Vicarious Trauma: The Silent Impact on Therapists

Vicarious traumaVicarious trauma refers to the impact of repetitive encounters with indirect trauma while working as a helping professional.

Most clients who attend psychotherapy will share their history of trauma that has impacted their mental health, relationships, and working lives (Sawicki, 2019).

The emotional impact of empathizing with trauma survivors increases therapists’ risk of vicarious trauma, yet it is necessary to facilitate the client’s post-traumatic growth (Rothschild, 2023).

This article is aimed at supporting all those helping professionals at risk of vicarious trauma by exploring the signs and symptoms, providing prevention strategies, and offering free science-based interventions to help you cope.

Before you continue, we thought you might like to download our three Resilience Exercises for free. These engaging, science-based exercises will help you effectively deal with difficult circumstances and give you the tools to improve the resilience of your clients, students, or employees.

Vicarious Trauma: How It Affects Mental Health Practitioners

Vicarious trauma, sometimes also termed compassion fatigue or secondary trauma (Kim et al., 2021), can significantly impact mental health practitioners who support their clients’ recovery from traumatic experiences. It happens due to the psychological impact of repeated exposure to trauma stories over time (Gaboury & Kimber, 2022; Roberts et al., 2022).

Here are some of the effects as listed in research (Sawicki, 2019):

1. Emotional exhaustion

Ongoing exposure to clients’ trauma stories can lead to emotional exhaustion. You may feel drained, overwhelmed, and emotionally depleted.

2. Increased stress and anxiety

Witnessing or hearing about traumatic events repeatedly is likely to increase stress levels in mental health practitioners. You may experience symptoms such as restlessness, irritability, and heightened anxiety.

3. Depersonalization and disengagement

Nervous system overwhelm may result in emotional detachment from clients as a coping mechanism, often called a freeze response. This depersonalization can lead to feelings of numbness, cynicism, or an inability to care anymore.

4. Decreased empathy

Over time, exposure to trauma can desensitize practitioners, making it more difficult for them to empathize with their clients’ experiences. This may leave you feeling guilty or ashamed.

5. Physical symptoms

Vicarious trauma can lead to headaches, gastrointestinal issues, high blood pressure, and fatigue. The constant stress can take a toll on practitioners’ overall health and wellbeing and worsen any previously well-managed conditions.

6. Impaired professional functioning

Vicarious trauma can impact practitioners’ ability to perform effectively at work. They may experience difficulties concentrating, making decisions, or maintaining boundaries with clients. Brain fog is a common symptom of impaired executive functioning resulting from vicarious trauma.

7. Burnout

Left unaddressed, vicarious trauma can lead to a state of emotional, physical, and mental exhaustion called burnout. Burnout may lead to decreased job satisfaction, absenteeism, and ultimately, a decision to leave the profession.

Drowning in empathy: the cost of vicarious trauma

For a real-life account of how vicarious trauma impacts helping professionals, take a look at this TEDx talk, Drowning in Empathy: The Cost of Vicarious Trauma, by Amy Cunningham.

She led the development of compassion fatigue training for CHRISTUS Health and has trained over 3,000 people.

What Are the Common Causes of Vicarious Trauma?

Vicarious trauma is caused by various factors inherent in the nature of the work performed by helping professionals who routinely engage with trauma survivors (Kim et al., 2021; Kounenou et al., 2023; Sabin-Farrell & Turpin, 2003).

Some common causes include:

  • Repeated exposure to traumatic stories
    Mental health practitioners often hear detailed accounts of traumatic experiences from their clients. Over time, this repeated exposure can lead to vicarious trauma.
  • Empathetic engagement
    Mental health practitioners empathically engage with their clients, which can result in them absorbing some of the emotional pain and thoughts about their distressing experiences.
  • Poorly defined professional boundaries
    When practitioners become overly involved in their clients’ lives or feel responsible for their wellbeing, it can increase their vulnerability to vicarious trauma.
  • Heavy workloads
    Busy schedules and long hours can exacerbate the effects of vicarious trauma. Mental health professionals who are overwhelmed with work have fewer resources to cope with the emotional toll of their job.
  • A personal history of trauma
    Exposure to clients’ traumatic stories can trigger or reactivate past trauma experiences. However, this shared lived experience can also provide a foundation for empathy and trust in the client’s capacity to grow and heal.
  • Insufficient support
    A lack of support from colleagues or supervisors can leave mental health professionals feeling isolated and overwhelmed. Without opportunities for debriefing, the impact of vicarious trauma may be compounded.
  • Poor organizational management
    Organizational factors such as a lack of resources, pressure to meet productivity targets, and a culture that prioritizes productivity or profit over self-care can contribute to vicarious trauma.
3 resilience exercises

Download 3 Free Resilience Exercises (PDF)

These detailed, science-based exercises will equip you or your clients to recover from personal challenges and turn setbacks into opportunities for growth.

