Shared Trauma: Helping Clients Cope with National Events That Affect the Therapist

by Advisory Committee on Colleague Assistance

One feature of psychotherapy after September 11, 2001, is that therapists and clients alike experienced psychological reactions to the terrorist attacks and subsequent events. This parallel processing of traumatic events created unique and challenging dynamics for psychologists in their professional work.

Common responses to traumatic events in the life of the therapist include:

• Emotional reactivity: More or stronger feelings; unexpected emotions or reactions.

• Fear and anxiety: Personal reactions to terror and threat that distract or inhibit.

• Fatigue: Emotional and physical exhaustion or weariness.

• Sadness, grief or depression: Feeling low; mourning; spiritual malaise or queries.

• Absences from clinical practice: For personal need or professional demands; can increase stress of clinical work

• Intrusive imagery: Reactions to the sound of planes; sight of towers.

All of these normal responses can influence professional work, and must be recognized and understood in order to be dealt with appropriately.

• Clients in distress may request additional sessions or need increased telephone contacts.

• When clients’ previous experiences of traumatic events are triggered, they may experience more symptoms or have more crises.

• When clients need more at a time when the therapist is managing personal reactions to a tragedy, the stress of professional work increases.

A unique aspect of a community trauma is the shift in therapeutic boundaries that may result.

• Clients know you have experienced a traumatic event and you have no choice about initial disclosure.

• Questions arise about the therapist's well-being, experience, family members: therapists have to make choices about disclosure and frame changes.

• Transference, responding to clients' perceptions about therapist's loss of control or safety.

• Countertransference, discomfort with feeling exposed or wishing to share your personal experience with a client as a fellow human affected by the same tragedy.

At a time of national trauma, all psychologists may be seen as trauma experts and asked to respond, give information and advice, and intervene in communities.

• Psychologists may be operating in new venues, e.g., public speaking, media interviews, group discussions, on Internet forums.

• Psychologist's own experience of the unexpected, unanticipated disaster may decrease feelings of professional competence and self-confidence.

• Some psychologists were asked to travel and leave families and practices to provide crisis services to people most affected by traumatic events.

Many of these circumstances increase professional demands and stress on the psychologist at a time of personal distress.

When both therapist and client share a traumatic event, there are multiple levels of vulnerability to traumatization for the therapist.

• Direct or primary traumatization. The direct effects of exposure to traumatic events, as perceived and experienced by you.

• Secondary traumatization. The effects of experiencing the traumatization of others whom you love and for whom you feel responsible.

• Vicarious traumatization. The transformation of your inner self as a result of your empathic engagement with traumatized clients in the context of a helping relationship.

Many psychologists experienced multiple levels of traumatization after the events of September 11.

A therapist's vulnerability to vicarious traumatization is influenced by the interaction between the self of the therapist and his or her current clinical work. Contributing factors include:

• Each therapist's unique personal response determined by personal history, dynamics and defensive style, current life circumstances, as well as proximity and personal connection to the events and people involved in the tragedy.

• His or her empathic engagement with each client’s unique experience of the tragedy.

For example, when your clients

• report sources of anxiety you had not yet thought of

• describe a known or imagined experience of a particular survivor or victim that was hitherto unknown to you or

• use coping strategies that conflict with your own defenses or coincide with your greatest anxieties,

then your emotional stress and vulnerability to vicarious traumatization increases.

Recognizing VT
VT affects the same general aspects of self that are affected by traumatic life events.

• Self-capacities: Affect management, object constancy, self-worth.

• Frames of reference: Identity, world view, spirituality

• Basic beliefs and psychological needs: Safety, trust, esteem, intimacy, and control

• Perception and memory: Verbal, somatic, visual imagery, emotional, relational and behavioral

• Loss of hope and meaning: Increased cynicism and pessimism; nihilism, existential despair.

The dangers of vicarious traumatization lie both in direct negative effects (intrusive imagery, disrupted beliefs) and in our defenses against pain (numbing, overgeneralized negative expectations, cynicism).

Responding to VT

• Self-assessment: Ask yourself, "How am I doing?" What do I need? How have I changed?

• Protect yourself: Be aware of your vulnerability and the negative consequences of your work, strive for balance, and maintain connection with others

• Address the stress of your work: Practice self-care, nurture yourself, that is focus on sources of pleasure and joy, and allow yourself to escape when necessary

• Transform the negative impact of your work: Focus on finding meaning in your work and day to day activities, challenge negativity, and participate in community building activities, joining with others around a common purpose or value.

• Connect with yourself and with others: Pay attention to your inner experience, talk about it with others, do not work alone, and ask for support as well as offering it to others.

• Forums for discussions about the work and its stresses

• A group with a focus on discussing and addressing vicarious traumatization

• Buddy system: identifying a colleague with whom you will discuss the work and its challenges

• Regular clinical consultation

• Personal psychotherapy

• Continuing education opportunities that address these topics

• Emotional release: opportunities to express strong feelings of grief, fear, anger, gratitude

• Realistic self expectations