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Therapist Self-Care Compassion Fatigue & Secondary Traumatic Stress
Domestic Violence continuing education psychology CEUs

Section 11
Vicarious Trauma: My Personal Struggle
"Can You Relate?"

CEU Question 11 | CE Test | Table of Contents | Domestic Violence
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

As you know, as a therapist you are ethically mandated to ensure that you take measures to care for yourself. However, as you will see, the therapist care of self can be quite enmeshed between client issues and agency policies and procedures. I know some will not agree with my actions and assessment of the situation, but I feel it beneficial, for the purposes of this article, to provide an accurate description of my perceptions at the time.

I’ve been the sole batterer’s intervention counselor at my agency (covering two counties) for over four years. Many events have led up to the insidious appearance of what I now know is Vicarious Trauma. I had all the symptoms and was taking numerous medications to try and cope with what I thought was the result of something inherently wrong with me. I battled feelings of shame, doubt, and intermittent suicidal “wishes.”

Determine What Can Be Done

Being a therapist teaching men to take responsibility for their violence, I didn’t want to “blame” anyone. Yet, I saw where changes could be made once I started looking into the phenomenon and continually ran into information regarding the types of environments that are conducive to the development of this disorder. Not only did I need to change some things personally, but also I needed some changes from my employer. So, I wrote a professional and detailed letter explaining the vicarious trauma symptoms I was experiencing. My letter noted the research supporting vicarious trauma as a real phenomenon. I attached documentation of both prevention and intervention actions an organization can take to address the very real occurrence of Vicarious Trauma among employees in the helping professions.

From my research I discovered several solutions to vicarious trauma. These solutions included: flexible schedules, adequate pay and leave, support of professional development, availability of non-trauma related work and supervision that is collaborative and not authoritarian. The most hurtful aspect of this situation is that I asked for help, but my request was only met with what I felt was judgment and blame by supervision. I expressed a desire for the letter to open a line of communication aimed at problem solving. Unfortunately, my supervisor became deeply offended by the truth and responded punitively. Does this sound familiar to you? On a scale of 1-10, how would you rate the support you currently receive from supervision?

Dual Stress: Experiencing Both Victim and Perpetrator Trauma
In my employer’s written response to my plea for help she stated, “If you were doing your job right you wouldn’t be having these symptoms.” She further stated that because I work with the men who “cause” the trauma I am not exposed to trauma and therefore my problems couldn’t possibly be related to my job. I explained to her that, in my opinion, I listen to more trauma than the victims’ counselor. I talk to both the victims and perpetrators. I contact victims to get a history of abuse; they call me when he’s re-offended or they’re afraid he will; and they call to check on progress and sometimes go into details about the abuse history again. In addition, I contact victims randomly to see if there’s any continued abuse. More significant than this, however, is that these men, of course, were not born to batter! In my experience, most of them have endured horrific abuse and abandonment or witnessed such. As you know, they batter for power and control, yes. But on a deeper level, they batter to obtain “love”. Through my years on the job, I have accumulated many hours of listening to these accounts. I explained to my supervisor that in order to empathize with a person I believe I have to feel what they feel. She wanted to know why these “trauma” symptoms didn’t happen sooner if that’s the case. I explained that it’s probably due to the fact that 80% of my clients at that time were court ordered after abusing a child. When I told my supervisor I had a three- and a half-year-old son, I was told that the problem was I just didn’t have good enough boundaries. My employer simply refused to accept that my experience of vicarious trauma was occurring and was valid.

Repercussion of Vicarious Trauma Reporting
My trauma became worse during the “meeting” wherein my employer gave me her written reply and an official review that contained the information I just described. She informed me that I was now on probation because of an event that had happened the previous day. I felt that my claims of experiencing vicarious trauma had caused my boss to treat me differently and unfairly.

The following are the events that happened on the previous day. One of my clients (who as a child had been kidnapped at the age of three, kept from his mother for a month, probably molested, injected with drugs, and experienced severe corporal punishment) and his wife had a violent fight. They filed protective orders against one another. When they came in to see me, they were in the process of dismissing these PO’s and desperately wanted help. I felt strongly that he needed immediate psychiatric intervention. He asked me to explain to his wife the what, where, how, when and why because he was confused and a bit disoriented. I asked her if she wanted to come in, if she felt safe, and she was adamant that she did. Because I allowed these individuals to violate a protective order I was written up; however, both my supervisor and I had violated a protective order in the past.

During the meeting, my supervisor demanded to see certain files. One of the files requested involved a victim I had been treating for two years. Even though I deal with the batterer, I treated the victim due to a case overload of the victims’ counselor. The victim is now 19, the primary abuser is her mother, and at this time she was four months pregnant. The file was incomplete, I had not kept up on the charting, and due to the extreme mistrustfulness of the client, I didn’t keep extensive notes. The point being…I also was written up for incomplete files. Sadly I was ordered to terminate her as a client or to transfer her to the victims’ counselor. This was in direct violation of my ethical standards to “not abandon my clients.” I was told to never talk to any victim. My supervisor then informed me that I would no longer be able to make up any time on the weekends, that if I could not get my forty hours in per week I would not only have my pay docked, but I would be reduced to part-time status, lose all my benefits, and not have an opportunity to become full-time again.

