5 Ways Vicarious Trauma Can Sneak Up on You as a Psychotherapist

Vicarious trauma is a term that is not unfamiliar to most therapists. Many of us were warned about VT in grad school, have attended self-care workshops that promised to resolve the effects of VT, or have simply resigned ourselves to white-knuckling it through each day. But do you really know how to identify vicarious trauma? Can you pick up on sneaky warning signs that VT is already present in your life? 

First - What Exactly Is Vicarious Trauma?

Before we begin to answer these questions, let’s make sure we’re all on the same page when it comes to terminology. The concept of vicarious trauma was first recognized in the mid-90s by psychologist Charles R. Figley as he noted that “there is a cost to caring” (p. 1). Since then, the term Vicarious Trauma is often used interchangeably with terms like Secondary Traumatic Stress, Compassion Fatigue, and even Burnout. While there is certainly overlap, these are truly unique experiences that are not uncommon amongst psychotherapists of any specialty, but especially for trauma therapists.

One way to think about these concepts is as a continuum of experiences that I often refer to as The Trauma Therapist Trauma Response:

(Please know that my work primarily focuses on supporting trauma therapists but Vicarious Trauma can be experienced by any kind of therapist, helper, or healer.)

This continuum of experiences always starts with Vicarious Trauma because it is a natural part of being a therapist. I say this because, as a therapist, you are an empathic human who cares about helping other people. This means you are soaking up the stress and trauma shared with you each day as you do the work you love. If you don’t have realistic and sustainable ways to wring out this metaphorical sponge of other people’s stress and trauma, the VT you are naturally experiencing can turn into things like Compassion Fatigue, Secondary Traumatic Stress, and even Burnout.

Hitting the Brakes on the Therapist Trauma Response

Just because Vicarious Trauma is a natural and inevitable part of our work as therapists does not mean it has to turn into more serious or painful experiences like Compassion Fatigue or Secondary Traumatic Stress. 

The greatest tool we have to help us hit the brakes on this process is knowing what Vicarious Trauma looks like for each of us as individuals. I don’t want to skim over this because, while there are certainly common signs of VT, it truly does show up differently for everyone. But, once we can name how VT shows up for us, we can come up with realistic and sustainable ways of managing it.

Common Signs of Vicarious Trauma

Before we get into the sneaky ways VT likes to show up in our lives, let’s talk about some of the most common warning signs that you may need to wring out your VT sponge. I teach therapists how to think about the ways Vicarious Trauma is affecting their Emotional, Physical, Relational, and Occupational functioning because it doesn’t affect only one area of our life.

As I go through each of these areas, I want you to start noticing if any of these signs might be happening for you now. Quick note - the signs below are not exhaustive and instead focus on some of the most common signs reported by psychotherapists like you.

Emotional Impacts of Vicarious Trauma

• Feeling more irritable than usual (major red flag for me!)

• Feeling like you’re on edge or more anxious

• Feeling more emotionally numb or checked out

Physical Impacts of Vicarious Trauma

• Sleep difficulties - falling/staying asleep or sleeping too much

• Chronic headaches, stomachaches

• Getting sick more often than usual

Relational Impacts of Vicarious Trauma

• Isolating from others (another major red flag for me)

• Always worrying about your loved ones’ safety

• Increased conflict with people close to you

Occupational Impacts of Vicarious Trauma

• Avoiding work (notes, voicemails, emails)

• Dreading sessions, even ones you usually enjoy

• Feeling unmotivated and uninspired at work

If your brain started checking off items, don’t fret! I want you to remember that this is a natural part of being an empathic human and therapist. The goal is not to avoid experiencing VT altogether, it is about learning how to pick up on the signs early enough so you can manage these experiences in healthy ways.

What About the Sneaky Side of Vicarious Trauma?

Finally, we’re getting to the good stuff! 😉 Whether you are close friends with Vicarious Trauma or not, the common signs probably didn’t surprise you. The thing about VT, though, is that it likes to sneak up on us in more subtle ways before we’re yelling at everyone and having nightmares. 

As we go through the top 5 ways Vicarious Trauma likes to sneak up on us as therapists, know that each of these could be caused by VT or any number of things - the goal here is not to be diagnostic about this but to name less obvious ways VT might be showing up.

1) Overworking

This might sound totally counterintuitive and your brain is probably saying, “but Jenny, you just said VT makes me want to avoid work!” Yes, that is certainly one shade of VT, but for a lot of us high achiever perfectionist types (🙋🏽‍♀️🤫), we turn to our work as a coping mechanism when things are feeling really heavy. 

One thing I often hear from trauma therapists is that they love the work they do. They are incredibly honored to serve their clients and walk alongside trauma survivors on their journey to recovery. It feels really good to help people! It’s also really empowering to know that the work we’re doing is making a difference - to feel effective. This means that many therapists will dive head first into their work as a coping mechanism when things are really difficult, or they have too many heavy sessions. Unfortunately, this can backfire if we’re not also wringing out our VT sponge.

