Most people are familiar with vicarious living — an act which involves having an experience through the lens of another person — in one way or another. Maybe you’ve refreshed a sibling’s Instagram feed one too many times while they were on vacation, or relished tales of your friends’ dating lives.
However, not all vicarious experiences are positive. Sometimes hearing the details of an unpleasant situation can cause vicarious trauma, the phenomenon where you feel negatively affected by a tragic situation like a mass shooting ― even if you weren’t physically present for it.
Vicarious trauma can materialize in many different ways and can range in intensity. It’s a natural, empathetic response to human suffering. Some people are also just generally more likely to experience vicarious trauma because they’re repeatedly exposed to the trauma of others. One of those groups? Therapists.
“Vicarious trauma is a very real thing that can manifest as a subtle phenomena, and it is important that therapists are keeping an eye on their own process when doing trauma work with clients,” explained Mahlet Endale, a licensed psychologist based in Atlanta. “The earlier you notice it happening, the quicker you can attend to it to prevent burnout or distraction from client care.”
While it might be easier to imagine themselves elsewhere or disengage during sessions, a lot of mental health professionals feel they need to experience their clients’ emotions on a certain level, said Tracy Vadakumchery, a practicing pre-licensed mental health counselor at The Feeling Good Center in New York.
“In order to be truly empathetic, we must share in that pain with our client to some degree — to feel what they are feeling,” she said. “When people share traumatic experiences, they feel quite vulnerable and need the safety of a trusting therapist in order to do so.”
Therapists often don’t feel affected by appointments right away, though, added Nicole M. Ward, a licensed marriage and family therapist who specializes in vicarious trauma. But they’re only human, and over time it can certainly take its toll.
“It is important to know that vicarious trauma is not an immediate response but is cumulative and can be an ongoing process from hearing and caring for those who have experienced traumatic events,” Ward said.
Feeling these emotions does not mean your therapist is putting their own mental well-being at risk simply by doing their job. “Therapists are taught how to manage this beginning from their early training in graduate school,” Endale stressed.
Additionally, each therapist has cultivated their own methods of dealing with or preventing vicarious trauma.
“There are several strategies I use to prevent experiencing vicarious trauma. First, I am mindful of how many clients I am doing active trauma work with at any given time. I also try to space out the trauma sessions I am doing across multiple days so there is time to recover between sessions.” Endale said.
Therapists ― when they’re able to choose clients ― are also instructed to be cognizant of potential patients that might not be a right fit for them.
“In training, we learn to be careful about accepting clients when they might trigger things you are managing in your own life. This goes for all things, not just traumas,” Endale explained. “For example, if a therapist had a recent loss, it would be a good idea to not accept clients with grief or loss-related concerns or traumas until the therapist has worked through their own process.”
Self-care is also just as important for your therapists as it is for you. “In my group, we place emphasis on therapists practicing what we preach by implementing a self-care regimen on our own time outside of work.” Vadakumchery said.
For Endale, self-care involves habits like “making sure I’m getting necessary sleep, eating healthy, staying active as much as possible, knowing my limit on how many clients I can see in a day and balancing my work life with enjoyable activities outside of work.”
Relaxation techniques are also crucial. “This often includes mindfulness meditation and protective visualizations that keep my clients’ experiences separate from my own experiences,” said Karen Whitehead, a clinical social worker in private practice.
Anthony Freire, the clinical director and founder of The Soho Center for Mental Health Counseling in New York, said he tries to implement one of two techniques in his sessions and “both are designed to keep the therapist from creating false ‘memories’ that come from listening to other people’s trauma.”
The first is what he called the balcony effect. “When the patient is describing the traumatic details, it’s very easy for the therapist to imagine themselves in the same scenario and therefore experiencing the trauma themselves,” he said. “With the balcony effect, I imagine myself on a balcony above the therapy room and ‘watch’ the client tell me the story so that I never fully engage in the story by putting myself ‘in the patient’s shoes.’”
The second, which is similar to the first effect, is called the movie theater effect. It involves “imagining oneself ‘watching a movie’ play out as the client is telling the story without becoming a character in the movie ourselves,” Freire said.
Finally, therapists never underestimate the power of getting their own mental health help.
“I also get consultation and supervision from colleagues and engage in my own therapy as needed to understand and process any strong or lingering reactions to a client’s situation,” Whitehead said.