What is vicarious trauma?
Vicarious trauma is something I have learned a great deal about in recent years, and it is vital to discuss it in this book, because the topic will already be, or will soon become, relevant to many of you. Even if you don’t know it yet.
First, let me take a quick step back and explain how vicarious trauma became such a big part of my world, to give you just one example of what it can look like, even though your experiences will be different from mine.
In 2014, after I published my partly autobiographical book The Fictional Woman, I was invited to appear on a panel on the current affairs TV program Q&A. I was asked by host Tony Jones why I had chosen to speak out about the experiences I’d related in chapter 3 of the book, of being stalked, attacked and sexually assaulted in my younger years (that this came up in numerous discussions of the book is something I have already discussed in Chapters 9 and 10). This is a transcript of how I responded on that occasion:
What I found was that when you’re talking about the experience of women and girls there are fictions that we hold – that things like sexual violence happen to other people. Things like miscarriage happen to other people. I’m someone who wants to be speaking out as an advocate for some of these issues for women and girls.
I really felt like I couldn’t talk about some of these issues for women and girls without talking about sexual violence and I couldn’t talk about sexual violence without putting my hand up and showing solidarity with other victims of crime and saying, ‘I’m one of you.’
I added that physical and sexual violence affects about one in three women. (One in three Australian women have experienced physical and/or sexual violence perpetrated by someone known to them, according to the Australian Bureau of Statistics1 and worldwide, about 1 in 3 (35%) women have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime, according to the World Health Organisation.2) Many men also experience sexual violence, and there would be people in the audience and at home who are affected by it.
Vicarious trauma can have an impact on even the strongest and most ‘prepared’ person. Knowing what it is, and how you can manage it, can help.
I went on to say, ‘I think there is a toxic silence surrounding this issue and we need to get a lot better at talking about it. And one of the reasons is because the silence protects the predators – it also shames the victims. It also robs us as a community of the tools to be able to support people adequately when these things happen to them . . .’
As for being called ‘brave’ because I was speaking out, which had suddenly started happening once the book came out, the thing is, survivors of these types of crimes rarely hear that at the time, when they really need that support. I went on:
They don’t tell you that at the time. They don’t tell you you’re brave, you’re a role model, that you’ve survived something. They often tell you that you should be silent. They tell you that it’s your fault. They tell you that you were asking for it, that you did something wrong.
Viewers at home: you will get through this. This will pass. You are strong. You do not need to be silent.
This spontaneous moment on the program prompted perhaps a thousand people to get in touch with me within a period of only a few days. For me, this was an unprecedented amount of contact from strangers in such a short period of time.
A few of the social media messages made personal rape and death threats – which is an important issue that I will discuss in the next chapter, Unsocial Social Media. But the vast majority sent heartfelt and supportive messages, and a large number of them also disclosed their own experiences of sexual assault, including gang rape, child abuse and intimate partner violence.
While I had mentally prepared myself for most of the media reaction, I had not been fully prepared for the outpouring of support, emotion and personal stories from ordinary people.
Though there were fewer messages each day after that first week – hundreds instead of thousands, and later, down to perhaps a dozen a day – the experience remained intense. As Rosie Batty relays in the previous chapter, ‘You will have intense times.’ That was certainly true for me. As I travelled around the country I was often met with hugs from strangers, and would find that some people actually spontaneously burst into tears at seeing me. Often they explained that they were reading that particular chapter (‘Chapter 3’, I’d hear again and again), or they would tell me they had seen me on Q&A and had been particularly moved by what I’d said.
It was often a beautiful experience, if emotionally draining. And though I would not change a thing – not one word – the fact is that while I had mentally prepared myself for most of the media reaction, arming myself with statistics and info on the topics that might come up, I had not been fully prepared for the outpouring of support, emotion and personal stories from ordinary people.
I could not have imagined that from that moment on, there would be men and women telling me about the child abuse they had endured, sometimes right before I went on air to speak about the book; or that there would be readers telling me about the abusive relationships they had fled; and that there would be women and girls telling me about the abuse they were currently experiencing in their own homes, sometimes in book-signing line-ups, or on the street.
I listened to many stories knowing that these people were not safe yet, and that they needed someone to help them right now. Sometimes these people were underage, and that truly broke my heart. I wanted to take all those kids with me and make them feel safe ever afterwards.
But of course I could not. I could only refer them to professionals, who would do as much for them as they could. I could advise kids that what was happening was not their fault and they should speak to a trusted adult or call the Kids Helpline (1800 55 1800 in Australia). In the case of adults, I would mention the 1800 RESPECT free professional counselling service and recommend they speak to a counsellor or police officer about their experiences and what their options were as soon as possible.
