January/February 2004 Issue

Understanding Vicarious Traumatization - Strategies for Social Workers
Social Work Today
By Shantih E. Clemans, DSW
Vol. 4 No. 2 p. 13

The last 30 years of the antirape and domestic violence movements have been socially significant in countless ways. One major contribution is the current understanding of the numerous, complex effects that violence has on the lives of its victims. Fear, anger, loss, anxiety, and difficulty trusting others are a few examples (Kelly, 1988; Koss & Harvey, 1991). Finally, society has come to acknowledge that victims are not to blame for their assaults and that violence against women and children is a socially sanctioned abuse of power (Schechter, 1982). Only recently, however, have the effects of violence on “secondary victims”—family, friends, social workers, researchers, and other helpers—been explored (Ahrens & Campbell, 2000; Campbell, 2002).

Although most victims ask friends for support, a small percentage seek professional assistance for physical and emotional recovery (Ahrens & Campbell, 2000). Victims may come to a hospital emergency department, rape crisis program, domestic violence shelter, police precinct, community mental health center, or another type of social service organization. Social workers are likely to be called upon in these settings to provide crisis intervention, advocacy, and individual and group therapy and to furnish information and referrals to these clients. With support, victims of violence can recover, but how do service providers manage the emotional consequences of their work?

What Is Vicarious Traumatization?
Social workers and other professionals who assist clients affected by trauma may be vulnerable to experiencing vicarious traumatization (VT). VT characterizes the cumulative effects of working with survivors of traumatic life events, such as rape, incest, child abuse, or domestic violence (McCann & Pearlman, 1991). VT is a way of framing the emotional, physical, and spiritual transformations experienced by those who work with traumatized populations. Related concepts include compassion fatigue and secondary traumatic stress (Campbell, 2002; Figley, 2002).

Work with traumatized clients can affect social workers in many obvious and subtle ways. Persistent feelings of fear and vulnerability to assault, difficulty trusting others, intrusive thoughts of violence, hopelessness to make a difference in their clients’ lives, and a cynical view of the world are examples of this transformative process (Clemans, 1999; McCann & Pearlman, 1991; Pearlman & Saakvitne, 1995). Workers and victims often experience parallel emotional reactions. For example, workers may find themselves experiencing symptoms that mirror their clients’, such as nightmares, dissociation, anger, and other elements of posttraumatic stress disorder (Campbell, 2002). This is a painful but preventable process for workers.

The early research on VT focused on psychologists in private practice who treated adult survivors of incest (Pearlman & Saakvitne, 1995). Research has since expanded to include a wide range of helpers whose jobs keep them intimately connected to violence, such as rape crisis workers (Clemans, 1999), child welfare workers (Dane, 2000), child sexual abuse therapists (Cunningham, 1999), and researchers (Campbell, 2002). Still, VT is a new field, beginning less than 15 years ago.

There are three specific ways of conceptualizing VT. First, it is an individual phenomenon that affects each worker differently. Factors such as gender and victimization history contribute to this unique picture. For example, one worker in a rape crisis program may experience intrusive thoughts of rape. Another worker may feel numb much of the time. Since people cope differently with stress, VT is experienced differently by various workers.

Second, VT is a cumulative process. It affects workers across clients, which distinguishes it from countertransference. The effect on workers intensifies over time and with multiple clients.

Third, VT is pervasive. It affects all areas of workers’ lives, including emotions, relationships, and their views of the world. The pervasiveness distinguishes VT from burnout, which generally refers to the effects of concrete stressors, such as one’s physical environment and work hours.

Social workers’ lives may be transformed on the following three major levels (Clemans, 1999; Pearlman & Saakvitne, 1995):

1. Feelings of vulnerability and fear
   
2. Difficulty trusting in personal relationships
3. A changed view of the world

Vulnerability and Fear
The experience of providing services to traumatized clients imbues social workers with powerful lessons about their personal vulnerability to victimization. This vulnerability is particularly acute for female workers. Hearing about violence day in and day out in a counseling session, a therapy group, or an emergency department fosters pronounced feelings of fear and vulnerability in social workers. Hearing details about clients’ rape or assault may cause workers to fear their own victimizations. Workers instinctively have protective strategies that insulate them from the horror of their clients’ experiences. However, sometimes a client’s story touches a vulnerable place, and story after story erodes a worker’s ability to be self-protective. Over time, feelings of safety are often unattainable. The following example illustrates a worker’s personal struggles with fear:

Elise has lived in New York City all her life. She loves exploring new neighborhoods. She has always felt safe and comfortable as a woman walking alone through the city. Since joining the staff of a rape crisis program this year, Elise has noticed that she feels hesitant and fearful to take her usual city walks. She feels more vulnerable to violence. She finds herself staying home more often; when she does venture out, she is always watching, worried that she is being followed. She is convinced that something bad will happen to her.

