case study on vicarious trauma

ANITA RAVI, MD, MPH, MSHP, FAAFP, JESSICA GORELICK, LCSW, MA, AND HARIKA PAL, MD, PurpLE Health Foundation, New York, New York

Am Fam Physician. 2021;103(9):570-572

Author disclosure: No relevant financial affiliations.

Case Scenario #1

A 35-year-old patient, J.P., presented to my office with difficulty sleeping and anxiety about job performance. J.P. is a lawyer who started a position six months ago to assist unaccompanied minors seeking asylum. The patient has been feeling more anxious recently and worries that something might happen to the children in her family if she is not constantly watching them. J.P. has difficulty sleeping for more than three hours at a time and drinks as many as five cups of coffee during the day to combat low energy. I suspect that the patient's work might be causing these symptoms, but what is the best and most efficient way to confirm the source of J.P.'s stress?

Case Scenario #2

Earlier this year, my colleague, L.R., led an initiative at our clinic to integrate medication-assisted treatment for substance use disorder. L.R. often provides staff training sessions on this topic and incorporates stories of people who have experienced addiction and overdose as an educational tool. My colleague has recently been asking for last-minute coverage on their clinic days and has been increasingly delayed in closing charts. Staff have mentioned that L.R. has become uncharacteristically impatient and irritable. When they ask whether there is anything wrong, L.R. brushes off their concern, saying, “Everything is fine. My patients have it much worse than me.” What is the best way to approach my colleague about these changes in behavior?

Many people, including health care professionals, law enforcement professionals, journalists, and lawyers, may encounter situations that result in secondhand exposure to trauma. Often, family physicians are vicariously exposed to the trauma of their patients as they share stories of domestic violence, war, gun violence, child abuse, homelessness, and life-changing diagnoses, including cancer and COVID-19. These clinical experiences can be compounded by other forms of witnessed trauma, including exposure to repeated violence portrayed in the news and social media. Chronic exposure to secondhand trauma can lead to vicarious trauma, whereby an individual internalizes the emotional experiences of others as though that individual had personally experienced them. Vicarious trauma can result in a change of worldview and disturb a person's sense of justness and safety of the world. See the Office for Victims of Crime toolkit 1 for a glossary of terms related to vicarious trauma ( https://ovc.ojp.gov/program/vtt/glossary-terms ). Unaddressed vicarious trauma can compromise a physician's ability to provide care or professional services and can affect their own personal health and relationships.

Risk Factors and Symptoms

Vicarious trauma is part of a spectrum of responses to trauma exposure, including secondary traumatic stress, caregiver fatigue, compassion fatigue, and burnout. These conditions have varying definitions and categorizations, with overlapping symptoms, diagnostic criteria, and management strategies. 2 , 3

Several personal and professional issues may predispose an individual to developing vicarious trauma. Factors that increase risk include a personal history of trauma, negative coping behaviors, a lack of social support, instability in non–work-related areas of one's life, and working with patient populations who disproportionately experience trauma. 1 Issues in the professional environment can also increase vicarious trauma vulnerability, such as excessive workload, unclear scope of work, and dissonance between institutional public-facing commitments to vulnerable populations and internal policies and incentives. 3

Vicarious trauma symptoms can manifest in one's professional and personal life. For example, a physician who is usually affable and empathetic may become increasingly irritable toward patients and colleagues, distant with family and friends, or overprotective in parenting. Health care–related manifestations can include excessive worrying (e.g., that a patient missed an appointment because they are hurt or have died), delays in completing the charts of patient encounters that involve upsetting stories, overreacting to unexpected environmental noises (e.g., overhead pages in the clinic, telephones ringing in examination rooms), experiencing visual images of examining an abuse-related injury in a setting outside of work, or finding it difficult to watch previously tolerable entertainment (e.g., shows or movies involving crime and violence). Symptoms of vicarious trauma are similar to those of posttraumatic stress disorder, with domains of intrusive thoughts, avoidant behaviors, and alterations in arousal. 4 The Secondary Traumatic Stress Scale is a validated 17-item questionnaire that was developed to measure symptoms associated with the indirect exposure to traumatic events because of one's professional relationships with traumatized individuals ( Figure 1 ) . 4 This scale can be used to evaluate vicarious trauma–related posttraumatic stress disorder. 5

Management and Prevention

We discuss a variety of tools and techniques that are available for physicians and health care systems to address vicarious trauma with patients, colleagues, and staff.

CASE SCENARIO #1

When addressing vicarious trauma with patients, as in Case #1, it is helpful to obtain a more detailed history, including the duration and range of symptoms. Introducing the topic of vicarious trauma can facilitate patients' insight into factors driving symptoms and foster a path toward addressing underlying causes. The Secondary Traumatic Stress Scale can be used to elicit symptoms and as a tool to educate and facilitate discussion on vicarious trauma. 4 Engaging in therapy is critical in managing vicarious trauma, particularly given the vast effect trauma symptoms can have on mental health. As patients initiate the sometimes protracted process of connecting with mental health services, routine primary care approaches can be used to manage acute, disruptive vicarious trauma symptoms, including coaching on sleep hygiene techniques for insomnia and reviewing strategies for alleviating anxiety. If indicated, physicians can also support their patients by facilitating workplace accommodations to decrease the exposure and/or impact of vicarious trauma or in securing medical leave.

CASE SCENARIO #2

Taking the initiative to address vicarious trauma with a colleague, as in Case #2, can be challenging. Because vicarious trauma can coexist with or exacerbate other conditions with similar workplace behavior manifestations, including depression and substance use disorder, 6 its presence may be difficult to confirm. Approaching a colleague who you suspect is having vicarious trauma can include taking time to communicate and listen in a private setting and/or helping your colleague connect with Balint groups or similar regular gatherings where physicians can discuss complex issues that arise during clinical encounters. 7 Individuals experiencing vicarious trauma may not recognize that their difficulties are related to their occupational trauma exposure, potentially leading to defensiveness or embarrassment, particularly when raised by a team member. In such cases, methods of support that directly address the colleague's daily workload may be helpful, such as encouraging strategic scheduling. This can involve anticipating and limiting the number of emotionally challenging cases during a clinic session and deliberately scheduling such visits at times when the physician feels the most equipped with emotional reserve and ability to focus, such as the first or last visit of a session. Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others offers practical strategies for personal and professional approaches to manage vicarious trauma. 2

System-level change is important in preventing and addressing vicarious trauma because all staff, including front-office employees, interpreters, and physicians, can be affected. Health care organizations should provide training to increase vicarious trauma awareness and inform employees of its various manifestations and specific strategies to prevent and combat it. Ensuring that all staff have adequate supervision and support is essential; organizational policies and procedures that ensure staff have well-balanced patient panels, paid time off, and access to mental health resources are also important. 8 Toolkits and resources to promote organizational trauma responsiveness are available from the Office for Victims of Crime. 1

Vicarious trauma is an occupational hazard for those in “helping professions,” including family physicians. Recognizing and addressing the signs and symptoms of vicarious trauma, while engaging in organizational efforts for its prevention and mitigation, will potentially promote the health of individuals and quality of patient care.

Office for Victims of Crime. Vicarious trauma toolkit: what is vicarious trauma? Accessed October 10, 2020. https://ovc.ojp.gov/program/vtt/what-is-vicarious-trauma

van Dernoot Lipsky L, Burk C. Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others . Berrett-Koehler Publishers; 2009.

Jenkins SR, Baird S. Secondary traumatic stress and vicarious trauma: a validational study. J Trauma Stress. 2002;15(5):423-432.

Bride BE, Robinson MM, Yegidis B, et al. Development and validation of the Secondary Traumatic Stress Scale. Res Soc Work Pract. 2004;14(1):27-35.

Kintzle S, Yarvis JS, Bride BE. Secondary traumatic stress in military primary and mental health care providers. Mil Med. 2013;178(12):1310-1315.

Fitzgerald RM. Caring for the physician affected by substance use disorder. Am Fam Physician. 2021;103(5):302-304. Accessed March 18, 2021. https://www.aafp.org/afp/2021/0301/p302.html

Benson J, Magraith K. Compassion fatigue and burnout: the role of Balint groups. Aust Fam Physician. 2005;34(6):497-498.

Bell H, Kulkarni S, Dalton L. Organizational prevention of vicarious trauma. Fam Soc. 2003;84(4):463-470.

Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to [email protected] . Materials are edited to retain confidentiality.

This series is coordinated by Caroline Wellbery, MD, associate deputy editor.

A collection of Curbside Consultation published in AFP is available at https://www.aafp.org/afp/curbside .

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A Causal Model of Children’s Vicarious Traumatization

Stephenie howard.

School of Social Work, Howard University, Washington, DC 20059 USA

Children may be vicariously traumatized from learning about the trauma of family and friends. To date, a causal model of children’s vicarious traumatization has not been empirically validated in the literature. This paper fills the gap in the literature by reporting on the direct effect of vicarious trauma on children independent of caregiving impairment. Data for the study came from the National Survey of Children’s Exposure to Violence I (NATSCEV I). This unique dataset features two indicators of vicarious trauma exposure: (1) family victimization and (2) community violence. Hierarchical multiple regression was conducted in order to control for nuisance variables such as caregiver impairment, defined as the degree of warmth or hostility; time elapsed since the trauma occurred and the study taking place; and other trauma exposure (i.e. direct and witnessed trauma). As expected, the study found evidence of a direct and positive relationship between learning about the trauma of close friends and family and children’s trauma symptomatology. Both adolescents and young children were found to be vulnerable to experience vicarious traumatization, with gender and ethnicity being contributing factors. Chronological age was not found to be significant in children’s vicarious traumatization. These findings support the causal model of vicarious traumatization. They demonstrate that children may be traumatized by exposure to the trauma material of others above and beyond the influence of caregiver impairment. As such, attention should be given to interventions, practices, and policies that intervene in the lives of children exposed to violence.

The leading adult model of vicarious traumatization assumes there to be a causal relationship between empathetically engaging in the trauma material of others and experiencing traumatic stress (Figley 2002 ). It is believed that exposure to the pain and suffering of others causes traumatization in adults. In contrast, the leading child model of vicarious traumatization implicates caregiver impairment in children’s pathology (Scheeringa and Zeanah 2001 ). Scheeringa and Zeanah ( 2001 ) assert that parent and child posttraumatic symptomatology may be associated by “a combination of moderating and vicarious traumatization effects” (p. 809). In this model, both the caregiver and the child are traumatized, and the symptomatology in one exacerbates that in the other. The caregiver’s trauma response prevents them from responding sensitively to their child’s needs, resulting in further psychological injury to the child. As such, vicarious trauma is thought to have a compounding effect on children’s reactions to a primary trauma.

