If you work in a field in which you interact with people who have experienced trauma, you may be (hopefully) familiar with terms such as Burnout, Secondary Traumatic Stress, Vicarious Trauma or Compassion Fatigue. But even if you aren’t familiar with these terms, how we define the impact of the work we do matters. For this post I’m going to give a broad overview of some terms and ideas, then will dive deeper into specifics in future posts.
First, what is trauma? According to the Diagnostic and Statistical Manual V (DSM), the instrument put out by the American Psychiatric Association, trauma is defined as “exposure to actual or threatened death, serious injury, or sexual violation.” So what is “exposure?” Also per the DSM, exposure includes:
- Direct exposure to a traumatic event
- Witnessing a traumatic event happen to someone else
- Learning about a traumatic event happening to someone you love
- Experiencing first-hand repeated or extreme exposure to aversive details of trauma (not through media, pictures, or TV unless work-related)
When we look at diagnosing someone with a trauma-related disorder, the first thing we consider is whether or not there was exposure. Depending on the type of work you do, you may meet all four of the criteria for exposure. For example, an in-home therapist working over many months with a family who has dealt with trauma can experience number four above.
But she also might experience either one or two above, if, say, a violent client attacks a family member or even the therapist herself. Now, keep in mind that just because you are exposed to trauma does NOT mean you will necessarily have adverse effects. If you truly don’t, that’s great. However, if you do, that is also OK and normal. And treatable.
If you have been exposed to trauma as part of your profession and are experiencing symptoms of that exposure, the common practice is to categorize your situation based on the types of symptoms you have, along with the severity and frequency of those symptoms.
That’s where the terms Secondary Traumatic Stress, Burnout, Vicarious Trauma, and Compassion Fatigue come from. They are not categories in the DSM. Rather, they were generated by researchers who explored the impact of trauma on professionals. In and of themselves these terms are good and can help people understand their experience with work-related trauma.
However, in my work diagnosing trauma in clients and supervising professionals who were exposed to trauma in their work, over time I became confused and then concerned with how these definitions were applied to professionals. For example, we typically don’t diagnose or even discuss professional trauma using DSM criteria, such as Post-Traumatic Stress Disorder, because those terms have been reserved for the people we care for professionally.
It’s striking to me that some of the names we use for this issue related to professionals, such as Secondary Traumatic Stress or Vicarious Trauma, have an element of distance in them. As if the trauma experienced due to professional exposure is somehow less or minimized. After years of working with people who have experienced trauma in whatever form, I don’t believe the body, brain, or spirit differentiates how trauma is processed.
Meaning, you can experience the same symptoms from helping people who have faced trauma as those people themselves experienced. So if a counselor is treating soldiers who suffer from PTSD, he too may eventually develop some of the same symptoms. (I’ll cover how this happens in a future post.)
Additionally, there has been a stigma about a professional experiencing the impact of their work in trauma support. It can be seen as a sign of weakness or as the fault of the employee. Questions are asked about the worker’s self-care plan, and how often it’s implemented.
Concerns about workload or burnout can be brushed aside with “it’s part of the job.” People feel like they should be able to “handle” their jobs because it’s what they chose to do. I believe the terms we’ve tended to use, such as Vicarious Trauma, were developed with good intentions and were appropriate for the time in which they were researched, particularly given the stigma that exists.
Today, however, as we’ve learned more about the true impact of trauma on professionals, it’s becoming clear that these terms can diminish the real issue they face. So instead, I prefer to use an umbrella term for the impact of professional exposure that is more appropriate and allows for various forms: Provider Trauma.
Provider Trauma: A collective term for the consequent symptoms a professional may have from helping others who have experienced trauma.
In upcoming posts we’ll dive into symptoms of Provider Trauma and what to look for, and some ideas of what can help. In the meantime, let’s be clear. Provider Trauma is not the fault of the professional or a sign of weakness. It is a job hazard of working with clients/students/patients etc., who are traumatized. Your body and brain reacting and trying to protect you is normal.
You don’t have to try and figure this out alone, because you aren’t alone. Consider this statistic from “Tip 57: Trauma-Informed Care in Behavioral Health Services,” published by SAMHSA (Substance Abuse and Mental Health Service Administration): “Master’s level Social Workers report two times the rate of Post-Traumatic Stress Disorder as the general population of Massachusetts.” This is real, and there is research to back it up. More on that research in an upcoming blog post
Until then, take good care,