Difficulty Trusting
In addition to experiencing increased feelings of fear and vulnerability to rape, assault, or other forms of violence, workers’ personal relationships—both real and prospective—are also affected by trauma work. These changes occur with parents and their children, partners, friends, colleagues, and other family members (Campbell, 2002; Pearlman & Saakvitne, 1995). Workers’ personal boundaries are consciously tightened and their eyes are opened to what constitutes abuse, making meeting new people a challenging prospect. After hearing many accounts of abuse within intimate relationships—through battering, acquaintance rape, and child sexual abuse—trusting someone new is often a daunting undertaking. The following example highlights how one worker’s ability to trust has changed:

Alberta has been a social worker at a crime victims counseling program for seven years. She is single but really wants to date and meet new people. She worries that she has lost her ability to trust her instincts and make healthy choices about relationships. She thinks about all her clients who are in abusive relationships. Every time she goes out on a date, she can’t enjoy herself because she is convinced that her date will be abusive. She has stopped believing that good relationships exist. She thinks she is better off being alone.

A Changed View of the World
Work in the trauma field causes emotional and interpersonal stress. Existential transformations such as a pessimistic view of the world may also develop. Daily interactions with traumatized clients change a worker’s ability and willingness to see the world as a good and safe place for themselves and those they love (Pearlman & Saakvitne, 1995).

Social workers, through ongoing exposure to the harm human beings inflict on each other, run the risk of becoming jaded, cynical, and exceedingly angry over the overwhelming injustices in the world. These feelings may interfere with workers’ abilities to genuinely empathize with their clients. A feeling of helplessness to make a difference in the lives of their clients may be a warning sign of trouble. Workers struggle, sometimes unsuccessfully, to come to terms with a world where there is extreme cruelty.

Over time, a previously hopeful and optimistic worker may come to view the world through skeptical and distrustful eyes. An inability to believe in the overall goodness of society may create intense feelings of anger, resentment, and isolation in workers. The following example shows a social worker’s experience with a changed world view:

Thomas always prided himself on being a caring, compassionate, and sensitive person. These characteristics contributed to his decision to enter the social work profession. Since working with families who have lost children to gang violence, Thomas has begun to feel less compassionate. In fact, he spends a lot of his spare time overflowing with anger over the injustice in the world. Thomas feels as though his compassionate, optimistic view of the world has been replaced by rage, hatred, anger, and a desire for revenge. He no longer sees the world as a good and safe place. His anger has begun to affect his work with all his clients, as well as his relationship with his family, friends, and coworkers.

Responding to VT
Although VT can have negative effects on both worker and client, it can be prevented and corrected with a responsive agency, worker self-awareness, and practiced self-care. There are rich emotional, psychological, and spiritual rewards for social workers engaged with survivors of rape, incest, violence, and abuse. Having the opportunity to help a client through a traumatic, terrifying life event can foster feelings of purpose and personal satisfaction in workers. However, without self-care and an attuned agency and profession, the benefits of the work may soon dissipate for workers and, in turn, clients. To illuminate the positive aspects of the work and reduce stress, social workers need strategies to recognize and respond to VT. These strategies can be divided into three levels: personal self-care, organizational responsiveness, and professional implications.

Social workers are taught to focus first on their clients, not themselves. Self-care has not been a priority in student education. However, if VT is left untreated, it is the clients who will be ultimately affected. By exercising basic self-care strategies, social workers can reduce their susceptibility to VT while improving their skill and sensitivity in their work with clients.

Self-Awareness, Balance, Connection
One way to remember self-care is ABC: awareness, balance, and connection. Social workers need time to be self-aware and self-reflective. This process can occur in supervision, in therapy, or through personal interactions with friends and colleagues. Keeping a journal and taking a few moments between sessions to check in with one’s self are examples of useful self-reflective habits. It is important for social workers in the trauma field to conduct regular self-assessments in supervision.