While Scheeringa and Zeanah ( 2001 ) posit that children’s vicarious traumatization may be moderated in part by impaired caregiving, there is extant evidence to suggest that the trauma material of friends and family may directly traumatize children. There are case studies (Terr 1990 ) and qualitative research (DeVoe and Smith 2002 ; Thornton 2014 ) which demonstrate that, like adults, children may identify with a victim and experience traumatic stress. Still, to date, no causal model of children’s vicarious traumatization has not been put forward or empirically validated in the literature. The purpose of this paper is to fill this gap in the literature.

This paper elaborates on a causal model of children’s vicarious traumatization and the findings of a secondary data analysis testing its underlying assumptions. This study did not test the full causal model due to limitations in the data collection procedures of the primary study. The secondary data analysis examined exposure to vicarious family and community trauma, age, socioeconomic status, gender, and ethnicity as predictors of trauma symptoms among children and adolescents, while controlling for time elapsed since the trauma occurred, witnessed and direct trauma, and parental warmth and hostility.

Data for this study came from the National Survey of Children’s Exposure to Violence I (NATSCEV I). The findings of this study do not refute the moderation model of children’s vicarious traumatization but rather support and expand it. The moderation model assumes, in part, that there is a direct relationship between vicarious trauma exposure and trauma symptoms in children. This study provides this evidence. It also broadens the range of primary victims whose trauma may traumatize children. This paper will elaborate on the practice and policy implications that arise from these findings.

Conceptual Definition of Vicarious Traumatization

Traumatic responses came to the forefront of scholarly attention in response to World War I veterans returning from combat with impairment in emotional and behavioral regulation (Jones and Cureton 2014 ). Examination of this population led to the conclusion that adverse experiences have the potential to produce impairment in social and emotional functioning. This observation resulted in the inclusion of posttraumatic stress disorder (PTSD) in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (Brewin et al. 2009 ; Jones and Cureton 2014 ). Trauma was then defined as “an event ‘existing outside the range of usual human experience’” (as cited by Jones and Cureton 2014 , p. 258).

Later iterations of the DSM brought a more inclusive exposure criterion for PTSD to include a range of adverse events such as car accidents and natural disasters (Jones and Cureton 2014 ). The diagnostic criteria entailed the presence of at least six of seventeen symptoms accompanied by a subjective response of intense fear, helplessness, or horror (APA, 2000 ). The subjective response criterion was later removed in recognition of the fact that trauma reactions may not accompany fear, helplessness, or horror (APA, 2013 ). The DSM IV also expanded the scope of the trauma exposure criterion to include that which is not personally or directly experienced (Brewin et al. 2009 ). The language indicated that “events experienced by others that are learned about” may produce PTSD (APA, 2000 , p. 464). The latest revision of the text further expanded on the construct of trauma by adding “experiencing repeated or extreme exposure to aversive details of the traumatic event” as possible subsets of trauma exposure (APA, 2013 , p. 271). This version also added a preschool subtype of PTSD, which modified the exposure criterion and limited it to traumatic events that occurred to a parent and are indirectly learned about (APA, 2013 ).

The addition of trauma that is indirectly learned about as a subset of the exposure criterion in the DSM 5 was the product of extensive research in the area of vicarious traumatization. Researchers observed that trauma workers may become emotionally overwhelmed by repeated exposure to trauma material. Formerly, this phenomenon was referred to as compassion fatigue (McCann and Pearlman 1990 ). McCann and Pearlman ( 1990 ) posited that vicarious traumatization goes beyond compassion fatigue, resulting in cognitive changes in the therapist’s worldview similar to that observed in primary trauma victims. In recent years, the concept of vicarious trauma has been expanded to and studied among trauma workers across a wide spectrum to include social workers, fire fighters, police officers, and judges (Figley 2012 ), as well as laypersons exposed to the trauma material of family and friends (Feldman and Kaal 2007 ; Scheeringa and Zeanah 2001 ; Smith et al. 2014 ; Weinberg 2011 ).

Vicarious traumatization is defined as a transformation in cognitive schemas and imagery systems (McCann and Pearlman 1990 ) as a result of empathetic engagement with the trauma material and sequelae of others (Pearlman and Mac Ian 1995 ). Empathetic engagement entails “listening to descriptions of horrific events, bearing witness to people’s cruelty to one another, and witnessing and participating in traumatic reenactments” (Pearlman and Mac Ian 1995 , p. 558). Trauma material and sequelae include “trauma survivors’ terrifying, horrifying, and shocking images, strong, chaotic affect, and intrusive traumatic memories” (Jenkins and Baird 2002 , p. 423). Cognitive transformations as a product of vicarious traumatization may be particularly evident in the areas of trust, safety, intimacy, control, and self-esteem (Jenkins and Baird 2002 ). These changes may be expressed as trauma symptoms: symptoms of intrusion, avoidance, negative alterations in mood, and/or alterations in arousal and reactivity (Aparicio et al. 2013 ). Notably, vicarious traumatization is not a mental illness, though it can be expressed as such.

Review of the Literature on Children’s Vicarious Traumatization

A review of the literature on the effect of vicarious trauma exposure on children’s mental health found that most studies rely on a moderation model similar to that put forward by Scheeringa and Zeanah ( 2001 ). These studies implicate caregivers in children’s vicarious trauma symptomatology. As a result, there is a dearth of research on the direct effect of vicarious trauma exposure on children. A review of the literature only found three prior sources examining or reporting on children’s vicarious traumatization independent of caregiver impairment (DeVoe and Smith 2002 ; Terr 1990 ; Thornton 2014 ).

Terr ( 1990 ) described four cases from the field in which children presented with significant trauma symptoms in response to the trauma of others. As one example, Terr reported on Timothy Donnario, a five-year-old boy who was referred to therapy following the tragic kidnapping of his peers. After learning that he had narrowly escaped the fate of his peers who were kidnapped moments after they exited the school bus they had been riding together, Timothy began demonstrating symptoms of avoidance and anxiety consistent with trauma exposure. Another case is that of two-year-old Winifred, who was not present at the time of her sister’s tragic death but, following repeated exposure to the details by family members who witnessed the trauma firsthand, began experiencing vivid memories and spontaneously recreating the traumatic event (Terr 1990 ). These cases, as well as two others reported by Terr, provide compelling evidence that children may have traumatic reactions to the trauma material of others.

In the area of empirical research, DeVoe and Smith ( 2002 ) convened focus groups to examine the impact of domestic violence on urban preschool children from the perspectives of their mothers. From five focus groups, the researchers found evidence that the women’s children were not only acutely aware of the violence in their home, but also deeply impacted by it. They described the violence as an omnipresent tension in the home. The women also suggested that, when their children did not witness the violence, they filled in the gaps using their imagination, resulting in exaggerated fears. This study provided moving testimony that children encounter violence in the home as a trauma, whether or not they witness the abuse.

Thornton ( 2014 ) added to the literature a qualitative study of eight children aged four to nine living in homes with domestic violence. Using projective play and drawing assessments to examine the emotional worlds of study participants, the researcher observed that violence in the children’s homes was ever-present. Distressing material that the children confronted on a regular basis included injuries to the victim, the intense affect of the victim, physical damage to property, and disruptions in relationships and family dynamic. The researchers concluded that violence that is indirectly learned about is a traumatic stressor that lingers in the home and affects children’s functioning over time.

Based on the literature on children’s exposure to violence and trauma, this researcher developed a causal model of children’s vicarious traumatization. See Fig. 1 for a visual representation of the causal model of children’s vicarious traumatization. Similar to the adult model, it posits that children are vulnerable to experience vicarious traumatization by virtue of their ability to empathize with others (Figley 2002 ). According to Hoffman’s ( 2001 ) theory of empathy development, empathy is an inborn tendency that may be apparent as early as a few hours following birth and maturates through adulthood following a three-step process: 1) egocentric empathetic distress, 2) quasi-egocentric empathetic distress, and 3) veridical empathetic distress. Hoffman indicated that children toward the end of their first year of life may display egocentric empathetic distress in response to the distress of others (e.g. crying). These toddlers may not be able to distinguish between their self and others and may demonstrate personal distress in response to that of others. As toddlers mature, they become increasingly aware of the causes and consequences of emotions as well as the relationship between feelings and facial expressions. As such, they are able to make inferences regarding the distress of others based on a range of cues (e.g. crying, facial expressions, affect, injuries, words, context) and to internalize these messages as evidence of personal distress (Hoffman 2001 ). Children as young as one year old have been reported in the literature as demonstrating empathetic responses to the distress of caregivers, strange children (Geangu et al. 2010 ; Hoffman 2001 ; Roth-Hanania et al. 2011 ; Zahn-Waxler et al. 1977 ), and siblings (Dunn and Kendrick 1982 ).

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The Causal model of children’s vicarious traumatization

According to Hoffman’s ( 2001 ) theory of empathy development, by the middle of the second year, children may have developed a sense of self such that they can focus on others’ distress and take their perspective without eliciting personal distress responses. This stage may continue to develop as the child matures. However, when the distress is intense or prolonged, older children and adults may regress back to egocentric empathetic responses (Geangu et al. 2010 ; Roth-Hanania et al. 2011 ). Thus, when exposed to traumatic material, they may experience vicarious traumatization.

Because infants and young children are more likely to have ego-centric empathetic responses, they may also be more vulnerable to experience vicarious traumatization. Older children and adults, on the other hand, have more mature cognitive abilities. They can understand “themselves and others as separate physical entities with independent internal states, personal identities, and lives beyond the situation and can therefore distinguish what happens to others from what happens to themselves” (Hoffman 2001 , p. 63). As such, they may be less vulnerable to over-identify with others trauma victims or to experience vicarious traumatization (Ancharoff et al. 1998 ; Harkness 1993 ).

