Psychologist defines vicarious traumatization

It’s a fact of human nature that Hollywood banks on: humans are both extremely empathetic and have an amazing ability to put ourselves into a storyline. While those talents might work well for losing ourselves in an action scene or in a good book, are there times when being attuned to others’ experiences can hurt us?

For a therapist helping a patient work through a traumatic event, hearing the details, sharing the emotions, visualizing what they describe and the ability to empathize can lead to the therapist experiencing symptoms of PTSD themselves.

This type of vicarious traumatization, says Ghislaine Boulanger, Ph.D., a psychologist and psychoanalyst who is on the faculty at the New York University post-doctoral program in psychotherapy and psychoanalysis, can be debilitating.

Boulanger recently spoke in Stockbridge, Mass., at an Austin Riggs Center workshop on both the symptoms of vicarious traumatization and the ways it can be turned around and put to use in a therapeutic setting. She spoke with New England Psychologist’s Catherine Robertson-Souter about her message and about the work she has done with adult onset trauma.

Q: What is “vicarious traumatization?”

A: As psychologists have started to work with survivors of frightening events, events that have threatened the lives of the people they are working with, they have become aware that they start to take on some of the symptoms of the patients that they are seeing, being jumpy or withdrawn or they start dreaming about the event as if it happened to them. We can anticipate what the patient is going to tell us as if we are being infected non-verbally by the patient’s experience, as if the boundaries between us have broken down.

When they are immersed in that work or when they are working on the front line as disaster respondents, it can be really exhausting.

Where I specialize is with on-going work with survivors of terrible events and about how psychoanalytic therapists can use this experience of vicarious traumatization to our advantage in the therapy session and the on-going work. How can we use it as a springboard for deeper insight and to help ourselves deal with these frightening experiences?

If you work psychodynamically in-depth with a patient you are more likely to experience these symptoms than if you work superficially but if you work superficially, I don’t think you help necessarily.

Q: You wrote a book, “Wounded by Reality: Understanding and Treating Adult Onset Trauma.” What is your theory on adult onset trauma?

A: When I was getting a Ph.D. as a clinical psychologist, I was a member of the first team in the late 70s that looked at Vietnam veterans and how they were adjusting to civilian life. My research with veterans going back to World War II revealed that people who had been in combat, regardless of their childhood experiences, developed a striking syndrome that was true across personality types and that could last for 25-30 years.

At that time, classical psychoanalysis was opposed to these ideas. They held with ideas about how all personality is basically laid down in childhood and cannot be disrupted. At the time, there was a big push in New York and California and Chicago to break away from these confining theories and thinking about personality more fluidly and thinking about pathology more fluidly.

Q: What do you teach in your workshop for therapists about how to address adult onset trauma and vicarious traumatization?

A: First and foremost, you validate the experience. The second thing is you, the therapist, have to be able to bear, to contain what you are being told and sometimes it is quite unbearable to hear. And that is where you can become infected by the experience. It is often not just unbearable but unspeakable – some of these experiences are transmitted nonverbally – the terror and the shame – and you start to feel these yourself.

We talk about taking that virtual traumatization and understanding that we are vicariously traumatized because we are being asked to contain, to bear something unbearable. We look at how we talk about it with the patient to make it bearable for both of us.

Q: You talk about a one patient/one therapist relationship but a therapist will have more than one patient in his practice. Does working with multiple traumatized people make it more difficult?

A: I tell people, you need to be sure that in your practice you do not just have people who are massively traumatized. That really makes you particularly vulnerable to vicarious traumatization. It is manageable if you only have a few people in your practice who have these issues.

But as I said this when I worked in New Orleans, [following Hurricane Katrina] I realized that everybody there not only went through it themselves but all their patients have horrendous stories to tell and have massive trauma. You can’t tell the therapists there to choose but they can at least recognize what they are going through.

Q: What was that experience in New Orleans like?

A: The fact that someone could come in from the outside and could be a witness and validate their experiences was important. It was unprecedented in the life of the therapeutic community that you lose the place where you practice, lose connection to your patients, sometimes for several weeks, and you are inundated by new patients and you went through the experience yourself.

Q: Did you also work with people who were affected by 9/11? What have you seen over the years as we move further away from the actual event?

A: I worked in the New York area so I did see a number of patients who had been in the towers and escaped. I went down at the time and worked with people who had lost their homes or family members. It was important work to do and well organized by the Red Cross, but that work ended and I believe these experiences last many years beyond the original event. I continue to be referred patients who had been deeply affected long after the event.

Q: Do you recommend therapists who have been through a traumatic event go help others as a first responder?

A: It is one way of handling it, if you are able to deal with your own symptoms. But, if it is the only way you are dealing with your own symptoms, then no, you will be overwhelmed. That is what happened with people after Katrina and they had no choice but to deal with others’ trauma and eventually they burned out. What happened to you will eventually come to the surface. Work with an individual therapist and perhaps have a group of colleagues whom you can talk with and share and validate each other’s experiences.

It is really important to mind your own mental health before you mind others. After a disaster, you don’t have much choice. You can’t do it before you help others but you can along the way be aware you have to take care of yourself.