What Are The Multi-Faceted Elements Of Vicarious Trauma?

The concept of vicarious trauma was first introduced over twenty five years ago. Believed to be a normal reaction to stressful and at times, traumatising work with clients, (just as PTSD is viewed as a normal reaction to an abnormal event); McCann and Pearlman (1990) provided a theoretical framework (Figure 1, page 20) based in constructivist self-development theory, for understanding the complex and distressing effects of trauma work on therapists (Pearlman & Saakvitne, 1995a). Representative of PTSD, vicarious trauma results in physiological, intrusive and avoidant symptoms and has a sudden onset of symptoms which may not be detectable at an early stage (Chrestman, 1995; Pearlman & MacIan, 1995; Schauben & Frazier, 1995; Trippany et al., 2004).

Just as trauma can alter its victims, therapists working within this field can also find themselves permanently altered by the experience (McCann & Pearlman, 1990). People construct their reality over the course of their lifespan through the development of cognitive structures which are used to interpret events (McCann & Pearlman, 1990). Described as schemas (Piaget, 1971), cognitive structures include an individual’s beliefs, assumptions and expectations about the self and the world. Through exposure to hearing traumatic material, McCann and Pearlman’s theoretical framework for vicarious trauma, sets out the disruptions to schemas and imagery a therapist may experience and links it to the associated emotions and thoughts (McCann & Pearlman, 1990). They describe these as:

Dependency/Trust. When working with victims of trauma, therapists may be

exposed to trauma narrative of clients that may have been deceived, betrayed or violated. This can disrupt a therapist’s schemas about trust, resulting in suspicion, cynicism and distrust.

McCann, L. and Pearlman, L.A. (1990). ‘Vicarious Traumatization: A Framework for Understanding the Psychological Effects of Working with Victims.’ Journal of Traumatic Stress, 3, pp.131-14.

Safety. Images involving a loss of safety, threats or harm to innocent people, may

challenge a therapist’s schemas within the area of safety; particularly if they have a strong need for security. Therapists working with victims of random violence or accidents may experience a sense of heightened vulnerability and awareness of the fragility of life.

Power. Clients who have been victimised may find themselves in situations of

helplessness, vulnerability or paralysis. Exposure to these situations can evoke concerns for the therapist about their own sense of power or efficacy in the world. Alternatively, a therapist may express a heightened sense of awareness of a lack of control over life events, leading to feelings of helplessness, despair or depression.

Independence. Therapists may identify with trauma survivors, such as rape

victims who may experience of disruption in their independence through a loss of personal control and restriction of freedom. For those therapists with a strong need for independence, identification with the client can be particularly difficult.

Esteem. The authors refer to esteem as the need to perceive others as

benevolent and worthy of respect. Clients who are violated or harmed through the acts of other human beings may experience diminished esteem for others. This feeling may be reflected in the therapist leading to cynicism, pessimism, bitterness and a sense of anger at other people and the world in general, as they consider the malevolence of others.

Frame of reference. Traumatised individuals can repeatedly reflect on the

question, “Why me?” Therapists may also find themselves in the position of trying to understand why their client experienced a traumatic event. This may become destructive if it takes the form of victim blaming or the focus of the therapy becomes more about the motives of the assailant or perpetrator. Furthermore, the authors suggest therapists may experience a sense of disorientation if their

schemas are continually challenged by client reports of traumatic experiences, resulting in unease.

Intimacy. Trauma victims can experience a profound sense of alienation from

other people and the world in general. Therapists may also experience a sense of alienation and separateness.

Disruptions in imagery. Like trauma victims, therapists may experience their

clients’ fragmented traumatic images without context or meaning, resulting in a variety of uncomfortable and negative emotions. Whilst the authors suggest the alteration to a therapist’s memory system is generally transient, they believe these changes can become permanently incorporated into the memory system.

Within trauma research, vicarious trauma is seen as a traumatic reaction to specific client-presented information. Such aforementioned changes and disruptions to a therapist’s basic sense of identity, world-view, spirituality and cognitive frame of reference (Pearlman & Saakvitne, 1995a), have been described as the hallmark of vicarious trauma (Pearlman, 1999).

Vicarious trauma occurs only among those who work specifically with trauma survivors, due to them being exposed to emotionally shocking images of horror and suffering, characteristic of serious trauma (McCann & Pearlman, 1990; Pearlman & Saakvitne, 1995a; Iliffe & Steed, 2000; Trippany et al., 2004). It is the result of an accumulation of experiences across many therapy situations (Sexton, 1999) described as:

‘...the cumulative transformation in the inner experience of the therapist that comes about as a result of empathic engagement with the client’s traumatic material...’ (Pearlman and Saakvitne, 1995a:31)

Since vicarious trauma was first described, further studies have been undertaken which agree and build upon initial findings (Schauben & Frazier, 1995; Pearlman & Saakvitne, 1995a; Steed & Downing, 1998; Iliffe & Steed, 2000). Whilst the

phenomenon is difficult to operationalise and measure, this study aims to contribute to the growing body of knowledge linked to understanding and ameliorating the effects of therapist vicarious trauma and concepts related to the phenomena (Sabin-Farrell & Turpin, 2003; Kadambi & Truscott, 2004; Kadambi & Ennis, 2004).