Written by Caroline Marlow, Director of L&M Consulting Ltd. April 2019
If you work in the emergency and medical services, social services, law and justice, immigration, journalism and the media/social media, humanitarian support, clinical psychology, military, MORE? you may well be regularly exposed to the trauma of others. And empathetic engagement with this trauma may well result in you being affected personally. If this change lasts for more than 4 weeks it might be Vicarious Trauma (NHS). Further, if unchecked or if work leads to repeated exposure, the problem can become even more serious and lead to post-traumatic stress disorder (PSTD) (American Psychiatric Association, 2013, DSM-V).
Exposure and repeated exposure to the trauma of others is not normal. However, culturally, and understandably, it can be hard for professionals to admit to themselves or others that they are experiencing vicarious trauma or PTSD. This might be due to a difficulty in making sense of, or by being embarrassed by, what they feel are irrational, emotional responses to the others’ experiences. Or they may feel guilt at experiencing pain themselves about another person’s trauma, or resort to denial or disguise in trying to maintain a resilient, objective, professional identity. Further, employers might not appreciate the severity or frequency of exposure, or inadvertently dismiss any potential concern as trauma-exposure is part of the job.
But the problem is growing. This is due to the increased number of those with current and historic trauma seeking support, and in the quantity and rawness of audio-visual evidence enabled through new technologies. Consequently, the problem should not be ignored; both trauma-exposed individual and institutions/organisations need to be aware and act.
It is normal to experience a negative response following exposure to trauma. Vicarious trauma and PTSD have slight variation in their symptoms and signs, but concern should arise if the below symptoms persist after 4 weeks or if they have a negative impact on personal resources, work performance and life outside work. Beware; deterioration in mental health often occurs slowly over time – this can make it harder to notice.
1. Intrusive re-experiencing, e.g., nightmares, intrusive sensory flashbacks, or triggers that arouse intense distress and/or physiological reactions.
2. Avoidance: of people, situations or circumstances that resemble or are associated with a trauma, e.g.: avoiding certain cases, clients, witness accounts and interview questions; dreading work; keeping busy; and being late or absent from meetings and work.
3. Hyperarousal: being hypervigilant, with intense concern for client, self or family safety. Experiencing excessive case ruminations or an excessive emotional client involvement / preoccupation that potentially threatens professional boundaries. Becoming more easily upset or increasingly irritable, argumentative or impatient with others. Having difficulty concentrating, remembering things and sleeping.
4. Emotional numbing, e.g.: experiencing decreased client empathy and / or detachment from family, colleagues and friends; feeling pessimism, cynicism or loss of hope; and increased engagement in unhealthy ‘comfort activities’ or risk-taking behaviour.
The individual’s core beliefs about themselves, others and the world can change, with a negative, knock-on effect on personal identity, confidence and relationships.
It is more likely that a person will develop VT / PTSD where:
– They are regularly exposed to trauma or exposed in an unexpected way.
– They have personal trauma experience in their past (particularly if they are exposed to the details of a similar trauma).
– There has been a relevant change in their personal circumstances e.g. having children might increase vulnerability when exposed to child trauma.
– They are experiencing other stressors which lower coping resources.
Trauma-exposed individuals should take preventative action (see above), but individuals can’t ‘cure themselves’ or be healed through ‘quick-fix’ training. Organisations need to make an active, long-term commitment to the organisational change required to create a supportive culture for those exposed to trauma.
1. Know the extent of the issue
Be sure that you have a strong understanding of the potential impact of trauma on your people. To do this, organisations should conduct a VT / PTSD-specific risk assessment and cultural assessment.
The risk assessment is a full clinical psychology risk assessment of trauma-exposed staff members’ roles and work environment to ascertain; the level of hazard exposure, the probability of harm, and the severity of consequence to members’ health (as required by health and safety legislation). The cultural assessment is a formal and impartial assessment of trauma-exposed staff members’ experience of how the organisation’s culture, strategy and procedure mitigate against, and provide support for those with, VT / PTSD.
These should be completed annually and form the basis of a consistent and co-ordinated approach to trauma prevention and support. Management should also be aware of, and prepared to respond to, shorter-term exposure changes.
2. Encourage a collaborative approach to trauma prevention and support
Consider how strategy and everyday practice can destigmatise, normalise and break the isolation associated with trauma; colleagues should be able to hold emotionally honest discussions without fear of judgement or of being considered personally or professionally weak. Signpost appropriate, accessible and confidential trauma-informed support with the flexibility to meet individual needs and preferences.
3. Limit unnecessary and unexpected exposure
Consider reducing the number of trauma-related caseloads, increasing case diversity, and ensuring case management systems are as effective as possible. What needs to be discussed and who needs to hear it?
4. Provide respite
Ensure regular, effective daily and weekly breaks and holidays are taken; consider creating physical spaces that allow full detachment from traumatic material.
5. Create and nurture a supportive culture
Bullying and a long-hours culture are obvious in their toxicity, but other, more insidious behaviours that show a lack of consideration for others can also have a negative impact on personal resources, lives and work performance. This might include; derogatory remarks / nicknames, taking credit for others’ work, passing blame, short-notice ‘work-dumping’, or shutting people out of networks. Provide individuals with opportunities to develop positive, psychological wellbeing. This includes encouraging cultural norms that demonstrate kindness and respect, and enable individuals to feel valued: a sense of meaning and purpose helps people cope and flourish.
L&M have a broad range of expert services that can support organisations in the prevention and mitigation of VT / PTSD and in the development of cultures that prioritise psychological wellbeing; thus buffering against stress and promoting sustainable, optimal performance. Please follow the above links for more details and contact us to discuss your organisation’s specific needs.
This blog was initially written for and published by the Law Society (29.03.2019) but adapted here for cross-industry consideration. Our thanks go to the Law Society editorial team for their editorial advice and to L&M Associate, Dr Sam Warner, Consultant and Chartered Clinical Psychologist, B.A.; M. Clin Psychol.; PhD; AFBPsS., for her expert advice regarding the clinical information provided within this blog.