Indirect exposure to client trauma and the impact on trainee clinical psychologists: Secondary traumatic stress or vicarious traumatization?

Abstract

The results, discussions, and conclusions presented herein are identical to those in the printed version. This electronic version of the thesis has been edited solely to ensure conformance with copyright legislation and all excisions are noted in the text. The final awarded and examined version is available for consultation via the University Library.ii Declaration This work has not been submitted for any other degree or to any other institution.iii Structure and word counts Literature Review 8000References 1582 Total 9582 Section 2 Research Report 11955References 1839 Total 13794 Appendices 3334 Total word count (excluding references and appendices) 19955 Total word count (including references and appendices) 26710 iv Thesis AbstractThis thesis consists of a literature review and research report Section 1: Literature ReviewConstructs of secondary traumatic stress (STS) and vicarious traumatization (VT) have been proposed to describe the negative impact of working with traumatized clients. In previous reviews of the literature, evidence to support these constructs has been limited and inconsistent; consequently their validity has been questioned. This review seeks to reassess the evidence from recent empirical findings. The review concluded that evidence to support the constructs remains limited, but tentatively there is greater evidence to support STS in contrast to VT. Section 2: Research ReportThis study investigates the extent of exposure to trauma work among trainee clinical psychologists and its impact on well-being. The study seeks to assess which theoretical model (STS, VT, or even a non-specific model of general psychological distress) best accounts for any negative effects associated with indirect exposure to client trauma. 564 trainees participated in an online survey, which included self-report measures of general psychological distress, trauma symptoms and disrupted beliefs. Most trainees had caseloads of 1-2 trauma cases, with the most common trauma being sexual abuse.Exposure to trauma work was not related to general psychological distress or disrupted beliefs, but was a significant predictor of trauma symptoms. Level of stress of clinical work and quality of trauma training contributed to the variance in trauma symptoms. It is concluded that the study provides support for STS and lacks evidence to support VT or a non-specific model of general psychological distress.v

Differentiation of Self: Enhancing Therapist Resilience When Working with Relational Trauma

“…According to Figley's (1995) definition, a therapist suffering STS would likely report that they were experiencing symptoms of avoidance, numbing, and hyperarousal. VT involves 'disrupted beliefs in relation to the self, others, and the world from cumulative exposure to client trauma narratives, in addition to trauma symptoms (Makadia, Sabin-Farrell, & Turpin, 2017, p. 1060McCann & Pearlman, 1990). Taken together, both STS and VT are consistent with some (although certainly not all) of the specifiers of a diagnosis of PTSD.…”

“…Baum, 2016), age, personal trauma history (see also Dagan, Ben-Porat, & Itzhaky, 2016), fewer years of trauma-informed training, fewer years in the field, poorer coping behaviour, and reduced social and supervisory support (Makadia et al, 2017). Recent Israeli studies, however, have found inconsistent mediators of resiliency in relation to VT and STS.…”

“…However, there are conflicting findings. Makadia et al (2017), in a cohort of 564 intern clinical psychologists, found no correlation between the symptoms associated with VT and trauma work, although they did find that there was a relationship between indirect exposure and symptoms of avoidance, intrusion, and arousal -symptoms consistent with STS. Environmental variables, such as those associated with burnout, were nevertheless found to be predictive of increased distress and disturbed belief systems (Makadia et al, 2017).…”

“…Makadia et al (2017), in a cohort of 564 intern clinical psychologists, found no correlation between the symptoms associated with VT and trauma work, although they did find that there was a relationship between indirect exposure and symptoms of avoidance, intrusion, and arousal -symptoms consistent with STS. Environmental variables, such as those associated with burnout, were nevertheless found to be predictive of increased distress and disturbed belief systems (Makadia et al, 2017). VT was reported in other studies of Enhancing Therapist Resiliency ª 2017 Australian Association of Family Therapy psychotherapists working with traumatised clients, as well as with social workers working in family violence, although vicarious resilience, that is, psychological growth in the face of exposure to trauma work (Calhoun & Tedeschi, 1999), was also found to be experienced concurrently in many cases (Arnold, Calhoun, Tedeschi, & Cann, 2005;Ben-Porat & Itzhaky, 2009;Gartner, 2014;Gil, 2015;Puvimanasinghe, Denson, Augoustinos, & Somasundaram, 2015).…”

A Systematic Review of Job Demands and Resources Associated with Compassion Fatigue in Mental Health Professionals

“…Burnout involves a feeling of being emotionally drained, a sense of detachment towards the recipients of one’s care and a plummeting sense of competence [ 15 ]. Studies have highlighted moderate to high rates of burnout and secondary traumatic stress in mental health professionals such as clinical psychologists, counsellors, psychotherapists, psychiatric social workers and psychiatric nurses [ 16 , 17 , 18 , 19 , 20 , 21 ].…”