Too much pain: what is vicarious trauma and how to prevent it

My story began with the book “Not Just Tired” and the project “Take Care of Yourself”. In it, support groups are addressed by women who are faced with a difficult experience of motherhood and with mental difficulties after childbirth.

I myself went through postpartum depression, and when I spoke about it publicly, hundreds of difficult stories about motherhood began to be told to me. I really want people to stop talking about this issue. First, I wrote a book, and then Daria Utkina, Maria Karnovich-Valois, and I launched the first project in Russia on the mental health of mothers, “Take care of yourself.” We have support groups, women from all over Russia turn to us.

In the very first weeks of launch, I was faced with absolutely monstrous personal stories. The topic of postpartum depression still often causes the reaction “itself to blame”, “bloomed”, “crazy egoist” – this is still the softest thing that a woman can hear in her address.

I know stories about rejection and lack of at least some support, years of depression and dislike for their children, about condemning psychiatrists, about how mental difficulties in motherhood were accompanied by violence from a partner. And also about how women could not cope with their condition and chose not to live. It hurts.

This year, the first season of the project “It’s good that you said that” was released at the podcast studio “Either / Either”, where I work. I produce and host it, it consists of real sessions of a client and a psychotherapist. It’s an incredible thing, every week people open up and let us into their most intimate experiences. They come to the office with difficult life situations and mental difficulties: emotional overeating, a fatal diagnosis, loss, anxiety.

Each issue has a hero, listeners will only recognize the name and voice. We cut out the details by which a person can be identified. I was at all the sessions, mostly listening to what was happening on the headphones from the next room. Several times it was especially difficult for me. Many characters are my close people, at some moments of the sessions I wanted this to stop happening.

At psychotherapists, people talk about the innermost, pull out their most severe pain into the light. It was scary at times to listen: you can’t imagine how a person can survive so much grief. You’re afraid that talking about experiences might re-traumatize him. But most importantly, I really want him to be well. I think that my experiences were connected precisely with the fact that I am emotionally involved in what is happening with my loved ones.

Vicarious trauma was first mentioned by my psychotherapist. I told her how the work on the podcast was going on – it was an important part of life. She offered to process this experience so that it does not stay with me and does not affect other areas of life. I was all for.

In one of the episodes of the podcast, a resuscitator from New York who worked in the midst of a pandemic appeared. He was not able to save far from all of his patients and was forced to inform the relatives of covid victims every day that their relatives were no more. His reception for the podcast was hosted by psychotherapist and psychiatrist Emma Aghasarian, who suggested he had a vicarious injury.

People in the helping professions work with those who have had traumatic experiences. Vicarious trauma may occur as a result of their “overload”. Its consequences can be experienced by doctors, editors, journalists, psychologists, psychiatrists, priests, rescuers, lawyers – everyone who is faced with human grief on an ongoing basis.

Its manifestations are generally similar to the symptoms of primary trauma, but their intensity, as a rule, is less pronounced.

Things to watch out for if you work a lot with people going through traumatic experiences:

• Sadness “as if out of nowhere”
• Irritability
• Mood Swings

To overcome the consequences of such an experience, people resort to psychotherapeutic techniques, practices of awareness and gratitude. According to research, social interactions and the opportunity to discuss difficult experiences with loved ones are also a resource for support.

I am used to discussing my experiences with my loved ones, and constant psychotherapy is important for me, so I don’t observe any consequences of a vicarious trauma in myself. I share responsibility for mental well-being with the therapist, and we both agree that I am fine now.

“The bearer of the vicarious trauma may begin to see the world as more dangerous and cruel.”

Emma Aghasarian, psychotherapist and psychiatrist, co-founder of Learning Schema Therapy

Vicarious traumatization is a permanent deep change in the vision of oneself and the world. They occur with therapists who deal with the traumatic experiences of clients in their work. This also happens in other representatives of the helping professions – those who work with people who have experienced severe trauma.

The symptoms of vicarious trauma can be similar to post-traumatic stress disorder (PTSD): flashbacks occur, vivid images of what happened to the client emerge, memories emerge of how they talked about the traumatic experience, thoughts revolve about what happened to them outside of therapy sessions. All this disrupts the usual way of life.

A person with vicarious trauma often encounters more negative stories and may begin to see the world as more dangerous and cruel. To some extent, the therapist begins to see the world through the eyes of his traumatized patients. Self-perception can change: therapists identify with clients, especially if they have similar experiences of their own. Sometimes, on the contrary, they feel guilty, responsible for what happened to clients.

With vicarious trauma (BT), symptoms of dissociation, depersonalization can be observed, when the therapist moves away from the negative experience associated with the trauma, loses contact with his own feelings.

Very often, therapists experiencing BT experience irritability, fatigue – symptoms resemble burnout, but extend not only to work, but also to other areas of life. If not tracked in time, such traumatization can have a very serious impact on the lives of therapists.

How can we prevent this?

1. First of all, it is necessary to train therapists in self-observation, reflection, understanding how to influence clients and how important it is to seek help in time. Paradoxically, research shows that therapists often feel that seeking help is, if not embarrassing, then optional. Often they themselves miss the moment when external support is needed. Specialists who work in large organizations are overloaded with administrative work, see too many patients, and they simply do not have time to take care of themselves. In this case, the likelihood of injury increases.

It is important that a supportive network of other professionals in this field be organized around the therapist, with whom one can discuss what is happening, share experience, receive support, supervision.

It is a structure that includes many support floors. It is important for psychotherapists to undergo personal therapy, especially if they have their own traumatic experience. It can be activated when working with clients who have experienced violence.

2. Mindfulness practices that are done on a regular basis also prevent traumatization.

Research shows that there is a difference between empathy and sympathy. Empathy as an identification of oneself with another can contribute to traumatization. But when the therapist remains in the sympathetic position “I see your suffering and I am ready to help you”, this suffering does not overwhelm him, and the position of sympathy is maintained.

Vicarious trauma occurs with other specialists. For example, doctors who work in hospices with seriously ill people report bad news, pediatricians, obstetricians and gynecologists. Such specialists are exposed because they have even fewer tools than professional therapists.

The topic of vicarious traumatization and burnout certainly requires more attention from society and psychological communities. It is important that therapists do not become victims of their own work.