During her early years as a therapist, Demitra McDonald worked at a counseling center in Sacramento, helping survivors of domestic violence and their families cope with the trauma they had endured. A few years ago, during one particularly difficult week, she was flooded with new domestic abuse clients. "It was just day after day, story after story of young ... women who were practically beaten to death by those [who] they loved the most," she said. McDonald had become accustomed to hearing similar stories from clients, but the relentlessness of that week pushed her farther than she was used to.
McDonald made it through the week. But after work one day, while walking to her car, she realized how loud it had been inside the busy center. And now, all of a sudden, it was quiet. "Something just cracked me open, and I just started to sob," she recalled.
It wasn't just one story that had affected her deeply. It was cumulative — all the stories had piled up inside her until she couldn't hold them anymore. She said it hit her "that we're all human; we're all connected; we're all sisters and brothers." She identified so much with her clients that, even though she knew their abusers weren't harming her directly, she felt the emotional and psychological pain nonetheless. "[The feeling] overwhelmed me, and once I realized that, I gave into it for a few minutes. And I said, you know, 'Just sob for it. Sob for all of it, all of them, and all of those [who] are going to come next week. Just sob for all of them right now and let it go.'"
McDonald's deep empathy for her clients changed her, so that after hearing their stories each day, their trauma had become her trauma. '"That can't keep happening,'" she recalled saying to herself. "What happens to a puzzle when you take it out every day, and then it goes all to pieces? Eventually you pull it out, and you've got a piece missing, and then the next time it's two or three pieces."
That day, McDonald experienced a culmination of her "vicarious traumatization," she said. She decided she had to make a choice about what kind of therapist she wanted to be. Did she want to be the kind that could only hold herself together long enough to get to the parking lot?
No. For her, it was vital that her clients knew "that if they are reaching out to me, they [are] going to have something to hold on to," she said.
McDonald, who now works at the La Cheim Behavioral Health Services in Oakland, is not alone in her realization of the impacts that vicarious trauma — which is often the result of repeatedly hearing trauma victims' stories — can inflict on social workers, psychologists, and other behavior health professionals. During the past decade, shelters, behavioral health clinics, and agencies around the country have attempted to begin coping with vicarious trauma by adopting a "trauma-informed care" approach, which not only acknowledges the role that past trauma plays in patients' lives, but also emphasizes the gravity of recognizing and addressing the vicarious trauma that affects clinicians.
When social workers and mental health care providers are suffering, they can't gauge whether they are "being present" with their clients, or if they're inadvertently causing them harm, according to Laura van Dernoot Lipsky, who is the author of the widely read and well regarded book, Trauma Stewardship: An Everyday Guide to Caring for Self while Caring for Others, which describes "being present" as a "radical act." It states: "[I]t's not about what we do, what we say, or how we touch — it's about being present in a way that tells those who are suffering that they are not and never will be alone."
The concept of "being present" came up repeatedly in interviews that I conducted in recent weeks with behavioral health workers, psychologists, and other experts. They said it's a vital part of providing quality care to traumatized people. If a caregiver's own mental health is compromised, he or she cannot be fully present with clients, and thus has trouble empathizing and helping clients cope with the violence they've suffered. "I haven't met a therapy bot yet," said McDonald, stressing that an unfeeling therapist, lacking the ability to make a human connection, will always fail. "Humans survive in relation to each other. So this is also how we heal."
But while the move toward trauma-informed care represents progress in acknowledging the existence and importance of vicarious trauma, experts say that many organizations still do not take the necessary steps to support their staffers and prevent trauma overload. Van Dernoot Lipsky, a veteran social worker and founder of the Seattle-based Trauma Stewardship Institute, said in an interview that there are still many barriers to creating environments that nurture healthy caregivers. Organizations are often under-funded and very sensitive to perceived financial challenges, she said. She asserted that there are plenty of creative, cost-free steps that can be taken, but "when you are exhausted, it's not people's most creative time. It can feel like a task, like one more thing to do." Steps that require more resources, like reducing caseloads and prioritizing supportive supervisory meetings, are sometimes dismissed as unsustainable.
Stigma, too, is a barrier. According to van Dernoot Lipsky, there is "a belief that if you are good enough and tough enough and committed, you're going to suck it up." She doesn't consider the grin-and-bear-it approach to be a viable option. She said that an individual or organization's ability to process the trauma to which they're exposed can be compared to a metabolic process. "If you are not readily metabolizing it or intentionally metabolizing [trauma], we see an individual can get saturated, and we see that a whole collective body can become saturated," she said. "You can only stay saturated for so long before hemorrhaging may start happening."