The office I worked for has no limitations for ability to pay, so we often served individuals that were on the lower scale of economic income, homeless individuals and people who have experienced societal and systemic oppression. So what happens when psychotherapists or social workers meet with people who are suffering and in crisis? What happens when they do this day in and day out?
When professionals are in the role of helper, often they experience vicarious trauma.
Helping professionals often hear a lot about self care; and I have seen a lot of professionals, including myself, give an eye roll when it’s mentioned. So, how do mental health professionals, health care professionals, teachers, police officers, helpers in general understand vicarious trauma and get the help they need? First, let’s look at what a day at a mental health crisis office might look like; as a way for family members or loved ones of helpers or other interested parties to understand crisis work. Also, even if you are not a crisis counselor, this blog series is for you. Crisis counselors aren’t the only helpers that experience vicarious trauma; it’s just the experience I’ve had the most exposure to. But, because I know about the nervous system and how our bodies deal with trauma, I know that ANY individual that works with people who are stressed, traumatized, or are in crisis….are going to experience vicarious trauma.
Ok, so Colorado now has crisis centers called walk in centers all over the state.The office I worked for was located close to a jail and shared a building space with a drug and alcohol detox facility. On staff we usually had two or three crisis counselors, supervisor, triage (someone who managed the workflow of our office) and an EMT. The crisis office would either get a phone call that someone needed a mental health evaluation at a jail or hospital within our contract area of the county we served. We also served clients on a walk in basis in our office, so people could walk in and ask to speak with a counselor and if we weren’t super busy, could meet with someone right away. As a crisis counselor, you would go in and find out what is happening for the person.
In my experience and opinion, there were three large areas where people would fall: 1) Needing resources to an outside agency for counseling, medications, substance use/abuse recovery 2) Needing resources for homelessness shelter or resources for housing 3) Needing resources and immediate support around abusive relationship, need for intimate partner violence (also known as domestic violence) sheltering 4) Needing in the moment grounding, centering, help with coping and able to go home with some sort of plan in place 5) Needing an in depth mental health evaluation with either discharge home with a plan or needing a level of care that required staying overnight in a facility. Ok, so these are the large areas of need that people might fall under. There are always exceptions to these rules and the crisis office is always a place where surprising things can happen, so there were people that did not fall into these categories or needed more than one category and it was up to the crisis counselor to suss this out. So, typically the crisis counselor would be seeing people at the crisis office, hospital and at times in peoples homes or out in the community (police departments are now responding with mental health workers out in the community and are calling it co-responding).
Some of the major mental and emotional symptoms that crisis counselors are assessing include: suicidal thoughts/behavior, homicidal thoughts/behavior, mania/depression, psychosis (i.e., hearing or seeing things that others don’t see, grandiose improbable beliefs).
Ok, so those are the different places, populations that crisis counselors might work with; as well as scenarios that they are sussing out taking into account the major mental/emotional symptoms a person is experiencing (e.g., does someone need psychiatric care in a hospital or can they go home with a plan to follow up with a psychotherapist and their doctor for medications?). Let’s come back now to the question I posed earlier:
What happens when psychotherapists and social workers meet with people who are suffering or in crisis? What happens when they do this day in and day out?
Helping people who are suffering leads to vicarious trauma; and let me be clear, it is not a matter of if, it is a matter of when this will happen. I don’t add the emphasis here to cause fear or panic, it is just important for anyone that is a helper (e.g., doctors, nurses, police officers, EMT’s, psychotherapists, social workers, teachers, etc) of any kind to know that when you assist people that are in crisis, or are sharing negative memories with you or have experienced trauma, you are going to experience vicarious trauma. What is vicarious trauma? The definition that the Headington Institute uses is, “…the process of change that happens because you care about other people who have been hurt, and feel committed or responsible to help them. Over time this process can lead to changes in your psychological, physical, and spiritual well-being.”
Let’s take a bit to break down the different psychological, physical and spiritual symptoms that can happen due to vicarious trauma; and it’s important to remember that when we help someone who is in pain, our own pain that is similar to theirs can be brought to the surface. It’s a natural and human thing and it can happen in each of the following categories.
When you work with people who are suffering, you begin to see the underbelly of the world; and when suffering is brought into our awareness we can sometimes start to see it everywhere. We begin to see people on the street in a verbal argument and wonder if they hit or are emotionally abusive to one another. We begin to see the people we treat out in our everyday lives and we can begin to think of them when it would be more appropriate to focus on our own lives. We can become cynical knowing that many people are in pain in the world. It’s important to address the psychological affects of vicarious trauma. There are many ways to address it, but one way is to spend time doing things that bring meaning to your life, because with meaning, it’s easier to face pain week after week.
Because vicarious trauma is a process of change and is cumulative over time; people can be unaware of the build-up of stress in their body (as well as psychological and spiritual). One part of vicarious trauma that the Headington Institute definition doesn’t address is the neurobiological affects trauma has. Researchers have found that trauma affects our nervous system, which deeply affects our physical selves. Some symptoms people may have are: tiredness, feeling jumpy or on edge, tight muscles. Sometimes people’s past traumas are affected in that this trauma makes the past symptoms worse or brings them to the surface, compounding them. Because vicarious trauma affects us on a neurobiological level, we need to address it in the body and nervous system. If you are looking to work with a therapist, I would recommend someone who is trained somatically or in trauma therapies that are somatic based. I am trained in sensorimotor psychotherapy which is a body based trauma therapy that allows the body to release trauma, without needing to tell a story. Stephen Porges is a neuroscientist and works in the field of psychophysiology, which basically means he studies how our nervous system informs behavior and emotions. He says that you can manually calm the nervous system by using deep breathing (like in yogic exercises or playing a wind instrument). Deep breathing though, can take time to learn, it might sound easy, but there is a real art to learning how to breath into your diaphragm. Most people typically breath pretty shallow, especially when we are upset. Learning deep breathing is like learning any skill, you have to practice it.
When we are exposed to other peoples’ suffering on a regular basis it can begin to make us question our spiritual beliefs. We might wonder why God/Allah/Buddha/Great Spirit is allowing all this pain to take place. This can be very difficult for people. Spirituality can be a practice that brings deep meaning to our lives; and I will be truthful, there are no easy answers when addressing spiritual symptoms. I would recommend working with your church/spiritual community or a spiritual therapist that can guide you through this process. If you are a helper in any fashion and are experiencing the effects of vicarious trauma or your work is bringing some of your own personal traumas; this is a normal occurrence. Vicarious trauma isn’t happening to you because you did something wrong; in fact, because you care and are devoted to helping others, you are vulnerable to it. I encourage you to seek help through your agency or through your EAP (employee assistance program) or an outside therapist.
One of my passions is to help people through vicarious trauma so they are able to connect joyfully with their spirituality and know they are larger than their pain. Feeling pain as a human is not something to steer clear of; it is actually feeling the pain and moving through it, that allows us to be free.