A perspective on the way to preserve and support professionals exposed to the suffering of others
Reading report written by Marine Galibert (E20B204M), Solène Hillion (E161492K) and Lara Pichon (E14E646L) (M2 PCPI)
Molnar, B. E., Sprang, G., Killian, K. D., Gottfried, R., Emery, V., & Bride, B. E. (2017). Advancing science and practice for vicarious traumatization/secondary traumatic stress: A research agenda. Traumatology, 23(2), 129-142. https://doi.org/10.1037/trm0000122
Introduction
Mental health of professionals whose job purpose is to help and care for others, has come of
prominent interest in scientific literature as well as in pop culture. Let’s consider the character of
Adel in the TV-Show “En thérapie”, a member of the intervention squad during the Bataclan
attack who after such a traumatic exposure will have a spectacular acting out by going to Syria
and committing indirect suicide on a sacrificial mode.
This fictive example showcases the psychological impact of working on an almost everyday basis
in an environment where you receive, but also hear, the sufferings of others. Indeed, if many
works zoom in on professionals who are in the front line, what about those who do not see but
receive others emotionally charged burden? A growing literature deep dives into the consequences
of this specific kind of trauma exposure and its consequences, which is also considered as a
vicarious trauma, or Secondary Traumatic Stress (STS) as developed by Figley (1995).
Molnar and al., (2017) gives here a review on this very specific psychopathology, the way to
prevent and treat it, as well as perspectives on the next level of research on the topic. She is a
specialist in social epidemiology, prevention science and psychiatric epidemiology with a special
interest in trauma.
Summary
Vicarious traumatization can be defined as the psychological consequences for professionals who
are regularly exposed to trauma of people they are willing to help. If a focus is often made on first
responders, workers indirectly exposed are also concerned. Social workers or mental health
specialists definitely belong to that category of professionals.
Even if some dedicated tools have been developed, such as the STSS (Secondary Traumatic Stress
Scale – Bride, Robinson, Yegidis and Figley, 2004) or the CFST (Compassion Fatigue Self-Test –
Stamm and Figley, 1996), it appears as a difficulty within the literature to identify the difference
of effect of a primary versus a secondary trauma among first responders. Specific studies have
also been led towards workers focusing on post-traumatic exposure, supporting the victims after
the event. A meta-analysis of 38 studies (Hensel, Ruiz, Finney and Dewa, 2015) showcases that
therapeutic workers are particularly at risk of STS, especially when risk factors are present such as
caseload volume, caseload frequency or personal trauma. Regarding the results and the lack of
significance for some of the studies, one aspect to be pointed out is the potential shame, feeling of
failure and stigma for those professionals when it comes to exposing personal and intimate details,
which might have minimized the results.
STS is then of growing interest within the literature but also among the organizations which are
willing to prevent, or at least reduce, the psychological consequences of so emotionally
demanding work. If strategies proposed to care for trauma, such as EMDR, can be deployed to
support professionals after a direct exposure, it seems that for indirect trauma, prevention and
wellness promotion are the techniques of choice. Self-care strategies, MBSR are highly
recommended, as well as psychoeducation programs which concentrate on concrete skills to
enhance emotional and cognitive regulation. In connection with Bandura’s theory about self-
efficacy (1997), helping professionals to raise their skills is also seen as a good STS prevention
factor. Finally, as the positive impact of a strong social support has no longer to be proven,
debriefing forums have been developed to share difficulties with peers who might have
experienced the same kind of situation.
Discussion / Conclusion
Exposure to vicarious trauma is now recognized within the DSM-5 as one the four potential
causes of PTSD. As a consequence, this recognition must encourage research and work to prevent
and treat the emotional difficulties of care professionals who are over-exposed to others’
sufferings. However, as mentioned by the author, a strong limit to this work needs to be
considered and worked on. Vicarious trauma, compassion fatigue, secondary traumatic stress are
three different concepts which mainly overlap and are used indistinctly, even if they have their
own specificities. This epistemological blurriness points at one of the difficulties regarding the
identification of this trauma and will undeniably impact the research. Clarity work needs to be
done, as the lack of specificities around the definition contributes to alter the quality of the
scientific work.
