by Martha A. Gabriel, Ph.D
(August 2001)

Increasingly, attention has turned to identifying the consequences of trauma work on the human services practitioner. Given that social workers are major providers to populations of traumatized persons i.e., abused children, physically and sexually assaulted women, homeless men and women, new immigrants, persons with chronic mental illness and substance use, and those with life threatening illnesses, identifying the consequences of our listening to trauma narratives as well as witnessing the effects of trauma becomes essential to our survival as healthy individuals and professionals. Whether one conceptualizes the process of listening /witnessing trauma as; soul sadness, caregiver=s plight, co-victimization, emotional contagion, secondary trauma, compassion fatigue or vicarious trauma, some of the outcomes remain the same. That is to say, working with persons who have been traumatized puts the social worker at risk for trauma (Figley, 1995). Trauma work can be dangerous to the listener and to the witness and these dangers are such that the practitioner needs to be both informed of the risks as well as ways to minimize the harmful effects of trauma work.

Of the different named concepts, vicarious traumatization appears to be the most disturbing. McCann & Pearlman, (1990) in their examination of work with trauma survivors suggest that continued exposure to persons actively experiencing trauma may result in permanent shifts in the practitioner's cognitive schemata. These cognitive changes include heightened feelings of vulnerability, extreme sense of helplessness and or exaggerated sense of control, chronic suspicion about the motives of others, loss of a sense of personal control, loss of sense of freedom, chronic bitterness, cynicism and alienation. Vicarious trauma unlike countertransference is not thought to be a state that one "snaps out of" but rather a state that is cumulative and permanent …One in which a practitioner's view of self, world and future may be ultimately affected. From this vantage point, empathy, i.e., listening to clients' trauma related narratives is not without serious consequences. Such listening and witnessing may, as Janoff-Bulman (1992) observed, "shatter assumptions" we hold about our identity as helpers, our world of the view and our spirituality.

The social worker practitioner may be quite unaware of the effect of trauma work . And in fact, may first become aware through the reflections and observations of others: "you have become so cynical," "you use to be so trusting," "you always think the worse," "what happened to you, you seem so worried," and "you're so isolated, you only talk about work and the people at work." These observations and a variety of behaviors, for instance, increased substance use, chaotic relationships highlighted by pessimistic themes, and suspiciousness suggest that the vicarious traumatization of the practitioner is observed in behaviors that parallel the behaviors of primary trauma survivors, e.g., isolation, disconnection, mistrust. The impact of such trauma work appears to extend beyond the scope of both countertransference reactions and burnout. In fact some suggest that the impact may be one of possible permanent cognitive, personality and behavioral changes (Pearlman & Saakvitne,1995).

A variety of interventions have been suggested for disrupting the emerging process identified as secondary traumatic stress and vicarious traumatization. Such interventions include: supervision, consultation, personal therapy, guided imagery, eye movement desensitization, support groups, psychodrama groups, stress reduction programs, mediation and spiritual renewal. Other antidotes include personal activities referred to as "healing activities." These include exercise; time with family friends, and children; journal keeping; travel; and other actions intended to reconnect practitioners with their minds, bodies and support networks. Although each of these and/or a combination of these may provide some relief to the practitioner, what continues to be elusive is the precise identification and parameters of vicarious traumatization. How much exposure to trauma narratives or images put the social worker at risk?. What are the early signs of the cycle of vicarious traumatization?

Given the nature of vicarious trauma, particularly that its manifestations on the practitioner may go undetected, programs that demonstrate effectiveness in diminishing it are difficulty to formulate or implement. Presently, it would seem that the practitioner who has had continuous and intense exposure to trauma narratives and images would be best served by assuming a state of vicarious traumatization and pursue the interventions suggested.

Figley, C.(1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.

Janoff-Bulman, R. (1992). Shattered assumptions: Towards anew psychology of trauma. New York: Basic Books.

McCann, I. & Pearlman, L. (1990). "Vicarious traumatization: A framework for understanding the psychological effects of working with victims." Journal of Traumatic Stress. 3,(1), 131-49.

Pearlman, L, & Saakvitne, K. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivor. New York: Norton.

Martha A. Gabriel is an Associate Professor at New York University, Shirley M. Ehrenkranz Graduate School of Social Work. She is author of AIDS Trauma and Support Group Therapy: Mutual Aid, Empowerment and Connection, Free Press, 1996.