I felt not only troubled by what these people were telling me, but I also felt inadequate because of how little I could do to help. I am someone who dedicates a lot of time to unpaid advocacy work in human rights and women’s and children’s rights, and who tries to stay informed. I attend conferences, read papers, speak to experts and pore over case studies and data. But that does not make me a qualified professional counsellor or psychologist. It doesn’t make me a police officer or a judge.
I was never able to ‘switch off’ when I heard these stories as a psychologist or other professional learns to do. I did not have ‘office hours’ as it were. I would be confronted while doing my shopping or catching a train. My exposure to this trauma was usually random and unexpected.
Sometimes, because a person was in a book-signing line-up, or had somewhere else to be, the exchange I had with them would take only a few minutes from start to finish. It would happen with little or no warning, and no follow up, unless I had a way to contact them again. That was sometimes the hardest part – knowing there was no way I could possibly do more for them, and no way for me to know what would happen to them.
The experience left me more determined than ever to speak out on the issues of sexual assault and intimate partner violence, but ultimately I also found the avalanche of stories triggering.
This, I now realise, was inevitable. I found myself running on very little sleep over many months, even feeling panicked at times. I was trying to respond to every unexpected disclosure in the most responsible and human way possible. I wanted to make sure I was supportive and did not make things worse with a poorly chosen word or a distracted response in a signing line-up of hundreds of people. I wanted to respond to each email and social media message myself, particularly because so many of them were clearly heartfelt and deeply personal. It was a responsibility I felt honoured to be faced with. But it was a lot of responsibility and I was never able to do enough. After a few months, I’d lost several kilos, I was not sleeping and I was deeply wary of further triggering stories. In short, I was burning out.
This kind of experience is, as it turns out, not at all unusual. What I was experiencing was vicarious trauma.
I was trying to respond to every unexpected disclosure in the most responsible and human way possible . . . I was burning out.
Support for vicarious trauma
Karen Willis is Executive Officer of Rape & Domestic Violence Services Australia, and has worked in the sector for over 35 years, providing frontline services for victims and survivors of sexual assault and domestic or intimate partner violence. She contacted me after I appeared on the show to see how I was doing, and to thank me for what I had done on air, showing solidarity with other survivors of crime and speaking out about a difficult topic that affects people of all genders, and in particular, a huge number of women and girls in Australia and around the world. The following year I became patron of the Full Stop Foundation, which supports their work, and which I launched at Parliament House.
Karen strongly suspected that I would benefit from learning more about vicarious trauma and self-care. And she was right.
Vicarious trauma is a major issue for advocates and other people in the sexual violence sector, and for anyone who hears highly distressing stories on a regular basis as part of their paid work or unpaid advocacy. This includes those who work as counsellors, police officers, paramedics, social workers and more.
‘When people tell us about the violence they have experienced it is inevitable that their story will be distressing,’ Karen explained. ‘While we choose to do this work the personal cost can be high. This impact, called vicarious trauma, can be managed. That way we can stay well and keep doing the work we are committed to doing.
‘Each client, regardless of what has happened, will at some stage express a hurt that is so deep in them and so painful. It is hard to really understand how someone [an abuser or rapist] can deliberately do that to someone else . . .’
I asked Karen how she handles vicarious trauma in her own life:
Firstly I recognise that I am only human and that the stories and the emotions they generate will have an impact on me and everyone else. Our workplace has a lot of practices in place to manage this impact called vicarious trauma.
It is a WH&S [workplace health and safety] issue and we also have a [personal] responsibility, it’s not all up to the workplace. I certainly make the best use of what the workplace offers, and I also do things in my own life to make sure there is balance – being with friends and family, doing things that have nothing to do with work and that are fun or good for the soul, being aware if my behaviours or thoughts begin to change and thinking about why, and if it is about the work then doing something about it.
I have a great extended family network, and while sometimes that can be a challenge all on its own, it is special to be part of something like that. I also have some great friends. They are busy women so we don’t see each other all the time, but when we do it is great.
My own work with UNICEF as their National Ambassador for Child Survival can also be challenging at times, in different ways. As one example, visiting several Syrian refugee camps in Lebanon in 2015 was a life-changing experience for me. I held kids we knew were dying. I was at one camp when a devastating fire tore through another camp just next to us, killing young children, all because of a simple cooking accident. I saw families lining up for the meagre services made available to them through charitable donations, knowing that if they were in Australia, things would be so different for them – if war had not broken out in their homeland, and they had not been forced to flee because of circumstances beyond their control. Many talked non-stop about their homes, their hopes of returning, their longing for news of family members or whether their houses were still standing.