2) Feeling Bored in Your Work

Feeling bored with our work is one of the counterparts of overworking caused by Vicarious Trauma but it’s different from avoiding our work because, since so many of us truly love the work we do as therapists, we are at least somewhat excited and motivated to show up each day. 

When our brain and body are starting to get over-burdened by the weight of VT, our natural trauma/survival response kicks in whether we like it or not. Yes, that can lead us to actively avoid our work, but it can also cause us to feel uninspired by our jobs, to become easily distracted in sessions, and to generally feel a sense of BLAH about what we’re doing (that’s the technical term 😉). 

3) Saying “No” to Everything

Don’t get me wrong; boundaries and limits are incredibly important as therapists! However, when VT is rearing its ugly head, our brain and body are more likely to go into survival mode and shut down. This often isn’t obvious to us at first, just like we usually don’t realize we’re overworking until it’s too late. 

This shut down mode is much like the Freeze response our clients describe when they’re processing stress and trauma. The big difference is that when we’re saying “No” to everything as professionals, it can include turning down activities or opportunities that would be helpful, healing, or beneficial to us (as opposed to freezing as a way to escape danger). This does not mean we have to say “Yes” to everything (see Overworking above!). The takeaway here is about balance - if we’re unbalanced in either direction it can be a big clue that our VT is going unchecked.

4) Constantly Thinking about Money

Depending on your past experiences with money, the messages you received growing up, and your current financial situation, this may or may not have anything to do with your experience of Vicarious Trauma. However, for a lot of therapists (particularly ones who are self-employed), money is a BIG deal, and not having enough of it is a strain on our wallets and can bring up other issues of self-worth. 

Unidentified and unaddressed Vicarious Trauma can amp-up these concerns and many therapists will start fixating on their finances much more than is necessary. This can look like checking bank accounts multiple times a day, not buying items that you truly need (and/or deserve!), or totally avoiding your financial situation by sticking your head in the sand. 

5) Believing “I shouldn’t feel this way”

I have to preface this one by acknowledging that helpers and healers of most disciplines often receive messages in school, from mentors, and from each other that we have to “buck up and suck it up” or else we’re not cut out for this work. While messaging around this is starting to change for trainees and early career therapists, the reality is that these beliefs are so deeply entrenched in our systems that they’re hard to escape and they often ramp up when our VT is getting really bad.

These kinds of beliefs set the stage for Vicarious Trauma to take root in our lives because they make us feel “less than” or shameful about acknowledging how difficult our work is (of course it is!). This then stops us from asking for help, connecting with fellow therapists, or making other changes that would allow us to receive the support we deserve and continues the vicious cycle of believing we’re not allowed to be affected by our work.

Next Steps

Now that we’ve covered some of the common, and not so common, signs of Vicarious Trauma, you are probably wondering what you’re supposed to do with all of this?! 

Naming Vicarious Trauma is the most important first step to getting the support and care you deserve as a therapist. Until we know what VT looks like for us at any given moment in our careers, we simply can’t do anything about it!

The VT Tracker will help you take a really honest inventory of how Vicarious Trauma is showing up in those 4 key areas of Emotional, Physical, Relational, and Occupational functioning. It will then guide you through how to track these signs for 7 days, giving you a healthy snapshot of how VT is impacting your personal and professional life. Once you have that snapshot, I guide you through how to develop a plan of action that is going to be realistic and doable - no recreating the wheel included! 

If you take away nothing else, I want you to remember that Vicarious Trauma is a normal part of being a therapist. You are doing an incredible job as a healer, and unfortunately there are some risks to doing the work you love. When you give yourself permission to be perfectly imperfect as a human and to name the ways your work naturally affects you, your abilities to show up for your clients and yourself will grow in leaps and bounds. 

So please, keep doing the work you love while getting the support you deserve! 

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References

Figley, C. R. (1995). Secondary traumatic stress in mental health care providers. Journal of Traumatic Stress, 8(1), 1-28. doi: 10.1007/BF02102860

Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue. Best Practices in Mental Health, 6(2), 57-68.

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Dr. Jenny Hughes is a licensed clinical psychologist specializing in the treatment of trauma and PTSD. As a clinician, she practices EMDR, Cognitive Processing Therapy, and Prolonged Exposure therapy.

Through her clinical work, Jenny has been able to also support helpers and healers through the common experience of vicarious trauma. As the founder of The BRAVE Trauma Therapist Collective, Jenny supports trauma therapists go from feeling drained and demoralized to energized and empowered.

Learn more about Jenny and her work at braveproviders.com, and on Instagram and TikTok: @braveproviders.

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Let’s Chat

• Which of these ways has been relevant for you?

• What is one consistent way you take care of yourself as a trauma therapist?

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Download the Vicarious Trauma Tracker—a resource created by Dr. Jenny Hughes and found in the Free Resource Library:

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