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February 28, 2015
by Lisa La Rose, M.A., L.P.C.

Vicarious Trauma and Behavioral Health

February 28, 2015 05:55 by Lisa La Rose, M.A., L.P.C.

Vicarious Trauma, also called compassion fatigue, secondary trauma, or secondary stress, is a type of trauma that sometimes occurs for people who helps others through very difficult situations and emotions.  We know that this type of trauma is a risk for those in the helping professions, like counselors and first responders.  But it is also possible for others who witness a traumatic event, or who are close to someone who has experienced trauma, to develop symptoms of Vicarious Trauma.  These symptoms can be similar to the symptoms experienced by those with Post Traumatic Stress Disorder (PTSD).  

For example, many of us experienced symptoms of vicarious trauma when we watched too much footage of the horrific events that happened in New York City on September 11th.  We may have had nightmares, anxiety, intrusive thoughts, avoidance of airports, or other symptoms related to what we experienced as a witness.  We may not have been there, but we heard the heart-wrenching stories, and absorbed the pain of our fellow human beings.

Vicarious Trauma happens when we take in and absorb the feelings, sights, sounds, and smells of detailed stories told by victims of trauma. These may be stories of abuse, accidents, natural disasters, death, loss, or other tragedy.  As they release their pain, it can be transferred to the listener. That may be a therapist, a family member, or a friend.  When we hear stories like these, we may feel a physical reaction and an urge to withdraw.  If we are in a helping profession, we may have to control our reactions, putting us more at risk.  Vicarious Trauma can sneak up on us, and before we know it, something is just not right. Subtle changes can start to happen, and others may notice it before we do (Richardson, 2001).

Recognizing Vicarious Trauma

It is essential for those in the helping professions to be able to recognize the signs and symptoms of Vicarious Trauma, or compassion fatigue in themselves and their co-workers.  It can be insidious and dangerous, affecting health, relationships, and career.  In his book, The Compassion Fatigue Workbook (2012), Franciose Mathieu shares some signs of secondary trauma, or compassion fatigue, that can sneak up on those working in the helping professions.

1.     Physical Symptoms: These include feelings of exhaustion, even after a weekend away from work; insomnia; headaches, chronic pain, low resistance to illness; somatizations.

2.      Somatization:  This is when we convert emotional stress into physical symptoms.  These may include gastro-intestinal symptoms, fainting spells, headaches, and anxiety about minor illness or injuries.

3.      Emotional Exhaustion: This goes beyond just being tired. This is a feeling of severe and constant fatigue that just doesn’t go away, even with rest. It’s as though you have nothing to give, and you just fall into bed at the end of the day.

4.      Increased use of alcohol or drugs:  This includes increased reliance on substances to relax or sleep.

5.      Missing work: Calling in more and more often due to illness or emotional exhaustion.

6.      Increased anger or irritability: This may come out as anger toward colleagues or family and friends, or being irritated by small things.  For counselors, this may include feeling irritated with clients when they don’t do homework.

7.      Avoidance of clients (for those in the helping professions): This may include not returning a client’s call, or disappearing when a difficult client stops by.

8.      Difficult making decisions:  For counselors, this can include doubting your skills and loss of self-confidence.  For others, it can become difficult to know what to do in a stressful situation, or to solve problems.  Everything can start to feel overwhelming.

9.      Problems in personal relationships:  This may be due to being so drained that you have no energy left for family of friends.

10.  Leaving your work or poor client care:  For those in the helping professions, this means lower quality care, or just leaving your career all together, and finding work that is not so triggering and difficult.

11.  Distancing:  You may find yourself avoiding loved ones, or not spending time with colleagues.  You start to become isolated because you no longer have the energy, interest, or patience to be with others.

12.  Negative Self-Image:  This includes both personal and professional self-image.  You wonder if you were ever any good at your job, and doubt your skills.

13.  Depression: This includes all the classic symptoms of depression, including trouble sleeping, appetite disturbance, feeling hopeless, guilt, and suicidal thoughts.

