Are There Any Pre-Disposing Factors of Therapist Vicarious

The literature regarding pre-disposing factors, whilst not extensive, falls under two main themes. These are: (i) personal trauma history and (ii) therapist clinical experience.

2.13.1. Personal trauma history

Whilst some studies have considered how therapists may be pre-disposed to becoming vicariously traumatised if they have suffered a personal trauma, (Pearlman & MacIan, 1995; Schauben & Frazier, 1995; Way, Vandeusen, Martin, Applegate & Jandle, 2004), the evidence has been fairly inconclusive.

A research synthesis of 16 publications on vicarious trauma and secondary traumatic stress found persuasive evidence for vicarious trauma predictors in therapists with a personal history of trauma (Baird & Kracen, 2006). However, the authors fail to address the evidence for therapists with no personal trauma history. Furthermore, findings suggested there was reasonable evidence both for and against secondary traumatic stress (page 25), a close concept of vicarious trauma, in therapists with a personal trauma history.

Therapists new to trauma work who are survivors of interpersonal violence or childhood abuse, may identify more closely with clients and find their responses to client countertransference more difficult (Neumann & Gamble, 1995). However, whilst the authors suggest that coping with transference dynamics of trauma clients can be difficult for even the most experienced of therapists, they fail to evidence how they know therapists who are survivors themselves and new to the work, have a ‘common feeling’ of being ‘thrown into a maelstrom with no lifeline’ (Neumann & Gamble, 1995:342). Whilst Neumann and Gamble (1995) specifically explored countertransference and trauma, it could be argued responses may be no different from that of any therapist, experienced or not, identifying with their clients particular presentation, as suggested by Freud (1910).

A pioneering study examining vicarious trauma compared therapists with a trauma history, against those with no trauma history (Pearlman & MacIan, 1995). Whilst results failed to support a clear link between therapist exposure to trauma via their caseload and any subsequent disruptions in cognitive schemas (Kadambi & Ennis, 2004); results showed therapists who were less experienced and had a personal history of trauma, reported the most difficulties. Findings suggested therapists were more affected over a period of time and by the number of trauma survivors within their caseload. However, as therapist difficulties could have stemmed from various other influencing factors such as lack of experience, supervision or training, findings must be interpreted with caution.

A cross sectional survey based upon retrospective self-report was carried out by Way et al., (2004), in which models of coping strategies were tested that helped minimize traumatic effects on therapists treating survivors of sexual abuse and/or sexual offenders. Three quarters of participants had experienced one form of maltreatment during childhood and just over half reported multiple forms of maltreatment. Upon analysis, results found the groups did not differ significantly in levels of vicarious trauma and maltreatment history was not found to be associated with trauma effects. Similar to the study by Pearlman and MacIan (1995), there was also a low return rate for this study. Unfortunately, due to the low return rates in both studies, this leaves unanswered questions as to why more participants did not respond. One plausible explanation is that potential participants who had suffered a personal trauma felt uncomfortable disclosing personal information and chose not to take part in the study. Qualitative data could have helped both these studies by determining such things as the type of personal trauma, how their participants managed any personal triggers and what part of the work had the biggest impact and why? This could provide valuable information to further help understand and minimise the effects of vicarious trauma.

2.13.2. Clinical experience

An exploratory study based on a phenomenological philosophy was carried out by Iliffe and Steed (2000), considering counsellors’ experience of working with

perpetrators and survivors of domestic violence. Almost all participants identified feelings of loss in confidence, powerless, inadequacy, ineffectualness, stress and anxiety when starting in the field of domestic violence, as well as experiencing changes in visual images and physical symptoms. Two thirds of participants reported having experienced symptoms of burnout, with a lack of training and isolation reported as secondary contributors. Whilst a lack of training could be seen as both ethically and morally wrong, as most of their counsellors had only received an average of three and a half days domestic violence training, this could also have influenced the study’s findings. A second, longitudinal study would have been useful to identify whether further training and a greater clinical experience went on to help their counsellors cope with the demands of the job.

In a study involving 116 self-selected professionals working with traumatised clients within a range of settings, McLean, Wade and Encel (2003) hypothesized that therapist endorsement of unhelpful beliefs would contribute significantly to both vicarious trauma and burnout. Furthermore, they believed therapists who were less experienced, had a recent personal trauma history, worked with children or had more contact time with traumatised clients, would have increased distress. Results suggested that amongst other things, less clinical experience may render therapists more prone to secondary traumatisation, burnout or emotional exhaustion. Those therapists who had less experience appeared to be more susceptible to the symptoms of intrusion and avoidance, backing up similar findings by others (Neumann & Gamble, 1995; Chrestman, 1999; Iliffe & Steed, 2000; Way et al., 2004). Again, because of the nature of self-selection biases which may influence results, the different work settings and the relatively short time frame over which this study was done, results should be considered with caution. Countertransference responses common to therapists working with survivors of chronic childhood trauma were explored by Neumann and Gamble (1995). Consideration was given to the negative impact responses may have. Specifically, its focus explored issues pertaining to those therapists who were relatively new to the trauma field. Throughout the paper, the authors highlight several important

points to consider in relation to the professional development of psychotherapists such as self-care and organisational issues. No evidence was given by Neumann and Gamble (1995) to support the suggestion that therapists with less experience may become pre-occupied with clients and engage in ‘rescue fantasies,’ whilst questioning their levels of competence. Furthermore, whilst countertransference and vicarious trauma are closely linked within the paper, the article fails to cite an evidence base to support the many sweeping statements offered by the authors for the negative responses that therapists may experience.

2.14. What Protective Factors Help Ameliorate Therapist Vicarious