Risk Factors and Self-care for Practitioners Working With Trauma Clients

by Kathleen M. Chard, PhD, and Leslie Cooper, PhD, and the Advisory Committee on Colleague Assistance

January 18, 2005 — Psychologists who work with trauma survivors may be affected by their clients’ life experiences. Therefore, it is critically important to be aware of possible interpersonal and/or situational factors that can put practitioners at professional risk.

Therapists’ reactions to their clients’ stories of interpersonal violence and neglect can trigger feelings that range from numbness to rage, helplessness to excessive control, and over-identification to distancing and detachment. As a result, all therapists need to continually self-monitor their responses to trauma clients, paying particular attention to the following areas.

Therapists working with trauma survivors commonly experience a sense of over-identification with a client (Stamm, 1999). This can lead to a blurring of therapeutic boundaries, with the therapist relying on the use of advice giving, self-disclosure and perhaps intentional contact with the client outside of therapy sessions.

These therapists often report ruminating about the client during the week, and will express strong feelings of concern or anger on behalf of the client (Figley, 2002). Some therapists can become caught up in the sensationalistic aspects of the trauma work and push clients to recount details of their abuse past the point of healthy processing. This causes the client to feel unduly distressed and overwhelmed. Rather than effective processing of the event(s), the result may be client retraumatization.

On the other hand, some therapists may feel so distressed by their clients’ stories that they may unconsciously distance themselves from their clients due to their own feelings of avoidance, denial, guilt or shame. This may appear in session as victim blaming or resistance to work on traumatic material. Therapists in these situations may avoid seeking consultation with other therapists or supervisors about their trauma patients, to the point of “missing” treatment team meetings about the client.

If these reactions occur frequently, it may suggest that the therapist has become stressed or burned out from working with clients who experience traumatic life events. When a therapist begins to notice any of the above reactions, or other behaviors that may be interfering with their therapeutic work (for example, forgetting or canceling appointments, loss of empathy, cynicism, rescue fantasies, feelings of helplessness, rage, disgust or grief), he or she could seek consultation from another mental health practitioner with experience working with trauma clients.

If consultation is not available, or if the disruptions are more severe, the therapist might consider therapy to examine his/her reactions and possible past traumatic history. Talking about one’s reactions to hearing trauma clients’ stories will help to assimilate the therapist’s experience.

Therapists also should consider seeking consultation or personal therapy if working with clients is affecting their personal life. This may include feeling numb, disconnecting from friends and family, increased feelings of irritation or anger over little things, or the inability to leave work behind at the end of the day.

Practitioners may find it helpful to take several steps to reduce the likelihood of impaired behavior:

• obtain adequate training in working with trauma survivors

• maintain ongoing collaborative consultation with other mental health practitioners, and

• continually reexamine their own reactions to traumatic stimuli.

The following references may provide helpful readings on this topic:

Collins S., & Long A. (2003). Working with the psychological effects of trauma: consequences for mental health-care workers — a literature review. Journal of Psychiatric Mental Health Nursing, 10, 417-24

Figley, C.R. (2002) Treating compassion fatigue: Secondary traumatic stress disorder from treating the traumatized. New York: Brunner/Routledge

Stamm, B. H. (1999). Secondary traumatic stress: Self-care issues for clinicians, researchers and educators. Baltimore: Sidran

Virtual Library: Compassion fatigue