Nurses, paramedics, psychologists and counsellors are often exposed to the traumatic experiences of their patients.

While there is widespread awareness and research into the effects of burnout and post-traumatic stress disorder (PTSD), there is increasing recognition of the impact of secondary exposure to trauma, including secondary traumatic stress and vicarious trauma on the caring workforce.

Dr Rebecca Diehm, a clinical psychologist and lecturer at Deakin University’s School of Psychology, has researched the impact of secondary traumatic stress and vicarious trauma on a range of mental health clinicians, including psychiatrists, nurses, social workers and psychologists.

Despite the terms secondary traumatic stress and vicarious trauma existing for some decades, Dr Diehm says it’s a field of research that remains in its infancy. Adding to the confusion, she says the research that exists often has different definitions and
ways of measuring secondary traumatic stress and vicarious trauma.

Dr Diehm says while secondary traumatic stress, vicarious trauma and burnout are terms often used interchangeably, even in research, they appear to be associated but separate concepts.

Secondary traumatic stress refers to psychological processes that are similar to those that occur in post-traumatic stress disorder, such as symptoms of intrusion, avoidance and hypervigilance, albeit to a lesser extent, and research shows that health workers may develop symptoms in similar ways to those who have directly experienced the traumatic events.

Research also indicates that levels of secondary traumatic stress vary from mild to clinically significant.

Vicarious trauma is an associated construct, which can develop as a result of clinicians engaging empathically on an on-going basis with their clients’ traumatic experiences, including child abuse, sexual assault, rape and other violence or accidents.

“The client or patient might not be telling you about their direct experiences of trauma, they might be telling you about the impact of that trauma on their life,” she says.

“As a clinician or a health worker, you can potentially start experiencing distress yourself, and over a long period of time it can start impacting on your beliefs about the world and the people around you.”

One of the key aspects of vicarious trauma is lasting changes to a person’s beliefs.

“Vicarious trauma is a little bit different (to secondary traumatic stress),” Dr Diehm says.

“It’s about how those experiences with clients change how you see the world. Because of repeated exposure to clients’ experiences of trauma, people are trying to make sense of how they can happen to people and it makes you question - that the world is safe, that life is meaningful or that people are essentially good.

“It can also lead to changes in how safe you feel, how much you want to be intimate with other people potentially, not sexually necessarily but intimate and connected to other people, how much control that you feel you have over yourself and other people.”

Research shows workers who are repeatedly, and for prolonged periods of time, exposed to clients or patients’ trauma are more at risk of developing vicarious trauma, while those practitioners who also have their own personal history of trauma are also more vulnerable to developing such difficulties.

While vicarious trauma does not appear prevalent based on a limited number of studies, Dr Diehm says it can result in some people experiencing significant disruptions to their beliefs.

“In the research I completed, on average the mental health clinicians in my sample experienced minimal levels of disruption but then there was five per cent that had quite high levels.”

Dr Diehm says her research indicates the psychological impact of secondary exposure to trauma may represent a developmental process that begins with the development of secondary traumatic stress, which could then lead to longer term vicarious trauma and, in addition, burnout.

A member of the Australian Psychological Society (APS), Dr Diehm says while there is little research evidence to show the most effective methods for mitigating the impact of vicarious trauma, it’s important for clinicians at risk of developing the condition to reduce their level of secondary exposure to trauma.

“So if you had a client load where the majority have experienced trauma then maybe you would try and break up your work a little bit, so that you have a wider variety of clients or patients,” she advises.

“Or it might be that you break up your work so you do some patient work but you also do education or training, so it’s not what you are doing all the time.”

Other strategies include accessing supervision for your work, completing training on vicarious trauma, and increasing your social supports.

“Being self-reflective and self-monitoring - noticing what is happening for you and being aware of your own personal vulnerabilities could also help,” she adds.

“So, if you know you’ve got a past history of trauma then you need to be aware you might be more likely to experience these difficulties.”


Dr Diehm says it’s important to raise awareness and discussion about the impact of vicarious trauma, and she urged health professionals who may be experiencing difficulties to seek professional help.

“It does affect people to varying degrees, however a lot of people are still fearful of the stigma attached to saying that they are being affected by their work, especially in medical settings,” she says.

“It’s really important to be mindful of how your work is affecting you and to go and get assistance for it.

“If you’re not comfortable getting assistance through your workplace then get assistance for yourself, privately. Go to your GP and get a referral to a psychologist.”