General Secondary Trauma

[anthony]

Trauma affects those who experience it indirectly. Secondary, or vicarious trauma, refers to those people who care for, or are involved with, those who have been directly traumatized.

For example,

* wives of Israeli veterans with PTSD suffered increased psychiatric symptoms, somatic complaints, and loneliness

* symptoms that appear in traumatized children appear in nontraumatized children who play with them

* in families of catastrophe there are deleterious effects on family members exposed to a traumatized member

* family members who had not been born when the trauma events occurred develop PTSD symptoms: children of Vietnam veterans with PTSD exhibit impaired self-esteem, poor reality testing, hyperactivity, aggressive behaviour, and have problems coping with their own feelings, especially fear, rage guilt and mistrust.

For the therapist or social worker counselling a victim of violence, her or his world-view may be challenged and trust undermined with the ensuing effects of secondary trauma. Aspects of the trauma may be re-enacted between the victim and the caregiver through engagement in patterns as trauma transference. The primary patterns of trauma engagement include: exploiter/exploited, allies/enemies, aggressor/aggressee, and rescuer/rescuee. This will produce an increase in affect in the therapist, with alternate periods of numbing and withdrawal. The therapist needs to have a support system, or team to process these symptoms of secondary trauma. The team serves to 1) validate the affect; 2) identify the trauma patterns; and 3) propose healthy patterns that restore trust.

Healthy patterns ensure cooperation, not exploitation, and restore trust and empowerment to both parties to effectively understand and cope with the world through strengthening social networks. These patterns include:

* nonexploitation that looks out for the best interests of both parties and including others
* ally/enemy dynamic is diffused by direct and open communication
* aggressor/aggressee intimidation and abuse is prevented by including others in the community who are not directly threatened
* rescuer/rescuee relation is replaced by prediction and planning

It is not uncommon for seasoned therapists, advocates, or caregivers to experience a sudden feeling of incompetence and hopelessness when dealing with a traumatized patient. The experience of vicarious symptoms of post-traumatic stress disorder may challenge the caregiver's basic faith, heighten a sense of personal vulnerability, distrust and cynicism about the human condition.(6) The therapist may experience profound grief and feel as though he or she were in mourning with the victim. As well, the caregiver may feel caught between identifying with the perpetrator and the victim. There may be moments of frank hate and contempt, and a wish to be rid of the victim. These may be indicative of the therapist's difficulty in coming to terms with the possibility of their own capacity for violent behaviour. For these reasons, those who work with traumatized people need an ongoing support system to deal with the intensity of their reactions in their relationship with the victim, or perpetrator. No survivor can recover alone, and no therapist can work with trauma alone.