Paper to Practice: Vicarious Trauma Transcripts

To crime victim advocates, helping carry the weight of others’ traumatic experiences is seen as just part of the job. Due to this normalization around emotional stress and advocacy, research on secondary or vicarious trauma in advocates didn’t take off until more recently. The issue of vicarious trauma began to receive attention in the 90s. However, the research focused primarily only on the negative effects of trauma in counselors and therapists. There was still little known about the demanding work of advocacy and what may endanger or protect advocate’s wellbeing. So by the early 2000s, researchers studied just that. The results prompted federal funding from the US Office for Victims of Crime, to assist victim service organizations in addressing vicarious trauma by launching a groundbreaking project called The Vicarious Trauma Toolkit. This was the first federal acknowledgement of vicarious trauma and has since fueled dozens of other research projects. Vicarious or secondary trauma is exposure to stories of other people’s traumatic experiences or witnessing trauma in which you are not the primary victim or survivor. This indirect trauma exposure can include witnessing people suffering from violence, injury, severe illness. Having someone tell you about their own traumatic experiences or even reading about trauma. By nature of the work, nearly all crime victim advocates are exposed to the traumatic experiences of others. In 2016, researchers from the University of Nevada surveyed over a hundred advocates from across the US and found that over half displayed significant levels of secondary traumatic stress. Making experts in the field take pause and ask what is being done to help advocates resist being traumatized at work? Secondary traumatic stress is a type of vicarious traumatization that can result when exposure to someone else’s trauma causes negative mental, physical, spiritual, or work-related reactions. Vicarious traumatization is a natural response to being exposed to trauma that as many as half of all crime victim advocates experience. And one that can lead to serious consequences if not properly treated. Vicarious trauma also affects researchers or other educators who regularly come into contact with stories or details of trauma in other ways, such as reading books and papers about trauma and training first responders who share what they’ve witnessed in the field. Advocates may be especially vulnerable to vicarious traumatization if they are repeatedly exposed to detailed accounts of violence and abuse and to witnessing survivor’s immediate post traumatic distress and injury. Advocates who have directly experienced trauma themselves have negative workplace conditions like poor leadership and high workload and who provide short term crisis intervention services such as hotline specialists, without getting to witness the positive impact they’ve had on survivor recovery are at greater risk for vicarious traumatization. Vicarious trauma can result in the same symptoms of post-traumatic stress as experiencing direct trauma like hypervigilance, flashbacks, feeling numb or shut down, emotional regulation difficulty, sleep problems and even full blown PTSD. In fact, current diagnostic criteria from the American Psychiatric Association lists vicarious trauma as a potential cause of PTSD. Advocates experiencing vicarious traumatization may feel like they’ve lost their sense of trust or safety in the world and in their ability to help. Or that they’ve lost their sense of value and personal identity and can experience problems in their personal and professional relationships. Advocates have described how vicarious trauma affects both their personal and professional lives.

[Advocate #1] I don’t watch the evening news anymore. Whenever I see a dad with a daughter, I worry he’s a perpetrator.

[Advocate #2] I can’t tolerate interruptions at work. I just read all I can about prior cases in an effort to do my best for my clients. And I become irritable and withdrawn from colleagues and get angry about their flippant attitudes.

[Advocate #2] I’m anxious and frightened of being assaulted when walking to my car.

[Advocate #1] I go out less, and when I do, I no longer tell anyone what I do for a living. When my partner is late getting home, I fear the worst.

