Pearlman and Saakvitne are equally prominent and well-respected experts in the field of vicarious trauma. As indicated in a previous chapter, these authors are credited for coining the term vicarious trauma (Stamm, 1997). As part of their endeavours, they focused on cognitive changes and developed the constructivist self-development theory (CSDT) to assist in understanding these changes. They also developed the TSI Belief Scale utilised to measure negative cognitive schemas in the present study.
The underlying premise to CSDT is that we construct our own realities by developing complex cognitive structures involving core schemas (McCann & Pearlman, 1990). Through these, we interpret all events which ultimately regulate our thoughts, feelings, attitudes and behaviour. The many traumatic experiences described by clients can negatively transform the worker’s personal schemas through continuous attempts to assimilate and give meaning to these experiences (McCann & Pearlman, 1990). Consequently, schemas become increasingly negative, hinder the development of adaptive schemas and promote maladaptive ones (Pyevich et al., 2003). Our schemas evolve over time in order for us to make sense of our world in a constant and stable way, therefore such negative changes are usually lasting (McCann & Pearlman, 1990).
In terms of CSDT, vicarious traumatisation is seen as a process of negative transformation of cognitive schemas through the empathic engagement with and the sense of responsibility for traumatised clients (Saakvitne, 2002). When traumatic experiences are shared, the therapist or worker becomes vulnerable. It is believed that we respond to traumatic materials through a “personal lens” shaped by our previous experiences, our most significant psychological needs, as well as our own distinctive emotional styles (Saakvitne, 2002, p. 446). When the therapist or worker encounters a source of anxiety not yet considered, or the client describes a scenario that coincides with the worker's greatest anxieties, the emotional burden and the task of coping can become unmanageable (Saakvitne, 2002). She also explains that when a client’s way of adapting or coping clashes with the beliefs and defences of the worker, the situation becomes even more emotionally onerous.
Vicarious trauma is also believed to affect the same general aspects of the self that are impinged upon by direct traumas (Saakvitne, 2002). Changes mainly take place in five distinctive areas:
• Frame of reference
• Self-capacities
• Ego resources
• Cognitive schemas in five psychological needs areas
• Perceptions and memories
Appendix B gives a broader explanation of these five areas as well as further points which explain
what each area entails.
The most devastating impact of vicarious trauma becomes discernible when cherished beliefs, hope or meaning are crushed and the person becomes trapped in a downward spiral of cynicism and pessimism (Saakvitne, 2002). Saakvitne explains that the dangers lie in the negative effects such as intrusive imagery and negatively transformed beliefs as well as our defences against the pain, such as numbing. Next, McCann and Pearlman (1990) identify five basic beliefs or schemas in various psychological needs areas that are particularly vulnerable to negative change. These are safety, trust, esteem, intimacy and control, in relation to oneself as well as others. The reader is again referred to Appendix B for more details on each of the five beliefs.
There seems to be a complex interplay between the five areas and the five basic beliefs. To begin with, the five areas outlined are our typical cognitive and experiential modes for organising our experiences (Saakvitne et al., 1998). Following trauma, persons must integrate the event, its context and consequences into their belief system about the self and others (Saakvitne et al., 1998). Reflecting on this statement for a moment, it would seem that negative changes in any of the five distinct areas outlined above could lead to negatively transformed schemas. It would also seem that negatively transformed schemas might in turn adversely affect any or all of the five distinct areas. Evidently, a vicious cycle of negative change feeding from psychological trauma is set in motion.
Regarding the five schemas vulnerable to trauma and vicarious trauma, trust could easily be negatively affected as those who deal with traumatised clients are constantly exposed to many examples of how criminals and predators deceive, betray and violate trust (McCann & Pearlman, 1990). They further explain that constant exposure to testimonies of loss of safety may challenge the worker’s own schemas and cause constant fear for their own safety and the safety of loved ones.
They add that loss of safety is usually flanked by loss of control or personal power and even paralysis. Negative changes in this area could also take the form of a fearful awareness of the illusory nature of power, life’s fragility and how little control we have in our lives (McCann & Pearlman, 1990).
