When Stories Hurt 

Clinicians who help victims of trauma increasingly realize that they also need help in coping with the impacts that their clients' stories inflict.

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When the hemorrhaging starts happening, that's when the quality of care becomes compromised on an individual, organizational, or systemic level. According to the California Health Care Foundation's 2013 report, "Mental Health Care in California: Painting a Picture," only half of adults and less than half of children who were prescribed medications for their mental health conditions received care that met quality standards.

California's mental health care system is, of course, a behemoth plagued by many challenges, and vicarious trauma might seem like a small problem, but experts say that for frontline workers, dealing effectively with vicarious trauma is key to improving the quality of care for victims of crime — the source of so much trauma.

That's especially important in cities with high violent-crime rates like Oakland. Last year, there were more than 6,000 reported violent crimes in Oakland, plus nearly 3,000 additional cases of domestic, child, and elder abuse. And while not all of those victims will seek professional help, many experts say it's essential that those who do receive care are treated by clinicians who have the support and tools they need to avoid becoming victims themselves in order to help their clients deal with trauma.

In the early Nineties, psychologist Laurie Pearlman coined the term "vicarious trauma" to describe the transformative personal repercussions a caregiver can experience when engaging empathetically with trauma survivors. There are many types of caregivers: social workers, psychologists, shelter workers, humanitarian assistance workers, medical professionals, and first responders — anyone who works with survivors of severe violence, abuse, and neglect.

These professionals are also at risk of primary trauma, which is distinct from vicarious or secondary trauma. "A mental health worker, like myself, experiencing someone screaming at them in a fit of psychosis — that's primary trauma," explained Jim Caringi, a professor of social work at the University of Montana who has co-authored a paper with Pearlman.

Vicarious trauma is different because it's a secondary experience. Caregivers experience trauma when they hear their clients' stories.

Quantitative data on the prevalence of vicarious traumatization are scarce. According to Northeastern University's Institute on Urban Health Research and Practice, the handful of studies that exist focus on individual sectors and have inconsistent definitions of vicarious trauma. However, several findings have reported that between 40 percent and 80 percent of helping professionals have experienced vicarious trauma, secondary trauma, or compassion fatigue.

"It's an occupational hazard," said Greg Merrill, director of Field Education at UC Berkeley's School of Social Welfare. "If you work with a highly traumatized population, it actually will happen to you. It's not whether it will or not, it's my belief that it actually will."

Merrill's interest in vicarious trauma originated when he was a social worker at San Francisco General Hospital and Trauma Center from 2001 to 2005. He worked daily with victims of severe trauma: gunshots, stabs, gang rapes. He recalled one day in particular, when he walked into a client's room as her bandages were being changed. She had been shot, and the wound from her emergency surgery stretched across her chest.

"I spoke with her at length, and she had a child. She had a lot of terror around what had happened, and because I was empathic with her, I felt very in the moment with her. And so I kind of experienced an empathic kind of terror. Just from connecting with her. And then I noted I just couldn't stop thinking about her for days," he said. "I had images of her wound pop up in my head."

Merrill said that afterward, he was afraid to talk about what he was feeling with his supervisor and other social workers. "I thought it was highly unusual and probably not professional," he said.

Merrill said that as a student and young professional, he learned to fear burnout — the emotional exhaustion that often comes with a strained workload. "What wasn't talked about was [when] dealing with a high volume and intensity of highly traumatized individuals, there are specific and unique ways that weigh on you," he said. "I do just think there are honestly some unique psychological things going on for people who work in high trauma settings that are just not always recognized."

Eventually, he did talk to his supervisor, and when he spoke to other social workers, he found that they were all experiencing similar effects in response to working with severely traumatized people. He decided to become a resource to other social workers who were struggling with their trauma exposure and later developed a vicarious trauma training curriculum.

The terms "vicarious trauma," "secondary traumatic stress," and "compassion fatigue" are sometimes used interchangeably to signify the effects that giving care has on caregivers, but for many researchers, they are distinct concepts. The literature describes secondary traumatic stress as having symptoms that mirror post-traumatic stress disorder — like insomnia, appetite changes, and exhaustion. Compassion fatigue is often defined as the broad, predictable effects of working with suffering people.


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