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When helping hurts: Program targets vicarious trauma

By Helen Buttery

It was the early 80s. Lorraine Telford was a young nurse – empathetic, ambitious and optimistic. Her first job was with a bereavement program in Alberta, which involved visiting grieving family members. Assigned to visit a widow who had recently lost her husband, Telford was shocked to hear that he had died by suicide. “It was horrific, traumatic, painful,” recalls Telford. When she left the woman’s house she felt scared, and the fear stayed with her for several days. At the time, she didn’t know what to call these overwhelming emotions or where to turn for help.

More than 20 years later, Telford discovered that these overwhelming feelings have a name: vicarious trauma (VT). Toronto Public Health (TPH), where Telford works as a quality assurance manager, is developing various VT initiatives so staff won’t have to endure the uncertainty and anguish Telford felt.

During a mandatory one-day workshop, staff learn that vicarious trauma, also known as secondary trauma, is an occupational hazard for anyone working with people dealing with trauma. It results from repeated exposure to client’s horrible stories and the empathetic response they elicit.

Sadly, exposure to trauma is a common experience for TPH staff who work with high-risk families and children. A 2006 employee survey of more than 200 staff confirmed higher than average rates of vicarious trauma among these professionals. That’s not surprising, as staff work with the most vulnerable members of society – children. They are also at a greater risk because they work with clients in extreme poverty and often face situations where a child has been injured or even died.

Few are prepared to deal with the painful stories they hear. Imagine, for example, a dietitian working with a homeless pregnant woman who tells her brutal stories of being raped on the streets. Her professional training certainly did not prepare her to deal with such situations.

To meet this need, the VT workshop educates front-line professionals about vicarious trauma and helps them develop ways to cope. It has been so successful that community agencies from as far away as Thunder Bay in northern Ontario have requested it. The workshop has also been delivered to mental health hospital staff, children’s aid workers and shelter workers throughout Toronto.

Cindy Rose, a mental health nurse consultant for TPH who helped develop and delivers the workshop, says its popularity stems from the pervasiveness of vicarious trauma. “People walk out of the seminar relieved,” she says. “They know something is going on, but they don’t have a name for it.” The relief also comes from understanding that vicarious trauma is not their fault, nor is it a reflection of competency. “We’re not blaming anyone – not the staff, not the client,” says Rose.

Understanding vicarious trauma is the first step towards getting support. To this end, TPH is currently piloting the Peer 2 Peer (P2P) program, which divides staff into teams, with each team headed by a colleague trained in and available to provide peer support. “Co-workers are already providing informal support, but we want to develop a culture of peer support and recognize its value,” explains Rose. This one-on-one support is essential because people experience vicarious trauma differently. What may not affect one person may trigger vicarious trauma in another. Many factors contribute to a person’s VT threshold, including protective factors, their own trauma and recognizing and addressing signs of strain.

“Unfortunately, professional helpers, especially nurses, are notorious for ignoring their needs,” says Rose. She says that women, who make up the majority of TPH staff, have been socialized to ignore stress alarms that may point to vicarious trauma, such as headaches and stomach problems or feeling grumpy or depressed. Others feel despair and a loss of purpose. When Telford worked at Toronto’s Hospital for Sick Children, she realized that her worldview was changing. She remembers being overly cautious with her daughter because her thoughts about child safety and health were affected by working solely with ill and injured children. She also remembers being depressed. “After being with a dead baby and the family all day, you aren’t able to be as responsive to the joy of your own children when you get home,” she says.

“We need strategies to counter the changes vicarious trauma creates,” says Rose. This could be as simple as exercising or it could include putting positive meaning back into life by contributing to constructive change. Telford, for instance, joined TPH ’s VT Committee at its inception in 2005. Still, despite every good intention and effort, vicarious trauma cannot be eradicated: “Empathy is a requirement of the job, but it’s also the vector or root of how trauma is transferred from client to worker,” says Rose. However, with strong supports in place, agencies can help not only clients experiencing the trauma, but also the professionals who work with them.