-hand.

Secondary trauma is especially common among various professionals who work with people who have experienced trauma, including physicians, psychotherapists, human service workers, and first responders. Moreover, the terms vicarious traumatization and secondary traumatic stress are often used interchangeably.

The Psychological Effects of Secondary Trauma

While counselling invites trauma workers to participate with their clients in their process of growth and healing, it may also threaten their well-being through exposure to their client’s trauma and its painful consequences. Research is beginning to show that for some individuals, working with trauma survivors may have physical, emotional and cognitive negative effects. The research literature describes the adverse impact of working with clients who have a history of trauma under a variety of terms, namely, vicarious traumatization. (VT), secondary traumatic stress (STS), burnout and compassion fatigue (CF) (Stamm, 1997).

When a caregiver begins to experience increasing levels of stress, the health and well-being of both the caregiver and the primary victim are at risk. For these reasons, it is particularly important to understand the factors that may protect caregivers from becoming secondarily traumatized. There is a cost to caring.

Working with an individual, as a professional or volunteer, who had experienced some form of trauma, may result in the caregiver not only experiencing increased levels of stress, but also mild to profound changes in their worldview leading to questions regarding justice and meaning in life. Shifts of meaning in life can be quite difficult to navigate, and may lead to high rates of change in staffing for both volunteer and professional positions (Hope, 2006). Figley (1999) cogitates that individuals could be traumatized without actually being physically harmed or threatened with harm.

Learning about a traumatic event carries traumatic potential and he believes that the indirect victims are the family members, friends, neighbours, lawyers and counsellors. Research done a few years later by Figley (2002), reveals that traumatic exposure is indirect and secondary traumatic stress is nearly identical to posttraumatic stress including symptoms associated with posttraumatic stress disorder (PTSD) such as intrusive imagery, avoidance, hyperarousal, distressing emotions, cognitive changes, and functional impairment (American Psychiatric Association, 2000).

Chrestman (1999) stresses that psychologically distressed professionals are more vulnerable to developing compassion fatigue-like symptoms due to personally experienced trauma as well as from the interactions and type of trauma cases that the novice counsellors experienced with clients. Counsellors may also experience symptoms of post-traumatic stress disorder (PTSD) as a result of their work with survivors. These symptoms could include intrusive thoughts as well as emotional reactions such as anxiety and anger suggest that these disturbances could affect all aspects of a counsellor’s life and could be permanent. This is consistent with their research where they argue that experiencing negative effects is an unavoidable result of trauma work. Furthermore the capacity to empathize, to feel with another person, is central to the process of therapy (McCann and Pearlman, 1990).

As therapists listened to the experiences of survivors, affective responses similar to those experienced in a traumatic situation could be stirred. The therapist’s beliefs and attitudes were repeatedly challenged as they heard in detail about exploitation, sadism, abandonment, and betrayal. Over time, the therapist began to view the world through a trauma lens. The sound of a child’s cry at the grocery store evoked images of a client’s brutal narrative describing childhood abuse. The therapist was filled with grief, anger, and a sense of helplessness. Higher levels of fearfulness, vulnerability and concern may be ways in which this disruption in safety needs is manifested. This was revealed by Neumann and Gamble (1995) in their study.

The therapist’s personal history appeared to influence the intensity of the psychological effects of trauma. Research suggest that highly stressful events affected people in a myriad of ways. Some people experience no change and some develop severe psychological difficulties. Findings have shown that trauma workers with a history of personal trauma are at risk of developing secondary traumatic stress.

Trauma work has the ability to reawaken a personal history of trauma along with badly healed wounds and therapists may find themselves emotionally drained or wounded anew in the context of their work, as reflected in cases of compassion fatigue or vicarious trauma. Exposure to clients narratives may sometimes overwhelm the therapist’s capacity to safely absorb and handle the information in therapeutic ways. Trauma workers who became overloaded by the traumatic material are, at best ineffective and, at worst, place survivors in a position of taking care of the helper.

