As this issue of Christian Counseling Today illustrates, we have accumulated a wealth of knowledge about trauma and its treatment. However, as counselors we know relatively little about the personal impact of providing such treatment. What toll does exposure to stories of suffering and trauma take on our emotional and spiritual well-being?
*Impact of Vicarious Trauma on Counselors* The term burn-out is often used to describe the deterioration and depletion counselors experience from excessive work-related demands.1 But recently the mental health profession has begun to address the sequelae more specific to counselors who are exposed to trauma-related suffering. Compassion fatigue, secondary traumatic stress, and vicarious traumatization are a few of the terms coined to describe the unique stress counselors undergo when helping trauma survivors.2 Symptoms identical to those of Post-Traumatic Stress Disorder (PTSD) can occur from indirect exposure to trauma so that counselors themselves may experience intrusive imagery, disturbing dreams, painful emotions, and avoidance behaviors.3 Further, Pearlman and Saakvitne suggest that counselors’ basic assumptions about themselves and the world can be disrupted. Our sense of identity, frame of reference, even our most sacred beliefs can be challenged.4 By empathically connecting with our clients, we, as counselors, make ourselves vulnerable to being wounded. This is similar to the concept of “suffering with” the writer of Hebrews describes as he calls Christians to share in the sorrows of others (Heb. 13:3). Despite the professional boundaries needed in all responsible counseling relationships we cannot entirely protect ourselves from clients’ painful experiences. When counselors are repeatedly exposed to stories and images of trauma within the context of a caring relationship, they are bound to undergo some sort of transformation. Some level of vicarious traumatization is an expected hazard of the helping profession and ministry.5
*Influence of Vicarious Trauma on Faith Experience* Traumatic events challenge survivors’ core assumptions about the benevolence of others and the meaningfulness of the world.6 Trauma often violates our basic sense of trust in others, including our relationship with God. God’s love, trustworthiness, sovereignty, and omnipotence may be called into question after a trauma. Traumatic events often “destroy faith and leave the victim in a state of spiritual disarray.”7 Trauma can undermine belief systems which help us to interpret our life experiences. The result can be that trauma survivors’ faith and understanding of God no longer seem to fit with their post-trauma experience of the world. Therapists who are exposed to trauma vicariously are confronted with similar challenges to their faith. Neuman and Pearlman believe that trauma work impacts the therapist most in the spiritual domain.8 When continually faced with stories of suffering and human cruelty, counselors may find themselves becoming cynical, doubting the goodness of God and his creation. But there is good news to report as well! Some findings indicate that exposure to trauma can actually produce positive results.9 Positive spiritual factors have been linked with exposure to vicarious trauma. In a recent survey of women psychotherapists, those who received more vicarious exposure to traumatic sexual abuse material actually reported a more positive sense of spiritual well-being and experience with God.10 Perhaps as clients grapple with God’s role in their life experiences, counselors are challenged to do their own tough wrestling as well. This authentic engagement with God, though likely painful at times, may yield a deeper level of intimacy and strength of conviction.
*Personal Coping Strategies* While spiritual growth may be the ultimate outcome for some, distress is often reported in the midst of conducting trauma therapy. Thus, personal measures of prevention and coping become imperative for the clinician. How can we as counselors better care for ourselves in the wake of trauma? *Practice what you preach* Much of the wisdom we impart to trauma survivors is good medicine for ourselves as well. Maintaining the health of our bodies is a basic self-care strategy we frequently encourage yet often ignore.11 Getting adequate sleep, exercising regularly, and maintaining a nutritious diet both reduce stress and provide important modeling. Pearlman and Saakvitne assert, “Being rested, fit and healthy sends strong messages to clients about what they might choose for themselves.” 12 Further, we must also claim for ourselves the “balanced life” we want for our clients. Trauma therapists must be wary of letting the demands of their work overtake their personal lives. Just as we encourage clients to engage in rewarding, pleasurable activities so we too must make play a priority. Have you made time for your favorite hobby lately? When was the last time you took a leisurely stroll or experienced the rejuvenating benefits of nature? Engaging in simple, enjoyable activities such as these in your personal life can make a difference in the way you experience your professional life. *Strive for professional balance* Varying your work activities is sound advice for any psychotherapist seeking longevity in the field.13 Teaching, research, attending, or participating in workshops, providing supervision or consultation, and engaging in administrative tasks are some of the activities in which clinicians engage to achieve balance. Including non-trauma related clients as well as non-clinical activities in your work week can help to reduce the effect of vicarious trauma. Pearlman and Saakvitne in their work with survivors of abuse, note the importance of a varied client load. “To hear in session after session of incidents of childhood sexual abuse creates despair and a distorted perspective that everyone’s life experience is traumatic.”14 No matter what the type of trauma, arrange your schedule, its pace and its content, to best attend to your needs. *Set limits on exposure* Another way to reduce trauma-related distress is to reduce exposure to such material. Yassen encourages therapists to be selective about the articles they read, the movies they attend, and the lectures they hear.15 Continued exposure to graphic details of trauma in the treatment relationship may need to be discussed with the client when it represents aggressive acting out or a reenactment of the trauma.16 At points in your career, it may even be helpful to remove yourself completely from trauma related work. Such breaks can be important times of rejuvenation and self-care. *Find a reason to laugh* Attending to the lighter side of life can be a challenge when faced with such troubling stories of trauma. However, researchers find that mental health professionals often use humor to cope with the difficulty of their work and those who do have fewer trauma related symptoms.17 Looking for the humor in our daily lives and laughing at our own misadventures can be an effective method of coping.
