Vicarious Trauma and New Clinicians

One joy of being a counseling supervisor is guiding new counselors into the counseling profession. It is fulfilling to see new counselors move from the beginning stages of being nervous to confident, well-developed counselors. As the journey begins, newer clinicians can find it anxiety-provoking to think about all that lies ahead. One of the first common questions I get in the beginning stage of counseling development is "How will I handle hearing trauma all day, every day?" This is one question supervisors and educators cannot overlook in counselor education and development.

As a supervisor, I have a call to support new counselors through their trauma processing that results from their empathic natures and engagement with clients. Vicarious Trauma is defined as the emotional impact working with trauma victims can have on a caring professional when exposed to traumatic stories or events of the client. The American Counseling Association says it "is a state of tension and preoccupation of the stories/trauma experiences described by clients", I believe education and awareness of the impact vicarious trauma can have a necessary element in all counseling programs and supervision. Vicarious trauma can impact any counselor at any point along their career journey, but educating and raising awareness early might save someone's career from burnout.

Signs and Symptoms

When I see a new counselor struggling with any amount of vicarious trauma, I first want to communicate there is no shame in admitting that a case or client is troubling you. Being willing to put words to your experience makes you a better therapist. It keeps you more objective and focused on your clients' goals rather than on what you are experiencing in the session.

To identify vicarious trauma, clinicians must know the signs and symptoms to look for. The British Medicine Journal has a comprehensive list of vicarious trauma symptoms:

experiencing lingering feelings of anger, rage, and sadness about the patient's victimization
becoming overly involved emotionally with the patient
experiencing bystander guilt, shame, feelings of self-doubt
being preoccupied with thoughts of patients outside of the work situation
over-identification with the patient (having horror and rescue fantasies)
loss of hope, pessimism, cynicism
distancing, numbing, detachment, cutting patients off, staying busy. Avoiding listening to client's stories of traumatic experiences
difficulty in maintaining professional boundaries with the client, such as overextending self (trying to do more than is in the role to help the patient).

I encourage new clinicians to review this list, especially if they are feeling off or overwhelmed. Ask your supervisees or engage in self-assessment to see if you are experiencing any of these symptoms. The National Child Traumatic Stress Network, 2011, says “Although estimates differ, it has been reported that as many as 50% of counselors are at risk of developing vicarious trauma.” Newer clinicians need to know they are not alone and that it is okay to seek help.

How to Care for Yourself

Working in trauma and the counseling profession in general is like building muscle. I love to share with newer clinicians my journey of learning how to care for myself while also caring for and extending empathy to my clients. I highlight how it was not a skill or muscle that I built overnight. Rather, it was a journey of intentionality to make healthy choices and set healthy boundaries. Just as any person who exercises will tell you, getting in shape and building muscle takes work, and consistency, and sometimes brings aches and pains. Building the muscle of self-care and boundaries to ward off vicarious trauma is no different.

I want to encourage new clinicians or even those years into the field who are struggling with vicarious trauma to try these strategies to reduce vicarious trauma’s impact:

Seek supervision or consultation. Simply knowing you are not alone or having a new direction/treatment plan for a client can help you increase your level of confidence. Ask a supervisor or another therapist to consult on the case with you and process how the case is affecting you.
Healthy work/life balance. In our constantly connected world, we forget it is okay to shut off work. Turn off your email, leave work on time and take vacations when you can. We all need time away from work and traumatic material to be reminded of the good in the world too.
Establish a balanced caseload. If you see too many highly traumatic cases, you will begin to feel burned out and unable to process high amounts of trauma materials. Seek to add clients to your caseload that have potentially less trauma associated with their presenting issue.
Take care of yourself physically. We cannot give our clients what we do not have to give. Make sure you are eating well, developing good sleep hygiene, and moving your body as often as possible. When you physically feel better, your tolerance of more difficult materials will be higher.
Look for ways to seek enjoyment, create beauty or simply have fun. Make sure you are seeking interests outside of work that can help build resilience to the traumatic materials you hear in sessions.
Know when to refer. If you cannot move past the effect a case is having on your well-being, be willing to refer the client to another clinician. We must first do no harm and it could be best for both you and the client to have a fresh start.
Be willing to seek your own therapy if you are not seeing various trauma symptoms resolve. When vicarious trauma symptoms impact your enjoyment of your personal life or your ability to do your job, seek counseling to resolve your trauma triggers or any past unresolved trauma you are experiencing as a result of your clients' stories.

To learn more about vicarious trauma click on the fact sheet below. Education and knowledge are key in combating this in our profession. Find a newer therapist and let them know about the resources too. We must care well for the next generation of clinicians so that we can continue the mission of providing support to trauma survivors too.

Resources:

https://www.counseling.org/docs/trauma-disaster/fact-sheet-9---vicarious-trauma.pdf

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