by Deborah Rozelle,
Psy.D.
To put it directly and simply, Dr. Pearlman’s message to us is heartfelt and frank: We are all vulnerable. No matter how capable we are, how well-trained, how strong and careful in taking care of ourselves as trauma therapists, we can and will be affected by our work in ways that can be unnerving, surprising and even harmful to us or others. As professionals we must acknowledge the presence of vicarious traumatization in our lives and take measures to prevent and ameliorate its effects.
A couple of recent examples come to mind as I consider Dr. Pearlman’s critical message to us. In May 2005, I spoke about vicarious traumatization at a conference. The conference was attended by a range of administrators, advocates and front-line workers who serve girls in the juvenile justice system. At the conclusion of my talk and over lunch, several participants came up to thank me. One woman, a supervisor at a residential program, approached me anxiously to relate that in her program, staff were unnerved by their girls’ frightening cutting behavior. To the horror of the supervisor, these same staff also disclosed that they were cutting themselves. The supervisor wanted guidance about how to help her staff, so that they could continue addressing the girls’ escalating self-abusive behaviors.
The second example involves a recent brush of my own with vicarious traumatization. As someone who is generally good at looking out for and preventing vicarious traumatization, I was humbly reminded of my vulnerability when I was jolted awake twice in one night last fall with the same nightmare. While I knew immediately that the content of the nightmare was directly linked to some newly disclosed and very distressing trauma history of one of my long-term clients, it wasn’t until I approached a trusted colleague to so some EMDR reprocessing on the nightmare’s content that it became clear to me what had hooked me psychologically. Only then was I able to identify, explore and resolve the mix of personal and professional issues my nightmare so poignantly represented.
Dr. Pearlman began her talk by laying out the bad news first, that vicarious traumatization (VT) is often an unavoidable negative effect of therapists caring about and for others. When VT happens it represents “the negative transformation in the helper that comes about as a result of imperfect empathic engagement with trauma survivors and their trauma material and a commitment or sense of responsibility to help.” Dr. Pearlman also declared that the hallmark of VT is “disrupted spirituality,” with cumulative and life changing effects. This is a sobering and powerful observation. She also described how VT arises out of an interaction between the helper, the situation (e.g. the client population, work setting, traumatic experience) and the socio-cultural context.
Dr. Pearlman also underscored how VT can take myriad forms, because it is unique to each individual helper. And while it is often overlooked as a primary problem, it lurks in the midst of more concrete behaviors or symptoms such as cynicism, auto-immune dysfunction, substance abuse, over-protectiveness, sleep disturbances, etc. She also reviewed for us what kinds of personal factors increase our risk of being vicariously traumatized, such as personal trauma history, countertransference, education, personal stress, coping/defensive style, attachment style and gender. The professional factors she mentioned included trauma exposure and the nature of our work setting.
So, where is the good news in this story? Dr. Pearlman is equally clear in her answer: Vicarious traumatization can be transformed. How? Her main suggestion is for us to follow the “ABC’s,” that is, to be Aware of our feelings and experiences, to Balance our personal and professional lives, and to Connect with others. Central to this prescription, of course, is committing to our own self-care program, including making time to play, escape and rest. What Dr. Pearlman could not do in this presentation, of course, was flesh out for each one of us a particular package of activities that suits us in accomplishing these goals. Nonetheless, she urged that we each commit to doing just that.
What I found myself wondering about at the conclusion of Dr. Pearlman’s talk, were two questions. First, how might we attend to the needs of the body in preventing or ameliorating VT? It seems to me that it may not be enough to use generic yoga, exercise or massage as ways to take care of our bodies. Just as the trauma field is developing particular body-based interventions for treating patients with PTSD, such as Sensorimotor Therapy and EMDR, it seems that we also need to refine our understanding and use of body-based activities to prevent and ameliorate VT. So, as Dr. Pearlman shared a lovely sensory-rich story about swimming, I found myself beginning to explore more deeply what I might do in the act of swimming to counteract the ill effects of VT. Be mindful of the present moment. Imagine the water sweeping away my distress. Kick away the frustrations.
The second question is how might we manage our vulnerability to VT when treating profoundly dissociative clients. Is our vulnerability to VT qualitatively different when we work with this client population, versus, let’s say, when we work with single-incident trauma survivors or survivors of natural disasters? The fact that we can be vicariously traumatized may be the same, but the specific tools necessary to ameliorate it may need to be adapted to these specific clinical circumstances. For instance, I think about how the Internal Family Systems model might be utilized in ameliorating VT.
Dr. Pearlman’s presentation provided an excellent springboard for such explorations. Her contributions to the trauma field on the topic of vicarious traumatization have been ground-breaking, and her engaging and clear presentation was a real gift. May we heed her wise words and provide for one another a community of understanding and support for the difficult work we do.