Vicarious vs. Secondary Trauma: What’s the Difference?

Vicarious trauma and secondary trauma are related concepts but have slightly different meanings.

Vicarious trauma refers to the emotional, psychological, and sometimes physical distress experienced by individuals who are exposed to the traumatic experiences of others during their professional roles.

This can include mental health practitioners, first responders, social workers, and other professionals who regularly engage with trauma survivors. Vicarious trauma can result in trauma-related symptoms and distress (Sawicki, 2019).

Secondary trauma, on the other hand, specifically refers to the emotional and psychological distress experienced by individuals in a close relationship with a trauma survivor, including relatives, friends, and other helping professionals.

Secondary trauma occurs indirectly, as these individuals witness or hear about the traumatic experiences of another person, which can lead to them sharing some symptoms of trauma (Hesse, 2002).

However, these terms are often used interchangeably, despite the differences outlined above.

How to Spot Signs & Symptoms of Vicarious Trauma

Signs of vicarious traumaRecognizing the signs and symptoms of vicarious trauma is a crucial skill set for mental health professionals who support trauma survivors (Kennedy & Booth, 2022).

Some common signs and symptoms have been covered in the effects section above. These include:

  • Emotional exhaustion and feeling depleted (i.e., “running on empty”)
  • High stress levels evident in persistent worry, restlessness, irritability, or hypervigilance
  • Depersonalization, where practitioners may begin to feel numb or disconnected from their clients’ experiences
  • Difficulty with professional boundaries, such as getting overly involved with clients’ lives and feeling responsible for them outside the professional relationship
  • Compassion fatigue, where practitioners are desensitized over time, making it difficult for them to empathize with their clients’ experiences or care like they once did
  • Somatic symptoms such as headaches, gastrointestinal issues, fatigue, or insomnia
  • Avoidance behaviors to cope with their distress, including avoiding certain clients or topics related to trauma, as well as avoiding discussions or reflections on their own emotional responses to their work
  • Impaired professional functioning, including difficulty concentrating, making decisions, or managing workloads
  • Personal life impacts, including difficulties in their personal relationships or a diminished interest in activities they once enjoyed (e.g., those working with sexual abuse survivors may lose interest in physical intimacy with their partner)

By recognizing these signs and symptoms, mental health practitioners can take proactive steps to address vicarious trauma and prioritize their own wellbeing (Sawicki, 2019). We provide some tips on how to prevent vicarious trauma and foster resilience with further resources below.

8 Prevention Strategies & Techniques for Secondary Trauma

Addressing the causes of vicarious trauma requires a multidimensional approach that includes maintaining healthy boundaries, ongoing support and supervision, fostering a culture of self-care within organizations, and implementing trauma-informed practices (Rothschild, 2023; Sutton et al., 2022).

By addressing these factors, mental health practitioners can protect themselves from the harmful effects of vicarious trauma and continue to provide effective care to their clients.

Here are eight preventive measures:

  1. Engage in regular self-care practices to promote emotional wellbeing. This could include exercise, mindfulness, hobbies, spending time with loved ones, or engaging in activities that bring joy and relaxation.
  2. Maintain clear boundaries between yourself and your clients. Recognize when you need to take a step back and prioritize your own wellbeing. Practice saying no when necessary and communicating your limits to avoid becoming overwhelmed.
  3. Ensure that you have a support network of friends, family members, or colleagues who can provide emotional support and understanding. Share your experiences and feelings with trusted individuals who can offer empathy and validation.
  4. Incorporate mindful practices into your daily routine to stay grounded and present. Mindfulness techniques, including deep breathing and meditation, can help reduce stress and promote emotional resilience.
  5. Limit the amount of exposure you have to traumatic material, whether it’s through news media, social media, or discussions with the trauma survivor.
  6. Take time to reflect on your emotions, reactions, and experiences related to supporting the trauma survivor. Journaling, expressive writing, or discussing your experiences with a supervisor or mentor can help you process your feelings and prevent emotional burnout.
  7. Learn to recognize the signs of compassion fatigue, which is closely related to vicarious trauma, and develop strategies to manage it effectively based on the information above. This may also include practicing self-compassion and self-soothing.
  8. Engage in regular supervision sessions for guidance, feedback, and support. Supervision can help you process difficult cases, debrief after challenging interactions, and identify areas for growth and self-care.

