The COVID-19 pandemic has affected us in innumerable ways. We cannot begin to understand its long-term impact on our beliefs about the world, our safety, and our future. During these harrowing times, our clear reliance on front-line healthcare workers for their tireless dedication and care has become readily apparent.
In collaboration with several incredible colleagues at The Chicago School, I was recently afforded the privilege of presenting to nurses across the country on vicarious trauma—a complicated concept, which is often used interchangeably with compassion fatigue and burnout.
Vicarious trauma is the emotional and psychological impact that occurs when helping professionals are affected by the traumatic histories and incidents of their patients and clients. Although the experience of vicarious trauma may be arduous, it can be navigated, leading to interpersonal and professional growth and resiliency for the practitioner.
The impact of vicarious trauma is profound, as it is a significant shift in one’s worldview and a crisis of identity. It is important to note, individuals experiencing vicarious trauma can also face burnout through the unrelenting demands of work and can also encounter compassion fatigue—the inability to feel empathy toward clients or patients. Individuals suffering from vicarious trauma may question their goodness of fit for their profession, lose confidence in their ability to shape change, and question their overall ability to be an effective practitioner. Many times, vicarious trauma becomes a parallel therapeutic process for clinicians since they begin to simultaneously suffer the worthlessness, self-doubt, identity confusion, and fears about self, which plague their clients and patients.
During my presentations, I was struck by the emotions of the participants. Many nurses had tears in their eyes. It was quite touching and overwhelming for me. Many of these nurses were suffering in silence and had no idea that this emotional phenomenon was a common byproduct of empathic attunement to one’s clients or patients.
As a clinician, I am always amazed by the power of words. Giving an elusive experience a name is the first step in giving it meaning. Phenomena without names or words can become frightening, threatening, and crushing. One participant thanked me for giving her the words to describe what she has been experiencing in isolation for many years. She stated, “I often thought I was ill-equipped or unfit for the profession, but now I feel like I understand myself better.”
The trauma symptoms that many front-line workers have endured during the COVID-19 crisis cannot be minimized. However, it is important for us to realize that moving through vicarious trauma can lead to “vicarious transformation.” Literature has demonstrated that healthcare workers, therapists, and clinicians with vicarious trauma can emerge from the shadows to a place of “vicarious resilience” when given proper education and assistance both at the individual and institutional levels. It is imperative that educational opportunities like continuing education and workshops are created that emphasize the importance of self-care, focusing on work and leisure balance, as a means to combat compassion fatigue and burnout. Additionally, institutions need to provide appropriate supervision and support groups for healthcare workers so that more avenues are available to process the emotional pain and frustration that many practitioners face during times of crisis.
Teaching the application of mindfulness and self-compassion skills can decrease the self-criticism and negativity that can result when overwhelmed by vicarious trauma. These types of interventional strategies can directly alleviate the despair and anguish associated with vicarious trauma, and through this process of self-care and self-reflection, revitalization is possible. The empirical research shows traversing this process can result in a renewed appreciation for one’s work, patients, and colleagues.
An example of this type of resilience was seen in Taiwan and Hong Kong during the current pandemic. The SARS outbreak in Taiwan and Hong Kong in 2002 produced mortality rates between 18-22%, leaving many practitioners to languish. However, when COVID-19 emerged in those same regions, communities joined together in social solidarity to fight the outbreaks, practitioners backed each other with medical resources and training, and citizens adhered to public health directives. Many have posited that these societies demonstrated a type of vicarious resilience in the face of another global trauma. Healthcare workers in these nations were buoyed by public support and were reinvigorated. This is a stunning illustration of how societies can go from collective trauma to collective empowerment.
Within the U.S., healthcare workers continue to selflessly provide us with needed care. It is now time for us to give them the words, knowledge, and emotional support so that they can more readily move from experiences of trauma to transformation.
Bina Parekh, Ph.D., is associate department chair and associate professor of clinical psychology at The Chicago School’s Anaheim Campus. She teaches courses on research methods, statistics, cognitive behavioral therapy, psychometric theory, diversity, and health psychology. Dr. Parekh is a licensed psychologist and has a private practice specializing in health psychology. Her clinical focus areas include pain management, obesity treatment, biofeedback, trauma, couples counseling, addiction medicine, general psychiatry, and multicultural counseling.
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