Secondary Trauma: A Therapist’s Guide

Young woman on pier at sunset.My mom has worked as a nurse for over 30 years. I remember she would sometimes come home from work and talk about how she had had a doctor or nurse as a patient that day. She would always say how health-care professionals were always the worst patients, usually because they would push themselves farther and faster than they should, which resulted in a longer recovery.

I think that as therapists, we are just as guilty of holding ourselves to a “higher standard.” I have seen colleagues and friends who are therapists give out excellent advice about the importance of seeking and accepting help and practicing good self-care, only to neglect themselves and fall into a cycle of depression, anxiety, and trauma symptoms, basically disregarding their own wise words.

I previously wrote an article about secondary trauma for loved ones of people who had experienced trauma. I felt it fitting to write another article for therapists, as I believe we have the potential to also experience secondary trauma. Figley (1995) defines secondary trauma as “the stress resulting from helping or wanting to help a traumatized or suffering person.”

Think about it: Most therapists see anywhere from 10 to 40 people per week.  These people are coming to us for help with their problems, which could range from normal levels of stress to severe depression, anxiety, trauma, or other mental health difficulties. We listen and offer tools they can use to overcome their challenges. They leave the sessions armed with new skills to face their lives and challenges. And what are therapists doing between sessions? I can answer from my own experience: doing notes, writing up treatment plans and assessments, returning phone calls, following up with other professionals, preparing for the next session, etc. After work, many professionals have other commitments and obligations. Life can get very busy and chaotic, and many of us consistently put ourselves last.

Therapists are just as susceptible to secondary trauma as any other person. We are not superhuman, nor do we possess mental powers that make us resilient to depression, anxiety, trauma, and other mental health challenges. Sometimes as therapists we forget this and, therefore, neglect ourselves. One study found that therapists who treat people with trauma are susceptible to the effects of secondary trauma, particularly if they do not have the appropriate training, support, and self-care (Pearlman & Mac Ian, 1995). In my experience, this applies also to therapists who are treating other mental health issues.

So what do we do about it?

  • First, make self-care a priority. Pearlman and Mac Ian (1995) emphasize the importance of self-care in order to provide the best services possible while protecting the provider’s own well-being. In my experience, I am much more effective as a therapist when I am taking excellent care of myself and being aware of any secondary trauma I might be experiencing. The basics are important here: getting enough rest, eating healthy foods, getting exercise regularly, spending time engaging in leisure activities, and spending time with loved ones, to name just a few. It basically comes down to taking our own advice and implementing the self-care skills we so often suggest to people who seek our help.
  • Get support from fellow therapists through supervision or consultation. Even after the days of internship are done, we can all benefit from continued supervision and consultation. Pearlman and Mac Ian (1995) state of their study, “Therapists who work with trauma survivors need supportive, confidential, professional relationships within which they can process” the work they are doing. I have found it extremely helpful and stress relieving to consult with colleagues and to even ask for supervision at times. It can be extremely validating to learn that you are not the only therapist who sometimes struggles with secondary trauma, stress, and other emotional consequences common in the helping professions. Consultation and supervision can also help a therapist to work through challenging cases by giving a new perspective and new ideas for intervention.
  • Consider furthering your training. One of the most stressful situations a therapist can encounter is having a person come to you with an issue with which you are not familiar or do not feel competent treating. Of course it is good practice to acknowledge when you are not competent to treat a specific problem, and to make a referral to a colleague who might be more skilled in that area. However, sometimes furthering your education and skill set can help to reduce anxiety and stress when it comes to treating people with unfamiliar situations. Furthering your education and training can also help you to effectively treat issues with which you are familiar. The bottom line is that getting the proper training can reduce your susceptibility to secondary trauma (Pearlman and Mac Ian, 1995).
  • Consider finding your own therapist. Therapists are not an exception to the fact everyone encounters difficulties in life at times. It is extremely important that we are willing to acknowledge that we are human, and to address our own issues, whether they are from the past or present. Engaging in your own therapy will ensure that you are working through your own challenges, which will make you less susceptible to the effects of secondary trauma and more available to engage in meaningful and effective therapy with people.

In conclusion, I believe one of the most important things we can do for people who see us is to take excellent care of ourselves. If we neglect our needs and ourselves, we are not able to give all we have to others. We can set a great example of self-care and avoid being susceptible to secondary trauma if we are just willing to follow our own good advice.

References:

  1. Figley, C.R. (Ed.) (1995). Compassion Fatigue: Secondary Traumatic Stress Disorders from Treating the Traumatized. New York: Brunner/Mazel, p.7.
  2. Pearlman, L.A., Mac Ian, P.S. (1995). Vicarious Traumatization: An Empirical Study of the Effects of Trauma Work on Trauma Therapists.  Professional Psychology: Research and Practice, 26 (6), pp. 558-565.

© Copyright 2013 GoodTherapy.org. All rights reserved. Permission to publish granted by Anastasia Pollock, LCMHC, therapist in Midvale, Utah

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • simone

    simone

    August 14th, 2013 at 11:20 AM

    How narrow minded I guess I have been- I DO think of my own therapist as superhuman, with the ability to easily separate out what is going on in all of our lives from what is going on in his own. I have never given any consideration to the fact that he could be hurting too, maybe just as much as I am and may need someone to talk to just like me. I know that I can’t help him with his own problems because goodness knows that I have enough of my own for any one person to deal with! But maybe I could be a little more sympathetic to the fact that he is human, there are feelings there too, and just to be a little more considerate of that fact.