Although the traumatic exposure is indirect according to Figley (2002), secondary traumatic stress is nearly identical to posttraumatic stress including symptoms associated with posttraumatic stress disorder (PTSD) such as intrusive imagery, avoidance, hyperarousal, distressing emotions, cognitive changes, and functional impairment. Figley’s work has been dedicated to researching the effects of secondary trauma and creating awareness and programmes for combating the adverse effects of trauma work. Therefore the level of exposure would include previous trauma history, the nature of the traumatic incident (i.e. the type of trauma and the severity of the traumatic experience) and the frequency of exposure to traumatic material.

Indicators of Psychological Distress

The ecological framework of trauma integrates potent aspects of Figley’s trauma transmission model. Furthermore, Dutton and Rubinstein (1995) have categorized the reactions of trauma workers into three domains:

• The symptoms of psychological distress, such as avoidance behaviour, intrusive imagery, somatic complaints or physiological numbing, represented in Figure 2.1, represent the first domain of trauma effects (Dutton and Rubinstein, 1995).
• The second domain represents shifts in assumptions and beliefs about the world (Janoff-Bulman, 1992). Exposure to trauma deflates an individual’s life goals and aspirations. This culminates either directly or indirectly into psychological stress and symptom formation.
• The third aspect represents the relational disturbances that may occur within a counselling relationship as a consequence of mistrust between the client and the counsellor. The secondary exposure experienced by the trauma counsellor, may result in distorted relationships on personal and professional levels. Past history or similar occurrences in their personal lives may cause difficulties in their relationships and they may isolate themselves in the workplace.

Four components of Secondary Traumatic Stress

These components are the traumatic event to which the trauma counsellor is exposed; trauma counsellors coping strategies; the trauma counsellors post traumatic stress reactions and personal and environmental factors. Since exposure to traumatic material is unique for every trauma counsellor, the traumatic material differs in intensity from one client to another (Dutton and Rubinstein, 1995).

Often the trauma counsellor exposed to traumatic material as well as the emotions that the client experiences in relation to the event. The counsellor is vulnerable to re-victimization of their client, due to social systems. The counsellor’s cognitive beliefs are challenged and the counsellor may have to deal with the clients previous trauma which may resurface (Dutton and Rubinstein, 1995).

The second component of the model identifies coping strategies that affect the development and course of compassion fatigue. Subsequently, the personal and professional strategies indicate links and connectedness to a persons social support network. Furthermore individual and environmental factors may be mediators of the effects of trauma. The individual factors include the trauma workers inner strengths, resources, vulnerabilities and their level of satisfaction with both their personal and professional life. Environmental factors such as social support, an organization’s response to the counsellor, the context within which the counsellor works and lives and social and cultural factors are important variables in influencing the counsellor’s reactions to traumatic material (Dutton and Rubinstein, 1995).

Psychological distress manifests itself in different forms.

• Distressing emotions, including sadness or grief, depression, anxiety, dread and horror, fear, rage, or shame.
• Intensive imagery by the trauma worker of the client’s traumatic material, such as nightmares, flashbacks and images.
• Numbing or avoidance of efforts to elicit or work with traumatic material from the client.
• Somatic complaints, including sleep difficulty, headaches or gastrointestinal distress.
• Addiction or compulsive behaviours, including substance abuse, workaholism and compulsive eating.
• Physiological arousal, such as palpitations and hypervigilance (Clark and Gioro, 1998). • Impairment of day-to-day functioning in social and personal roles, including missed or cancelled appointments, decreased use of supervision, chronic lateness, and feelings of isolation, alienation, or lack of appreciation.

Model for Preventing Secondary Trauma

Personal trauma had been considered by some to be more harmful to the counsellor’s psychological well-being than work related trauma, and its effects may lead to compassion fatigue symptoms being experienced. Subsequently a multi-dimensional framework based on the ecological model indicate primary, secondary and tertiary intervention to be implemented by organizations to comprehensively address compassion fatigue and burnout in trauma counsellors.

