The Dark Side of Caring: Vicarious Trauma

By Jason Raines

It can go by different names. Sometimes it is referred to as vicarious trauma or emotional fatigue. Other times, we simply call it burnout. Although none of us would like to admit it, no matter what we call it, we all have seen it in our peers and at times, even in ourselves. The dark side of caring so much for others is that we can lose part of ourselves in the process. As caregivers, we see ourselves as highly-skilled professionals who come to the aid of others in need. As the masters of our disciplines, we often do not think that we are the ones who may need to be taken care of at times. This great drive to help others before ourselves is one of the greatest strengths of a caregiver. However, it can also place us at great risk. Simply put, when we are too preoccupied with helping others, we may not take the time to take care of ourselves, until it is too late.

What Are the Causes?
There are many challenges facing caregivers today. These can include long hours, endless amounts of documentation, high-stress situations, threats of false allegations, deterioration of the boundaries between work and home and threats or actual physical violence. A key function of any caregiver is to actively listen to clients, which creates vicarious trauma. Often clients openly discuss in great detail the physical, psychological and/or sexual abuse they have experienced. This is part of the dark, sad reality that caregivers experience with clients on a daily basis. In some fields, caregivers will hear accounts of abuse from multiple clients on a daily basis. Repeated exposure to these recollected events can weigh heavily on any caregiver.

High levels of threats and actual physical violence can create stress, fear and trauma for any caregiver. Some caregivers face occupational risks of injury nearly five times as high as other professions. Going back to the early 1990s, the Department of Justice’s (DOJ) National Crime Victimization Survey for 1993 to 1999 lists the average annual rate for non-fatal violent crime for all occupations as 12.6 per 1,000 workers. The average annual rate for physicians is 16.2; for nurses, 21.9; and for mental health professionals, 68.2. The Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII) reported during the 2003 to 2010 time period the Healthcare and Social Assistance Industry accounted for 63 percent of injuries and illnesses each year. Some of our clients react violently toward caregivers because of their mental health problems, disabilities or misunderstanding of social cues. Sadly, some of our clients may have also learned that violence is a way to solve problems or get their needs met. This can perpetuate the cycle of violence toward the caregivers who are trying to help them. Another threat often faced by caregivers is the threat of false allegations or spurious lawsuits made by clients who are angry. Very few other jobs have the same sorts of career-ending threats, such as loss of license or clearances caused by untrue allegations. This creates great stress for the caregiver.

Another difficult reality facing caregivers that causes great stress and frustration is the fact that not all clients understand that they need help or are willing to accept it. No matter how much caregivers want to provide help, they cannot force clients to be open to it. At times, clients may need more time to develop trust with the caregiver so they can feel comfortable working through traumatic events they have experienced. Other times, the clients may not realize how severe their addictions or behaviors have become, and they often may need multiple interventions before they are ready to accept help. This can be very trying on caregivers who want to provide help, but must wait to do so as they see their clients in distress.
Another stressor that often impacts caregivers is the fact that regardless of how much effort and dedication a caregiver gives to a client, some clients will not improve. This is not attributed to something the caregiver did or did not do, but it is often a sad reality of the client’s condition. Caregivers who work in the mental health field know that some of their clients will commit suicide despite efforts to help them or keep them safe. The University of Washington reported more than 90 percent of people who die from suicide suffered from a diagnosable mental disorder. The university reported people with personality disorders are approximately three times as likely to die by suicide. When a client takes his or her own life, it leaves the caregiver questioning, and even doubting, their efforts and ability to treat other clients. Likewise, caregivers who work in hospice realize that no matter how hard they try or want the person in their care to get well, the client will succumb to his or her illness in a short time. The same holds true for caregivers working with dementia or Alzheimer’s clients. The caregiver slowly watches his or her client’s personality fade away and his or her body decompensate. This process is repeated time after time with new clients. All of this is very traumatic to a caregiver.

