When is vicarious trauma a necessary therapeutic tool?

Abstract

Trauma is contagious; its powerful affect and frequently unformulated memories can be transmittedsometimes nonverbally and often mysteriously-within families, across generations, and from patient to clinician; in the latter case it is commonly referred to as vicarious trauma. In emphasizing trauma's contagious quality, the current paper explores the relationship between vicarious trauma and dissociation. The author reviews a number of neuropsychological, cognitive, and psychodynamic explanations for this uncanny clinical phenomenon and its frequently unremarked boundary failures. Despite its disorienting effect on clinicians, it is suggested that in a long-term clinical engagement with a survivor of massive psychic trauma, vicarious trauma can be essential in helping both clinicians and patients process the traumatic material. Contrasting examples illustrate those occasions in which the emotional contagion can be addressed in treatment using containment, validation, and imagination, and other occasions, when there is no therapeutic contract, and other means must be found to formulate the dissociated material.

Hurtful Gifts? Trauma and Growth Transmission Among Local Clinicians in Postearthquake Haiti

“…Indeed, the findings underline the ambivalence of clinicians’ experience and the complex negotiations involved in developing their double position. Our analysis supports the idea that trauma transmission in clinical work is not necessarily a pathological phenomenon and that it can also lead to rewarding experiences, such as learning and understanding, feelings of hope, solidarity, and connectedness (Boulanger, ; Gil, ; Triplett et al., ).…”

“…Despite the challenges, going back to clinical work was often described as a source of mobilization for professionals, in multiple ways. Reengaging in their roles allowed clinicians of Port‐au‐Prince to meaningfully contribute to their community's reconstruction and give meaning to their suffering, as for professionals in other postdisaster settings (Boulanger, ; Rousseau & Measham, ). Mutual transmission of traumatic experiences and growth appeared intimately intertwined in professionals’ narratives, challenging the common theoretical boundaries drawn between these processes (Boulanger, ).…”

Applying contemporary interpersonal theory to the study of trauma

“…It is also a task that is particularly amenable for interpersonally focused approaches to clinical supervision (e.g., Levendosky & Hopwood, 2017) in which disrupted interpersonal patterns such as those associated with trauma (vicarious and otherwise) are of primary interest. In such supervision, vicarious traumatization can not only be understood and managed for the sake of the clinician's own mental health, but potentially also leveraged in the clinical care of the trauma survivor (see Boulanger, 2018;Pearlman & Caringi, 2009).…”

Return of the Repressed: Revisiting Dissociation and the Psychoanalysis of the Traumatized Mind

“…Neuroscientific research indicates that such integrative failure is mediated by stress-related alterations in brain regions that serve major integrative functions; thus, traumatized individuals are more apt to react to sensory input with irrelevant, often harmful subcortically mediated responses that further impair symbolic formulation of experience (see, e.g., Krystal 1988; Schore 1994, 2009; van der Kolk 2006). 4 Because of the consolidating function’s failure, heightened affect and sensory impressions are repetitively processed by the amygdala, thereby producing a confusing “disconnect between the cognitive and affective spheres” (Boulanger 2018, p. 65).…”

“…This is easier said than done because disruptions in memory and representational functioning often force the analyst to suffer with the patient’s terrified states of mind, contain highly charged enactive tendencies, and endure deadening dissociative defensive operations before representational interventions can be used. Vicarious traumatization experienced by the analyst often ensues and may become a necessary therapeutic tool for representing and interpreting the meaning that has been unconsciously repudiated (Davies and Frawley 1994; Bromberg 2011; Diamond 2014; Boulanger 2018; Craparo and Mucci 2018). I hope to clarify how successful treatment often rests on gradually developing the ego’s capacity to represent such encrypted psychic experiences and to mentally process unbearable anxieties and psychic pain (Birksted-Breen, Flanders, and Gibeault 2010).…”