Children’s exposure to trauma material may include overhearing the details of the trauma narrative (Dalgaard et al. 2016 ), witnessing the aftermath of the violence, observing injuries or bruising on the victim (Thornton 2014 ), and/or unwittingly participating in trauma reenactments (Ancharoff et al. 1998 ). The manner in which the trauma is communicated to children may vary and influence children’s symptomatology (Dalgaard et al. 2016 ; DeVoe and Smith 2002 ). Children’s mental representations of the incident form and are stored as memories, which may be re-experienced in their mind, in play, behavior and/or in storytelling (Pillemer et al. 2015 ). As with children who are directly exposed to trauma, their re-enactments or re-experiencing symptoms may or may not be accompanied by evidence of distress (APA, 2013 ; Miller-Graff et al. 2015 ). Additional trauma response patterns may be weighted by child intrinsic and extrinsic factors (e.g. the child’s social supports, age or developmental stage, ethnicity, gender, temperament, coping skills; National Children’s Traumatic Stress Network Core Curriculum on Childhood Trauma Task Force, 2012).

Study Question and Theoretical Framework

This author conducted a study to test part of the causal model of children’s vicarious traumatization as described above. Due to limitations in the data collection procedures of the primary study, this study was not able to test the full model. This study explored the following three research questions:

How many children in the study sample have experienced vicarious trauma in their lifetime?
While controlling for time elapsed since the trauma occurred, witnessed and direct trauma, and parental warmth and hostility, which set of factors best predicts trauma symptomatology in the study population: exposure to vicarious community trauma, exposure to vicarious family trauma, age, socioeconomic status, gender, or ethnicity among children and adolescents?
How does the child’s age group (i.e. young child or adolescence) impact the strength of the relationship between vicarious trauma exposure and trauma symptomatology in the study sample?

This study was undergirded by constructivist theory (McCann and Pearlman 1990 ; Pearlman and Mac Ian 1995 ) and Hoffman’s ( 2001 ) theory of empathy. Constructivist theory holds that one’s worldview is created by interactions with the social environment, as mediated by one’s cognitive schemas (Deering 2000 ; Kondrat 2002 ; McCann and Pearlman 1990 ; Michalopoulos and Aparicio 2012 ). From this perspective, vicarious traumatization occurs through a process of empathetic engagement with the trauma material and sequelae of others that is incongruent with one’s pre-existing cognitive schemas, resulting in maladaptive changes in cognitions (Michalopoulos and Aparicio 2012 ). Hoffman’s ( 2001 ) theory of empathy development informs this study that empathy is an inborn tendency that matures over time. Thus, all children are vulnerable to experience vicarious traumatization but, the impact may be graded by the child’s age.

Data for this study came from the National Survey of Children’s Exposure to Violence (NatSCEV I; Finkelhor and Turner 2008 ). The study was sponsored by the Office of Juvenile Justice and Delinquency Prevention, part of the U.S. Department of Justice, Office of Justice Programs and was supported by the Centers for Disease Control and Prevention (Finkelhor et al. 2009b ). The National Survey of Children’s Exposure to Violence was conducted between January and May 2008. Procedures for the secondary data analysis were approved by the Institutional Review Board at [removed for blind review].

Participants and Procedure

The primary researchers for NatSCEV I reported that participants were selected from a list of residential telephone numbers that were randomly generated. Households located in the contiguous United States excluding New Hampshire with children aged 0–17 were eligible to participate (Finkelhor et al. 2009a ). Because minorities are underrepresented in the general population, oversampling was utilized to increase the representation of African American, Hispanic, and low-income households. The oversample group was also sampled through random-digit dialing. The final sample population consisted of 4549 children between the ages of zero and seventeen years old with 70% or greater African American, Hispanic, or low-income households. The cooperation rate for the nationally representative group was 71%, with a response rate of 54%. The oversample group indicated slightly less cooperation at 63%, with a response rate of 43%. Researchers conducted nonresponse analysis and found that the risk of victimization for those that opted out or were unavailable did not differ systematically from those that participated (Finkelhor et al. 2009b ). The subsequent sample ( n = 4549) included a diverse selection of participants by age, gender, and ethnicity (Finkelhor et al. 2009a ).

The secondary analysis excluded children under two years old because they were not asked comparable questions regarding trauma symptoms to that of their older counterparts. The remaining sample was children ages 2 to 17, for a final sample size of 4046 ( n = 4046). The sample size was large enough to provide sufficient statistical power for robust analysis. Young children under the age of 10 ( n = 1951) and adolescents ( n = 2095) were approximately equal in size.

Accounting for missing values, the total number of valid cases for analysis was 3816 ( n = 3816). Of the total sample analyzed, 5.7% was missing data. See Table Table1 1 for details regarding the demographics of the sample. Just over half of the sample population, 55%, were White, 20% were Black, 20% were Hispanic, and 5% were Other. Half of the sample were male, and the other half were female. Fifty four percent of the sample were young children (between the ages of two and nine), and 46% were adolescents (aged 10 to 17). The unweighted mean household income for the sample population fell between $30,000 and $40,000, with an average of two children in the home.

Total number of valid cases by Demographics

The independent variable for this study was vicarious trauma exposure, defined as indirectly learning about the violent victimization of others (Jenkins and Baird 2002 ; McCann and Pearlman 1990 ; Michalopoulos and Aparicio 2012 ; Pearlman and Mac Ian 1995 ). This study featured two indicators of vicarious trauma, the violent victimization of close friends and family (vicarious family trauma) and community violence (vicarious community trauma). Researchers used an enhanced version of the Juvenile Victimization Questionnaire to operationalize exposure to trauma and PTSD symptomatology (Finkelhor et al. 2009b ). Nine items asked respondents to indicate if the child heard about the victimization of others. Responses for these items were yes, no, not sure, or refused. In addition to the individual totals, a composite variable was calculated for vicarious trauma exposure to community violence and another for vicarious trauma exposure to family violence. This measure was shown to have strong construct validity for PTSD symptomatology and adequate test-retest reliability. The primary researchers conducted a small assessment of test-retest reliability and found agreement among the two administrations for 95% of the screener endorsements with a range for items from 79 to 100% (Finkelhor et al. 2005 ). A test of Cronbach’s Alpha also demonstrated that the measure had strong coherence in assessing victimization with a value for total victimization of 0.93 (Finkelhor et al. 2005 ). In addition to the individual totals, a composite variable was calculated for vicarious trauma exposure to community violence and another for vicarious trauma exposure to family violence.

Trauma symptomatology was the dependent variable under investigation and was assessed using the Juvenile Victimization Questionnaire, which was previously described. This tool used a four-point Likert scale consisting of “not at all, sometimes, often, and very often” and asked respondents whether they had experienced the identified symptoms within the last month. Nonresponses of not sure and refused were also included. Twenty-five questions related to trauma symptoms for young children and 28 for adolescents. Composite scores were developed for the trauma symptoms variables. The validity of this tool for trauma symptoms has been supported by moderate correlations as assessed by Cronbach’s Alpha. The Cronbach value for total distress score was 0.93 (Finkelhor et al. 2005 ).

This study sought to evaluate the direct effect of vicarious trauma on children independent of caregiver impairment or other trauma exposure and time elapsed. For control variables, this study used perceived parental warmth or hostility towards their children, which were continuous data assessed by Likert scales. They were thought to capture caregiver impairment. Questions asked respondents to report on how often they engaged in behaviors reflective of these qualities. This study also held time elapsed since the trauma occurred and direct and witnessed trauma constant. Time elapsed (in years) since the trauma occurred were new control variables created for the purpose of this study by subtracting the participant’s age at the time that the trauma occurred from the child’s age at the time of the primary study. Direct trauma was conceptualized as any physical or sexual assaults that occurred to the child. Witnessed trauma was any violent victimization that occurred to others that were observed firsthand by the child. Both witnessed and direct trauma were treated as binary questions (i.e. yes or no).

Demographic variables served as predictors. Gender was conceptualized as the child’s gender (male or female). Age referred to the child’s age at the time of the primary study. Ethnicity was conceptualized as White, Black, Asian, American Indian, Alaskan Native, Native Hawaiian, Pacific Islander, or other. Socioeconomic status was a variable computed by the primary researchers by calculating the sum of the standardized scores of the child’s household income and the highest level of parent/partner education (Finkelhor and Turner 2008 ).

Data Analysis

Because this study was interested in understanding the direct effect of vicarious trauma exposure on children, multiple regression was selected as the method of data analysis (Allison 1999 ). To correct for non-sampling and oversampling biases in the final sample, weights were entered in the equations for weighted least squares analysis (Abt SRBI 2008 ). The researcher used hierarchical regression procedures to control for factors other than vicarious trauma that impact trauma symptoms (i.e. caregiver impairment and other trauma exposure; Lewis et al. 2013 ; Petrocelli 2003 ). The forced method of data entry was also used to allow for theory testing (Petrocelli 2003 ). Given that the data followed a random order (Finkelhor and Turner 2008 ), missing data was handled using the means imputation method to retain statistical power (Raaijmakers 1999 ; Schafer and Graham 2002 ; Schlomer et al. 2010 ). Because children under the age of 10 were asked different questions regarding trauma symptoms and exposure than adolescents, separate but similar models were developed for young children and adolescents. The researcher sought to examine the differences in regression coefficients that each model yielded in order to draw inferences regarding how age impacted the strength of the relationship between vicarious trauma exposure and trauma symptomatology.

The order of variable entry was based on theory and research, and the focus of analysis was on the change in predictability of the variables entered later in the analysis over and above that contributed by predictors previously entered (Lewis 2007 ). The regression models entailed four steps based on their theoretical position and following causal priority (Petrocelli 2003 ): (1) In the first block, best practices in mental health research dictate that demographic variables (gender, age, ethnicity, and SES) be entered into the equation (Petrocelli 2003 ). The time elapsed variables were also forced into the equation at the first step. In the second step, known predictors of trauma symptoms from extant research (i.e. direct and witnessed trauma) were entered as control variables. Because this study was interested in understanding the direct effect of vicarious trauma on children independent of caregiver impairment, caregiver warmth and hostility were entered as controls in the third step. In the fourth and final step, the researcher entered vicarious family and community violence into the equation.

Rates of Vicarious Trauma Exposure

See Table Table2 2 for a breakdown of rates of vicarious trauma exposure by type of trauma and demographics. Twenty-nine percent of the sample population reported some vicarious trauma exposure ( n = 1094). Rates of family vicarious trauma exposure were the same (3%) across all demographic groups except age, which was 2% for young children and 4% for adolescents. Vicarious community violence was significantly more prevalent among adolescents at 40% than it was among children at 8%. Black children overall were observed to have higher rates of community violence exposure (35%) than Other children (29%), Hispanic children (23%), or White children (23%). Girls had slightly higher rates of community violence exposure than did boys (27% and 24%, respectively).