*Interpersonal Coping Strategies* *Establish nurturing relationships* Given the interpersonal nature of our profession, it’s not surprising that counselors find relationships to be a helpful and satisfying way to cope.18 Creating time and space to be with the ones we love may be one of the most important ways to prevent and cope with vicarious trauma. Perceived social support buffered trauma-related effects for paramedics19 and was associated with fewer PTSD symptoms in sexual violence counselors.20 *Boost your professional support* Often clinicians need a safe place to discuss their responses to specific client material. Arranging regular supervision or consultation with a competent trauma therapist can be essential to maintaining our own well-being and upholding our ethical duty to our clients.21 Further, advancing your clinical training in trauma-related areas, participating in professional organizations, developing a peer support group, or utilizing a co-therapist are just a few of the ways to enhance your professional connections.22 Since isolation is often considered the primary hazard of conducting psychotherapy,23 trauma work likely amplifies that sense of loneliness, making professional support even more important for our well-being and longevity in the field. *Utilize your own profession* The majority of psychotherapists have sought out their own psychotherapy to treat their personal distress and found the results to be quite positive.24 Using personal treatment to understand the unique ways in which stories of trauma interact with your own life history and emotional needs can result in amelioration of distress and significant personal growth.
*Spiritual Coping Strategies* *Put your role in perspective* Finally, and perhaps most importantly, we can use the rich and unique old_resources of our faith to cope with our clients’ suffering. The Christian psychotherapist understands that he or she is not the sole healer in the therapeutic process but rather a partner with God in facilitating growth and change.25 As mere participants in the helping process, counselors can resist owning ultimate responsibility for the outcome of therapy, recognizing that their abilities are exceeded by God’s power, love, and wisdom. Counselors who are able to embrace this larger perspective can let go of former anxieties and engage in their professional and personal lives with confidence. *Renew your sense of mission* Yassen reminds trauma counselors to remain aware of their goals, including the value and importance of their work.26 Many religiously committed counselors entered the mental health field because of a sense of mission or desire to fulfill their faith’s call to service. In the midst of work-a-day pressures it can be easy to lose sight of our greater purpose. In a study of “master” clinicians’ methods of coping with professional distress, Norcross and Guy found that renewing their sense of mission was rejuvenating for these therapists.27 Recommitting ourselves to God’s call of bringing hope and healing to the lives of others can foster meaning and fulfillment in our work. *Actively engage in spiritual practices* Because our vicarious exposure to trauma has the potential to hamper our experience of God, tending to our spiritual needs becomes especially vital. What brings you into awareness of your place in God’s great creation? How do you practice the presence of God in everyday life? Prayer, meditation, journaling, nature walks, jubilant singing, or simple silence are some of the diverse ways in which Christians reconnect with God. The practice of such spiritual activities can help us to develop a sense of quiet peace amidst the suffering and pain we encounter. *Remember where ultimate meaning is found* Finally, the practice of psychotherapy, as important as it may be, is not “the end all” of our existence. We must take care to find our meaning outside our office doors.28 For the Christian counselor, our ultimate meaning is found in our covenantal relationship with our Maker and Redeemer. While our work contributes to our meaning and fulfillment, it pales in comparison to the sacred knowledge that we belong to the Most High.
Joan Laidig Brady, Ph.D., is Assistant Professor of Psychology at Wheaton College in Wheaton, Illinois, and is a Post-Doctoral Fellow in Clinical Psychology at RML Specialty Hospital in Hinsdale, Illinois.