#117- My Personal Experience With Vicarious Trauma: Recognizing and Healing Secondary Traumatic Stress

The first sign I was experiencing vicarious trauma hit me like a ton of bricks. Learn how to recognize, prevent, and heal from the emotional impact of therapy.

I am so glad that you're here and joining me for part two of Trauma-Informed Care with Older Adults. Today’s episode focuses on you—the professional in your role of providing care and services to older adults.

Whether you’re a healthcare professional, mental health provider, aging services professional, or home health aide, your health and wellness matter just as much as the people you serve.

For over 20 years, I’ve worked with older adults in various settings, many of whom were recovering from significant trauma. I have always been diligent about self-care and sought support through my own therapy. But my experience with vicarious trauma still caught me off guard—and it hit me hard.

In this episode, I share my own journey of recognizing vicarious trauma, the signs to look for, and how to navigate healing so you can continue doing the work you love without sacrificing your well-being.

What You'll Learn in This Episode:

• I share the first sign I was experiencing vicarious trauma
• What vicarious trauma is and why professionals are at risk
• Key warning signs of vicarious trauma
• The impact of trauma exposure on mental health providers and aging service professionals
• Strategies to recognize, manage, and prevent vicarious trauma
• Organizational and personal solutions to creating a sustainable career in care work

Click here to Get your free Trauma-Informed Care Guide

Why Trauma-Informed Care Matters in Aging Services

A trauma-informed approach:
✔️ Improves trust and engagement between older adults and providers
✔️ Leads to better health outcomes and reduces health inequities
✔️ Helps providers avoid burnout and fosters resilience within care teams

Click here to go to the show notes for this episode

PROFESSIONALS: Grab your free guide to working with older adults here


Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits

Transcript

Regina Koepp: Welcome back. I am so glad that you're here and that you're joining me for part two of trauma informed care with older adults. This episode today really will focus on you as the professional in your role of providing care and services to older adults. And so I want to talk about today the impact of trauma on Healthcare professionals, mental health professionals, aging services providers, home health aides, whatever your role in working with older adults.

It's really important that we also are attending to your health and wellness. This topic is really important to me, understanding the impact of trauma on us as professionals, because I have experienced my fair share of vicarious trauma. I've worked for more than 20 years with older adults and, and many of the people I've worked with in many of the settings I've worked in are recovering from trauma or traumatic events and I have always been really good at my own self care.

I've always been good at doing my own, engaging in my own psychotherapy. And I thought I'm very well supported in my own wellness. And My experience of vicarious trauma hit me like a ton of bricks. 

I was working at healthcare system. I had worked there. At this time, I'd probably worked there about eight and a half years.

And most of my career had been working with people with A complex host of challenges from complex post traumatic stress disorder, plus poverty, plus racism based trauma, the majority of my clients were black plus, a whole host of people. of experiences. 

Part of my role at health care system as a psychologist providing psychotherapy and psychological assessments to older adults and families, and also on the spinal cord injury clinic, where my patients would range in their spinal cord injuries from complete to incomplete injuries, meaning that they might have mobility in their extremities or paralysis from the neck or waist down.

And I worked with a lot of different people, a lot of complex medical problems, complex trauma histories, like I said. And I always did very well managing and I worked on a team which was very helpful. Which I strongly recommend anybody working in the health system or mental health system work on a team because the emotional weight of carrying the stories and the healing journeys need to be supported by a team.

So I was about eight and a half years into my tenure and I remember the management changed at the hospital. It was starting to become much less patient centered, much less staff centered. I just felt unappreciated, unrecognized. It was like work more, work faster, work harder, treat more people. And my productivity was always very high, I always had a lot of students, psychology interns and postdoc fellows working with me. At one point I had seven people I was supervising. And the management changed. I was overproductive. I would meet my metrics and beyond. And I brought grants into the hospital and I still felt very underappreciated. And unsupported in the system. And I remember I was going to see a new patient and he had a spinal cord injury and was paralyzed from the neck down.