Rates of vicarious trauma exposure by Demographics

*Unweighted percentages

Young Children’s Multiple Regression Analysis

For the children’s regression model, the assumptions for multiple regression were evaluated. The data met the assumptions after transforming the criterion variables to approximate normality. See Table Table3 3 for the young children’s regression model and Table Table4 4 for a list of the significant factors. The analysis indicated that all factors were statistically significant except for age. The full model significantly predicted young children’s trauma symptomatology. Overall, the model explained 93% of the variance in the criterion (R = .96). Only 7% of the variance in young children’s trauma symptomatology were unaccounted for by the model. The model that included vicarious trauma exposure was a better overall fit. The overall effect size for the full model using Cohen’s f 2 was very large (Abu-Bader 2011 ). Vicarious trauma exposure, as a whole, had a statistically significant influence on the model (F (df = 2, 1932) = 241.910, p < .001), contributing an additional 1.8% in explaining the variability in the criterion. With a beta of .14 (p < .001), vicarious community trauma was a stronger predictor of children’s trauma symptoms than was family vicarious trauma with a beta of .03 ( p < .01).

Young children’s hierarchical multiple regression model summary

a Adjusted R 2

Multiple regression analysis—predictors of children’s trauma symptomatology

*Significant at the .01 level

**Significant at the .001 level

Adolescents’ Multiple Regression Analysis

For the adolescents’ regression model, the assumptions for multiple regression were evaluated. The data met the assumptions after transforming the criterion variables to approximate normality. See Table Table5 5 for the adolescents’ regression model and table six for a list of significant factors. All of the factors in the adolescent model, with the exception of age and the time elapsed variables, were observed to be statistically significant predictors in adolescents’ trauma symptomatology. The results of the hierarchical regression analysis indicated that the full model significantly predicted adolescents’ trauma symptomatology, explaining 29% of the proportion of variance in the criterion (R = .54). This means that 70% of the variance was still unaccounted for by the model. Vicarious trauma exposure accounted for 2.3% of the variance in the criterion (F (df = 2, 2076) = 34.091, p < .01). The overall effect size for the full model using Cohen’s f 2 was moderate (Abu-Bader 2011 ). Vicarious community trauma emerged as a stronger predictor of adolescent trauma symptomatology than did vicarious family trauma (ß = 15%, p < .001 and ß = 6%, p < .01, respectively) (Table (Table6 6 ).

Adolescents’ hierarchical multiple regression model summary

Multiple regression analysis—predictors of adolescents’ trauma symptomatology

This study found vicarious trauma exposure to be prevalent, with almost 30 % of the children reporting that they learned about the victimization of a close friend or family member in their lifetime. Vicarious community trauma exposure was found to be significantly more prevalent in the sample than was vicarious family trauma. Though, this finding should be interpreted with caution. It is possible that family violence was underreported because of its sensitive nature and the possibility of legal ramifications for the family (Agüero and Frisancho 2017 ).

While family vicarious trauma exposure was relatively stable across gender, ethnicity, and age group, this study found that these demographic variables influenced the likelihood of vicarious community trauma exposure. These findings were consistent with extant studies on children’s exposure to community violence. Girls were observed to have higher rates of community violence exposure (Horowitz et al. 1995 ; Rojas-Gaona et al. 2016 ). Black youth also had the highest levels of vicarious community trauma exposure compared to all other ethnic groups (Roberts et al. 2011 ; Turner and Lloyd 2003 ). And, adolescents reported significantly higher rates of vicarious community trauma exposure than did young children (Rojas-Gaona et al. 2016 ).

Children’s Vicarious Traumatization

As expected, this study found there to be a direct effect of learning about the violent victimization of close friends and family on children’s trauma symptomatology. In fact, vicarious trauma exposure predicted trauma symptomatology in young children and adolescents above and beyond caregiver warmth and hostility and witnessed or direct trauma exposure. Thus, while extant studies indicate that proximity to the trauma is an important factor in children’s development of trauma symptoms, this study demonstrates that vicarious trauma exposure is also a significant factor in children’s trauma symptoms (Lewandowski et al. 2004 ; Scheeringa et al. 2013 ). This study also lends support for the underlying assumptions of the causal model of children’s vicarious traumatization.

Contributing Factors in Children’s Vicarious Traumatization

Not surprisingly, a number of variables were found to be significant predictors in children’s vicarious traumatization to include caregiver warmth and hostility, witnessed and direct trauma, gender, and socioeconomic status. Contrary to the importance of the family unit in child outcomes, vicarious community trauma was found to be a stronger predictor of trauma symptomatology than was family vicarious trauma exposure (Pat-Horenczyk et al. 2009 ). However, these differences were likely influenced by the fact that significantly more children reported vicarious community trauma exposure than vicarious family trauma exposure. Notably, among both young children and adolescents, being White emerged as a stronger predictor of trauma symptomatology than did other ethnicity groups. Given that White youth reported the lowest rates of trauma exposure than other youth and weights were used to control for differences in sample sizes, this finding is surprising. Though, it does support past research, which suggests that exposure to traumatic events produces greater changes in cognitive schemas among White populations than among cultural groups with a history of oppression (Hall-Clark et al. 2017 ; Williams et al. 2014 ). This research points to higher baseline expectations about safety and control in White populations as compared to African Americans and other historically marginalized communities. In line with this theory, this study observed Black children and adolescents to have the highest rates of exposure to vicarious trauma but greater resilience against trauma symptoms than White children.

Notably, age was not observed to be a significant factor in the vicarious traumatization of children or adolescents, as was initially predicted. It is possible that age was not significant because children are vulnerable to experience vicarious traumatization at any age. In other words, vulnerability may not be graded by age. Supporting this theory, this study found a direct and positive relationship between exposure to either vicarious family trauma or vicarious community trauma among both young children and adolescents. It may be concluded that children of any age are equally likely to experience vicarious traumatization.

Strengths of this Study

To the best of this author’s knowledge, this is the first study to examine children’s vicarious trauma exposure independent of caregiver impairment or other forms of trauma (i.e. direct or witnessed trauma). Data for this study came from The National Survey of Children’s Exposure to Violence, which was credited as “the most comprehensive nationwide survey of the incidence and prevalence of children’s exposure to violence to date” (Finkelhor et al. 2009b , p. 1) and represented the first attempt to measure children’s cumulative and long-term exposure to violence over a child’s lifetime (Finkelhor et al. 2009b ). This data was also unique because it featured multiple forms of trauma exposure to include direct, witnessed, and vicarious trauma, which allowed this researcher to examine the unique contribution of vicarious trauma above and beyond the impact of direct and witnessed trauma or caregiver impairment on children’s trauma symptomatology.

This study was methodologically rigorous. Its dependent variable had strong construct validity for PTSD symptomatology and adequate test-retest reliability (Finkelhor et al. 2005 ). The study also had strong external validity. There were three indicators that point to the generalizability of the study findings. First, data for this study came from a large, nationally representative sample (Finkelhor et al. 2009b ). Second, the primary researchers used random sampling to select study participants (Finkelhor et al. 2009a ). Third, oversampling was done to increase the number of ethnic minorities and low-income households in the study (Finkelhor et al. 2009a ).

Limitations

There are a number of limitations that should be noted. First, this study was limited in scope to acts of violence that occurred during the child’s lifetime. The number of observations of vicarious trauma exposure was also low relative to the number of valid cases, especially among young children and in the context of family violence. The low probability of exposure may have impacted the study findings. Note should also be made that trauma symptoms were not etiologically and topically anchored to a specific trauma and thus, a diagnosis of a trauma-related disorder cannot be made (APA, 2013 ). However, psychometric research was conducted by the primary researchers, and the variables for trauma symptoms demonstrated strong construct validity for PTSD symptomatology and adequate test-retest reliability (Finkelhor et al. 2005 ).

Another limitation of this study is that acute symptoms at the time of the trauma were not measured in the primary study, which precluded an assessment of the immediate impact of vicarious trauma and limited it to the long-term effect of trauma. To reduce concerns for extraneous variance in the outcome variable due to differences in time elapsed since the trauma occurred, a new control variable was created by subtracting the difference between the participants’ age at the time that the trauma occurred from that at the time of the survey. This variable was also thought to account for the variability in the frequency of vicarious trauma experienced overtime. This study was also limited by the use of caregiver-reports for young children’s symptomatology and exposure to violence, which are not as reliable as self-reports (Dubi and Schneider 2009 ; Scheeringa et al. 2013 ; Thornton 2014 ). For these reasons, analysis between proxy and self-reports were conducted. No significant disparities were observed Finkelhor et al. 2009a ).

Implications

This study found evidence that vicarious trauma exposure in the form of the violent victimization of family and friends in the community is common among children. It also found that children’s trauma symptoms are a function of vicarious trauma exposure. This means that children are vulnerable to experience vicarious traumatization from the exposure of family and community victimization. The implication is that children should be assessed and extended clinical services when a family or friend experiences a traumatic event. In the case of vicarious trauma that occurs in the context of the family, family-focused interventions may be warranted (Ridings et al. 2019 ). Alternatively, community-based interventions may be suitable for community-based vicarious trauma (Hanson et al. 2019 ). Prevention of children’s vicarious traumatization may also be possible if children are provided clinical services to inform them about the trauma of family and friends in age-appropriate ways and to help them to cope with the trauma material. This is particularly true for populations most vulnerable for vicarious trauma exposure such as adolescents, girls, and Black children.

Importantly, the findings of this study identify the violence as the root cause of distress and not the victim. This distinction is important given that extant models implicate traumatized caregivers in children’s vicarious traumatization (Scheeringa et al. 2013 ). This study suggests that safety interventions should be implemented to protect children from those who perpetrate violence against children’s family and close friends because they put them at risk for vicarious traumatization. As such, it provides support for the development of policies and practices that allow social workers, law enforcement, and the courts to intervene in the lives of children exposed to the violent victimization of others.

Finally, this study indicates that Black children are exposed to vicarious trauma at higher rates than those from other communities. As such, clinicians working with Black children should be prepared to assess for trauma symptoms and to implement trauma informed services, as appropriate. However, they should also appreciate the resilience of Black communities, as demonstrated by this study. This study found that, despite their elevated rates of trauma exposure, they Black children demonstrated greater resilience against trauma symptoms than other ethnic groups. Thus, mental health and social work practitioners should approach Black children with an understanding of the resilience of Black communities and an appreciation for the cultural values and perspectives upon which it is based (Williams et al. 2014 ; Hall-Clark et al. 2017 ). Practitioners should operate from a strengths perspective and seek to highlight and enhance the strengths of Black communities.

