Trauma Therapists Often at Risk From Treating Trauma Survivors

Jon G. Allen, PhD
Senior Staff Psychologist with The Menninger Clinic

Treating clients with trauma-related disorders can be traumatic to us therapists. Ironically, the more compassionate and empathic we are, the greater our risk. From infancy onward, we are all subject to emotional contagion-suffering begets suffering. But vicarious trauma goes beyond that. As we listen, we conjure up visual images of trauma. Our imagery bolsters our empathy. Yet, like our clients, we may be haunted by the images we construct.

On top of this widely recognized vicarious stress, I have become increasingly aware of a professional hazard that does not receive sufficient attention in the treatment of trauma: the strain of working with clients who are especially difficult to help. Posttraumatic stress disorder that develops after exposure to a single traumatic event can be challenging to treat. Yet many persons suffering adverse reactions to traumatic events in adulthood also have a lifetime of exposure to extreme stress.

Most vulnerable are persons with a history of childhood trauma, especially those who have suffered abuse and neglect in their primary attachment relationships. This is a double-edged sword, because such trauma not only creates enormous distress but also undermines the development of the capacities to regulate distress. Then trauma may spawn a host of intertwined disorders. Posttraumatic stress disorder, mood disorders, and compensatory problems-dissociation, substance abuse, self-harm, and eating disorders, to pick a few-tend to be chronic and recurrent. Developmental psychology and neurobiology are beginning to clarify the basis of the daunting persistence of such posttraumatic psychopathology and pathophysiology.

Therapists who strain to help severely traumatized clients with brief interventions may find themselves vicariously traumatized and demoralized. Many traumatized clients need to be helped on several fronts over a considerable period of time. As they endeavor to use our therapeutic help in “processing” the trauma-thinking, feeling, and talking about it-clients also may need a great deal of containment. The two pillars of such containment are supportive attachment relationships and self-regulation strategies (e.g., exercise, relaxation, meditation, sleep). Education about trauma also provides important containment.

We therapists also need precisely the kinds of help we prescribe for our clients. Extensive evidence now documents the high prevalence of a trauma history among mental health professionals. In addition, we are subject to all the kinds of stressful life events that our clients suffer, not to mention our own stressful lifestyles. We are working in a high-stress profession, and working with traumatized clients presents us with the risk of vicarious trauma as well as the strain of working with many persons who are difficult to help. We, too, may suffer from a pileup of stress. And becoming a mental health professional confers no immunity to any of the psychiatric disorders we treat. In the face of our own stress pileup, we need all our own prescriptions: education, social support, self-regulation skills, and an opportunity to process our stressful experience by talking about it in a trusting relationship. As our clients will attest, these prescriptions are far easier to write than to follow.