Trauma expert and forensic psychologist Paula A. Madrid, PsyD, has been involved in disaster and crisis relief efforts for over two decades. Here, she shares with Editor Angie Drakulich, her take on the growth of vicarious trauma among mental health providers. This dialogue is part of an ongoing Psycom Pro series on Treating Trauma in the 21st Century.

Symptoms of Vicarious Trauma, Secondary Trauma

Psycom Pro: Let’s first define vicarious trauma, also called secondary trauma or secondary traumatic stress. Can you provide a brief description?

Dr. Madrid: Vicarious trauma essentially refers to the consequences that occur when caring for others in distress. More specifically, it is the emotional and cognitive hardship that clinicians may end up experiencing from years, or even months, of listening to accounts of first-hand trauma from their clients.

Over time, this experience can result in emotional, cognitive, and behavioral symptoms in the provider that are similar to those reported by the primary trauma survivor they are treating.

Symptoms may include intrusive thoughts, flashbacks, feelings of detachment, restricted affect, avoidance, and sleep disturbance. Vicarious trauma symptoms are different from burnout, or compassion fatigue. Burnout arises out of working in a setting that is challenging and/or working long hours without proper balance. Clinicians who are in situations where burnout is likely – including in our field of mental health care – are also more likely to also experience secondary trauma as they have less time to engage in self-care and to take advantage of peer support (more on this below).

COVID Has Brought Secondary Trauma to the Forefront for Mental Health Providers

Psycom Pro: Secondary trauma is not a new phenomenon but it has perhaps increased exponentially in the past year. With the COVID pandemic, mental health professionals have faced huge increases in demands for care while also trying to wage their home lives as spouses, partners, daughters, sons, and so forth. They have essentially been forced into the role of “caretaker” 24/7. On top of this, the political climate has increased levels of stress and fear for nearly everyone. What’s your take on how these rapid changes and demands are playing out for those working in the mental health field?

Dr. Madrid: Licensed mental health providers – in particular those who are experienced in trauma – are well prepared to deal with challenging cases and are great at adapting to the needs of their patients. They are able to take into account the context in which therapy is happening – as this is part of their training. However, the unique situation we are still going through – in which the world is literally impacted by an ongoing pandemic – results in therapists and clients having the common experience of overarching anxiety, fear, and a sense of unpredictability about their lives and that of their families.

The current political climate has resulted in more pressure on everyone and to those of us who work in mental health, the pressures are different perhaps because we end up having more clients to care for who are suffering. Thus, we experience this additional pressure at both the personal and professional level.

Psychotherapists Report Heightened Levels of Vicarious Trauma

Psycom Pro: In August 2020, the American Psychological Association’s Division of Trauma Psychology published survey results of 339 psychotherapists who took the Vicarious Trauma Survey (VTS). A majority reported feeling more tired, about one-third felt less competent in their professional skills, and half said they were less able to emotionally connect with their clients, compared to before the pandemic. Overall, nearly 63% of those surveyed reported moderate levels of vicarious trauma.

Can you offer any insights into these effects – the fatigue and confidence levels? Are there other common symptoms in your experience that clinicians should be aware of?

Dr. Madrid: I would assume this has to do with the fact that empathy and connection require a person to have a good mental state. It is hard to put that forward when you are feeling drained, and most of us have experienced days of feeling either overwhelmed, helpless, or anxious about the present and the future during the past several months.

These results make sense because the news of the past year has involved tragedy in many ways. From COVID deaths and increased hospitalizations to fear about what will happen in the “long winter,” political division that has been painful to the country, financial hardships in most sectors involving very hard-working people … it has been unending.

When dealing with unprecedented trauma, loss, fear, and what we are currently living, this results in physical and emotional fatigue. I believe the current environment has also led to less ability to care for ourselves and, therefore, for others.

(See also, how therapists and clients alike can find new sources of meaning.)

The Pandemic’s Uneven Impact on Female Therapists

Psycom Pro: Let’s talk about women for a moment – 73% of the APA’s survey subjects were women and it is well established that the psychology workforce is primarily women. How does this factor into the effects of secondary trauma as many women are also the primary caretakers at home?

Dr. Madrid: Many women – including those caring for children or family members – are particularly vulnerable to the effects of secondary trauma because they often have less time to practice self-care given the many responsibilities they have at home. Being a primary caretaker while working with challenging cases and having little or no time to process material discussed in sessions, to obtain clinical supervision, peer support, or enough social interaction can result in the work of therapy becoming burdensome.

Clinicians should actively seek supervision and engage in self-care as much as possible. This is often not talked about as a priority. But self-care activities, such as exercise and meditation or mindfulness, can help to ease secondary trauma symptoms.

See a related EdSurge report on secondary trauma and teachers during the COVID pandemic.

Young Providers and New Mental Health Practitioners Are More Prone to Secondary Trauma

Psycom Pro: I also think it’s important to speak to those clinicians who may be relatively new to the field. In the APA survey, younger therapists or those with less clinical experience were more likely to report higher levels of vicarious trauma.

Dr. Madrid: Yes, those who lack clinical experience are more prone to vicarious trauma or secondary traumatization. The reason for this is that the lack of abundant techniques/experience results in their not having as many tools to help their clients/patients. They are more likely to have fears, anxiety, and worry about both the process and outcome of treatment than say someone who has done this work for a long time and has more confidence.

The key is to obtain training, read vastly, seek clinical supervision and be aware of not accepting cases that are beyond the clinician’s present clinical capacity. (More advice for young professionals entering clinical psychology.)

Mental Health Practitioners Need to Take Advantage of Peer Support

Psycom Pro: Do you think clinicians feeling the effects of vicarious trauma are getting the help they need? For instance, are there enough resources for them, such as being able to find a therapist they can talk to or finding time in their day to adequately de-stress? Are there peer or professional support groups you recommend?

Dr. Madrid: It has been my experience that clinicians often fail to get support until they are feeling very impacted. Others are great at managing this and have their own therapist and/or clinical supervisor, even if they have been doing this kind of work for years. Having a regular support system can make a huge difference.

The most common approach for private practitioners dealing with secondary trauma and general work stress is to participate in peer groups that are formed by group practices of all sizes. Local professional associations can be a great resource for finding a group as well.

More on Treating Trauma in the 21st Century

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Last Updated: May 3, 2021