By implementing these preventive measures, those who support trauma survivors can reduce their risk of experiencing vicarious trauma and promote their own self-care and resilience.

How a psychiatrist manages vicarious trauma

In this episode of Doctors Getting Coffee, a forensic psychiatrist describes how he prevents vicarious trauma in the course of his work with traumatized patients using some of the strategies mentioned above.

10 Science-Backed Interventions to Help You Cope

Coping with the risk of vicarious trauma is crucial for individuals who work in helping professions, such as therapists, counselors, nurses, social workers, and emergency responders.

Each of these 10 positive psychology interventions is linked to science-based articles packed with free resources designed to move you from surviving to thriving and post-traumatic growth.

1. Self-care practices

Engage in regular self-care activities such as exercise, meditation, self-soothing, hobbies, or spending time with loved ones. Taking care of your physical and mental health is essential for resilience.

For more ideas, take a look at our article 10 Self-Care Tips for Psychologists, Therapists & Counselors.

2. Supervision, peer support, and mentoring

Regular supervision sessions with a supervisor or peer support groups can provide a safe space to process difficult emotions and experiences. Sharing with others who understand the nature of your work is validating and supportive. Mentoring and coaching can provide extra support during difficult times and help prevent burnout.

3. Healthy boundaries

Maintaining clear boundaries between work and personal life sets limits on your exposure to traumatic material. Learn to say no when necessary and prioritize your own needs.

Take a look at our article How to Set Healthy Therapist–Client Relationship Boundaries for tips.

4. Mindful grounding techniques

These practices help you to stay present and manage overwhelming emotions. Techniques such as deep breathing, progressive muscle relaxation, or guided imagery can help you stay centered and in the moment.

Our article 10+ Mindful Grounding Techniques is packed with resources.

5. Education and training

Attend workshops, seminars, or training sessions on trauma-informed self-care strategies. Our article 23 Post-Traumatic Growth Worksheets for Therapy explores the science and provides worksheets you can use to grow from vicarious trauma.

6. Take a break

Regular breaks are needed to rest and recharge. Schedule time off to disconnect from work-related stressors and focus on rejuvenating activities.

We shouldn’t regard rest as a reward for hard work, but as the foundation of optimal productivity and wellness. Our article Non-Sleep Deep Rest (NSDR): Exploring a World Beyond Sleep explores the latest science in detail and is full of NSDR resources.

7. Use your creativity

Engage in creative self-expression such as writing, art, music, or dance to express and process your emotions in a healthy way.

Creative activities are a form of self-expression, reduce stress, and boost catharsis. Read our article Fostering Creativity: 12 Strategies to Boost Creative Skills to learn more.

8. Reflective practice

Reflect on your experiences and reactions to challenging situations. Journaling or regular self-reflection exercises can help you gain insight into your emotional responses and identify patterns or triggers.

Try our 87 Self-Reflection Questions for Introspection [+Exercises] for ideas.

9. Self-compassion practices

Self-compassion involves treating yourself with kindness, understanding, and acceptance, especially during times of suffering or difficulty. Cultivating self-compassion through practices such as self-soothing and mindfulness can help individuals cope with vicarious trauma and reduce the risk of burnout (Hashem & Zeinoun, 2020).

Try these 8 Powerful Self-Compassion Exercises & Worksheets.

10. Eye-movement desensitization and reprocessing (EMDR)

EMDR involves reprocessing traumatic memories while engaging in bilateral stimulation, such as eye movements or tapping.

EMDR can reduce symptoms of vicarious trauma and improve emotional resilience in mental health professionals who work with child abuse and neglect (Tsouvelas et al., 2019).

Take a look at Your Ultimate EMDR Guide (Incl. Techniques & Exercises) to find out more.

Remember that coping with vicarious trauma is an ongoing process, and it’s essential to prioritize your wellbeing and seek support when needed.

World’s Largest Positive Psychology Resource

The Positive Psychology Toolkit© is a groundbreaking practitioner resource containing over 500 science-based exercises, activities, interventions, questionnaires, and assessments created by experts using the latest positive psychology research.

Updated monthly. 100% Science-based.

