Helping those who help
According to American researchers, Laurie Anne Pearlman and Lisa McCann, vicarious trauma – a term they coined – refers to “the enduring psychological consequences for therapists resulting from exposure to the traumatic experience of victim clients” (Pearlman and McCann, 1990).
In a talk given at the National Workers’ Compensation Summit, counselling coordinator at the New South Wales Rape Crisis Centre, Jackie Burke, described the high risk of vicarious trauma in her field.
Her talk looked at the ways risks – the effects on workers of providing assistance to traumatised populations or witnessing the aftermath of a traumatic event – are managed in her workforce.
As part of the job, employees at the Rape Crisis Centre hear horrific trauma stories all day as they provide telephone counselling to victims of sexual assault.
“It’s a high risk workforce,” she said, describing reactions to the environment in three broad categories.
The environment produces beneficial effects in that counsellors (like fire people and police officers) usually have “an esteem about their jobs and feel that they contribute to society.”
“There are also neutral effects,” Ms Burke said, explaining that some will change their perspective on safety after exposure to a traumatised population; but, “they may not necessarily be more concerned or anxious about it.”
Most effects regarding exposure to trauma, however, are detrimental. These can include, said Ms Burke, “intrusive thoughts, reduced ability to stop thinking about the traumatic event, dreams with trauma content in them and flash backs,” which are considered “normal symptoms of trauma.”
Exposure to trauma, she said, can change people’s frame of reference, which alters “as a result of the experiences that we come into contact with.”
After eight hours a day of hearing about vicious assaults, one could conclude that the world is not a safe place, she said. When our frame of reference changes, our psychological needs for functioning well are affected. There are five of these needs that Ms Burke outlined, which can be affected by contact with trauma:
- Safety – to think we and loved ones are safe in the world
- Trust – we need to believe we are reasonably trustworthy people and that so are loved ones
- Connections – knowing who we are
- Control – about influence; we need to believe we can control our own behaviour and influence other people’s to a reasonable extent
- Esteem – self-worth and the worth of other people.
As an example of what vicarious trauma can do to an employee, Ms Burke discussed the case of a rape crisis counsellor who, after eight months in the job, began to experience serious troubles in her relationship. “She had concluded that all men would abuse women given the chance; relating to her male partner as a perpetrator,” she said.
The problem was overcome. “She accessed good supervision, her supervisor knew about vicarious trauma and she could resolve the issues – but she nearly lost her partner,” Ms Burke said.
The potential personal cost of vicarious trauma is more than evident. What about the cost to business?
Vicarious trauma takes its toll on business, said Ms Burke, in the following ways:
- Decreased performance
- Replacement, recruiting, orientation and training
- Excess of workers compensation claims
- Increased insurance premiums
- Possible professional misconduct
- Possible indemnity claims.
The NSW Rape Crisis Centre estimated that vicarious trauma was costing the Centre $74,000 per year.
So what can supervisors and managers do?
“Exposure to trauma material is the only factor that significantly predicts if the worker will get vicarious trauma or not,” said Ms Burke. “Therefore it is a workplace risk and so an organisational responsibility.”
Symptoms can be effectively managed. Management programs which have proved effective at the Rape Crisis Centre, programs which are to be trialled in other high risk environments. Strategies include:
- Acknowledge the risks – build a culture of inevitability, talk about the question of trauma not as an ‘if’ but a ‘when – and to what degree’
- Reduce risk where possible – staff should have training and professional development about their role and about vicarious trauma; there should be clinical supervision, a shift handover process in which staff can “dump work at work” and not carry trauma stories home
- Build resilience – how vicarious trauma manifests itself changes in individuals. Management programs are best when they’re individually tailored
- Monitor symptoms when they arise – for example, monitor sick leave patterns
- Intervene as early as possible – the NSW Crisis Centre has a 24-hour call support through which a supervisor is available to counsel (on or off shift) for those who need immediate input in to how to manage their symptoms.
Vicarious trauma management programs have saved the NSW Rape Crisis Centre 3.5% of the budget, said Ms Burke, and since their implementation the organisation has the lowest turnover rate of any other organisation, and no WorkCover claims (where there had been two per year), staff retention rates have improved.