"Feeling heavy"

Vicarious trauma and other issues facing those who work in the sexual assault field
ACSSA Wrap No. 4 – September 2007

What is vicarious trauma?

Vicarious trauma is described as a transformation in a therapist (or other worker) as a result of working with clients' traumatic experiences. The full definition, developed by Pearlman and Saakvitne (1995), is as follows:

The inner transformation that occurs in the inner experience of the therapist [or other professional] that comes about as a result of empathic engagement with clients' trauma material.' (p. 31).

It is related to concepts such as 'emotional exhaustion', 'burnout', 'compassion fatigue', 'secondary traumatisation' and 'counter-transference', but some key differences exist between some of these concepts (see Dunkley and Whelan, 2006). It can also be expressed as 'feeling heavy', or when the work (or an aspect of the work) 'gets inside you'.

A very short history of the concept

Effects of trauma exposure on professionals were first observed formally in the late 1970s in emergency and rescue workers who displayed symptoms similar to the trauma victims they were helping. This prompted investigation of other people working with victims in various capacities, such as disaster relief workers, nurses, and crisis and hotline workers (Mouldern & Firestone, 2007). In 1995, Stamm stated that the issue was not whether such a phenomenon existed, but what it should be called. 'Vicarious trauma' was coined by McCann and Pearlman in 1990, and is the term perhaps most widely referred to in much of the literature on this topic, with some even arguing it is the most appropriate term (Dunkley & Whelan, 2006).

What does vicarious trauma involve?

Vicarious trauma is a cumulative effect of working with trauma, which can affect many aspects of a person's life. It may consist of short-term reactions, or longer-term effects that continue long after the work has finished. Some have even argued its effects are potentially permanent (Mouldern & Firestone, 2007, p. 68).

As mentioned above, some effects of vicarious traumatisation parallel those experienced by the primary victim/survivor. For example, vicarious traumatisation can lead to a person experiencing the symptoms of post-traumatic stress disorder (PTSD).

While the symptoms of trauma need to be recognised as culturally diverse and specific (Wasco, 2003), trauma reactions are generally divided into three categories:

  • intrusive reactions: dreams/nightmares, flashbacks, obsessive thoughts, physiological reactions and other persistent re-experiencing of the traumatic event;
  • avoidant reactions: general numbing in responsiveness and avoidance (particularly of things related to the traumatic material); and
  • hyper-arousal reactions: hyper-vigilance and difficulty concentrating.

Workers may also experience the following:

  • anxiety;
  • depression;
  • de-personalisation;
  • feeling overwhelmed by emotions such as anger and fear, grief, despair, shame, guilt;
  • increased irritability;
  • feeling of reduced personal accomplishment;
  • procrastination;
  • low self-esteem;
  • having no time or energy for self or others;
  • increased feelings of cynicism, sadness or seriousness;
  • an increased sensitivity to violence and other forms of abuse, for example when watching television or a film;
  • avoiding situations perceived as potentially dangerous;
  • feeling profoundly distrustful of other people and the world in general;
  • disruptions in interpersonal relationships;
  • sleeping problems; and
  • substance abuse.

Connected to these experiences, vicarious traumatisation may also involve a change in a person's beliefs about themselves, the world, and other people within it. This is known in the psychological field as changes in their 'cognitive schema', and may involve:

  • feeling that the world is no longer a 'safe place' (for themselves and/or others);
  • feeling helpless in regard to taking care of themselves or others;
  • feeling their personal freedom is limited; and
  • feelings of alienation (that their work within the field of sexual assault sets them apart from others).

However, it also needs to be recognised that for many people, particularly those who have already experienced or been exposed to trauma, these beliefs may already be apparent. Also, while some psychological literature classifies the above beliefs as 'disrupted' or 'distorted', others argue that they are in fact accurate reflections of the lived reality of many (Wasco, 2003).

Overall, it is useful to state that vicarious trauma is just one way of conceptualising people's reactions to working in the field of sexual assault. It can be a useful way of conceptualising these reactions, because it can give legitimacy to what people are experiencing (it is a known psychological concept), it recognises that many other people experience it (it's not just you), and it taps into a field of useful psychological research and enquiry. However, it is important not to 'pathologise' these reactions (view them as medically or psychologically abnormal) through using the concept of vicarious trauma. In fact, all research on this subject points out that these reactions are normal human reactions to repeated exposure to distressing events.

Impact of vicarious trauma on organisations

Organisations overall can also feel the impact of vicarious traumatisation and related issues. There may be a 're-enactment of client issues'; for example, betrayal, secrecy, mistrust, rage, or boundary violations (McAllister, 2003, p. 6). There may be a high worker turnover; there may be ongoing conflict within and between organisations; and there may be poor productivity and/or, by contrast, over-conscientiousness.

Other issues facing those working in the sexual assault field

While vicarious traumatisation deals with a 'transformation' in the therapist's 'inner experience', other research points out that, connected to this, working in fields such as sexual assault can involve a change in a workers' 'psycho-social relationships' - their relationships with friends and family, and their 'public relationship' (Hindle & Morgan, 2006).

In regard to relationships with family and friends, research on vicarious trauma has pointed out that interpersonal relationships may be affected. Other research has pointed out the ways the emotional impact of this work can affect overall home or 'family life'. For example:

Quite often you take home your work in your head ... it owns you I suppose ... yeah it takes over your life and that's it. ('Petra' in Hindle & Morgan, 2006, p. 37)

Negative comments or perceptions about their work by those in their social circle may lead workers to feel hurt, unappreciated, misunderstood and disconnected from others in their social world, prompting changes in their social relationships. For example:

Since I've worked [in the field] I've let quite a few friends go because ... I've got nothing in common with them anymore. Yeah, my whole circle of friends apart from a few very close friends has changed quite considerably. ('Leslie' in Hindle & Moran, 2006, p. 39)

In relation to the public relationship, or the relationship with the wider world, workers can encounter negative and inaccurate stereotypes about the work that they do, which can have an emotional toll on workers, causing hurt, frustration, feelings of alienation and personal questioning (Hindle & Morgan, 2006). Workers may also experience bullying or harassment because of their work in this field. These negative experiences can be compounded when dealing with a lack of funding, or temporary and/or insecure funding. Finally, factors such as adverse political responses and media coverage to sexual assault (such as media that support rape myths or are misogynous) can also adversely impact workers.

Research on this topic that focuses on this broader social level (rather than at the level of the individual or organisation) is still limited. However, it can be said that the relationship between the sexual assault professional and the wider world is likely to affect the wellbeing of the professional and her/his ability to continue working in the field.