Stockholm Syndrome
I was completely devastated by my employer’s lack of understanding, could not stop crying. I was hyperventilating, and just wanted to go home and recover. She stated that if I left I would not have a job, that I needed to just go and put some cold water on my face. Even now as I recall these events I become nauseous. My response to my employer followed the course of Stockholm Syndrome in that the next day I came in apologizing for hurting her feelings, thanking her for helping me, and apologizing for being so awful at my job. My employer had also suggested that perhaps I shouldn’t be a therapist because of my claims of trauma.

There were a few things that my employer did which made a significant difference. There were things that I did that also helped. In response to my letter, she agreed to hire a part-time male counselor to co-facilitate the treatment groups and provide an opportunity to case-manage with a peer. Another action taken by my employer was to bring in a special guest speaker to the following staff meeting (held once per month). The guest speaker volunteered on a regular basis at the numerous fund-raising activities and she is a licensed spiritual counselor and Riki practitioner. She came and talked about stress management. The speaker’s focus was on aromatherapy, massage therapy, and meditation. Her spiritual practices are similar to my own and the workshop she facilitated reconnected me to this valuable aspect of self-care.

I believe my supervisor was at least willing to accept that the working environment was stressful. My employer also followed through with hiring a very competent, amiable, laid-back, and experienced therapist to co-facilitate my treatment groups. At this point my anxiety and intrusive thought symptoms had become so bad that I was unable to confront the men in these groups. Luckily most of them had been there so long they knew how I would normally have responded. So when I would just shake my head at some victim blaming or sexist remark, one group member would inevitably verbalize my non-verbal communication accurately, or one would say, “You’re gonna let him get away with saying that?!”

Also, once I had a co-facilitator I felt safe. Up until this point also I was leaving the building by myself at night in a rural community with no lighting. I began having mild panic attacks at this point because I was certain that the odds were against me; I had never been accosted, but I felt it was only a matter of time given the number of men I tended to alienate on a daily basis. Having that other person to share the charting with after each group has also allowed me to stay on top of client records. In addition, being able to case-manage each client has allowed me to feel more confident in the decisions I make, and less vulnerable to complaints or allegations of inappropriate treatment.

Sources of Prevention to Prevent Trauma for the Worker
Actions that I took that helped me regain a sense of sanity included returning to a spiritual foundation. Nothing radical, I simply began replacing negative and self-defeating thoughts with thoughts of faith. I began to choose on a daily basis to detach emotionally from the abuse of my boss and focus on my belief that God always has, and always will, provide. I set new priorities. I stopped stressing over being on time and started enjoying my son and patiently helping him to make the right choices, even if that meant I would be late. I began dreaming about what to do instead of work at the agency and became excited knowing that I CAN do other things. I may not play the political games of social service work very well, but I know that I am an excellent therapist, conduct excellent psychological evaluations, and I am loyal (perhaps to a fault). I try to do the right thing, even if it’s not the PC thing.

Ultimately I had to really practice what I preach; that is, I had to accept that the only thing I have control over is me, my thoughts, my beliefs, and my actions. Most importantly, I had to realize that I am not trapped. I can leave, I can find a new job or start my own practice, and I can take care of myself as a priority. The ironic reality is that as a therapist I am ethically mandated to ensure that I take measures to care for myself first and foremost; however, the working environment sends the message that I can only do so on my employer’s terms and if I can’t complete the self-care outside of the walls placed around me, then I’m out of luck. It’s not their problem. I’ve learned that my best protection against vicarious trauma is to not let others invalidate me, to not buy into the belief that you keep your job at all costs [even over your family and health], and to remember what truly matters.
---Danielle Balletto, LPC, LBP A licensed professional counselor (LPC) and a licensed behavioral practitioner (LBP) in the State of Oklahoma. A graduate of The University of Tulsa. Graduated Magna Cum Laude with a Bachelors’ in 1996 and graduated with a Master’s in Clinical Psychology in 1998. Batterer’s counselor working with offenders and severely mentally ill for eleven years. Currently working on a Doctorate in Criminal Justice through Capella University.


Personal Reflection Exercise #4
The preceding section was about the vicarious trauma that can result from working with batterers. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
DelTosta, J. E., Ellis, M. V., & McNamara, M. L. (2019). Trainee vicarious traumatization: Examining supervisory working alliance and trainee empathy. Training and Education in Professional Psychology, 13(4), 300–306.

Nissen-Lie, H. A., Orlinsky, D. E., & Rønnestad, M. H. (2021). The emotionally burdened psychotherapist: Personal and situational risk factors. Professional Psychology: Research and Practice.

Sprang, G., Ford, J., Kerig, P., & Bride, B. (2019). Defining secondary traumatic stress and developing targeted assessments and interventions: Lessons learned from research and leading experts. Traumatology, 25(2), 72–81.

Online Continuing Education QUESTION 11
What solutions did Balletto provide for vicarious trauma? Record the letter of the correct answer the CE Test.

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