So he came to see me on a stretcher. So the transportation. was that an ambulance would bring him to my office. Okay, you also have to realize my office was so small. It was like the size of a closet, a walk in closet maybe, and not a fancy one. And there were no windows. And I had several patients who I would see who used a stretcher for transportation because they were paralyzed from the neck down.

And sometimes people would be on bed rest because of wounds that they would need to Remove the weight from so they would need to be on bed rest. And people would come into my office and we would be squeezed in so tightly where if a person came into my office with a stretcher, and this was like 10 like this, if a person came into my office with a stretcher, I would have to stand to provide therapy.

There was no place for me to sit. There was no room. And And yeah, of course, the system didn't care. I have mentioned this many times and this is why I left that system. But anyway a new patient was coming to see me. He came in to see using a stretcher. And he came into my office, and a few minutes into our conversation, maybe ten minutes in, this is our first meeting, he asks me for privacy.

So he asked me to step out of my office, and into the hallway so he can have some privacy. Okay, and you have to realize he also had a catheter that would drain his bladder. He also has been with the ambulance drivers escorting him here to my office because he used a stretcher. So there are all sorts of reasons he may have needed privacy.

He may have needed to adjust his catheter. He may have needed to I don't know, Make a phone call. He may have needed just some privacy and and I didn't know this person. And so I say, okay, of course, and he can't, he's predominantly paralyzed, so he can't like rifle through my things.

I'm not worried that he's going to go through my things. But But I, it's an unusual request. It's not a meeting someone. You don't often ask for that. And so I step out and I just become flooded with fear and the first thing that comes to my mind is oh my gosh, what if this person takes his life in my office?

What if he has a weapon and it's going to take his life in my office? And I was. Overcome. I was just flooded and I'm standing there. I'm like doing my best to regulate myself and I do. I regulate myself and and sometime later I knock and I go back in. He's fine. He didn't take his life and we continued our initial session.

This was one of the early signs for me. That I was experiencing vicarious trauma.

Another time. I was working with this woman and I felt so unsafe with her. She was in psychiatric crisis and needed to be psychiatrically hospitalized.

But I remember just before she and I decided together that she would be psychiatrically hospitalized because she was dysregulated. I remember sitting across from her and thinking, oh my gosh, she's going to attack me. And she didn't. And it was in that moment where I had this, I was also overcome with a bit of terror and fear.

And I felt a little out of my body, which was also very strange, because I always feel very grounded in myself when I'm working with people. with patients and I thought oh, gosh, like this is really intense. I cannot this is, I'm not the right therapist for this person. And she needs a higher level of care than I can provide.

And so we got her psychiatrically hospitalized. But I was like, wow. So that was another sign that I was experiencing vicarious trauma. 

And it wasn't like it was one person's story that brought on that vicarious trauma. It was the compilation of decades of stories and my own personal trauma history.

And so it was that, it was accumulation and it was compounded and it all caught up to me. And I have to tell you, these weren't the only experiences. I also had just like patients who shouldn't have died that died from medical malpractice in a very Tragic ways or patients who are resuscitated when they were DNR leaving the family and, and the worst decision possible to remove life support when they wouldn't have had to do that, if they had just honored the person's DNR. There were so many experiences that added up that when I finally left the healthcare system, it took me like a year and a half to fully grieve and Get this sort of trauma out of my system to process it to move through it.

It was so Complicated for me and so emotional and also I think another thing that made me vulnerable to vicarious traumas I remember I'm a very relational psychotherapist So I developed deep relationships with my clients I tend to work with my clients for years and decades. And and I remember one other psychologist said to me, Oh, you're going to get burned out having that level of connection with your clients.

My clients didn't know me very well. They knew my emotional reactions to things, but they didn't know me as a person very well, like in terms of my own histories or life. And I remember thinking, oh no, this interpersonal psychotherapy and relational psychotherapy is the way to go. And then I do think that there was an element of truth to what she said, I think that because I'm so relational and the bond, the therapeutic bond is so important to me, and that's where I believe healing and change happens is in the security of that bond, that also made me more vulnerable to vicarious trauma.

