A Philadelphia College of Osteopathic Medicine mental health counseling professor has issued a warning for her fellow therapists: Second hand trauma can be hazardous to your health.
Therapists exposed to patients’ traumatic stories can experience vicarious trauma, a condition created when the details of a client’s story slowly seep into the daily lives of clinicians and alter their worldviews, says Lisa Corbin PhD, LPC, NCC, the chair and director of the MS in Mental Health Counseling program at PCOM.
“Vicarious trauma is what happens to us when we are unable to disconnect from clinical sessions and infuse details of a client’s story into our real world,” says Dr. Corbin, an assistant professor in PCOM’s School of Professional and Applied Psychology. “It’s the process of change that happens because you care about the people you serve. Strong therapists can step into the worlds of our clients and begin to understand their worldview.”
Vicarious trauma, also known as second hand trauma or insidious trauma, occurs when therapists internalize the disturbing patient ordeals they hear hour after hour, day after day, and integrate those traumatic experiences within their own daily functioning.
It is normal for clinicians to experience vicarious trauma when they work with clients who experienced trauma, notes Dr. Corbin, adding that clinicians experiencing vicarious trauma may feel the physical, emotional, and cognitive symptoms that are similar to those of their clients who experienced trauma, including nightmares, difficulty concentrating, sleep difficulties, repeated thoughts or images regarding traumatic events (especially when you are trying not to think about it), feeling numb, and increased sensitivity to violence.
“We carry the stories of trauma and they can change our worldview,” says Dr. Corbin.
One symptom of vicarious trauma that’s especially harmful to a therapist’s ability to effectively treat patients is known as the “silencing response”—being unable to pay attention to and sometimes avoiding others’ distressing stories because they seem overwhelming and incomprehensible.
Not only has Dr. Corbin studied and lectured on how working with traumatized clients affects therapists—in March, she presented “The Ethics of Self-Care for Trauma Counselors” at the Mediterranean Region Counselors Association in Budapest, Hungary—but she also knows firsthand how debilitating vicarious trauma can be, both personally and professionally.
Around 25 years ago, while a rape crisis counselor on a college campus, Dr. Corbin heard repeated stories from sexual assault victims who were incapacitated with date-rape drugs. Whether out with friends or at a family party, Dr. Corbin became so hypervigilant that she began taking her drinks with her to the bathroom. “I was so afraid someone was going to slip a date-rape drug in one of my drinks,” she says.
Later, during her doctoral internship, Dr. Corbin treated two young girls who were groomed by a human trafficker at a shopping mall. When her children asked if they could go to the mall, Dr. Corbin loudly forbade them from doing so. “My worldview of the mall had changed to that of a dangerous place,” she says.
The good news for Dr. Corbin—and for all mental health therapists—is that self-care, a concept most counselors preach to their clients, is the key to tamping down the emotional residue of exposure to others’ traumatic experiences, says Dr. Corbin, who starts each day with two “self-care non-negotiables: 30 minutes of yoga followed by 30 minutes of cardio no matter what.”
Dr. Corbin has built self-care into PCOM’s MS in Mental Health Counseling program curriculum, each month incorporating an activity for her students. April was mindfulness and meditation. May will be yoga. She asks first-year students to create a self-care plan for themselves “because counselor burnout is real and we want to provide our students with the tools to combat vicarious trauma and burnout.”
Here's a short list of the many small and not-so-small things you can do to care for yourself. Remember, says Dr. Corbin, to choose a self-care act that is right for you … not what others tell you to do or what you “think” is right.
Setting and maintaining boundaries between your professional and personal life can make a significant difference, says Dr. Corbin. Some therapists wash their hands after their work day and envision themselves washing away all of the stress and client-related issues to which they were exposed. You might also consider changing clothes when you get home (thanks, Mr. Rogers!) and not checking work email after a certain time of day.
Our mind and body are interconnected. Ensuring that you are filling your body with nutrients and staying active are great ways to reward yourself and stay healthy. Maintaining an exercise routine does not mean going to the gym every day, but we all have time to move our bodies and stay active in some way. This could look like doing yoga or stretching each morning, waking up earlier and making a healthy breakfast, or going for a walk in the evening with your family.
Even if it is for five minutes in the evening, make time to celebrate the small victories of your day. Think about something you enjoy doing but have not been making time for, whether it be having a cup of tea at night or watching your favorite show.
“These small acts of kindness toward ourselves can make a huge difference,” says Dr. Corbin.
The lack of self-care initiatives can lead to a violation of American Counseling Association Code of Ethics, says Dr. Corbin.
For example, if you’re experiencing empathy fatigue as a result of vicarious trauma, your patients aren’t getting the care they deserve because you’re not likely to encourage patients to tell their stories if you’re burnt out. Patients are also less likely to attend sessions if their counselor is not giving them the empathy or the attention they deserve.
Just as flight attendants warn before takeoff to first secure your own oxygen mask before trying to help someone else in the event the masks fall from the ceiling, how can counselors who neglect their own self-care help their clients? Taking care of yourself doesn’t mean me first. It means me, too.
For the past 125 years, Philadelphia College of Osteopathic Medicine (PCOM) has trained thousands of highly competent, caring physicians, health practitioners and behavioral scientists who practice a “whole person” approach to care—treating people, not just symptoms. PCOM, a private, not-for-profit accredited institution of higher education, operates three campuses (PCOM, PCOM Georgia and PCOM South Georgia) and offers doctoral degrees in clinical psychology, educational psychology, osteopathic medicine, pharmacy, physical therapy, and school psychology. The college also offers graduate degrees in applied behavior analysis, applied positive psychology, biomedical sciences, forensic medicine, medical laboratory science, mental health counseling, physician assistant studies, and school psychology. PCOM students learn the importance of health promotion, research, education and service to the community. Through its community-based Healthcare Centers, PCOM provides care to medically underserved populations. For more information, visit pcom.edu or call 215-871-6100.
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