Grab a cuppa, let's talk about... coping with vicarious trauma

​For the latest issue of our CSE Aware bulletin focusing on substance misuse and women who sell or exchange sex, we wanted to reflect on the impact of vicarious trauma and frontline workers’ coping strategies. For this reason, we decided to ask members of the research project Women working to support women in the welfare sphere to share some of the findings and learnings. Below is our interview with researchers Michele Burman, Loraine Gelsthorpe and Joana Ferreira:

1. Could you tell us more about the projects you’ve been involved with on vicarious trauma?
Our current research project ­aims to identify and explore the challenges faced in the post-Covid pandemic period by women in third sector organisations across the UK who work closely with marginalised girls and women. The research is documenting the cumulative effects of intensified client need, arduous work conditions, job security concerns, and additional domestic caring responsibilities, on the psychosocial wellbeing and personal welfare of women workers, many of whom come from the same communities and share the same experiences as their clients. We have recently published a report on the preliminary findings of our first round of interviews.

With this work, we are hoping to contribute to response and recovery efforts tailored to support women in this sector, by identifying innovative practices and providing insights to inform policies and models of working to support resilience and wellbeing.

This research builds upon earlier work conducted by members of the research team, including a study of vicarious trauma in those working with young women in criminal justice settings.

2. How would you describe vicarious trauma? How prevalent was it among research participants?
Vicarious traumatisation (VT) refers to a set of symptoms that are developed through indirect exposure to trauma, particularly in the context of supportive and therapeutic relationships.  As a result of the cumulative effects of exposure to information about traumatic events and experiences, VT can potentially lead to distress, dissatisfaction, hopelessness, serious mental and physical health problems and collapsed belief systems (Robinson, 2015). In our study, we consider VT as a phenomenon that occurs as a result of interactions with services users who have experienced trauma. These are not always direct interactions – VT can be experienced by those in managerial and research or policy positions, as we have found in our research; although most of our participants had some experience of recent frontline work.

The process of VT can disrupt an individual’s sense of safety, resulting in increased fearfulness, terror, and perception of vulnerability to harm, and is shown to erode trust, safety, and empowerment. It can lead to physical and mental ill health and results in staff absence and a loss of efficacy in the delivery of the work. These are impacts which we have recurrently heard during interviews with our research participants, who spoke of the impacts of this work on their mental, emotional, social, and physical wellbeing.

This research is not specifically looking at prevalence – and it is not something we asked directly in interviews or in our survey – however, it can be conceptualized as a ‘normal’ response to working in trauma-saturated environments. It is something that most respondents are aware of, and many could recount instances of experiencing VT either themselves or by their colleagues. 

3. Is the concept of vicarious trauma helpful in understanding the impact of working alongside traumatised populations?
The term VT is often used interchangeably with other terms such as ‘burnout’ and ‘secondary traumatic stress’, but it is not the same. Unlike burnout – which is a fairly common experience and can be understood as an overwhelming state of physical and emotional exhaustion caused by excessive work-related stress, and secondary traumatic stress which may be acquired by a single incident of disclosure/exposure to another’s experiences, resulting in post-traumatic stress disorder –  VT is a cumulative process of psychological and somatic symptoms of acute and post-traumatic stress that can result from the close and constant work of service providers with traumatised individuals. The term captures the impacts of this constant ‘exposure’ to trauma – it highlights the ‘build-up’ process that often occurs for those working in these environments.

As mentioned above, most of our participants were aware and familiar with the term ‘vicarious traumatisation,’ and we heard many accounts of workers experiencing this.  Our preliminary findings highlight the impacts of VT on workers, including changes in psychological wellbeing, mental and physical exhaustion, and internalisation of trauma (particularly when boundaries between personal and professional become blurred). Identifying this phenomenon allows for the consideration and development of strategies to address it.

4. Practitioners use a number of so-called positive and negative coping strategies to manage the impact of their work. However, negative coping mechanisms are less talked about, both in practice and in the literature. Would you agree? What ‘’negative’’ coping strategies have you identified among research participants?    Yes, there is more in the research literature about positive coping strategies, but some studies have focused on negative strategies (i.e., drinking excessively as a response to the traumatizing nature of the work). These are perhaps not best thought of as strategies, but rather as things people do when work becomes very tough and traumatizing and they start to feel out of control or hopeless.

5. What effects of negative coping strategies have you observed? How did the workers manage them? 
We heard about a range of reactions  to the challenges of the work, including heightened anxiety, safety concerns, the difficulty of maintaining professional boundaries,  sickness, and  staff absences.  Many  participants spoke of ‘positive’ strategies that they have developed in order to cope with the work and its heavy impact. For instance, exercise (e.g., yoga, pilates, running), creative activities and hobbies (e.g., arts and crafts, knitting), and social activities with family and friends. Other strategies involved self-awareness, reflection, and mindfulness. Interestingly, for some participants, the need to attend to their other ‘responsibilities’ outside of their jobs (e.g., looking after family, caring for a pet, roles within the community) provided an ‘escape mechanism’ from work and its impacts.
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These strategies were crucial for participants to deal with the emotional toll of their work and the potential for VT. It is important to emphasise, however, that embedded policies and mechanisms within organisations are needed to ensure the health and wellbeing of service providers. This was recognised by our participants who highlighted the fundamental role of organisational-led initiatives in responding and minimising the effects of VT. These include, for example, adequate supervision (including externally provided clinical supervision) and support, opportunities for reflective practice, and regular debriefs, among others. It is key that worker-facing trauma-informed practices are implemented and we aim to provide insights into developing adequate support policies and processes, as well as resources for organisations and for their staff to assist in the identification and mitigation of vicarious trauma.