The task of helping people restructure, reframe and cope with traumatic events in their lives in an environment free of stigma is one that mental health professionals shoulder selflessly.
Patients are often required to be as transparent as possible as they narrate what troubles them in order to get adequate help and accurate diagnoses.
Though this work is voluntary, counsellors may fall victim to vicarious trauma after interacting with the often-gory details of a patient’s traumatic event.
Vicarious trauma is the result of a professional’s interaction with the trauma of a client that manifests as a change in behaviour as well as their core belief system.
It is easy to confuse this with burnout, another form of work-related stress. However, while burnout is influenced by a variety of factors in the workplace, vicarious trauma stems directly from listening to trauma survivors narrating their pain and accumulates over a period.
This has earned it the alternative name ‘compassion fatigue’.
The condition affects those in other professions that involve interacting with traumatic material as well. Lawyers, the police and journalists see and hear things while in the field that can greatly alter their worldview.
The role that natural empathy plays, especially in the field of counselling psychology, is immense.
“Counsellors are trained to engage clients with empathic understanding while remaining objective and professional. However, they are also human and often get affected by the suffering of their clients. If this happens they should seek immediate supervision and therapy,” says Dr Joseph Omollo, a clinical psychologist.
“Vicarious trauma may arise from counsellor sympathising with the patient and thereby secondarily becoming symptomatic,” he adds.
For psychologists involved in humanitarian missions, offering aid to the severely traumatised and witnessing first-hand the atrocities meted out on them increases the risk of vicarious trauma.
“Working with victims of terrorism in Mogadishu had an impact on me,” says Nancy Nyambura, a psychologist with Medecins Sans Frontieres (Doctors without Borders), of an experience she had in her previous assignment.
“After listening to [stories of] a similar theme of invasion of security and stories of gunshots and bombings, it began affecting my sense of safety and security. I began having vivid dreams which were playing out some of the trauma that my clients had shared,” she adds.
She also narrates how the experience made her sensitive to any sounds that remotely resembled gunshots despite never experiencing an attack of this kind, a symptom that lingered even after her return to Nairobi.
Symptoms of this trauma include difficulty in making decisions and in their relationships, anger towards the perpetrators of a patient’s traumatic event, to God as well as the victims, avoiding clients, a distorted sense of what is going on around them, hyper vigilance and even physical aches, to name a few.
The symptoms may also be more difficult to identify as the psychological effects erode their sense of self.
Being in charge of the mental health of populations in refugee camps, war-torn regions and low-income areas requires the management of vicarious trauma to be thorough and effective. Each humanitarian aid mission has its own mechanisms to provide this care for its workers. One needs continuous attention to recover from mental illnesses, as they are often enduring.
“After Somalia, I had great peer support. I shared with my fellow psychologists and I had peer supervision. My CEO at the time also gave me a moment not only to debrief my work, but also my personal experience working in such a volatile and highly insecure environment. I also had clinical supervision,” Nancy describes.
How do organisations help counsellors cope with vicarious trauma? At Medecins Sans Frontieres (MSF), some of the mechanisms in place include mentoring, breaks in-between missions, holidays after every three months and an on-site psychologist.
“We also make sure a psychologist or counsellor is not taking a very large number of traumatic cases all at once,” she adds.
As for self-care, which keeps the individual stable on a day-to-day basis, Nancy recommends self-awareness.
“Pay attention to how your work is impacting you- keeping a journal is one of the best ways to do this,” she says.
Another self-care mechanism one can adapt is having practices that help one transition out of the workplace mentally and emotionally, such as exercise or reading non-work related materials.
Engaging in hobbies, having a strong psychosocial support system and affirming your boundaries is also helpful.
It is important to note that the prevalence of this occupational hazard should not deter people from getting the help they need to recover from a traumatic event. Mental health professionals have dedicated their lives to inspiring positive change in society.
With the right mechanisms in place for the management of vicarious trauma, they are further equipped as caregivers in the practice of their vocation.
This article has been edited for clarity.