Faced with stories like these, it’s hard not to feel guilty, inadequate. I have been a UNICEF ambassador since 2007. But this time, on the third day of my trip, I began to fall apart. I was unable to get myself together as I’d hoped to. I needed to take a break at one camp as a result, and that felt humiliating to me. I was glad that at least I’d held it together in front of the kids and families, but some of the other workers saw me in that vulnerable moment, when I couldn’t stop crying.
It’s the little details that sometimes make you crack. In this instance it was the reality that over a dozen small children had been electrocuted to death while walking or playing in a particular area of a camp with bad wiring. As a parent of a young child, I couldn’t help but imagine what it would be like to be living in limbo with her somewhere in a camp, where it was that dangerous for my child. I lost it.
After sitting down in private, drinking some tea and using some tissues I picked myself up again and carried on. Fortunately I’d only slowed down our demanding schedule by 10 minutes, but I hated that I’d been unable to go on.
I kept it together again until I got back to my hotel that night. I was exhausted, dehydrated (despite my best efforts) from the soaring temperatures and hot tents, and again, I fell apart trying to process what I’d seen. It can happen to anyone. It wasn’t even the worst scenario I was exposed to on that trip. But that was another part of it: I knew I’d only gained security clearance for the ‘safer’ areas. I knew it got far worse in other areas, and yet the things I’d seen were things I’ll never forget.
I can judge myself harshly sometimes, and in that moment I felt inadequate and weak – my tears weren’t going to help those families – but they needed to come out anyway. After that, I was stronger. I am human, after all.
It takes a special kind of strength to do this work on a regular basis, as foreign aid workers and my colleagues at UNICEF do. As Kate Moore from UNICEF explains:
My colleagues and I see a lot of the bad, bad things that happen to children, their families and their communities. It’s true, there have been times I have noticed in my peers a sense of despair or distress as images flood through from our friends and colleagues in the field, or as we worry for changing community attitudes toward people who are vulnerable and need us to be compassionate for them. It’s really OK to say you’re angry, or upset, or distressed, and that you need a moment. If you are mentally and emotionally drained and fatigued, you can’t be your best self – and the people we’re advocating for really need us to be our best selves. These people, often children, are already emotionally and very often physically wrecked. They need strong supporters who can champion their needs, so taking a moment to build yourself back up really is nothing if you’re prepared to play the long game.
Vicarious trauma will be relevant for many readers of this book. Speaking out often involves speaking out for others in difficult circumstances, or speaking out about our own difficult experiences, which (as I discovered) can in turn attract a lot of disclosures about similar experiences from others, often in unexpected moments. Vicarious trauma can have an impact on even the strongest and most ‘prepared’ person. Knowing what it is, and how you can manage it, can help.
Understanding and responding to vicarious trauma
The following information (pages 193 to 198) is provided by Rape & Domestic Violence Services Australia, who have an award-winning Vicarious Trauma Management program.
What is vicarious trauma?
Vicarious trauma is the negative impact of being exposed to traumatic content, such as hearing stories about traumatic events people have experienced.
What does vicarious trauma look like?
Symptoms of vicarious trauma generally fall into three categories:
• Re-experiencing (intrusive thoughts, nightmares, flashbacks)
• Avoidance (of people, places and feelings, or blocking out things using alcohol or drugs)
• Hyper or chronic arousal (on edge, anxiety, disturbed sleep).
Vicarious trauma can also change the way people feel about themselves and about others:
• Esteem (‘I deserve good things in life’, ‘Other people’s help/input is valuable’)
• Trust (‘I am a trustworthy person’, ‘Other people are generally trustworthy’)
• Control (‘I’m not worried about losing control of my emotions or behaviour, ‘I feel OK when other people are in charge’)
• Intimacy (‘I don’t mind spending time alone’, ‘I feel connected to other people’)
• Safety (‘I am safe’, ‘The people I care about are safe’).
Near-miss story
This story is about a practitioner who worked as a generalist counsellor for three years before she took a role as a trauma specialist counsellor for Rape & Domestic Violence Services Australia. When she started work as a sexual assault counsellor, she was keen and interested and felt fine. However, after a few months she started to realise that something wasn’t right. She was starting to worry about her personal safety, which was unusual for her. She would start to check that doors were locked, that windows were shut tight and that someone would always stay at home with her. Once a month her husband worked nights; this started to impact on her relationships, as she was always trying to convince her friends to stay over. The counsellor realised that she was experiencing symptoms of vicarious trauma, as previously she had never really worried about personal safety. She realised that listening to stories that were trauma-related was having a negative impact on her. She informed her supervisor and they developed a self-care management plan to manage the symptoms and work though her feelings of safety in her external counselling sessions.