14.  Decreased ability to feel empathy and sympathy:  You’re just too tired to care. You can become numb or desensitized to the pain of others.

15.  Becoming cynical and resentful: This is a very common sign of vicarious traumatization.  You have lost your enthusiasm, and start resenting any demands placed upon you by others.

16.  Loss of enjoyment: You just don’t enjoy your work or get energy from it anymore. You’re not excited about learning new things.

17.  Depersonalization or Dissociating: This can be spacing out during sessions, or other times, and daydreaming more than usual.

18.  Increase in irrational fears and anxiety:  Hearing about traumatic events in the world may cause you severe anxiety fear. You begin to view the world as an unsafe place.

19.  Experiencing intrusive imagery:  This may include thoughts or dreams/nightmares about the details of traumatic stories you have heard.  

20.  Becoming hypersensitive: This includes crying easily and unexpectedly.

21.  Becoming Insensitive: This is the opposite of hypersensitive, and is more like becoming numb.  For example, watching extreme violence on TV doesn’t even have an effect on you.

22.  Loss of hope:  This may include a loss of hope that clients will ever get better and maybe even a loss of hope in humanity.

23.  Merging personal and professional life:  Signs of this include having no life outside of work, only talking about work (or complaining about work), working through lunch, skipping vacations, or being tied to the cell-phone.

24.  Lack of a life outside of work: This includes letting go of hobbies, sports, friends, interests, and activities that you enjoy. It also includes neglecting personal relationships.

It can be difficult to know if what you’re experiencing is just fatigue, burn-out, or vicarious trauma, but being vigilant and aware of the signs can help you prevent more serious symptoms. If symptoms are persistent, even after taking a few days off, or a vacation, that could be a sign that you’re suffering from compassion fatigue.  If you find that you have many of the symptoms above, it’s time to take action to protect your health and your career. Many time, helpers like counselors or social workers put themselves last, and neglect their own needs.  That is a recipe for disaster. Psychologist, Maria Masotta, suggests these strategies to prevent and manage the symptoms of vicarious trauma:

  • Stay connected and avoid professional or personal isolation
  • Take excellent care of your mind, body, and spirit
  • Practice self-care that is holistic and nurtures your mental, emotional, physical, and spiritual health.
  • Maintain and supportive workplace, and attend regular supervision or peer-supervision.
  • Learn about vicarious trauma from books and seminars
  • Spend time with supportive, healthy people
  • Have friends who are not in the helping professions
  • Learn mindfulness or relaxation skills that you can use anywhere
  • Journal—as catharsis or for inspiration
  • Balance personal and professional life
  • Maintain personal boundaries- say “no”, when needed
  • Maintain realistic expectations about your work in the helping profession
  • Allow yourself to experience normal emotional reactions
  • Use your personal and vacation time to rest and relax –no work!
  • Minimize/avoid dual relationships
  • Recognize if drugs or alcohol have become a problem, and get help
  • Access mental healthcare for yourself.
  • Build in time for non-clinical work (research, administrative, teaching)

These are just a few ideas for preventing vicarious trauma, and holding it at bay if you’re starting to feel its grip.  The most important thing is awareness.   It’s also essential for behavioral health providers to access behavioral health services and clinical supervision, when needed.  It may not be immediately apparent, but the symptoms of vicarious trauma can harm your career, and put your license at risk.  Being a helping professional is a difficult, but rewarding and fulfilling, calling. By taking care of yourself, you will be able to continue to help others, and you are a model for clients who are trying to take care of themselves.  


Mathieu, F. (2012). The compassion fatigue workbook: Creative tools for transforming compassion fatigue and vicarious traumatization. New York: Routledge.

Masotta, M., PsyD. (2011, June 15). Vicarious traumatization: Recognition, response, and prevention. Retrieved September 5, 2014, from

Richardson, J. I. (2001). Guidebook on vicarious trauma: Recommended solutions for anti-violence workers. Ottawa, Canada: National Clearinghouse on Family Violence. Retrieved September 4, 2014.

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