Secondary Trauma with Mental Health Professionals 

There are over one million mental health professionals as of 2021, with no stop of growth in the field in sight. With the rise and then aftermath of the pandemic, people are seeking out therapeutic resources more than ever. This leads to higher caseloads and potential blurred lines between a client’s life experience and the therapist’s experience. It is important to recognize the signs of burnout and secondary trauma to protect our well-being as well as continue to enjoy our careers.

What is Secondary Trauma?

Secondary trauma is the emotional and behavioral effect of a mental health professional’s work on the professional. Mental health workers are trained to develop their empathetic responses. They help guide and “sit” with others in their feelings and thoughts. It is an extremely rewarding job, but it is also difficult. Because of our proclivity for understanding, it is easy to feel those same feelings as the client. Secondary trauma and burn-out also occur from ever-increasing caseloads and longer hours in office.

Different types of Secondary Trauma

Two of the most researched phenomena in psychotherapy and social work are compassion fatigue and vicarious trauma (Bercier & Maynard, 2015.) Though they come about through similar events (working with a client who has trauma), they display differently.

 Compassion fatigue

Compassion fatigue, or CF, refers to physical and emotional exhaustion from working with specific populations. CF affects many healthcare professionals, including but not limited to, mental health and nursing. Research shows that the most common predictor of compassion fatigue is the professional’s personal trauma history (Turgoose & Maddox, 2017.)  It seems that the higher amount of empathy a professional has toward a client, the higher the compassion fatigue score. When we can relate to what others go through, even on just an emotional level, the more real it feels. 

Vicarious Trauma

Vicarious trauma, or VT, refers to the mental health professional experiencing their own symptoms of post-traumatic stress through working with the client. Vicarious trauma is unique in that it does not need to be experienced by the therapist. It is through hearing about the trauma in specific detail, and working through the negative emotions with the client, that the therapist feels personally affected. 

What leads to Secondary Trauma?

In a study from Australia of 152 professional participants, a high statistical significance (p<0.01) was found between the correlation of secondary traumatic stress and vicarious trauma (Devilly, Wright & Varker, 2009.)  Variables measured from the study include work stress, amount of caseload, amount of time in the field, time working with trauma clients, and perceived support from their organization. 

Interestingly, time working with trauma clients was the least predictor of secondary traumatic stress. The two most predictors of stress were time spent working in the field and the higher level of empathy (Devilly, Wright & Varker, 2009.)

This is good news, in that many professionals do not want to work with many trauma cases because of fear. Working with trauma cases does not cause second trauma. However, it is concerning that the longer a professional works in the field, the higher amount of compassion fatigue and trauma responses (hyper-arousal and avoidance.)

Secondary Trauma with Mental Health Professionals

How Can Organizations Help Their Workers with Secondary Trauma?

The best way that organizations can help their mental health workers is to keep open lines of communication between upper management and employees. A couple examples of scales used:

The Secondary Traumatic Stress Scale- DSM 

Compassion Fatigue Assessment 

By opening lines of communication to promote honesty, employees will feel more confident to express feelings of burnout, uneasiness, and stress. Organizations can use the results of these anonymous assessments to see patterns in the company and figure out where are the gaps. 

Hosting workshops and team-building exercises focused on self-care practices, as well as doing follow-up events to ensure that self-care practices are being utilized, is good practice. When your employees feel heard and understood, they will feel more comfortable taking care of themselves without the fear of retribution.

Ways to Combat Secondary Trauma

The most important way to combat signs and symptoms of secondary trauma (compassion fatigue, vicarious trauma) is to study and be able to recognize them. A graduate student would be wise to seek out counsel from seasoned professionals to learn what to look for before it happens. 

For the employee that has been in the mental health field for a while, it can be easy to forgo self-care practices in the busy day to day work. However, making yourself a priority is just as, if not more, important when taking care of others. Here are some tips:

  1. Set time limits for tasks, such as notes and other administration work. By setting hard start and stop times, with adequate breaks, it will feel less overwhelming.
  2. Seek counsel from other mental health professionals, especially when cases feel overwhelming, and you don’t know where to begin.
  3. Make time for yourself each day, whether it is twenty minutes or much more, to unwind with an activity or hobby you like to do.
  4. Lean on your support system outside of work. Due to HIPPA laws, mental health professionals carry so many secrets and stories that we can’t share, and that can feel isolating. Let your trusted people know when you’re struggling, and to be patient and kind.
  5. Lean into self-work, whether that is spiritually guided or self-guided. Journaling, art, poetry are some examples. Exercise (by yourself or on a team) your body, as movement is necessary to release bodily feelings of tension.

In Conclusion

In the mental health field, trauma will always be around. The longer one works in the field, the more is seen. It can be exhausting, emotionally and physically. Taking active steps to protect yourself is key for longevity, not just in this career field, but in life. Keep yourself accountable with self-care, even when time is short, is critical to success. Organizations that encourage honesty and openness will keep a happier workforce.

Written By:
Megan Witt, LPC-MHSP
Casey Merrill

Casey Merrill


Christal Pennic

Christal Pennic