Direct hit story
Lucy was in her forties when she decided to train as a social worker. She had worked as a hairdresser for over 20 years and felt that she wanted to do something that was more altruistic. She took out a Higher Education Contribution Scheme loan and spent the next four years studying to be a social worker. She was delighted when she passed her course and she soon began work as a child protection case worker. However, after a year, she started to experience difficulties and began to have a lot of time off work. One day when she was travelling to court with a colleague, her colleague noticed a map on the passenger car floor. Lucy had made a map of a route from the office to court and the map had lots of red dots on it. The colleague was perplexed and asked her why she needed a map, as they always travelled to court and she could find it with her eyes shut! Lucy confessed that she was really struggling to cope and that she needed a map to identify toilet stops on the way, as she often felt sick or needed to go to the toilet. The colleague didn’t follow up on this issue with Lucy or with Lucy’s supervisor. Shortly after, Lucy left her role as a social worker and went on long-term sick leave, submitting a workers compensation claim. The cost to this woman was enormous: she incurred financial hardship and a deterioration in her relationships and spent four years training in a profession that she could no longer work in.
Managing symptoms of vicarious trauma
Symptoms vary from a minimal impact on a person’s life to a severe impact. The aim is to keep symptoms manageable, close to minimal impact, by addressing symptoms early. There are five strategies that should be used to manage symptoms effectively:
1. Education
Learning about vicarious trauma, or training for your workplace.
2. Reduce risk
Leave work at work by debriefing or doing a grounding activity.
Exercise: Debrief with a colleague by answering these questions:
• What was your shift like?
• Did any of the information impact you?
• What are you planning on doing to leave it at work?
Alternative exercises when debrief isn’t possible:
• Answer the debrief questions in an email sent to yourself
• Listen to the radio in the car on the way home to ground yourself.
3. Monitor symptoms
Measure symptoms using questionnaires:
Google: Compassion Fatigue Self Test by Charles Figley
Check in with yourself:
Exercise: How do you know if you might be experiencing vicarious trauma?
Write down your ‘dominant emotion’ 10 days in a row – do you feel ‘hopeful’? ‘frustrated’? ‘anxious’?
It’s normal for the dominant emotion to vary most days. If it’s a negative emotion that is similar most days, there may be an issue that could be explored with a counsellor.
Daily monitoring:
• ‘Eyeball’ your colleagues – do they look stressed?
• Checking in with your colleagues – are they OK?
• Talk about vicarious trauma in the workplace.
4. Early intervention for symptoms
• Access a supervisor for debrief after trauma exposure (24/7)
• 1800RESPECT is available for support managing vicarious trauma (in Australia).
5. Offsetting symptoms
• Self-care
• Access an external supervisor who specialises in vicarious trauma.
Symptom |
It might look like |
These activities might help |
Re-experiencing |
Intrusive thoughts, nightmares, flashbacks |
Grounding based on the type of impact (sight, hearing, touch, smell, taste): • A visually creative activity helps to clear a nasty mental picture • Listening to music to clear an audio recall • Playing with a puppy; stroking a cat |
Avoidance |
Staying away from certain people or places, avoiding feelings by blocking out things using alcohol or drugs |
• Arrange to spend time with other people • Consider talking with a counsellor about how you feel |
Hyper or chronic arousal |
On edge, anxiety, disturbed sleep |
• Physical activities (swimming, walking) • Creative activities (beading, knitting) |
Final thoughts on vicarious trauma
Rosie Batty, domestic violence campaigner, 2015 Australian of the Year:
I tried to be accessible to everyone, and try to help everyone, but I can’t cope with the volume of the people trying to contact me, and the intense expectation that I am going to save their life . . . I have had my fair share of PTSD [post-traumatic stress disorder]. I’ve always had a journey of recognising my emotional space, when I need the company of good friends, or counselling. I had to, from the beginning, due to confronting hate mail, kind of detach myself. Initially I tried to answer the emails myself. Now I have someone helping me. I know it is inadequate. I am unable to intervene with [individual] victim journeys . . . I am advocating for systemic change, and I use those victim stories in a confidential way, to make change, to make those stories heard. I wish I could do more. It has been incredibly overwhelming. I am not working at that crisis frontline place. I see my place as advocating. Certainly I have a lot of victim contact, but it’s mainly people recognising I want people’s voices and stories to be heard . . . I work out ways to feel like I’m still making a difference.