But the effects of working with trauma survivors aren’t all negative. People exposed to others’ traumatic experiences can also experience vicarious resilience or compassion satisfaction which refers to positive self growth that can happen as a result of working with trauma survivors. Advocating for trauma survivors can be deeply personal, rewarding and fulfilling work that gives advocates a sense of purpose and identity. So what can be done to promote these positive impacts of working with trauma survivors and prevent advocates from being traumatized at work? In 2020, a research paper looked at that question by systematically reviewing the existing research on vicarious trauma in those who work with children traumatized by abuse or neglect. This review confirmed the suspected high levels of vicarious traumatization in the majority of child welfare and protection workers. And identified many factors that can influence how advocates are affected by vicarious trauma, including what promotes advocate resilience. Lisa Tieszen is one of the authors on that research paper and an advocate and clinician whose expertise focuses on working with trauma exposed teams and organizations across the country. She helped reach the conclusion that while being exposed to the traumatic experiences of others is inevitable in victim advocacy, experiencing the negative effects of vicarious traumatization is preventable and treatable. Advocates can gain vicarious resilience when they observe resilience in their clients and help them overcome challenges. Compassion satisfaction can result when advocates feel they are able to do work efficiently and effectively help people. Advocates who have resources to recover from personal trauma, who are able to follow a client through their healing journey and who work in supportive organizations are more likely to experience positive outcomes like vicarious resilience and compassion satisfaction. Recent research has shown that levels of compassion satisfaction in advocates are just as high as levels of vicarious trauma and both can be present at the same time. Highlighting that despite the risks of vicarious trauma and victim advocacy, there are a great deal of rewards to doing such important work. If you’re experiencing vicarious traumatization, you’re not alone. And there are ways to get help. Since the effects of vicarious trauma are similar to those of direct trauma, the same supports that advocates direct to other trauma survivors too, can be useful for vicarious trauma as well, including therapy and support groups. However, while many recommendations for vicarious trauma focus on advocate self-care. Recent research has found that organizational factors like policies, practices and resources that impact an advocate’s ability to practice self-care and that foster wellbeing and resilience at work are critically important in addressing vicarious trauma. Vicarious traumatization can be prevented when organizations provide supports that promote vicarious resilience and compassion satisfaction, including creating supportive workplace environments that allow advocates to have a voice in decision making and the ability to give feedback to their supervisors. Policies for reporting and addressing negative workplace experiences, regular debriefing sessions to help advocates talk about difficult experiences and emotions, and offering mental health services and social support, while also creating an organizational culture that normalizes and encourages seeking help. For advocates with a personal history of trauma, organizations can prevent vicarious traumatization by acknowledging unique survivor advocate needs, fostering a sense of belonging in the work and honoring survivor advocate’s unique strengths. There are specific plans that organizations can follow to become vicarious trauma informed and prevent vicarious traumatization. In the next video, Lisa Tieszen will elaborate on ways to prevent the negative effects of vicarious trauma in victim advocacy. Visit the resource library to find the vicarious trauma toolkit, the advocacy education and support project and other resources for more information.

Dr. Apryl Pooley: “Hi, I’m Dr. Apryl Pooley, and you’re watching Paper to Practice. Today, we’re talking with Lisa Tieszen, an advocate and clinician whose expertise focuses on working with trauma-exposed teams and organizations across the country. Lisa has facilitated the Michigan Vicarious Trauma Response Collaborative, which includes a group of advocates and their supervisors working through implementing the Vicarious Trauma Toolkit together, and we are honored to have Lisa here to talk with us about the toolkit and about her work on a recent research publication titled “Vicarious traumatization among child welfare and child protection professionals: A systematic review,” published in the journal “Child Abuse & Neglect” in 2020.

Welcome, Lisa. Thank you for being here with us today.”

Lisa Tieszen: “Thank you so much for having me Apryl.”

Dr. Pooley: “I just wanted to start by asking a little about terminology. Your research review has the term “vicarious traumatization” in the title, but I’ve also heard the terms “vicarious trauma,” “indirect trauma,” “secondary trauma,” “secondary traumatic stress,” and “compassion fatigue”—are these terms all used interchangeably?”

Tieszen: “They are, and they have really confounded the field in ways, I think we’ve gotten way hung up on these terms and the distinctions. There are slight differences, but really what we’re talking about is work-related trauma exposure. Vicarious trauma being that exposure, and vicarious traumatization, secondary traumatic stress, compassion fatigue—all the negative impacts of work-related trauma exposure. So I think in some ways it’s even more useful just to call it that. But do recognize that out in the field, people are using the terms interchangeably.”

Dr. Pooley: “Okay thank you for that clarification. So vicarious traumatization can kind of be an umbrella term to talk about the negative effects of being exposed to other people’s trauma at work.”

Dr. Pooley: “I wanted to ask a little bit about the findings of that research review that looked at the rates of vicarious traumatization in people who work with children who have experienced trauma. How common is vicarious traumatization in this line of work?

Tieszen: “It’s very common, and it’s common both in child welfare/child protection specifically, as well as advocacy with survivors of domestic and sexual violence.

Dr. Pooley: “Is there a correlation between vicarious trauma and burnout in advocates?

