Every Therapist Needs a Therapist
By Madalyn Vanarthos, MusicWorx Intern
- Have you felt emotionally drained at work?
- Have you experienced difficulty empathizing with your clients?
- Have you noticed that you are overly involved in your client’s emotional pain?
- Do you carry your client’s trauma home with you?
If so, you are not alone. Mental, emotional and physical exhaustion are realities when you work in a helping profession, especially with survivors of trauma. The terms vicarious trauma (VT), secondary traumatic stress (STS), burnout (BO) and compassion fatigue (CF), some of which have been around for 25 years, did not fully capture the public eye until around 5-10 years ago when self-care became a topic of interest. Let’s not let the awareness fade. We need to constantly relearn these terms to take care of ourselves so we provide the best possible client care.
Why am I writing this post?
I had the opportunity to create a partnership with a local organization in San Diego called North County Lifeline (NCL). Their vision is to “build self-reliance among youth, adults, and families through high-quality, community-based services” (North County Lifeline). In order to make that vision a reality, the case managers and administration daily advocate for and serve adolescents in the community who have experienced trauma. In particular, NCL serves adolescents who have been incarcerated, in foster care, trafficked, sexually or physically abused and/or homeless. In addition to leading sessions for the NCL participants, I decided to offer the NCL staff music therapy education and support. After just two 15-minute relaxation and mindfulness experiences incorporated into an educational presentation about music therapy for the staff, I received an overwhelmingly positive response that the music was relaxing, needed, and created a space where a lot of unexpected emotions arose. My supervisor and I decided to offer 30-minute staff support sessions and collect data on their responses. The staff described the music therapy experience by saying the following:
- “I felt more relaxed and present during and after the session”
- “I truly felt at peace and was engaged with the session for the entire time.”
- It was a slow, peaceful way to start the morning with gratitude
- The music therapy session was amazing, I was able to open my inner feelings and connect with myself in a new level.
The staff’s responses and engagement led me to take a deep dive into the literature on VT, STS, CF and BO. After taking a self-care class in college, I was familiar with the terminology, but had let the significance of the terms fade. For myself, the professional music therapy community, humanitarian workers, mental health workers, social workers, etc., I want to pause and remind everyone that the following experiences are real and worth our consideration and awareness.
What Does the Research Say?
Bride (2007) sent a survey filled out by 282 licensed social workers that determined that “…social workers are likely to experience at least some symptoms of STS [secondary traumatic stress], and a significant minority (15.2 percent) may meet the diagnostic criteria for PTSD” (p. 68). Conrad & Kellar-Guenther (2006) found that “approximately 50% of Colorado county child protection staff suffered from “high” or “very high” levels of compassion fatigue.” Peters et al. (2020) interviewed 11 staff from an organization working with homeless individuals. They described the plight of the workers by saying, “Witnessing such events and behaviours that challenge staff, whilst having to stay connected with service users and their distress, whilst staying professional and caring, is likely to take an emotional toll on staff in these settings.” Tatano (2011) found that “between 40% and 85% of helping professionals were found to have compassion fatigue and/or high rates of traumatic symptoms.” These studies are just a few of many highlighting the needs of helping professionals with VT, STS, BO and CF.
Originally coined by Saakvine & Pearlman (1996), vicarious trauma is experienced when one’s worldview begins to negatively change as a result of listening to traumatic content. Mathieu (2012) adds that “vicarious trauma occurs when the stories we hear from our clients transfer onto us in a way where we are too traumatized by the images and details, even though we did not experience them ourselves” (p. 9)
Questions to ask yourself:
- Do you experience intrusive nightmares or mental images from the stories you hear?
- Are you abnormally sad or angry at the world?
- Are you overwhelmed by the stories in your mind at home?
- Do you look at your relationship negatively as a result of hearing traumatic content?
Compassion fatigue (CF) is stress and exhaustion from extended exposure to trauma, or work in a helping profession “[and] has been described as the convergence of secondary traumatic stress (STS) and cumulative burnout” (Cocker & Joss, 2016) that that inhibits your ability to feel compassion or empathize. Compassion is an essential ingredient in any helping profession, and without it our services are negatively impacted. Charles Figley, one of the original proponents of compassion fatigue stated that compassion fatigue is a “disorder that affects those who do their work well.” CF is not something of which to be ashamed. Clinicians experience CF in different degrees at any point in their career. Mathieu (2012) mentioned multiple potential adverse effects of CF to keep an eye out for that I will list below:
- Bitter at work
- Contributing to a toxic work environment
- Clinical errors
- Violating client boundaries
- Loss of respect for clients
- Short-tempered with clients or loved ones
- Feeling resentment for the demands at work
- Apathy towards client stories
Naomi Rachel Remen in The Compassion Fatigue Workbook (2012) stated, “We burn out not because we don’t care, but because we don’t grieve. We burn out because we’ve allowed our hearts to become so filled with loss that we have no room left to care” (p.7)
Burnout as defined by Mathieu (2012) is “the physical and emotional exhaustion that workers can experience when they have low job satisfaction and feel powerless and overwhelmed at work” (p. 10). The key difference is that burnout does not necessarily mean a change in the experience of compassion, or worldview. Burnout is usually a result of overwork, a toxic work environment, poor pay, a terrible work schedule, etc. The likelihood of burnout diminishes after a change of work, decreasing hours, and lots of self-care, but chronic burnout makes clinicians more vulnerable to VT, CF and STS.