This paper has reported on the results of an empirical investigation of children’s vicarious traumatization. The study found evidence that children may be directly traumatized by learning about the violent victimization of family and close friends. This relationship was observed independent of caregiver impairment. The study also found that adolescents, girls, and Black children may be increased risk to encounter vicarious trauma, and White children may be at increased risk to have traumatic reactions to the trauma material of other. This suggests a need for targeted interventions aimed at protecting children from adverse outcomes. The findings also support and give validity to policies and practices that allow social workers, law enforcement, and the courts to intervene in the lives of vulnerable children who live in homes and communities where violence is prevalent.

Compliance with Ethical Standards

The author declares that the author has no conflicts of interest.

This article does not contain any studies involving human participants or animals performed by the author.

This article does not contain studies involving human participants.

This study was reviewed and deemed exempt by the Ethics Committee of Howard University (5/11/2019/ FWA00000891).

Not applicable.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Vicarious Trauma Toolkit

Vicarious Trauma Organizational Readiness Guide (VT-ORG) is an assessment tool your organization can use that measures five evidence-informed areas of organizational health. Assessment results can then be used to identify gaps and prioritize next steps to address them.
Compendium of Resources contains nearly 500 tools that organizations can use to become more informed about vicarious trauma, including policies, research literature, training materials and links to websites, podcasts, and videos. The Compendium can be searched by organizational strategy, topic, and discipline, so organizations can find appropriate tools for their agency to use to address identified gaps.
Resources created for this toolkit include: VT 101, an introductory PowerPoint presentation for each discipline (with notes for presenters); and guidelines for VT-informed supervision, family support, employee and volunteer assistance, among others.

Vicarious trauma and nursing: An integrative review

Affiliations.

1 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
2 Sydney Local Health District Mental Health Service, Sydney, New South Wales, Australia.
PMID: 34799962
DOI: 10.1111/inm.12953

Nursing requires empathic engagement, within therapeutic relationships, to ensure the delivery of compassionate care. Empathic engagement with people who have experienced trauma is known to potentially lead to experiences of vicarious trauma occurring in the caregiver. However, relatively little is known about the implications of vicarious trauma for nurses. This integrative review aimed to explore what is known about vicarious trauma and consider its implications for nursing. Twenty-two articles were included in the review, with findings considering how vicarious trauma is conceptualized and applied to nursing in the literature, what implications of vicarious trauma, specific to nursing, are identified in the literature, and what vicarious trauma interventions are identified to apply to nursing. The findings highlight clear articulation of the concept of vicarious trauma and its relevance to nursing, including its pervasive and significant personal and professional effects. Vicarious trauma was identified to be a workplace hazard for nurses working across settings, which also impacts upon organizations. The review highlighted that at individual, team, organizational, and social levels, awareness and preventative approaches are recommended. These approaches require systemic supports that foster individual coping mechanisms, self-care and support networks for nurses, education about vicarious trauma, screening for vicarious trauma, and formalized access to clinical supervision and peer support for all nurses. With increasing awareness of trauma across health care settings, and a move towards the delivery of 'trauma informed care', recognition of vicarious trauma amongst nurses as a likely 'cost' of the delivery of compassionate care to trauma survivors, is essential.

Keywords: compassion fatigue; secondary trauma; vicarious trauma.

Publication types

Adaptation, Psychological
Compassion Fatigue*

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Vicarious Trauma and Resilience

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CASE STUDY 1

Case study: type i countertransference reaction.

Mr. A is a psychotherapist who has worked at a community mental health clinic for the past 10 years serving adults with a wide range of presenting problems. He has been treating Patient M for the past six months. Patient M is a highly educated, married woman, 35 years of age, from a country in Latin America and has been in the United States for the past two years. She was referred to the mental health clinic by her primary care doctor because of her severe and frequent panic attacks, nightmares, seeing and hearing dead people talking to her, and severe depression. Over the course of the first several months of treatment, Patient M has shared bits and pieces of her story with Mr. A. He has learned that the patient was working as a teacher in her community and was active in one of the opposition political groups in her country. She fled her country after soldiers killed opposition party supporters and their families in her town one night, including her husband and child. She was at a distant neighbor's house when the massacre took place, tending to a sick friend, and she believes that is why the soldiers did not find her. She tells Mr. A that she is too afraid to return to her country and is seeking asylum in the United States.

Mr. A finds himself flooded with many painful emotions in and after sessions with Patient M. He often feels horrified and has desires for revenge as she discusses her memories of finding her dead husband and child when she returned home that night. He feels terrified by the thought that Patient M may be deported to her native country where her life may be in danger. Mr. A has not experienced much trauma in his own life and definitely does not identify with Patient M's experiences.

Mr. A finds it extremely difficult to tolerate the intensity of his feelings when working with this patient. In order to avoid the pain associated with these feelings, he unconsciously develops empathic withdrawal toward Patient M. Mr. A's countertransference reactions alternate between intellectualizing, blank-screen façade, and misconception of the dynamics with his client. For example, Mr. A has unconsciously distanced himself from Patient M and often blankly stares at her when she brings up anything related to her traumas. Mr. A's reactions have led him to neglect to thoroughly assess the patient's traumatic experiences and the origins of her current symptoms. This, in turn, has led him to inaccurately assume and interpret Patient M's experiences of seeing and hearing of dead people talking to her as psychotic symptoms rather than as possibly part of her post-traumatic stress reaction. Patient M has not experienced any significant relief of symptoms.

Reflection Questions

What might be the impact on Patient M if the course of therapy and Mr. A's reactions continue in the same manner as it has up until now?

What can Mr. A do to address his countertransference reactions and positively affect the course of his treatment with Patient M?

Have you ever found yourself intellectualizing or otherwise empathically withdrawing from a trauma client?

What did you do when you realized that this was happening?

Did you notice any negative impact of this in your work with your client?

Did your countertransference reaction(s) shift or change during the course of your work with a given client? If so, what was/ were the shift(s)? What factors seemed to be associated with the(se) shift(s)?

What one strategy could you employ on an experimental basis to either enhance your awareness of your countertransference reactions or address the impact?

CASE STUDY 2

Case study: type ii countertransference reaction.

Ms. B is a relatively new therapist who works at a center that serves women who predominantly have experienced domestic violence and abuse as children. She is only one year out of graduate school and has not had extensive specialized training about trauma or the impact of trauma work on herself. She has begun to feel extremely overwhelmed in her work with Patient P, a young Cambodian woman, 19 years of age.

Patient P was referred to Ms. B's center by the Federal Bureau of Investigation (FBI) a month ago after they rescued her from a sexual human trafficking ring in a sting operation. The FBI has arranged for the patient to stay at a secure shelter, and they have certified her as a trafficking victim in exchange for her cooperation in prosecuting her traffickers. She should be eligible to be granted a T-visa, which would entitle her to legal status in the United States as well as work authorization because of her cooperation with the federal authorities. Patient P will be required to testify in court against her traffickers, something that frightens her considerably, particularly because they threatened to harm her and her family back in Cambodia if she ever reported them to the authorities. She worries that her traffickers may see her when she leaves the shelter to go to the store or to the center.

In the past month, Patient P has shared with Ms. B about the extensive emotional and physical abuse she experienced as a child—abuse that left her with a broken arm and two broken ribs. She was eventually sent by her parents to live with a distant aunt in the capital Phnom Penh. When Patient P was 16 years of age, her aunt lost her job and became financially destitute. The aunt told Patient P that she had found a well-paying job for her with a family, but when she showed up for her first day of work she quickly learned that her aunt had sold her into a life as a sex worker. Patient P initially refused to cooperate, and her traffickers beat her daily and drugged her in order to force her to submit to engaging in prostitution. They kept her locked up and, after several months, trafficked her to the United States, where she continued to be forced to engage in sex work, servicing up to 8 or 10 men per day, seven days per week. She developed gonorrhea and herpes and became pregnant. She had an abortion, and her traffickers forced her to return to sex work after only two days of rest.

Ms. B develops intense stomach pains and headaches during and following sessions with Patient P. She finds herself full of uncertainty about how to proceed with treatment and overwhelmed by intense anxiety and horror, as well as graphic images of the patient's repeated abuse. She is plagued by self-doubt and insecurities about her ability as a therapist to help Patient P heal from the traumas she has experienced and prepare psychologically to testify against her traffickers. Ms. B feels exhausted every day and at times feels despair; her countertransference reactions are illustrative of empathic disequilibrium.

What are the factors that appear to have made Ms. B at risk for developing empathic withdrawal?

What might be the impact of Ms. B's countertransference reactions on Patient P?

Have you ever found yourself experiencing signs of empathic withdrawal or another Type II countertransference reaction? If so, what were they? If not, what factor(s) do you think helped to protect you from developing these reactions?

How did you handle or address any Type II countertransference reactions you may have developed?

Were your efforts at addressing these reactions successful? Why or why not?

Would you do anything differently the next time you found yourself in such a situation? If so, what would you do differently and why?

While not all countertransference reactions are problematic, each of the discussed reactions would likely have a less than optimal impact on the therapeutic relationship and course of treatment of the survivor. It is an ethical duty, above all, for health and mental health professionals not to do harm to their clients and patients. Therefore, it is essential that clinicians strive to become aware of, understand, and develop the skills to address or make therapeutic use of the information provided by their countertransference reactions. Attending effectively and appropriately to one's countertransference reactions will also enhance one's professionalism and the quality of one's work.

CASE STUDY 3

Case study: anticipating and preventing burnout.

Before Ms. C decided to apply for admission to a Master's in Social Work (MSW) graduate program, she reflected on whether this was a good choice for her or not. She had heard stories about social workers who burned out. Professionals, once passionate about their work with runaway teens or domestic violence victims, had become disillusioned and exhausted and had lost their passion and energy for their work. This gave Ms. C pause and made her worried. She was nervous about entering a profession that seemed to pose a high risk for burning out, but she was raised in a family where she was encouraged to pursue a career that she was passionate about and was surrounded by examples of family who remained energized and fulfilled in their work after many years. Ms. C was told that she had many options open. She had not had any significant contact with social workers up until then, and she was not sure if this would be a career she loved. She did know, however, that many jobs were definitely a poor match for her abilities and interests.