Workers need to be aware of the particular areas of their jobs that cause them the most emotional stress, such as a certain type of client victimization. By learning to recognize the rewards of the work, social workers can also see a fuller picture of their interventions and efforts. Self-awareness can be an integral part of a social worker’s developing professional identity.

Trauma work is important, but it need not be one’s whole life. Maintaining healthy boundaries between work and home is one important way for social workers to reduce symptoms of VT. Developing and maintaining interests outside of work is especially critical. Establishing quiet time each day for reflection can be restorative. Exercising, learning to relax, and recognizing the importance of taking vacations are other ways to stay balanced.

Trauma work should not be done in isolation. Regardless of a social worker’s practice setting or agency, having supportive colleagues can reduce isolation and create lighter moments. Work in the trauma field may whittle away at social workers’ natural abilities to trust. It is important for workers to learn to share positive connections with others. This can occur through formal supervision or peer groups, or informally through social gatherings. Positive connections are instrumental in reminding workers of the meaningful and rewarding elements of life at home and work. Seeking and nurturing supportive relationships with peers, actively engaging in supervision, and talking to friends are other avenues of connection.

Organizational Responsiveness
A range of responses to VT can be easily initiated on the agency level. For example, facilitated support groups, peer groups, in-service trainings, and supportive supervision are all needed on a regular basis. Peer lunch groups and informal socializing also need to be encouraged by agencies. These services offer social workers essential emotional support during times of stress.

Efforts to bolster staff camaraderie to reduce feelings of isolation are also necessary (Pearlman & Saakvitne, 1995). Variety is indicated for work schedules, types of clients, daily job responsibilities, and treatment modalities. Concrete needs such as adequate funding, space, and supplies, and manageable caseloads speak to another need. Organizations must send the message that their workers and, in turn, their clients are important.

Professional Implications
By understanding the dynamics of VT and how it may be recognized and managed, social workers can strengthen their skills and response to their traumatized clients.

The national and international climate portends that skilled trauma work is needed, perhaps now more than in recent years. With an increasing number of professionals working in the field of trauma, not only in sexual assault and domestic violence but also with victims of terrorism, torture, and other war crimes, the social work profession must be adequately equipped to respond to these growing challenges. Social work students should be taught self-care strategies early in their education to prevent VT and help them develop into well-rounded professionals. Seasoned professionals also need to adopt self-care strategies.

Participation in antiviolence coalitions and organizations is necessary to reduce isolation, pool knowledge and expertise, and coordinate funding strategies and resources. Such coalitions will foster a connection to social action, an important element of professional social work. With its emphasis on person-in-environment, the profession of social work must take a leadership role in conceptualizing and responding to the complex effects of trauma work on workers.

— Shantih E. Clemans, DSW, is an assistant professor at The Wurzweiler School of Social Work, Yeshiva University, in New York City. Prior to joining Yeshiva University, Clemans directed the Rape Crisis Intervention/Victims of Violence Program at Long Island College Hospital in Brooklyn, NY.

References
Ahrens, C. E., & Campbell, R. (2000). Assisting rape victims as they recover from rape: The impact on friends. Journal of Interpersonal Violence, 15(9), 959-986.
Campbell, R. (2002). Emotionally involved: The impact of researching rape. New York: Routledge.
Clemans, S. E. (1999). In the face of violence: Rape crisis workers talk about their lives. Unpublished dissertation: The City University of New York.
Cunningham, M. (1999). The impact of sexual abuse treatment on the social work clinician. Child and Adolescent Social Work Journal, 16(4), 277-290.
Dane, B. (2000). Child welfare workers: An innovative approach for interacting with secondary trauma. Journal of Social Work Education, 36(1), 27-38.
Figley, C. R. (2002). Treating compassion fatigue. New York: Routledge.
Kelly, L. (1988). Surviving sexual violence. Minneapolis: University of Minnesota Press.
Koss, M. P., & Harvey, M. R. (1991). The rape victim: Clinical and community interventions. Newbury Park, CA: Sage Publications.
McCann, I. L., & Pearlman, L. A. (1991). Vicarious traumatization: The emotional costs of working with survivors. Treating Abuse Today, 3(5), 28-31.
Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: W.W. Norton & Co.
Schechter, S. (1982). Women and male violence: The visions and struggles of the battered women’s movement. Boston: South End Press.