And I think we need to be talking about that as as professionals. 

So today I'm gonna describe vicarious trauma. What are the signs, how to address it, and to really share the message that your health is just as important as everybody else's and you are not impervious to your client's trauma, just because you're a therapist. 

So what is Vicarious Trauma? Vicarious Trauma is the emotional residue of exposure to traumatic stories and experiences of others, In our work, so this is where we witness fear and pain and terror that others have experienced.

And this is sometimes referred to as secondary traumatization or secondary stress disorder or insidious trauma. But it's essentially that we carry with us and that our clients stories and that these stories impact us.

I love this quote by I believe it's Rachel Remen, the expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.

I have to say this again, because this quote is The quote that I want every professional working with anybody who's worked with trauma. I want every professional who is working with anybody who's lived through trauma, which is everybody. Especially in healthcare systems, on hospice aging services providers, mental health providers, healthcare providers.

The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. We are going to get wet. We are going to have an accumulation of our clients experiences, and this accumulation is going to impact us.

So what are the signs of vicarious trauma? So I shared some of my signs earlier, but according to the Office for Victims of Crime in their Vicarious Trauma Toolkit, they identify difficulty managing emotions, Feeling emotionally numb or shut down, fatigue, sleepiness, or difficulty falling asleep, physical problems like aches and pains, being easily distracted, a loss of sense of meaning in life, relationship problems, feeling vulnerable or worrying excessively about potential dangers in the world, increased irritability.

Destructive coping or addictive behaviors, lack of decreased participation in activities that you used to enjoy, avoiding work and interactions with clients, and a combination of symptoms that comprise a diagnosis of post traumatic stress disorder.

The manifestation of vicarious trauma can occur in a variety of ways from excessive worrying if your client misses an appointment delays in completing your patient charts or encounters or client encounters, overreacting to unexpected environmental noises. So my reaction to the person who wanted privacy was an overreaction.

Experiencing visual images of abuse- related injuries or traumatic injuries like flashbacks or re experiencing symptoms or finding it difficult to watch movies or TV shows that evoke experiences that you might have in your workplace or of your clients. 

So one way to identify secondary trauma or vicarious trauma is with a scale called the secondary trauma scale and I'll link to this scale in the show notes .

[00:13:25] Regina Koepp: So say we have say we have vicarious trauma or secondary trauma or we're noticing symptoms for us as individuals. It's really important that we monitor this and that we take care of ourselves.

And so I had a very close friend who I worked with and I, she and I were on the same team. I would talk with her about everything. And so I would share with her, I don't think I can work with this person. This is what I'm experiencing. I need help navigating what's an ethical way to transition the care.

And that was a way of setting professional and personal boundaries around the care. It can be, to take advantage of professional development opportunities if your system allows them, to engage in your own psychotherapy, which I did and do and and it still happened, 

one of the things that was really important that I don't see a lot in the literature is I had a lot of, I don't know if it was shame necessarily, but I had a lot of disbelief this can't be happening to me. I've been working in this for so long. Like, how is this happening to me? And so I think maybe there was some shame and that I wasn't like quick to talk about it with other people. It was also I like the term insidious because It wasn't like, Oh, this is vicarious trauma. Like I didn't put the pieces together all at once.

I thought, Oh, this is a problem with me. Or maybe this is a problem in my own attunement with the patient rather than, Oh, this is vicarious trauma. So I had Some challenges differentiating. Oh, what's vicarious trauma versus what's my problem versus what is the patient projecting on to me that I'm experiencing.

And so it was a messy process for a while. And so I think stating that it's a messy process and stating that it requires a lot of work to differentiate is really important. It's, it may not be entirely clear that you're experiencing vicarious trauma. And so another. The other thing that you can do is to practice self compassion.