Ultimately, Ms. C decided to give social work a try and applied to graduate school. Before she applied to a MSW program, however, she developed a plan and commitment to herself that served her well over more than two decades in the field. Her plan was to check in with herself often about how she was feeling and functioning in relation to work and life in general. Ms. C vowed that if she ever found that she was starting to burn out, she would make a change by switching the population she worked with or changing her role and duties; she could leave clinical work altogether and do policy- or community-based advocacy, or she could combine clinical work with research and policy work. Ms. C was relieved to know that the options within the profession of social work were many. Just knowing that she had options and the power and ability to be in control of her choices and work life made a huge difference. Over the years, she made several changes in her work setting, role(s), and the populations served. Ms. C is pleased to report that she has successfully avoided burning out.

Do you check in with yourself regularly to assess how you are feeling and functioning at work and in other realms of your life?

Are there particular aspects of your work to which you feel you are well suited? What are those and why?

Are there particular populations, issues, settings, or roles that you think may be difficult for you to work with or in? Why or why not?

Is there anything that you have found to be helpful in preventing you from burning out in your work?

Do you have a burnout prevention plan in place? If so, what is it? If not, what would the first step be to develop one?

It is possible to recover from burnout, and compassion fatigue in general. Not all of the symptoms are extreme or long-term in nature. Burnout and compassion fatigue exist on a continuum of severity. It can be helpful when one becomes aware that they have developed a sign or symptom of burnout or compassion fatigue, as this could serve as a signal of the need to do something about it. Without such awareness, it is less likely for professionals to make positive changes in their lives to promote well-being. Ideally, however, professionals will develop plans to prevent becoming burnt out or developing compassion fatigue in the first place.

CASE STUDY 4

Case study: an early warning sign.

Ms. C's first job after graduating with her MSW degree was as a psychiatric social worker and trainer of paraprofessional refugee counselors in a first asylum camp for Vietnamese boat people on an isolated island in the Philippines. When she arrived, she found that she had the most mental health training of anyone on the island. The Filipino non-profit she worked for had psychiatrists on call for consultation by phone and would fly a psychiatrist in for several days every two months to assess and prescribe medications. There were very few telephones on the island, and Ms. C had to borrow another agency's phone to make a call. Often, the connection was poor, and it was hard to communicate with the psychiatrist. Ms. C had a caseload of more than 100 clients who had fled Vietnam by boat and had experienced multiple traumas. Many of the clients were suffering from severe mental health problems, and some faced ongoing violence. Ms. C found herself working with multiple cases of trauma with both the perpetrator(s) and victim(s) at the same time. She only had access to peer supervision, with only sporadic access to a more senior, experienced supervisor when they visited the island.

Within several months, Ms. C's sleep became routinely disrupted. She began to have frequent nightmares. When she examined her nightmares, she realized that they were not her own—they were those of her clients, especially those who had experienced atrocities on the high seas during their escapes from Vietnam. The nightmares were filled with images of Ms. C hanging on to driftwood, watching helplessly as her loved ones lost strength and drowned in front of her. She also saw images of herself being attacked by pirates at sea, shot, and left for dead in a pile of dead bodies, and pretending to be dead until the pirates left. She had a recurrent nightmare of watching her brother murdered by others on the boat and seeing them eat his corpse in order to stay alive.

Instead of becoming alarmed at this development, however, her anticipatory work prior to starting the MSW program (vowing to check in regularly with how she was feeling and functioning) proved protective and reassuring. Her approach was to view these nightmares as fortuitous, because it gave her the opportunity to develop and implement a prevention plan and recognize the importance of taking care of herself and creating balance in her life very early in her career. More than two decades later, she is still working with trauma survivors. Her role has evolved and expanded and the population she works with is different (survivors of state-sponsored torture from all over the world—no longer restricted solely to Southeast Asian refugees). She also reports that she no longer has the nightmares of her clients.

Have you ever developed nightmares that include images from your clients' traumatic experiences or themes related to these experiences?

Have you experienced other signs or symptoms of vicarious trauma?

Are there particular settings or situations that tend to trigger your vicarious trauma reactions? If so, what are these?

Have you switched populations, work settings, or professional roles as a result of developing symptoms of vicarious traumatic stress?

How do you address your vicarious trauma reactions?

Have your efforts been successful?

Are there things you would like to try differently to address these reactions or, in general, to take care of yourself?

Case Study: Making Sense of Trauma Work

I remember being on the stand in court as an expert witness in the asylum hearing for a torture survivor and the judge stated that I must find my work to be very depressing. I recall responding that no, I did not find it to be depressing but rather inspiring because so many of the torture survivors I work with have enormous strengths and are resilient people. This same feeling is recounted by the clinicians studied by Hernandez, Gangsei, and Engstrom, who reported that they became inspired and gained strength and a sense of meaning from their work with survivors of severe trauma [8, 9] . This is perhaps what enables some professionals to work with survivors of torture and other forms of severe trauma for years and decades.

Case Study: Mindfulness as a Self-Care Strategy

I was originally introduced to meditation as a high school student by my school principal. Years later, as a professional social worker working with traumatized refugees, two colleagues encouraged me to further explore and deepen my study of meditation. I had already experienced some benefits of meditation in my daily life and for some years had worked with Buddhist refugees in refugee camps in Asia and in the U.S. I had seen for myself the benefits that some of my clients experienced from meditation practice in coping and living with the impact of their traumas and other life challenges.

As my meditation practice deepened, in addition to setting time aside in my day to formally "sit" and meditate, I began to integrate it into my clinical sessions with survivors of state-sponsored torture. At first, I was not aware that I was doing this. Soon I began to notice that I was focusing on my own breath, particularly during the portions of sessions when I would be talking with survivors about their histories of torture and other traumas and when they were expressing extreme distress in session. I would split my awareness and continue to attend carefully to my client while at the same time focusing a portion of my awareness on my own breath, as I had learned to do in my meditation practice. I spoke with several meditation teachers about what I had discovered that I was doing in session, and they encouraged me to consciously expand what I was doing to include not only an awareness of my breath but also my physical sensations during sessions with my traumatized clients. As I became more adept at doing this with practice, I found that it was quite beneficial in various regards. It seemed to make it easier for me to remain calm, composed, nonreactive, and centered even while listening to horrific details of torture or while my clients were experiencing flashbacks to their torture or expressing utter hopelessness and suicidal thoughts in session. This in turn appeared to contribute to a calmer and safer atmosphere for the clients, one in which they seemed to be able to more fully express themselves (including about particularly gruesome details or events that were taboo or considered deeply shameful or stigmatizing in their culture and society) without feeling that they were harming or contaminating me or being harshly judged.

The calmer state of mind I experienced when using these meditation skills made it easier for me to think clearly and calmly about how to proceed in session. I was better able to access my professional knowledge and experience and intervene appropriately. Integrating an awareness of my breath and sensations during sessions with trauma survivor clients appears to promote my ability not to take my work home with me in that I am better able to attend to and process my distress in the moment as I am with my clients. Utilizing these skills in session with my clients also appears to enhance my ability to be aware of my countertransference reactions. This increased self-awareness in turn enables me to be less likely to be unconsciously driven by my countertransference in negative ways and facilitates my ability to respond professionally.

I also find these same tools extremely valuable in helping me to manage my performance anxiety and function better during stressful moments as I am cross-examined in court, where I often testify as an expert witness, or when I am presenting in front of a challenging audience. Several of my colleagues employ similar meditation skills in session with their trauma survivor clients with great success. If you are not already an experienced meditation practitioner, it may help to obtain some instruction in meditation first and have a meditation teacher available to consult with you in the early phases of experimenting with these techniques.

Case Study: New Year's Resolutions

For many years, starting as a youth, I practiced the time-honored tradition that is widespread in the United States of making New Year's resolutions. Not just one resolution a year, but a list of things I would do differently or goals I would achieve each year. Inevitably, I would not be successful and would eventually, one by one, abandon most, if not all, of my resolutions as the year marched on. Some years, I achieved success or partial success, but in hindsight my efforts seemed haphazard. Clearly, my old approach was not working for me. I, like many people I know, grew to laugh about and expect this as inevitable. Some friends and colleagues gave up or never developed New Year's resolutions at all.

Some years ago, I decided to adopt a very different approach to New Year's and use it as an opportunity to recommit myself to taking care of myself, something that was so important to my personal and professional lives. What I have found works the best for me is to adopt an overall theme of "self-care" instead of a more traditional New Year's resolution. My plan includes routinely and frequently checking in with myself and asking myself if whatever I am doing or planning to do is in keeping with my self-care. I have found that this strategy is profoundly more helpful and easy to follow and stick with. It supports my setting boundaries and limits and makes it easier for me to weed through the many emails I receive each day and requests for my time in an efficient manner.

I spend much less time agonizing over how I can juggle my schedule to accommodate conducting a training course, attending an interesting workshop, or squeezing in another meeting. I used to have a harder time saying no when I was asked to do something that I knew I had the skill set to do or something that inherently interested me but conflicted with my other responsibilities. Now I find it generally easy to say, "Sorry, I do not have time right now to do that," or "I am overextended as it is and I cannot take that on right now."

An important component of my new strategy includes being gentle and not overly harsh or critical with myself if I slip in my self-care occasionally. I am going for an overall commitment to self-care for the long-haul, as a lifestyle change. Beating myself up if I have a bad day or neglect myself occasionally is, after all, antithetical to self-care. I use that opportunity as a wake-up call to assess what happened and rededicate myself to taking care of myself.

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The students-as-partner experience

Perspectives from the students and the faculty.

Bria Scarff Mount Royal University, Department of Child Studies and Social Work
Patricia Kostouros Mount Royal University, Full Professor, Department of Child Studies and Social Work

This article offers a case study of a student-faculty partnership. Focusing on the perspectives of two student research assistants and a faculty member, the authors utilize current literature on student-faculty partnerships to support their perspectives. This case study adds to the body of research suggesting student-faculty partnerships enrich and mutually benefit those involved. This article explores the working partnership of the consultation team and their work as part of a large collaborative project amongst post-secondary institutions and community-based organizations. Over the course of 3 years, success was evidenced by the outcomes of this project. The team has led workshops on the subject matter, and, additionally, contributed to the co-creation of a workbook/e-course on mitigating vicarious trauma for English language learning teachers. The research team published two subject-related articles. This article explores the facets that impacted the quality of the partnership.

Author Biographies

Nathan millar, mount royal university, research assistant. department of child studies and social work.

Nathan Millar holds a Bachelor of Child Studies, with a major in Child and Youth Care Counselling from Mount Royal University. He has worked as a Child and Youth Care Counsellor in varying roles for 20 years. In addition to emerging interests around the use of the arts in therapeutic counselling, Nathan works as a Program Supervisor in a Youth Transitions to Adulthood program, and as a Research Assistant at Mount Royal University studying vicarious trauma.