Tieszen: “It can be. One thing I think is useful to recognize is that burnout can happen in any field. For those of us in the domestic and sexual violence world, and child welfare world, we’re exposed to traumatic events of others all the time, and that can lead to burnout. Or vicarious traumatization can lead to burnout itself.But burnout is really when we’re at the end of our road in a way. That we need to leave the work, we may need a leave of absence, we may need to actually leave the field for a period of time

Dr. Pooley: “Does vicarious trauma have an effect on staff and advocacy turnover–how long advocates are staying in their job or in the field?”

Tieszen: “Absolutely. And we’re seeing it even in more extreme now with covid and the impact on staff at all levels, but certainly on advocates and the demands on their time and energy. But we also can see in the research many risk factors that exist in the workplace that it can increase ones vulnerability to vicarious trauma. They include: isolation—being the only advocate in an organization, maybe working in isolated offices or isolated locations. Inadequate training and preparation for the job, inadequate supervision, not having supervision. Low self-efficacy. Role ambiguity—not knowing how far your job reaches is really important, and important to recognize how we need to be clear about the parameters of our job. Lack of independence, or lack of—as I said self-efficacy—the counterpart being micro-management. When we’re always micromanaged, and in a sense might feel controlled. That can also contribute.”

Dr. Pooley: “So it sounds like there’s been a lot of research on these risk factors of what leads to vicarious traumatization, or burnout or turnover in advocates. Are there signs of vicarious traumatization that advocates or their supervisors should be looking for in order to help themselves and their staff prevent this?”

Tieszen: “Absolutely. And I think it’s really important to recognize what organizations can do to both mitigate the negative impacts but also be paying attention to. When staff are not showing up, when they’re not showing up in a variety of ways. Bringing themselves into their work fully, not following up with survivors, not making the calls they need to make, not even showing up for appointments or meetings, can really be a sign of their own suffering. Isolating—their choice of isolating, closing their doors, not talking to other people, maybe it’s really an effort to stay focused to stay in the work, but it can really harm by being really on your own. So this not engaging with others, including not engaging with supervision., either pulling way back and isolating as I was describing, or overextending, which is really in direct contrast to that not showing up. Being pulled into the negative consistently, really focusing on the negative, and losing hope for clients and themselves. For survivors and themselves. All of those are important ways that supervisors and other leader, even peers, can be paying attention for their coworkers for the advocates really struggling.

Dr. Pooley: “And it seems important to recognize vicarious trauma because when you see an advocate maybe not showing up in some of these ways, instead of punishing them or doing some punitive measures at work, you can recognize that as a potential sign of vicarious trauma and offer them help so they can stay engaged in the work in a safe way.”

Tieszen: “Absolutely. And that’s where recognizing form the top down how much this work can impact us in the negative. And in multiple ways we’ll be talking about. But just really having a culture of acknowledging that this work is hard, it is challenging, and it can have a negative impact on any of us in the organization whether we are face to face with survivors all the time or whether we’re reviewing records, raising money for the organization, we all hear those stories, maybe a bit more removed but we are exposed to the harm that has been done to the survivors that come through our doors.

Dr. Pooley: “That’s something that’s been enlightening for me in learning about vicarious trauma is that it doesn’t just impact people providing direct services to trauma survivors, like you said, it can impact people going through records, raising money for the organization, just being around those trauma narratives is what can lead to vicarious traumatization. So it’s important for all people in an organization that provide services like this to be aware of the vicarious trauma.”

Dr. Pooley: So if someone is recognizing and realizing that maybe they are experiencing some of these signs of vicarious trauma, is there something that they can do? Or is there something an organization can do to more adequately respond to this?”

Tieszen: “Absolutely. Talk with your supervisor, if that supervisory relationship is one of trust and respect, that can become a place for talking about and being supported through some of the difficult impacts of the work. You can lay out what’s weighing on you, how it might be impacting your work, your life, your self. If you’re more comfortable talking with your peers, do it. And in fact, that can open the door to sharing experiences so that you and your colleagues can know that you’re not alone. And it may also being more of a dialogue across the team or across the organization, which I think is really important. That can then serve as a catalyst for change within the organization that it’s really okay to talk about this.”

Dr. Pooley: “What do organizations or leadership in organizations need to be thinking about and do in order to respond to vicarious trauma?”

