Several years ago I was doing some research on the differential effects on psychotherapists of working with patients who were dealing with the aftereffects of traumatic histories. It is well known that some therapists who work over long periods of time with trauma victims, particularly survivors of sexual abuse/violence, are afflicted with what is variously called "compassion fatigue," "vicarious traumatization (VT), or secondary trauma".
The terms "vicarious traumatization," "compassion fatigue," and "secondary trauma" refer to changes in one’s world view, inner experience, sense of safety, attitude toward work life, and possibly behavior.
Trauma therapists are exposed daily, if they see a lot of patients with trauma histories, to tales of betrayal, violence, extreme cruelty and manipulation of young children. Their craft requires them to immerse themselves empathically with the experiences that they witness. While non-therapists can listen and tune out or find some way to emotionally remove themselves from testimony of abuse, this is obviously counterproductive for therapists working with patients who have been victimized brutally and subsequently had their suffering ignored or minimized by those closest to them.
Most forms of therapeutic engagement with victims of childhood trauma emphasize the therapeutic relationship. Paradoxically it is empathic immersion that is both necessary and understood to be the portal through which harm can come to the therapist’s inner life.
Scores of scholarly books have been written on the subject of secondary traumatization of therapists (and other witnesses to extreme trauma), dissertations by the bushel, published. The aim of my research was to see if the effects were different for therapists with their own trauma history than those who identified themselves as without a significant trauma history. I looked at trauma therapists who had a least five year’s experience in this specialty.
Officially the finding of my research was that there was no difference between groups. Unofficially I found that therapists weren’t particularly good at classifying themselves. In the course of an interview I often found that a self-identified trauma-free individual had indeed suffered significant loss and trauma during childhood. Additionally those who testified to being free of vicarious traumatization were hobbled by all kinds of difficulties that could be fairly classified as V.T.
More significantly, and somewhat surprisingly, I also found several therapists insisting that they had been changed in very positive ways by their work. They had become wiser, more spiritual, more hopeful, more mature. What I came to label as PST (Positive Self Transformation) did not exclude signs of wear and tear on the therapist, including vicarious traumatization.
What is notable about this finding is that positive effects, self enhancing effects, can co-exist right alongside harmful consequences for professionals doing very difficult, often painful work as therapists and this not ordinarily acknowledged in the field, and certainly not widely studied.
Barbara began her interview with me apologetically. She suggested that she would not have a lot to say about the deleterious effects on her of working with trauma patients over the years but rather that she had experienced significant enhancement both professionally and personally as a result of focusing her work on trauma.
She felt she had grown spiritually, inspired by the courage of her patients and their determination to get better. She felt that she had grown as a clinician and mastered a complex and taxing practice. Her caseload had drawn out the best in her and this was a source of strength and pride.
During our interview, Barbara explained she might need to lie down as she suffered from chronic fatigue syndrome and felt quite tired during her work day and needed to take breaks. She did not connect her condition with anything in particular and certainly not with the work that she did.
According to the NIH Chronic Fatigue syndrome has no clear cut etiology and is a diagnosis often made by eliminating other possibilities. Obviously I have no way of knowing if the etiology of Barbara’s debilitating illness was in any way connected with her work, but I was struck when later in the research, I met another trauma therapist with the same diagnosis. My sample size was small.
Other participants in my study were more forthcoming about the deleterious effects of doing this work over a long period of time, but most paired these observations with testimony of enhancement and inspiration as well. Many observed that they had grown spiritually as well as professionally from their immersion in trauma work and had few misgivings about having pursued this specialty in their professional lives.
Concern about the secondary traumatization of therapists seeing seriously traumatized survivors of childhood abuse should be coupled with the awareness that there may be a corresponding enhancement in the clinician’s sense of self, both professionally and personally.
Davies, J. and Frawley, M. (1994). Treating the adult survivor of childhood abuse: A psychoanalytic perspective, New York: Basic Books.
Figley, C.R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized, New York: Brunner/Mazel.
Herman, J.L. (1992). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.
Kassam-Adams N. (1996). The risks of treating sexual trauma: Stress and secondary trauma in psychotherapists. In S.J. Gamble and J. Munroe (eds.), Trauma’s impact on helpers: Research handbook.
Kluft, R.P. (1994). Countertransference in the treatment of multiple personality disorder. In J.P. Wilson & J.D. Lindy (Eds.), Countertransference in the treatment of PTSD. New York: Guilford.
Pearlman, L.A. & MacIan, P.S. (1995). Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Professional Psychology: Research and Practice, 26, 6, 558-565.
Pearlman, L.A. & Saakvitne, K.W. (1995a). Trauma and the therapist. New York: W.W. Norton & Company.
About the Author: May Benatar is a licensed clinical social worker in practice as a psychotherapist in the D.C. metro area. She has her PhD in clinical social work and has published, taught, and consulted on the topics of adult development, parenting, and the treatment of the long term effects of psychological trauma. May blogs at Posts from the Unconscious. Please come by and visit.
The views expressed are those of the author and are not necessarily those of Scientific American.