Bria Scarff, Mount Royal University, Department of Child Studies and Social Work

Bria Scarff is a graduate of the Bachelor of Child Studies with a major in Child and Youth Care Counselling from Mount Royal University. Bria has worked as a Research Assistant with Mount Royal University for four years. Bria’s areas of research include vicarious-trauma, child and youth care pedagogy as well as teaching and learning in post-secondary settings. Bria has a strong belief of personal strength and resilience that can be achieve through education. Bria works with children and youth in schools and therapeutic campus-based care settings.

Patricia Kostouros, Mount Royal University, Full Professor, Department of Child Studies and Social Work

Dr. Patricia Kostouros is Full Professor in the Department of Child Studies and Social Work at Mount Royal University. Patricia’s research includes intimate partner violence, post-secondary student wellness, vicarious trauma/compassion fatigue, and trauma-sensitive teaching. Patricia co-chaired the post-secondary student mental health initiative across Canada. Prior to academia Patricia managed a youth shelter, a women’s shelter, and was the Executive Director of a residence for women with a trauma history and a dual diagnosis. Her publications include a variety of articles and edited books.

Acai, A., Akesson, B., Allen, M., Chen, V., Mathany, C., McCollum, B., Spencer, J., & Verwoord, R. E. M. (2017). Success in student-faculty/staff scholarship of teaching and learning (SoTL) partnerships: Motivations, challenges, power, and definitions. The Canadian Journal for the Scholarship of Teaching and Learning, 8(2), 1–17. https://doi.org/10.5206/cjsotl-rcacea.2017.2.8

Barradell, S., & Bell, A. (2021). Is health professional education making the most of the idea of “students as partners”? Insights from a qualitative research synthesis. Advances in Health Sciences Education: Theory and Practice, 26(2), 513–580. https://doi.org/10.1007/s10459-020-09998-3

Bonney, K. M., (2018). Students as partners in the scholarship of teaching and learning. International Journal of the Scholarship of Teaching and Learning, 12(2), 1–5. https://doi.org/10.20429/ijsotl.2018.120202

Bovill, C., Cook-Sather, A., Felten, P., Millard, L., & Moore-Cherry, N. (2016). Addressing potential challenges in co-creating learning and teaching: Overcoming resistance, navigating institutional norms and ensuring inclusivity in student–staff partnerships. Higher Education, 71, 195–208. https://doi.org/10.1007/s10734-015-9896-4

Bovill, C., & Felten, P. (2016) Cultivating student–staff partnerships through research and practice, International Journal for Academic Development, 21(1), 1–3, https://doi.10.1080/1360144X.2016.1124965

Hill, J. T., Thomas, C., & Brown, B. (2019). Research assistant as partner: Collective leadership to facilitate co-production. International Journal for Students Aas Partners, 3(2), 129–138. https://doi.org/10.15173/ijsap.v3i2.3674

Mercer-Mapstone, L., Dvorakova, L.S., Matthews, K. E., Abbot, S., Cheng, B., Felten, P., Knorr, K., Marquis, E., Shammas, R., & Swaim, K. (2017) A systematic literature review of students as partners in higher education. International Journal for Students as Partners 1(1), 1–23. https://doi.org/10.15173/ijsap.v1i1.3119

Mount Royal University. (2023). Child and youth care counsellor, BCST. https://catalog.mtroyal.ca/preview_program.php?catoid=31&poid=5704&returnto=2514

Northouse, P. (2019). Leadership: Theory and practice (8th ed.). Sage.

Thomas, D. (2006). A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation, 27(2), 237–246. https://doi.org/10.1177/1098214005283748

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Adoption study links child behavior issues with mother’s trauma.

Mothers’ childhood experiences of trauma can predict their children’s behavior problems, even when the mothers did not raise their children, who were placed for adoption as newborns, a new University of Oregon study shows.

The research team, led by Leslie Leve , a professor in the UO College of Education and scientist with the Prevention Science Institute , found a link between birth mothers who had experienced stressful childhood events, such as abuse, neglect, violence or poverty, and their children’s behavior problems. This was true even though the children were raised by their adoptive parents and were never directly exposed to the stresses their birth mothers had experienced.

If a child’s adoptive mother also experienced stressful events as a child, then the child’s behavior issues were even more pronounced, the researchers found.

The paper in the journal Development and Psychopathology was recently published online.

This research underscores the importance of efforts to prevent child neglect, poverty, and sexual and physical abuse, and to intervene with help and support when children experience them.

“We can’t always prevent bad things from happening to young children,” Leve said. “But we can provide behavioral health supports to individuals who have been exposed to childhood trauma or neglect to help them develop coping skills and support networks, so that difficult childhood experiences are less likely to negatively impact them — or the next generation.”

Leve is the Lorry Lokey Chair in Education and head of the counseling psychology and human services department.

In the only study of its kind, Leve and other researchers have followed 561 adopted children, their birth parents and adoptive parents for more than a decade. Participants were recruited through 45 adoption agencies in 15 states nationwide. The researchers collected data from the birth parents when children in the study were infants and from the adoptive parents when the children were age 6-7 and again at age 11.

The researchers found when birth mothers reported more adverse childhood experiences and other life stress when they were young, their children showed less “effortful control” at age 7. Examples of “effortful control” include the child being able to wait before initiating new activities when asked and being able to easily stop an activity when told “No.”

At age 11, the children of these same mothers showed more “externalizing behavior,” such as rule-breaking and aggressive behavior.

The study also points the way for additional inquiry. For example, exactly how does stress in one generation become associated with behavior in the next generation?

“We know from nonhuman animal studies that stress can change the expression of genes by essentially changing which genes are turned “on” or “off” when passed on to the next generation,” Leve said. “That could be a plausible pathway.”

Further, what is the effect of the environment in which the child was raised?

“Can we find something positive in the rearing environment, perhaps parents’ warmth or sensitivity, that can help offset the child’s genetic or biologic risk for impulsive or externalizing behavior?” Leve asked. That is the next question the research team is asking.

Along with Leve, the study’s authors include Veronica Oro and David DeGarmo with the UO’s Prevention Science Institute; Misaki Natsuaki with University of California, Riverside; Gordon Harold, University of Cambridge; Jenae Neiderhiser, The Pennsylvania State University; Jody Ganiban, George Washington University; and Daniel Shaw, University of Pittsburgh.

— By Sherri Buri McDonald, University Communications

This research was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health & Human Development; the National Institute on Drug Abuse; National Institutes of Health Office of Behavioral and Social Sciences Research; National Institute of Mental Health; National Institute of Diabetes and Digestive and Kidney Disease; National Institute of Health’s Office of the Director; and the Andrew and Virginia Rudd Family Foundation.

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Up to 40pc of mental health conditions are linked to child abuse and neglect, study finds

Mother smiles proudly with her arm around her daughter.

In 1996, Ange McAuley was just 11 years old when ABC's Four Corners profiled her family living on Brisbane's outskirts.

At the time her mother was pregnant with her sixth child and her father had long ago moved back to Perth.

WARNING: This story contains details that may be distressing to some readers.

It was a story about child protection and the program was profiling the role of community volunteers helping her mother, who had been in and out of mental health wards.

Ange was the eldest and it fell to her to get her younger siblings ready for school.

By the time the new baby arrived, she would stay home and change nappies.

Polaroid of a young girl holding a birthday cake getting ready to blow out the candles.

"It was pretty crazy back then — I wasn't going to school a lot," she said.

By that age she was already holding a secret — she'd been sexually abused at age six by her stepfather, who would later be convicted of the crime.

"Back in the nineties, a lot of people kept stuff hidden and it wasn't spoken about outside of the family," she said.

"I've carried all these big burdens that weren't even mine. Sexual abuse happened to me. I didn't ask for it."

She says the trauma triggered a lifetime of mental health problems from substance abuse and self-harm as a teen, right through to post-natal depression.

Hidden source of our mental health crisis

A new study from the University of Sydney's Matilda Centre has established just how much Australia's mental health crisis can be traced back to this kind of childhood abuse and neglect.

The research has found that childhood maltreatment is responsible for up to 41 per cent of common mental health conditions including anxiety, depression, substance abuse, self-harm and suicide attempts.

The research, which draws on a 2023 meta-analysis of 34 research studies covering 54,000 people, found maltreatment accounted for 41 per cent of suicide attempts in Australia, 35 per cent of self-harm cases and 21 per cent of depression episodes.

Woman wearing black top smiles gently in office.

It defined childhood maltreatment as physical, sexual, emotional abuse, emotional or physical neglect and domestic violence before the age of 18.

Lead researcher Lucy Grummitt said it is the first piece of work to quantify the direct impact of child abuse on long-term mental health.

It found if childhood maltreatment was eradicated it would avert more than 1.8 million cases of depression, anxiety and substance use disorders.

"It shows just how many people in Australia are suffering from mental health conditions that are potentially preventable," she said.

Dr Grummitt said they found in the year 2023 child maltreatment in Australia accounted for 66,143 years of life lost and 118,493 years lived with disability because of the associated mental health conditions.

"We know that when a child is exposed to this level of stress or trauma, it does trigger a lot of changes in the brain and body," Dr Grummitt said.

"Things like altering the body's stress response will make a child hyper-vigilant to threat. It can lead to difficulties with emotion regulation, being able to cope with difficult emotions."

While some areas of maltreatment are trending down, figures from the landmark Australian child maltreatment study last year show rising rates of sexual abuse by adolescents and emotional abuse.

That study found more than one in three females and one in seven males aged 16 to 24 had experienced childhood sexual abuse.

Dr Grummit says childhood trauma can affect how the brain processes emotions once children become teens.

"It could be teenagers struggling to really cope with difficult emotions and certainly trauma can play a huge role in causing those difficult emotions," she said.

Mental health scars emerge early

For Ange, the trauma of her early years first showed itself in adolescence when she started acting out — she remembers punching walls and cars, binge drinking and using drugs.

"I would get angry and just scream," she said.

"I used to talk back to the teachers. I didn't finish school. Mum kicked me out a lot as a teenager. I was back and forth between mum and dad's."

By the time she disclosed her abuse, she was self-harming and at one point tried to take her own life.

Polaroid of a teenage girl showing a thumbs-up.

"I was just done," she said.

"I was sick of having to get up every day. I didn't want to do it anymore."