Tieszen: “You know, I think that leadership acknowledging that the work has an impact on staff is pretty critical because unless from the top down, there’s acknowledgement that there are real challenges to this work in the negative, as well as the positive, but there’s recognition of the negative that can be addressed, that unless that’s happening, I believe that the impact, the negative impact, is minimized and made to be dismissed. And in fact, the single advocate who’s voicing struggles may be scapegoated. So it’s really important that the organization as a whole grabs onto it, acknowledges it, and begins to think about how will they, how with the organization better respond to staff, and that’s really through culture change. Culture that values each and every person on staff for who they are and what they bring to the organization. That respects their time, respects their personhood, one that prepares staff to do their job and provides ongoing training, professional development, and supervision. So those I would really emphasize here because I think there’s so much we expect advocates to do, and they do need to take care of themselves on and off work time, but organizations as well have pretty important responsibility in responding to this.”

Dr. Pooley: “Are there any specific resources that advocates or their supervisors can refer to for more information if they really want to start digging into this work of becoming a vicarious trauma-informed organization?”

Tieszen: “Absolutely. So the Vicarious Trauma Toolkit certainly is a resource, and there are tools about supervision, there are tools about peer support, and wide range of research articles, abstracts, policies and procedures, that people can dig into. And there’s an assessment tool for an organization to really look at where they are succeeding and where they may have some gaps to build up their efforts to become vicarious trauma informed. I also always encourage, within the toolkit, there is a link to TEND Academy. Colleagues in Canada have been doing a lot of great organization work and there are some great supervisory strategy resources in there as well as in the toolkit itself. And there are a number of powerpoints within the Vicarious Trauma Toolkit that could be useful in sharing this word about vicarious trauma and traumatization with your organization, across the organization. So they’re ready-made. There are notes there. So those two resources, and I guess what I would say is Trauma Stewardship is a book that many organizations have decided to read together, and it was written by an advocate and has really been a useful tool for book groups within an organization, so I would mention that as well.”

Dr. Pooley: “Absolutely. And we’ve talked a lot about the negative effects of vicarious trauma and how hard it can be, and how important it is to watch out for these things. But your review paper also mentioned, and you mentioned earlier, that not all of the effects of vicarious trauma are negative. Some people can experience what’s called vicarious resilience or compassion satisfaction. So what does that look like and is there anything advocates and organizations can do to promote those positive outcomes?”

Tieszen: “I love that question. And I’m so glad that you raised it. And we could spend a whole other interview on the positive impacts. We got into this work maybe not knowing how it would impact us. And many of us were not necessarily told of the negative or positive impacts. So knowing that we get good stuff from the work is really important because that also serves to buoy our spirits, our morale, our wellbeing. And we can then enhance that organizationally across the organization. So those terms are fewer, and maybe that’s good in some ways. But compassion satisfaction is about the satisfaction we get form doing the work. It’s feeling good about our job. Maybe about the one-to-one work with survivors. Maybe about a law we’ve gotten changed. Maybe a policy within our organization. It’s taking pride withing our work. Vicarious resilience, vicarious transformation, are more specifically about that engagement that we have with survivors and how we actually learn through that relationship. It’s not just about what we give, but it’s what we get, and it’s that exchange that can help transform us. The vicarious resilience, we’ve seen so much resilience in survivors, their hardiness, their ability to move forward and beyond some of what they’ve experienced, that we can be changed by that.

Dr. Pooley: “That was one of the things that really stood out to me when I was reading that research paper, that while vicarious trauma—being exposed to other people’s trauma—is inevitable in this line of work, experiencing those negative effects it’s not. And that is something that is preventable and treatable, and there are ways to promote those positive effects of doing the work that we’ve all gotten into this work because we care and we want to help.

Tieszen: “I’m really glad that our model represents the negative and positive, and neutral, impacts so that we can go through this work experiencing all of those. And by lifting up and acknowledging the positive, I think that helps the field continue to see the positive that’s happening.

Dr. Pooley: “Well and we’re grateful for you and the work you do, and that you were able to come talk with us today. I think that is a great positive note to end on, that there are ways to mitigate the negative impacts of vicarious trauma and strengthen our own mental and physical health and well-being to sustain us in this work. So thank you so much, Lisa, for being with us today.”

Tieszen: “Thank you so much for having me, and I appreciate the opportunity to share these results and keep talking together so that we can bring some of the negative out of the dark so we can address it and lift up that positive. Thank you.”