Vicarious trauma, compassion fatigue, burnout, secondary trauma: What's the difference?

There are a multitude of terms that are often applied to the impacts of working in the areas of DVSA. These include vicarious trauma, compassion fatigue, burnout and secondary trauma. There are some definitional differences in these terms, which we will briefly explore, but first we wanted to explain our position on terminology.

We use the term vicarious trauma, defined by Pearlman and Saakvitne (1995, p. 31) as being “the transformation of the therapist’s or helper’s inner experience as a result of empathetic engagement with survivor clients and their trauma material”. What differentiates this definition from others is that vicarious trauma is framed by Pearlman and Saakvitne (1995) as an interaction between the individual’s personal history and the victim's traumatic experiences, as well as the social and cultural contexts. While this term still presents many of the issues we discuss below, such as individualisation, framing vicarious trauma as occurring within particular contexts and specific times, allows an understanding that much of the impacts of DVSA work is often beyond the control of the individuals involved.

The terms vicarious trauma, compassion fatigue, burnout and secondary trauma are often used interchangeably however there are some differences in these terms:

• Vicarious trauma: As we described above, vicarious trauma occurs when there is a transformation in the inner worldview of the worker as a result of empathetic connection with those that have been victims of DVSA. This can be due to a one-off encounter, or repeated interaction with victims. The term vicarious trauma was first used the early 1990s by practitioners working with survivors of childhood sexual abuse (McCann & Pearlman,1990). The Sexual Violence Research Initiative (2015, p. 4) lists the following effects of vicarious trauma on practitioners and researchers as being: - Alterations in views of themselves, their identity, their society, and the larger world; - Loss of a sense of personal safety and control; - Feelings of fear, anger, and being overwhelmed; - Feelings of guilt and/or diminished confidence in capacities and frustration with the limits of what one can do to improve a situation; - Increased sensitivity to violence; - Altered sensory experiences, such as symptoms of dissociation; - Loss of ability to trust other individuals and institutions; - Inability to empathise with others; - Social withdrawal; - Disconnection from loved ones; - Inability to be emotionally and / or sexually intimate with others; - Lack of time or energy for oneself; - Changes in spirituality and belief systems; - Cynicism; - Loss of self-esteem and sense of independence; and - Minimising the experience of vicarious trauma as trivial compared to the problems of respondents/clients.

• Secondary trauma (or secondary traumatic stress): While secondary trauma is a similar concept to vicarious trauma, there are differences as it is based on a set of clinical symptoms. Symptoms of secondary trauma are akin to posttraumatic stress disorder and include: intrusive thoughts, images and feelings about victims' experiences; numbing or avoidance behaviours such as avoiding working with a particular client, or blanking out whole sections of an interview; and physical impacts such as heart palpitations, sweating and sleep issues such as nightmares (Bober, 2006).

• Burnout: Burnout relates to how individuals function within their workplace and occurs when their health and outlook on life is negatively impacted due to their work. There is a gradual development of burnout, which includes physical and emotional symptoms of exhaustion. People who experience burnout have low job satisfaction, feel overwhelmed at work and have feelings of powerlessness (Figley, 1995).

• Compassion fatigue: Compassion fatigue is a generalised term for anyone who suffers as a result of helping others. It is seen as a consequence of exposure to another’s trauma and is influenced by an individual's empathic response (Portnoy, 2011).

While we use terminology such as vicarious trauma we want to emphasise that these are not ideal terms, and we share Reynolds' (2011) concern that these concepts individualise the impacts of DVSA work. By locating the impacts within individuals, there is a sense that what is “wrong” is within us, and that the burden of fixing this “wrong” is our responsibility. However the issues that we are exposed to in our work are societal issues, they are issues of oppression and social injustice, and the fact that they impact us is not due to our faulty coping skills or lack of self-care. Reynolds' (2011) highlights that it is often not the victims that we work with and their traumatic experiences that burn us out. It is the context in which we work that create the conditions that facilitate the development of vicarious trauma, particularly when we feel our ethics and our deep commitment to social justice is not shared and supported by our workplaces and colleagues.

The terms used to describe the impact of DVSA work on researchers and practitioners are important, but as this brief overview shows, the definitions often overlap and may place an unwarranted burden on individuals to fix themselves. What is most important is that there is recognition that work in the DVSA field can and does impact individuals, and that this impact needs to be taken seriously, at an organisational and structural level, as well as by individual workers and practitioners.

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References

Bober, T. & Regehr, C. (2006). Strategies for reducing secondary or vicarious trauma: do they work? Brief Treatment and Crisis Intervention, 6(1):1–9

Coles, J., Astbury, J., Dartnall, E., & Limjerwala, S. (2014). A Qualitative Exploration of Researcher Trauma and Researchers’ Responses to Investigating Sexual Violence. Violence Against Women, 20(1), 95–117. http://doi.org/10.1177/1077801213520578

Figley, C. (1995). Compassion fatigue as a secondary traumatic stress disorder: an overview. In: Figley C, (Ed). Compassion Fatigue: Coping with Secondary Stress Disorder in Those who Treat the Traumatized. New York: Brunner Mazel.

Pearlman, L. & Saakvitne, K. (1985). Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors. New York: Norton and Company.

Sexual Violence Research Initiative (2015). Guidelines for the prevention and management of vicarious trauma among researchers of sexual and intimate partner violence. Pretoria: Sexual Violence Research Initiative

Reynolds, V. (2011). Resisting burnout with justice-doing. The International Journal of Narrative Therapy and Community Work. (4) 27-45.

Portnoy, D. (2011). Burnout and compassion fatigue; watch out for the signs. Health Progress (92)4: 46-50.