Furthermore, as the authors slightly tackle the point in the article, the positive effect of vicarious
trauma exposure might be considered deeper in the modulation of professional identity. As for
post-traumatic growth (Collier, 2016), a concept which defend the idea that one can grow after a
trauma on five fields (Appreciation of life, Relationships with others, New possibilities in life,
Personal strength, Spiritual change), it would be of great interest to see what could be the
transformation as far as professional identity is concerned. Some authors work for instance on the
concept of vicarious transformation, considering the spiritual impact on professionals when
helping others (Sanders, Kirby, Tellegen and Day, 2014).
We will end up on a personal note, not covered in the article, which echoes with our perception of
psychopathology which goes further than a nosographic categorizing. On a transdiagnostic
approach, it would be interesting to explore the comorbidity after an indirect trauma exposure with
other psychopathologies such as depression, anxiety and above all burnout. Even if this
psychopathology is still not recognized within the nosography, a link has been established
between PTSD and burnout (Boudoukha, Ouagazzal, Goutaudier, 2016) inducing the idea of a
common factor, emotional exhaustion, to both kind of pathologies. We are then facing a most
comprehensive issue, involving not only individual psychopathology but also social and
organizational psychology. Indeed, it is a critical duty for organizations to put all the best
programs in place to preserve, and help, the helpers.
Key words
● Vicarious trauma (Trauma vicariant): vicarious trauma can be defined as the psychological impact of a regular exposure to the suffering of others, especially in the professional field
● Compassion fatigue (Fatigue de compassion): for professionals frequently exposed to indirect trauma, it can impact their capacity to help properly and effectively patients seeking for their support
● Secondary Traumatic Stress (Stress Traumatique Secondaire): almost a synonymous of vicarious trauma, it focuses most specifically on the trauma symptoms one can already deal with in PTSD: intrusion, avoidance, and emotional numbness
● First responders (Premiers intervenants) : professionals, such as policemen or firemen, who are the first to intervene on an emergency and rescue scene.
● Health Promotion (Promotion de la Santé): health promotion is a concept to preserve employees well-being at work. It is declined in prevention programs, which purposes are to prevent rather than to treat the consequences of trauma, with personal methods (ex: MBSR) but also programs promoted by the organization (peers review groups).
References
Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: Freeman.
Boudoukha, A. H., Ouagazzal, O., & Goutaudier, N. (2016). When Traumatic Event Exposure Characteristics Matter: Impact of Traumatic Event Exposure Characteristics on Posttraumatic and Dissociative Symptoms. Psychological Trauma: Theory, Research, Practice, and Policy. http://dx.doi.org/10.1037/tra0000243
Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. R. (2004). Development and Validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice, 14(1), 27–35. https://doi.org/10.1177/1049731503254106
Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder. New York, NY: Brunner/Mazel.
Collier, L. (2016). Growth after trauma. Monitor on Psychology, 47(10). https://www.apa.org/monitor/2016/11/growth-trauma
Hensel, J. M., Ruiz, C., Finney, C., & Dewa, C. S. (2015). Meta-analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims. Journal of Traumatic Stress, 28, 83–91. http://dx.doi .org/10.1002/jts.21998
Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J. (2014). The Triple P-Positive Parenting Program: A systematic review and metaanalysis of a multi-level system of parenting support. Clinical Psychology Review, 34, 337–357. http://dx.doi.org/10.1016/j.cpr.2014.04.003
Stamm, B. H., & Figley, C. R. (1996). Compassion Satisfaction and Fatigue Test. Retrieved from http://www.isu.edu/~bstamm/tests.htm