And I really think also getting some critical distance from the work, like with those professional boundaries, is important. And maybe, depending on how severe it is, a leave of absence may be in order. It also can help in your own psychotherapy to explore your own experiences with trauma and how that might make you vulnerable to experiences in the workplace, hearing other stories.

So our own trauma histories can make us vulnerable to traumatic stress and vicarious trauma. And so having trusted friends, colleagues, or a therapist can really help us to understand our own triggers and how this might be manifesting.

So if you are noticing vicarious trauma in a colleague or a coworker, it might help to reach out and talk with them privately about the impact of the work. Or if you yourself have experienced vicarious trauma, to share what your experience was like so that they feel less alone and that they know what to look for.

Also can help to encourage your colleague to establish consistent work to home transitions that create important boundaries outside of the workplace, encourage them, to engage in their own self care, support connections with friends and family. If they're open to, this also, this is, requires a lot of finesse and sophistication and good timing.

You don't want the person to feel, put upon or berated or like they've done something wrong and referring to organizational supports may be helpful or encouraging them to discuss the experience with their supervisor could also be helpful as well. And really this has to do. With the culture of the system that you're working in, I think in the system I was working in, , I wasn't getting much support when I was doing well, so , I couldn't imagine that I would get much support if I wasn't doing well.

And so I think you have to be considerate of the culture of the system that you're working in and how you're supporting your co workers.

If you're a supervisor it might be helpful to discuss vicarious trauma as part of supervision. And again, if you yourself as a supervisor have experienced vicarious trauma to share that experience and what helped you, what signs were prevalent for you, what kind of care did you get for yourself, maybe also to consider flexible work schedules and recognize the need For and protect downtime or professional development, so that there is some critical distance from the work create time and physical space for reflection through reading, writing, meditation, and so on, and to consider referral to therapeutic and professional assistance when appropriate.

And if you're an administrator working in a system, It also is important that you're aware of vicarious trauma and what you can do organizationally. To attend to it. So you can reduce any system causes of vicarious trauma and burnout, like level of workload, provide team based care, which I mentioned early on, referral to employee assistance programs, maybe sabbaticals or professional education or community service and even to consider providing a psychologist peer advocacy group, which maybe a specially trained therapist provides consultation to a group of clinicians who are working with clients who may have experienced high rates of trauma.

And so those are some things that you can do for yourself, for a colleague, for a supervisee, for a system to help address vicarious trauma. And I think Again, the organizational culture is really critical. Is there psychological safety in the system itself? Is there a culture of care in the system that you are working in or managing and if there's not, I might venture to say that if there are higher workloads and there's not a good system of care and support for staff, my guess is you'll also experience higher vicarious trauma and greater turnover.

And so really attending to this is important. Like I mentioned, I will include resources in the show notes to that secondary trauma scale so you can download it and use it if you think that's appropriate. 

I think the take home message here is that none of us are impervious to trauma, whether it's our own, Or our clients and that it can come as a surprise, the symptoms that come with vicarious trauma, but to take them seriously and to take care of yourself. There's another quote that I love that is generally geared toward caregivers, but I think everybody in the sort of healing and helping professions is innately a caregiver, Which is, the quote is, You are not required to set yourself on fire to keep others warm.

Take care of you first, you are not required to set yourself on fire to keep others warm. And if I could leave on that quote," the expectation that we can be immersed in suffering and loss daily and not be touched by it, is as unrealistic as expecting to be able to walk through water without getting wet."

So if you'd like more information on trauma informed care for Older adults, I have a free trauma informed care guide. It's called you can get that guide at mentalhealthandaging. com forward slash T I C for trauma informed care. I hope that you check it out. It has some great information and resources.

And I just want to end this episode by saying thank you so much for the work you do. I know how deeply important it is. I know in my core, and you're not alone in this great work that you're doing. I see you, I value you, and I value you so much that I want you to prioritize your own care. 

Next week I'm going to be talking about supporting older adults who are survivors of financial exploitation and fraud. And that was from a request from a listener. I hope that you join me then. Until then, please take good care of yourself and your colleagues. Bye for now.