“The best positive psychology resource out there!”
Emiliya Zhivotovskaya, Flourishing Center CEO

Helpful Resources From PositivePsychology.com

Here at PositivePsychology.com, we have a lot of resources to help you take care of yourself and prevent vicarious trauma. The following articles are packed with resources. The titles speak for themselves.

In addition, you could take a look at the following free worksheets:

  • The Workplace Mindfulness worksheet guides you through a mindful reflection on practicing loving-kindness to yourself and others at work.
  • Our Resilience and Change worksheet can help you evaluate your current resources and challenges to help you make changes that build resilience.
  • Finally, our Workplace Boundaries worksheet can help you identify limits and set boundaries at work to protect your mental health and keep you safe.

A firm recommendation is The Science of Self-Acceptance Masterclass©, which has been designed to support you and your clients in accepting imperfections and limits and retaining a sense of being good enough. This can be especially useful when facing compassion fatigue or burnout.

If you’re looking for more science-based ways to help others overcome adversity, check out this collection of 17 validated resilience and coping exercises. Use them to help others recover from personal challenges and turn setbacks into opportunities for growth.

A Take-Home Message

All types of helping professionals are at risk of vicarious trauma, but especially those who work regularly with trauma survivors and are repeatedly exposed to trauma narratives.

These stories may be quite disjointed and punctuated by gaps in a client’s understanding or ability to articulate their experience.

Therefore, psychotherapists and counselors in particular may find themselves having to help traumatized clients reconstruct their stories to help them make sense of what happened to them and heal.

Self-care and regular supervision are therefore essential for all helping professionals working with traumatized client groups to prevent compassion fatigue, vicarious trauma, and burnout.

If you have any other self-care strategies you find useful, please share them in the comments.

We hope you enjoyed reading this article. Don’t forget to download our three Resilience Exercises for free.

  • Gaboury, K., & Kimber, M. (2022). Consequences of vicarious traumatization among mental health service providers with a history of child maltreatment: A narrative review. Psychological Trauma: Theory, Research, Practice, and Policy, 15(2), S203–S212.
  • Hashem, Z., & Zeinoun, P. (2020). Self-compassion explains less burnout among healthcare professionals. Mindfulness, 11(11), 2542–2551.
  • Hesse, A. R. (2002). Secondary trauma: How working with trauma survivors affects therapists. Clinical Social Work Journal, 30(3), 293–309.
  • Kennedy, S., & Booth, R. (2022). Vicarious trauma in nursing professionals: A concept analysis. Nursing Forum, 57(5), 893–897.
  • Kim, J., Chesworth, B., Franchino-Olsen, H., & Macy, R. J. (2021). A scoping review of vicarious trauma interventions for service providers working with people who have experienced traumatic events. Trauma, Violence, and Abuse, 23(5),1437–1460.
  • Kounenou, K., Kalamatianos, A., Nikoltsiou, P., & Kourmousi, N. (2023). The interplay among empathy, vicarious trauma, and burnout in Greek mental health practitioners. International Journal of Environmental Research and Public Health, 20(4), Article 3503.
  • Roberts, C., Darroch, F., Giles, A., & van Bruggen, R. (2022). You’re carrying so many people’s stories: Vicarious trauma among fly-in fly-out mental health service providers in Canada. International Journal of Qualitative Studies on Health and Wellbeing, 17(1), Article 2040089.
  • Rothschild, B. (2023) Help for the helper: Preventing compassion fatigue and vicarious trauma in an ever-changing world. W. W. Norton & Company.
  • Sabin-Farrell, R., & Turpin, G. (2003). Vicarious traumatization: Implications for the mental health of health workers? Clinical Psychology Review, 23(3), 449–480.
  • Sawicki, S. M. (2019). Mental health workers’ vicarious trauma, secondary traumatic stress, and self-care. DBC.
  • Sutton, L., Rowe, S., Hammerton, G., & Billings, J. (2022). The contribution of organisational factors to vicarious trauma in mental health professionals: A systematic review and narrative synthesis. European Journal of Psychotraumatology, 13(1), Article 2022278.
  • Tsouvelas, G., Chondrokouki, M., Nikolaidis, G., & Shapiro, E. (2019). A vicarious trauma preventive approach. The Group Traumatic Episode Protocol EMDR and workplace affect in professionals who work with child abuse and neglect. Dialogues in Clinical Neuroscience & Mental Health, 2(3), 130–138.

Let us know your thoughts

Your email address will not be published.

Categories

Read other articles by their category

3 Resilience Exercises Pack