  • Laura

    Laura

    August 14th, 2013 at 3:47 PM

    Simone, I believe it would be a mistake to worry about what you say in a therapy session based on your therapists needs. We join this profession for a reason. This article is a reminder to take our own advice or compassion. It is NOT for a patient to care for the psychologist. You have to remember that you are paying a professional. If your math tutor were having troubles in math you would question his/her qualifications. If he/she needed to see his/her own math teacher that is their problem.

  • Barry

    Barry

    August 15th, 2013 at 1:02 AM

    Its easy for professionals to do this-offer advice to others and then not follow it to benefit themselves.While the life of a professional is no way easy it is important to remember that following the advice that we give out to others each day is something that we need to apply to ourselves too.

    You have mentioned good points about how this can be done.And I hope more and more professionals and especially therapists take up and follow this to enrich their own lives in the midst of helping so many others.Thanks.

  • simone

    simone

    August 15th, 2013 at 4:20 AM

    Oh I don’t necessarily worry about what I say, but rather that this just gives me a new found respect for the things that you all do have to hear and listen to everyday.
    Look, I know that I need that soft place to fall and very often for me that is my therapists office. I just think that by reading this more of us will realize that we all have these needs and that no one is above all of that because I think that this is one thing that actually keeps some people out of therapy, that they think that there is no one who will understand what they are going through or feeling.
    This makes is very clear that some realize all too well because you could be going through it yourself. That does not mean that I will hold back or that I think that anyone should, just that it adds another level of respect, that’s all.

  • Emma

    Emma

    August 15th, 2013 at 9:11 AM

    Laura, thank you for your post. What you write is true but I find it so difficult to not worry about what I say in a therapy session so I don’t anger, irritate or go against the therapist because I feel that if I do anger, irritate or go against her, she won’t help me or the conflict will remain in the back of her mind and negatively affect her actions with me during a time when I need help. Even when she is wrong about something, I feel very uncomfortable saying it. How can she stop that conflict affecting her?

  • David Flowers

    David Flowers

    November 14th, 2015 at 3:13 AM

    Great question Emma. The best therapists have worked hard to deal with our own issues, our own problems with ego, and to be able to recognize when we’re not being rational.

    If your therapist is good, they will not take your comments negatively or personally. Your therapy isn’t about them, it’s about you! Ultimately your most valuable lessons in counseling will come from the risks you learn to take in the counseling relationship itself, so I encourage you to be authentic with your therapist, even when it’s hard.

  • Josie

    Josie

    August 15th, 2013 at 9:49 AM

    What makes a therapist so able to relate to their clients is that they are also human. Its important to remember that as therapists we can need the same support that our clients need sometimes- and that is OKAY!

  • Camille

    Camille

    August 15th, 2013 at 12:01 PM

    This article is affirming that all the support I get is ok. Caring for clients can be overwhelming but is necessary for effective change. I have three professionals I process my reactions with. I have reactions to each client and their anxiety. My responsibility to myself is first to providing exceptional care. Thank you to all who listen to me so I can help others.

  • Ray

    Ray

    August 16th, 2013 at 4:34 AM

    The key for any of us is to maintain a level of self care that keeps us comfortable. That might not necessarily be what a giver is going to want to do, you do so much for others that you forget about your own needs. But in order to stay healthy you have to make this a priority too. It can’t always be ablut what you are saying to other people. It has to be about being healthy so that you continue to have something positive to offer those clients as well.

  • W.Q

    W.Q

    August 17th, 2013 at 1:28 AM

    A task to convince and show to another how this or that can benefit.

    A HUGE task to do so for oneself!

    This stems from the fact that we are at most times so into saying this that we forget to implement it ourselves.

    I hope the therapists out there are reading this.

  • Anastasia Pollock, LCMHC

    Anastasia Pollock, LCMHC

    August 19th, 2013 at 12:10 PM

    Emma,

    As a therapist I welcome my clients’ honest feedback and opinions. Therapists are human and sometimes we are wrong. It is important that you communicate as openly as you can so your therapist can better understand the situation. A good therapist will not be angry or retaliate if you disagree with something they say. In fact, they will be appreciative of your honesty.

    I hope you can talk to your therapist about your current concerns as they are not uncommon. Doing so will likely improve the therapeutic relationship and hopefully you will feel that you can be more open with your therapist.

    Best of luck to you and thank you for your comment!

  • AKL

    AKL

    August 31st, 2014 at 7:07 PM

    This is all too true, and I hope that at least an informal weekly check-in between therapists as colleagues and friends is on every therapist’s to do list. One week ago, the trauma therapist I had been seeing weekly for the last 9 months shot herself. As her client, I of course never saw the side of her that wasn’t coping. I’m aware she had been going through a divorce and was planning to move across the country several months from now; but I don’t know anything about what became too much or why she failed to get help. Instead, I knew her as cheerful, supportive, insightful, empathic, encouraging… She devoted all of her 22-year-career to treating childhood and adult trauma, PTSD, and dissociative disorder, and so on. Given her commitment to healing trauma, it is very difficult to comprehend that this has happened. I can only picture her smiling and with a twinkle in her eye, in the lovely office that she clearly took great care in creating as a healing space. Our work together was life-changing, which is some comfort. But I hate knowing she was alone and in pain.

  • Pat E

    Pat E

    February 21st, 2015 at 3:08 PM

    This article, as well as others written on Complex PTSD in this newsletter, are well written and helpful.

  • David Flowers

    David Flowers

    November 14th, 2015 at 3:21 AM

    Great article. I appreciate the references.

    I teach and supervise graduate Counseling students and routinely tell them that in my opinion it is not only essential to practice self-care, including having a therapist of their own, but it’s unethical not to.

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