“It is one of the most beautiful compensations of this life that no man can sincerely try to help another without helping himself”- Ralph Waldo Emerson.

Secondary trauma

Secondary traumatic stress has been defined as the experience of stress and distress experienced by those who become aware of a traumatising event impacting another person. According to Charles Figley (1995, p. 6), secondary traumatic stress is “the stress resulting from wanting to help a traumatised or suffering person”. Until recently, when we spoke about persons being traumatised we were speaking of those people who were directly exposed to the trauma. It has only been recently that researchers and practitioners have acknowledged that persons who work with or help traumatised persons are indirectly or secondarily at risk of developing the same symptoms as persons directly affected by the trauma. Clinicians and parents who listen to their clients or children describe the trauma are at risk of absorbing a portion of the trauma.

Secondary traumatic stress is sometimes confused with burnout. It should not be. Pine and Aronson (1981) define burnout as a state of physical, emotional, and mental exhaustion caused by long term involvement in emotionally demanding situations. Unlike secondary traumatic stress, burnout can be described as emotional exhaustion, depersonalisation and a reduced feeling of personal accomplishment. Burnout is a condition that begins gradually and becomes progressively worse. Secondary trauma, conversely, can occur following the exposure to a single traumatic event. When there is some interaction between the adult professional (or caregiver) and the traumatised child secondary trauma can occur.

Secondary traumatic stress refers to the presence of Post-Traumatic Stress Disorder (PTSD) symptoms caused by at least one indirect exposure to traumatic material. Several other terms capture elements of this definition but are not all interchangeable with it.

Table 6.1 Secondary stress and related conditions: sorting one from another

Please note this table has been reproduced with permission from the National  Child Traumatic Stress Network (2014). No further reproduction of this table is permitted without prior permission from the copyright holder.

Bruce Perry and the Child Trauma Academy (2014) have identified several reasons why professionals working with maltreated or traumatised children are at increased risk of developing secondary trauma:

Empathy

Empathy is a valuable tool for educators working with traumatised students. Our compassion and care for these children helps them, not because we talk to them or at them, but because we are emotionally there for them when the other adults in their life are frightening or preoccupied with other matters. However, by empathising with a child or ‘feeling their pain,’ the teachers become vulnerable to internalise some of the child’s trauma-related pain. We take on their pain as if it was our own, and this leads to becoming emotionally drained and fatigued.

Insufficient recovery time

Teachers working with children and families are sometimes required to listen to children describe some horrific situations they have experienced. Some teachers become secondarily traumatised by having to listen to the same or similar stories over and over again without sufficient recovery time.

Unresolved personal trauma

Many teachers have had some personal loss or even traumatic experience in their own life (e.g., loss of a family member, divorce). To some extent, the pain of experiences can be ‘re-activated’. Therefore, when professionals work with a student who has suffered a similar trauma, the experience often triggers painful reminders of their own trauma.

Children are the most vulnerable members of our society

Young children are completely dependent on adults for their emotional and physical needs. When adults maltreat these vulnerable persons, it evokes a strong reaction in any person with a sense of decency and morality. At times, the senseless and almost evil nature of some of the trauma inflicted on children shakes one’s sense of humanity.

Isolation and systemic fragmentation

When individuals feel valued and are in the presence of others who respect and care for them, they are more capable of tolerating extreme stressors. Clearly this means that the current practices in education – specifically, individual educational practice rather than team-oriented practice within a fragmented system with high-turnover – are a set up for increased stress for individuals working in that system.

Lack of systemic resources

A lack of economic and personnel investment in front-line services for high-risk children exacerbate each of the problems listed above. In our current socio-political climate, no public system is likely to address adequately the issues related to development of secondary trauma in front-line personnel. The task of addressing these problems, then, falls to the mid-level leader, supervisors, program directors and others who are working to create a positive work climate for their co-workers.

Secondary Trauma: Indicators and Warning Signs

Individuals affected by secondary stress may find themselves re-experiencing personal trauma or notice an increase in arousal and avoidance reactions related to the indirect trauma. The signs and symptoms of secondary traumatic stress are similar to those experienced by survivors of traumatic events. These symptoms include hypervigilance, hopelessness, excessive feelings of guilt, and even physical ailments, such as headaches, and irritable bowels (Figley, 1995). More signs and symptoms of secondary traumatic stress are highlighted in the table below.

