Secondary Trauma Issues for Psychiatrists.

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Psychiatrists face growing challenges both as health practitioners and as sources of reassurance and empathy for their patients. But what if the effort to understand and help patients itself becomes a burden? The purpose of this article is to provide a brief overview of what we know about secondary trauma—frequently called compassion fatigue or vicarious trauma. Studies related to the effects of exposure to psychosocial stressors on individuals have primarily focused on the effects on nonprofessionals who provide social support.1,2 Until recently, there has been far less concern about the impact of social support provisions on professionals working with traumatized patients.3,4 Secondary traumatization also affects other health care professionals, including those who work with patients with AIDS or cancer or who are involved in critical care or hospice care.5 Generally, those who work in psychotherapeutic professions attempt to alter the cognitive status, emotional state, or the behavior of patients by providing cognitive-therapeutic interventions as well as empathy and strategies for coping with stress.6 Within this context, it has been suggested that providing therapy to patients who have experienced a traumatic event can be especially emotionally difficult.4 Specifically, therapists who work with traumatized patients often show signs of psychological distress, including symptoms of posttraumatic stress disorder (PTSD), which appears to result from “vicarious” traumatization.4,7–9 Thus, it appears that providing psychotherapy to traumatized patients puts therapists at risk for mental health problems.4,5 Despite findings that suggest that many therapists experience symptoms of vicarious traumatization, research has been limited.10 One problem has been a lack of conceptual clarity.11 For example, the adverse consequences of working with traumatized patients have been variously described as vicarious trauma, secondary traumatic stress, and compassion fatigue, and also in other terms.10 Moreover, different scales used in the past have used different conceptualizations.5 We briefly review a study that attempted to address these problems and, on the basis of this research, we offer brief assessment tools to screen for both vicarious trauma and job burnout in clinical practice.