Trauma survivors often compromise their independence, restrict their freedom and personal autonomy or grow overly dependent on others (McCann & Pearlman, 1990). Reflecting on this point, the complete opposite could also happen: a person could disengage completely out of loss of trust. Victimisation often leads to loss of esteem for others, themselves or even result in a disappointment in the human race (Goldenberg, 2002). A less caring stance towards oneself could result in serious secondary problems, such as self-destructive or risky behaviours, substance abuse and other numbing behaviours as well as self-neglect (Norman et al., 2006).
With regards to intimacy, trauma often causes profound alienation (McCann & Pearlman, 1990). Those who work with traumatised clients can also experience detachment as they become over- invested in their clients and emotionally unavailable to others, even to themselves (Hesse, 2002). Finally, the need to develop a meaningful frame of reference is an innate human need (McCann & Pearlman, 1990). This need, in part, is represented by cognitive schemas about causality. Traumatised individuals often obsess about why something happened (McCann & Pearlman, 1990). Similarly the worker may also attempt to understand why the event happened and may even start internalising the clients’ unhelpful causal beliefs about the event. As in the trauma survivor, those who listen to ongoing reports of trauma may experience trauma imagery to return in fragments as intrusive and disruptive flashbacks, dreams or thoughts (McCann & Pearlman, 1990). They add that temporary or even permanent alteration of the memory system and a general sense of disorientation are not uncommon when the worker internalises client memories.
Simply put, one cannot remain completely unmoved and unchanged by continuous stories of trauma and suffering. Even mental healthcare professionals, despite their training and ongoing supervision, cannot fully escape the effects. Claims workers could be experiencing similar cognitive changes and their beliefs could be equally uprooted. It is also logical to argue that any negative cognitive changes could result in consequent behavioural changes. For instance, if one has constructive beliefs regarding safety, this will allow one to comfortably roam about public places. When safety beliefs are challenged, the person could start behaving differently – becoming nervous when leaving home, avoiding public places and perhaps even attempting to restrict the behaviour of loved ones
out of fear for their safety. Needless to say, these behaviours could cause friction and interpersonal conflict.
As with most other theories and concepts related to vicarious traumatisation, constructivist self- development theory was also mainly developed with professional trauma workers in mind. However, and very importantly, Pearlman and Mac Ian (1995) acknowledge that the effects of vicarious trauma do not arise only from client/therapist relationships but can occur across time in
any helping relationship with trauma survivors. CSDT is not without flaws, but it was favoured by
the present study for being very flexible and responsive. It suggests that each individual’s reaction to traumata is based on a complex interaction between the individual’s personality, personal history, the traumatic event, the context of the aftermath as well as the work context (Saakvitne et al., 1998; Dunkley & Whelan, 2006). Therefore, CSDT accounts well for variability in individual trauma responses. This theory is highly adaptable and relevant to most situations involving vicarious trauma, especially when one takes into account the principle that we each construct our own unique reality and are thus affected in very different ways (Saakvitne et al., 1998).
In conclusion, CSDT fits well into the theoretical framework employed by the study. As stated before, the tenet that trauma and vicarious trauma filter into all aspects and levels of existence, ties in with the bio-psychosocial notion of systems thinking about phenomena. It also shares features with Figley’s model, in that it acknowledges and draws upon the same concepts and processes of vicarious trauma. Figley (2003) states that his conception of compassion fatigue and the CSDT conception of negative cognitive changes are complementary. The two concepts in combination give a wider perspective and understanding of vicarious trauma. Figley’s model focuses on delineating the process of vicarious trauma whereas CSDT focuses on negative cognitive changes – two related but different outcomes of the same process.
However, CSDT goes beyond describing an outcome of vicarious trauma, by showing how construction of reality is affected by direct and indirect trauma and how this reality, alongside beliefs, feelings and attitudes, can eventually impact behaviour and relationships. As stated earlier, the study utilised the TSI Belief Scale developed to quantitatively measure negative cognitive changes. This instrument was utilised to gauge the level of negativity in the cognitive schemas of the worker groups in relation to one another. Finally, the next part of the discussion focuses on the theory behind how vicarious trauma will be approached and investigated by the study.