Table 6. 2  Signs and symptoms of secondary traumatic stress

Please note this table has been reproduced with permission from the National  Child Traumatic Stress Network (2014). No further reproduction of this table is permitted without prior permission from the copyright holder.

These difficulties have been found to interfere with capacity for individuals to offer support, by diminishing their willingness and capacity to listen to others, an inability to tolerate uncertainty and complexity and chronic feelings of fatigue and exhaustion (Figley, 1995). Client care can be compromised if the therapist is emotionally depleted or cognitively affected by secondary trauma. Some traumatised professionals, believing they can no longer be of service to their clients, end up leaving their jobs or the serving field altogether. Several studies have shown that the development of secondary traumatic stress often predicts that the helping professional will eventually leave the field for another type of work (Pryce et al., 2007).

Identifying secondary trauma

Supervisors and organisational leaders in child-serving systems may utilise a variety of assessment strategies to help them identify and address secondary traumatic stress affecting staff members. The most widely used approaches are informal self-assessment strategies, usually employed in conjunction with formal or informal education for the worker on the impact of secondary traumatic stress. These self-assessment tools, administered in the form of questionnaires, checklists, or scales, help characterise the individual’s trauma history, emotional relationship with work and the work environment, and symptoms or experiences that may be associated with traumatic stress (Figley, 2004).

Supervisors might also assess secondary stress as part of a reflective supervision model (Pearlman & Saakvitine, 1995). This type of supervision fosters professional and personal development within the context of a supervisory relationship. It is attentive to the emotional content of the work at hand and to the professional’s responses as they affect interactions with clients. The reflective model promotes greater awareness of the impact of indirect trauma exposure, and it can provide a structure for screening for emerging signs of secondary traumatic stress. Moreover, because the model supports consistent attention to secondary stress, it gives supervisors and managers an ongoing opportunity to develop policy and procedures for stress-related issues as they arise (Pearlman & Saakvitine, 1995).

Formal assessment of secondary traumatic stress and the related conditions of burnout, compassion fatigue, and compassion satisfaction is often conducted through use of the Professional Quality of Life Measure (ProQOL), as seen in the resource below (Craig & Sprang, 2010; Sprang et al., 2007; Stamm, 2010; Stamm et al., 2010). This questionnaire has been adapted to measure symptoms and behaviours reflective of secondary stress. The ProQOL can be used at regular intervals to track changes over time, especially when strategies for prevention or intervention are being tried (Stamm, 2010).

References

Child Trauma Academy. (2014). Child Trauma Academy Library. Retrieved from https://www.childtrauma.org/cta-library.

Craig, C. D., & Sprang, G. (2010). Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma treatment therapists. Anxiety, Stress, & Coping, 23(3), 319-339.

Figley, C. R. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 1-20). New York, NY: Brunner/Mazel.

Figley, C. R. (2004, October). Compassion fatigue therapist course workbook. A weekend training course. Green Cross Foundation. Black Mountain, NC. Available at: http://www.gbgm-umc.org/shdis/CFEWorkbook_V2.pdf

Pearlman, L. A., & Saakvitne, K. W. (1995). Treating therapists with vicarious traumatization and secondary traumatic stress disorders. In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 150-177). New York, NY: Brunner/Mazel.

Pines, A., & Aronson, E. (1981). Burnout: From tedium to personal growth. New York: Free Press.

Pryce, J. G., Shackelford, K. K., & Price, D. H. (2007). Secondary traumatic stress and the child welfare professional. Chicago: Lyceum Books, Inc.

Sprang, G., Whitt-Woosley, A., & Clark, J. (2007). Compassion fatigue, burnout and compassion satisfaction: Factors impacting a professional’s quality of life. Journal of Loss and Trauma, 12, 259-280.

Stamm, B. H. (2010). The concise ProQOL manual, 2nd Ed. Pocatello. Retrieved from  http://www.proqol.org/uploads/ProQOL_Concise_2ndEd_12-2010.pdf

Stamm, B. H., Figley, C. R., & Figley, K. R. (2010, November). Provider resiliency: A Train-the-Trainer mini course on compassion satisfaction and compassion fatigue. International Society for Traumatic Stress Studies. Montreal, Quebec, Canada.

The National Child Traumatic Stress Network. (2014). Trauma types. Retrieved from https://www.nctsn.org/.