In relation to an ecological approach, primary interventions have a long term social change when implemented resulting in elimination of the root causes. Secondary interventions consisted of environmental and personal planning for the preparation in coping with the impact of secondary traumatic stress. Tertiary interventions were crisis interventions for individuals and their communities in order to reduce the long term effect. However in order for an ecological model to be effective, it must be consistently maintained on a primary, secondary and tertiary level.

Clinical Risk Management Team (CRMT).

This model has two components. The first component is the structured protocol for case discussion, this helps to organize and counterbalance the impact of trauma on complex cognition. The aim is to support and facilitate thorough and careful thinking that may be lost in the intensity and confusion of trauma stories. The second component is a collegial team that provides a safe context in which to reflect on the work, offering support and connection to the trauma counsellor or clinician in response to the potentially isolating effects of trauma

The aim of this model is to facilitate a reflective process that enables staff to express their feelings about trauma cases in an atmosphere that is validating, normalizing, and safe. Research has shown that when one is enhanced by structure and support of colleagues, clinicians are able to work more effectively with traumatized clients.

The individual category has two components: personal and professional levels. These strategies prevail to facilitate the prevention of secondary traumatic stress. The personal domain consists of the physical dimension which includes wellbeing and self-care suggestions for the individual; social dimension includes support, help and activism and psychological dimension life balance, relaxation, contact with nature, creative expression, skills development, mediation, spiritual practice, self-awareness and humor.

The professional domain consists of balance, boundaries, getting support, coping strategies, professional training, self evaluation, job commitment and replenishment. These self-care strategies are recommended for a professional context to facilitate preventative measures.

The environmental category shows preventative methods within the individual’s environment that can help to regulate and install methods for preventing or diminishing the effects of secondary traumatic stress. The societal structure includes societal reform, educational strategies, legislative reform and coalition building. The work setting involves the physical setting, value system, job tasks, supervisory support and collegiality. These sub-components of the societal structure and work setting indicate preventative methods that can be introduced to keep secondary traumatic stress from reaching mammoth proportions.

Resilience

In times of national crisis and disaster, therapists need to be more resilient than their clients. They need to be able to facilitate a healing process and provide a context for the healing to be regulated. Resilience is the ability to adapt to difficult, challenging, stressful, or traumatic life experiences that can be particularly important for the psychologist. It is an ongoing process that can be learned and developed. Resilience can be enhanced by available social supports, self-awareness, the ability to provide self-care, and an ability to connect to something larger than themselves. This could include religious or spiritual activities, or an affirmation of humanitarian values.

Resilience can be achieved by

• Self-assessment. The therapist must indulge in self-reflections and discussions of the effects of the experience with their colleagues, supervisors or family.
• With other health professionals, colleagues or on a professional platform like EWP etc.
• Self- Protection. The counsellors must be aware of their vulnerability and the negative consequences of their work. They must strive for balance and maintain connection with others.
• Address the stress of your work. Practice self-care, nurture oneself by focusing on sources of pleasure and joy, and allowing for escape when necessary.
• Transform the negative impact of the work. Focus on finding meaning in their work and day-to-day activities, challenge negativity, participate in community building activities and join with others around a common purpose or value.
• Connect with yourself and with others. Pay attention to your inner experience, talk about it with others, do not work alone, and most importantly, ask for support as well as offering it to others.

Conclusion

Secondary traumatic stress and burnout are two components of compassion fatigue. Secondary traumatic stress was renamed compassion fatigue by Figley (1995b). This indicated the natural occupational hazard for trauma workers and mental health professionals. Furthermore the stress and fatigue of compassion in the line of duty better describes the causes and signs of their duty related experiences. Figley (1995b) considered compassion fatigue to be identical to secondary traumatic stress disorder and to be an equivalent of post traumatic stress disorder.

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