Later on, she would have inappropriate relationships with much older men and suffered from depression, including post-natal depression.

"It's definitely affected relationships, it's affected my friendships, it's affected my intimate relationships," she said.

"Flashbacks can come in at the most inappropriate times — you're back in that moment and you feel guilt and shame.

"I feel like it's held me back a lot."

Calls for mental health 'immunisation'

Dr Grummitt said childhood abuse and neglect should be treated as a national public health priority.

In Australia, suicide is the leading cause of death for young people.

"It's critical that we are investing in prevention rather than putting all our investments into treatment of mental health problems," she said.

Her team has suggested child development and mental health check-ins become a regular feature across a person's lifetime and have proposed a mental health "immunisation schedule".

Chief executive of mental health charity Prevention United, Stephen Carbone, said they estimate that less than 1 per cent of mental health funding goes toward prevention.

"There's been a big steady increase in per capita funding for mental health over the last 30 years but that hasn't translated into reductions," Dr Carbone, a GP, said.

"You're not going to be able to prevent mental health conditions unless you start to tackle some of these big causes, in particular child maltreatment."

Man wearing suit smiles in front of orange banner with text saying awareness advocacy and research innovation.

He said most of Australia's child protection system was about reacting to problems rather than trying to prevent them.

"If you're not tackling the upstream risk factors or putting in place protective factors you just keep getting more and more young people experiencing problems and services being overwhelmed," he said.

Mother smiles adoringly with her arm around her daughter as they look into each other's eyes.

Now a mother of two teens herself, Ange says she wants to break the cycle and has been going to therapy regularly to help identify and avoid destructive patterns that she's seen herself fall into.

"I love my girls so much and I want better for them."

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'It's a really massive deal': Unpacking what's going on with Gen Z and ways to improve teen mental health

'The air went out of the room': Shocking new statistics on the abuse and neglect of Australian children

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Child Health and Behaviour
Mental Health
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COMMENTS

A Scoping Review of Vicarious Trauma Interventions for Service
However, this study did not measure vicarious trauma-related outcomes, even though the program aimed to cover CF. ... studies that did not consider previous trauma might fail to control for confounding effects on the study outcomes. In the case of the qualitative research, studies often lacked information regarding how robust research methods ...
Identifying and Addressing Vicarious Trauma
Taking the initiative to address vicarious trauma with a colleague, as in Case #2, can be challenging. ... Jenkins SR, Baird S. Secondary traumatic stress and vicarious trauma: a validational study.
"The Ugliness of It Seeps into Me": Experiences of Vicarious Trauma
Vicarious trauma arises from empathic engagement with traumatic ... IPA focuses on lived experience through case-by-case analysis and empathic engagement with the participants' narrative accounts. ... in facilitating coping and the positive transformations that can occur in the clinician's sense of self through trauma work. Another study ...
A Scoping Review of Vicarious Trauma Interventions for Service
However, this study did not measure vicarious trauma-related outcomes, even though the program aimed to cover CF. The Reiki treatment for mental health professionals adopted an RCT design and showed no significant difference in compassion satisfaction, STS, or burnout between the treatment and control groups ( Novoa & Cain, 2014 ).
Vicarious Trauma: Exploring the Experiences of Qualitative ...
Objective: A substantial body of research exists regarding vicarious trauma (VT) exposure among helping professionals across disciplines and settings. There is limited research, however, on exposure to VT in qualitative researchers studying traumatized populations. The objective of this study was to explore the experiences of qualitative researchers who study traumatized populations and to ...
Vicarious Trauma: A Trauma Shared
Vicarious trauma (VT) is defined as unfavorable changes, both affective and cognitive, resulting from exposure to second-hand traumatic material. (Jimenez et al., 2021b) What We Know About ...
A Causal Model of Children's Vicarious Traumatization
This study found vicarious trauma exposure to be prevalent, with almost 30 % of the children reporting that they learned about the victimization of a close friend or family member in their lifetime. ... In the case of vicarious trauma that occurs in the context of the family, family-focused interventions may be warranted (Ridings et al. 2019 ...
Exploring Mental Health Professionals' Experiences with Vicarious
Abstract The purpose of this instrumental qualitative case study was to explore how mental health counseling professionals at an outpatient counseling agency in Arizona described their experiences of empathic responsiveness, therapeutic or personal relationships; and vicarious resilience, related to vicarious trauma, related to vicarious trauma.
Vicarious trauma in mental health care providers
The purpose of the present study was to assess vicarious trauma in mental health care providers, including psychologists, psychiatric and mental health nurse practitioners, marriage and family therapists, rehab counselors and therapists, and licensed social workers. An electronic survey, consisting of the eight-item VTS and demographics items ...
PDF Vicarious Trauma and First Responders: A Case Study Utilizing Eye
This paper then focuses on a specific treatment intervention, EMDR, utilizing a case study by way ofexplanation.[International Journal ofEmergency Mental Health, 2007, 9(4), pp. 291-298]. Key words: vicarious trauma, EMDR, helping professionals, police officers, cognitive schemas, stigma. Paul Keenan MSc.
Vicarious Trauma: Exploring the Experiences of Qualitative Researchers
Vicarious Trauma: Exploring the Experiences of Qualitative Researchers Who Study Traumatized Populations - Volume 17. ... Your email address will be used in order to notify you when your comment has been reviewed by the moderator and in case the author(s) of the article or the moderator need to contact you directly. ...
PDF Vicarious Traumatization: An Empirical Study of the Effects of Trauma
tence of vicarious traumatization and independent variables that might predict it. Method Participants Participants were 136 (72%) female and 52 (28%) male self-identified trauma therapists who volunteered to participate in a study investigat-ing the effects of trauma work on therapists. They were primarily White
ISTSS
Vicarious Trauma Organizational Readiness Guide (VT-ORG) is an assessment tool your organization can use that measures five evidence-informed areas of organizational health. ... International Society for Traumatic Stress Studies 111 West Jackson Blvd., Suite 1412 Chicago, IL 60604 USA Phone: +1-847-686-2234 Fax: +1-847-686-2251 [email protected] ...
Vicarious trauma and first responders: a case study utilizing eye
Vicarious trauma and first responders: a case study utilizing eye movement desensitization and reprocessing (EMDR) as the primary treatment modality ... what of those people not directly involved in the trauma, but those who have borne witness to it, either by listening to the stories of survivors, or in the case of the helping professionals ...
Vicarious trauma and nursing: An integrative review
Vicarious trauma was identified to be a workplace hazard for nurses working across settings, which also impacts upon organizations. The review highlighted that at individual, team, organizational, and social levels, awareness and preventative approaches are recommended. These approaches require systemic supports that foster individual coping ...
PDF Case Managers' Lived Experiences Working with Trauma Victims
Key themes included frequency of hearing trauma stories, the role of the CM, becoming desensitized, supportive supervisor, and a supportive work environment. The potential impact from this study for positive social change is a broader definition of vicarious trauma, which may allow for further theorizing of vicarious trauma.
Teacher Experiences in Trauma-informed Classrooms: a Qualitative Case Study
This chapter described the research methods used in the qualitative case study concerning. teachers' experiences teaching students experiencing trauma due to ACEs. Chapter 3 included. information about the type of qualitative research, the chosen research site, and the recruitment.
Vicarious trauma and first responders: A case study utilizing eye
Keenan, P., & Royle, L. (2007). Vicarious trauma and first responders: A case study utilizing eye movement desensitization and reprocessing (EMDR) as the primary treatment modality. International Journal of Emergency Mental Health, 9(4), 291-298. Abstract. Traumatic events can occur and adversely affect people during their lifetime.
Sexual violence and vicarious trauma: A case study.
Using a case study approach, this quantitative and descriptive analysis explored the incidence and consequences of sexual violence, particularly rape, occurring among Nigerian university students' acquaintance. It discusses the concept of vicarious trauma as a form of post-traumatic stress response sometimes experienced by those who are ...
Course Case Studies
Case Study: Type I Countertransference Reaction. Mr. A is a psychotherapist who has worked at a community mental health clinic for the past 10 years serving adults with a wide range of presenting problems. He has been treating Patient M for the past six months. Patient M is a highly educated, married woman, 35 years of age, from a country in ...
Vicarious trauma in the judicial workplace: state liability for
This might be even more controversial in any case concerning liability for judicial trauma where it might be argued by some that State intervention is inconsistent with judicial independence. ... Marsha L Vanderford, 'Vilification and Social Movements: A Case Study of Pro-Life and Pro-Choice Rhetoric' (1989) 75 Quarterly Journal of Speech ...
Sexual Violence and Vicarious Trauma: A Case
Using a case study approach, this quantitative and descriptive analysis explored the incidence and consequences of sexual violence, particularly rape, occurring among Nigerian university students' acquaintance. ... It discusses the concept of vicarious trauma as a form of post-traumatic stress response sometimes experienced by those who are ...
PDF Case Study in the Treatment of Trauma and Suicidality
Elicits feelings of terror, powerlessness and out-of-control physiological arousal. Includes re-experiencing the event, avoidance, hyper-arousal and persistent difficult thoughts and emotions. May have a profound effect on his/her perception of self, others, the world and future.
The students-as-partner experience
This article offers a case study of a student-faculty partnership. Focusing on the perspectives of two student research assistants and a faculty member, the authors utilize current literature on student-faculty partnerships to support their perspectives. ... Bria's areas of research include vicarious-trauma, child and youth care pedagogy as ...
Adoption study links child behavior issues with mother's trauma
Adoption study links child behavior issues with mother's trauma. May 8, 2024 - 5:00am. Twitter Facebook. Mothers' childhood experiences of trauma can predict their children's behavior problems, even when the mothers did not raise their children, who were placed for adoption as newborns, a new University of Oregon study shows.
Birth Trauma: Poor maternity tolerated as normal, inquiry says
Birth trauma inquiry urges maternity care overhaul. An inquiry set up to discover why some women have traumatic experiences in childbirth has called for an overhaul of the UK's maternity and ...
Federal and National Opportunities Week of May 13
The term vicarious trauma refers to the emotional distress experienced by individuals who witness or hear about the traumatic experiences of others, often occurring among law enforcement officers, first responders, and threat assessment professionals. The impact of vicarious trauma can range from emotional numbness to burnout.
Up to 40pc of mental health conditions are linked to child abuse and
The research has found that childhood maltreatment is responsible for up to 41 per cent of common mental health conditions including anxiety, depression, substance abuse, self-harm and suicide ...