Watch out for:
- Working on your days off
- Not feeling like you have a voice in your company/organization to stand up for your mental health
- A monotonous routine and schedule
- Physical depletion every day after work
- A lack of desire to do anything after work with friends/family or loved ones
Secondary Traumatic Stress
Secondary traumatic stress is a response to hearing, reading or being witness to traumatic events that often results in PTSD-like symptoms. STS stems from numerous sources including colleagues, clients, court hearings, testimonies and footage (Mathieu, 2012, p. 13). Mathieu (2012) lists the following as common symptoms: “re-experiencing, avoidance, chronic tension, irritability, insomnia, difficulties with concentration and memory, and emotional numbing” (p. 14). Avoidance refers to avoiding triggers whether that be locations, people, sounds, etc. Barrington & Shakespeare-Finch (2013) found that, among 17 frontline clinical and administrative staff who provided services to survivors of torture and trauma, the most common coping strategies for staff were the following (p. 96):
- Practicing mindfulness
- Eating healthily
- Exercising regularly
- Limiting exposure to violent or dramatized material outside of work
- Spending more time outdoors
- Developing a healthy work–life balance
- Speaking to friends or family about work-related stress
Be mindful of the differences between CF, VT, STS, BO, anxiety, or depression and how they compound. Chronic STS or CF can lead to depression, anxiety, unhealthy coping behaviors, etc. And vice versa, if you have preexisting anxiety or depression, you can more easily acquire VT, CF, STS or BO. Having a history of trauma can lead to more vulnerability. Know your limitations and needs!
You Are Not Alone!
You might be reading this blog post and never have experienced VT, STS, BO, or CF. Nevertheless, it is still your responsibility to be aware of these experiences so that you are able to look out for the symptoms in your own life and potentially your coworkers’ lives. And if you have experienced one or more, or currently are, the resources below are meant to be a first step towards healing.
- NCTSN Learning Center
- Burnout Prevention and Self-Care CMTE Courses
- Mental Health At Work:
- MusicWorx Blog Posts
- ▫ Work through The Compassion Fatigue Workbook: Creative Tools for Transforming Compassion Fatigue and Vicarious Traumatization.
- ⬝ This book includes wonderful reflections, resources, journaling assignments and descriptions!
- Read Trauma Stewardship by Laura van Dernoot Lipsky
- If you are like me, making time for self-care is a struggle! Here is an article on some helpful apps for taking care of yourself!
- Every therapist needs a therapist!
- Find local therapists in your area or find an online option!
- Start here!
Barrington, A. J., & Shakespeare-Finch, J. (2013). Working with refugee survivors of torture and trauma: An opportunity for vicarious post-traumatic growth. Counselling Psychology Quarterly, 26(1), 89–105. https://doi.org/10.1080/09515070.2012.727553
Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work (New York), 52(1), 63–70. https://doi.org/10.1093/sw/52.1.63
Cocker, F., & Joss, N. (2016). Compassion fatigue among healthcare, emergency and community service workers: A systematic review. International Journal of Environmental Research and Public Health, 13(6), 1–18. https://doi.org/10.3390/ijerph13060618
Conrad, D., & Kellar-Guenther, Y. (2006). Compassion fatigue, burnout, and compassion satisfaction among Colorado child protection workers. Child Abuse & Neglect, 30(10), 1071–1080. https://doi.org/10.1016/j.chiabu.2006.03.009
Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Brunner/Mazel.
Françoise, M. (2012). The compassion fatigue workbook: Creative tools for transforming compassion fatigue and vicarious traumatization. Routledge Taylor & Francis Group.
North County Lifeline. (n.d.). Our vision and values. https://www.nclifeline.org/our-vision
Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. American Journal of Clinical Hypnosis, 38(4), pp. 298–299
Tatano, B. C. (2011). Secondary traumatic stress in nurses: A systemic review. Archives of Psychiatric Nursing, 25(1), 1-10.