Even greater trauma is experienced when caregivers look after family members. Not only do they face normal issues of being caregivers, they now have to work through issues of role reversal. In many cases, it is the child who becomes a caregiver for the ailing parent. The caregiver must process through issues of being a caregiver to the person who took care of him or her as a child. It is an extremely heart-wrenching process to watch a loved one slowly die, being powerless to prevent it. All the caregiver can do is make his or her loved one as comfortable and peaceful as possible, while trying to make the most of the precious time they have left together.

In the inpatient setting, caregivers who work with clients on a direct basis are often the newest and youngest caregivers. This means they may need more supervision and support than more experienced caregivers. However, they often do not receive this necessary support, increasing the likelihood that they will become overwhelmed and victims of vicarious trauma. This not only leads to the loss of a passionate caregiver, but it also creates a negative impact on the quality of care for that client. 

Other common causes of burnout found in the caregiver’s workplace can be found in any other type of workplace. These causes include work overload, feelings of not being appreciated or recognized, strained relationships among colleagues and job dissatisfaction. With all of the possibilities for stress, it should be no surprise that according to a survey done by Harris Interactive in 2013, 60 percent of healthcare workers (caregivers) report burnout.

What are the warning signs?
There are a number of warning signs that can indicate a caregiver is in need of help to prevent him or her from leaving the field because of vicarious trauma. Warning signs can vary from one caregiver to the next as well as in intensity and duration. However, here are some of the most common warning signs:

  • An increasingly cynical or negative outlook
  • Having less energy than in the past
  • Feelings of helplessness, hopelessness, being trapped or defeated
  • Skipping work, coming in late or leaving early
  • Constantly feeling exhausted
  • Neglecting your own needs, either because you are too busy or you don’t care anymore Isolating yourself from others
  • Your life revolves around caregiving, but it gives you little satisfaction
  • You have trouble relaxing
  • Feeling increasingly impatient or irritable
  • Withdrawing from responsibilities

What can we do to prevent it?
A self-care plan is one of the best means to help maintain one’s own well-being. It is an individual plan created by the caregiver to help him or her balance work and home life. It provides positive outlets for stress and frustration. Many different variations of the self-care plan can be found on the Internet and in books. Free templates are available online for any caregiver to download and use. Any version of a self-care plan can be helpful, but the key is actually following through with the plan. As caregivers, we often do not complete this step. We spend a large amount of time telling our clients to use their care plans and coping mechanisms, yet we fail to do this ourselves.

In the workplace, weekly supervision of caregivers is the most useful way to provide support and monitor for vicarious trauma, compassion fatigue or simple burnout. The weekly supervision is focused on the caregiver and the work environment, rather than on clients. The meeting is an effective way for a supervisor to gauge how the caregiver is doing and allows the caregiver to vent frustrations and possibly receive help or guidance in resolving these frustrations. The caregiver can also receive reassurance from his or her supervisor that he or she is doing the right thing, even though a client is not showing progress. The meeting may only last 10 or 15 minutes, but the key is that honest open communication takes place between the caregiver and the supervisor. 

Clinical supervision is another tool that can be useful in some caregiving fields. In this process, caregivers meet and review current client cases. This can be done in one of two ways. The first way is to review current cases in a group setting with other caregivers. This allows for the caregiver to voice concerns and frustrations and receive advice and support from the group. Another way is for clinical supervision to be conducted between the caregiver and a second caregiver who has been trained as a supervisor. In this form, not only are the caregiver’s current cases reviewed, but items from the caregiver’s personal life that may affect either the caregiver or the treatment provided are also discussed. Emerging research shows that when clinical supervision is used by caregivers in the nursing field there are decreases in burnout. 

To be strong caregivers, we must understand that to successfully help others, we need to take care of ourselves first. We must be well balanced and in a confident, positive frame of mind. Only then are we able to perform our greatest gift – the ability to help others in need.

Jason Raines is the program director of the Inventor Center at KidsPeace in Orefield, Pa., with more than 10 years of experience in the nonprofit world treating children. Jason also serves as the vice chair of the Child Abuse Prevention and Treatment Citizen Review Panel, Northeast Region of Pennsylvania, and is an adjunct professor at Lehigh Carbon Community College.