Vicarious Trauma

Listening to patients share intimate details about their traumatic thoughts and experiences puts some mental healthcare providers at risk of vicarious trauma. Clinicians may find themselves haunted by thoughts of their patient’s traumatic situations outside of sessions. It may interfere with their sleep, cause relationship tension, or lead to a shift in their core beliefs, making them less empathetic and less effective at their jobs. 

“Mental health workers and psychiatrists are particularly vulnerable to vicarious trauma based on personality factors, including the tendency to be very empathic and compassionate people,” says Michael Young, MD, medical director of The Retreat by Sheppard Pratt.  

Clinicians frequently exposed to traumatic content in their work, those with personal trauma history or unresolved grief, and those with little peer support may be more vulnerable to vicarious trauma.  

Compassion fatigue, burnout, and vicarious  trauma 

Clinicians who experience vicarious trauma may become less empathetic listeners and less invested in patients’ emotions. “The emotional and psychological toll from vicarious trauma can ultimately cause the clinician’s defenses to kick in, which can present as compassion fatigue—having reduced capacity to be empathic with the person as a protective mechanism,” Dr.  Young  says. 

It can also lead to burnout, causing usually compassionate clinicians to become irritable, callous, and cynical, and experience physical, mental, and  emotional  exhaustion, he  says. 

Repercussions of vicarious  trauma 

Vicarious trauma may also lead to poor judgment, causing clinicians to make careless errors and strain relationships with colleagues and  patients. 

 “When clinicians are less compassionate and more callous in interactions with patients and families, the very important therapeutic rapport can be disrupted,” Dr. Young says. “In some cases, this can lead to the patient wanting to switch to a new clinician or the clinician getting negative performance evaluations at work.” 

Outside of work, feelings caused by vicarious trauma may lead to maladaptive coping skills, like substance use, Dr. Young says. 

How to manage vicarious trauma 

It’s often easier to see signs of vicarious trauma in a colleague than in yourself. Engaging in self-care and recognizing your own limitations may help reduce your risk. 

“Check in with yourself each day to see where you are in terms of personal wellness and your capacity to engage with the patient’s traumatic content,” Dr. Young says. “Make sure you’re using your allotted vacation days, taking enough time off to recharge and focus on your own priorities. This work can become overwhelming if you are not intentional about self-care.”   

Healthy mind and body practices like exercising regularly, eating a Mediterranean-style diet, and maintaining good sleep hygiene are the pillars of self-care.  

Try to maintain healthy boundaries in your cases and diversify your caseload to see a mix of patients each day. 

Dr. Young adds that regularly meeting with other clinicians in your specialty can be helpful. “They have experienced similar things. You can talk about what you’re going through, get peer-to-peer supervision debriefing on cases, and find reliable social support,” he says. 

Finally, find ways to accept appreciation and gratitude from patients. 

“We’re a source of hope and support to people who are suffering, which can give us a sense of meaning and purpose,” Dr.  Young says. “That can help us be resilient and maintain our motivation to do this life-saving work.”