Self-Care Strategies for Managing Secondary Traumatic Stress

While empathy is a useful skill for people in helping professions like counselors, teachers, healthcare workers, and first responders, providing care for individuals can be mentally and emotionally taxing depending on their needs. In fact, the expectation to empathize with clients who have experienced any kind of traumatic experience can lead to secondary traumatic stress (STS), otherwise known as vicarious trauma.

“Any time that [counselors] express empathy, we are not just using a counseling skill of empathy, but we’re actually engaging in an experience of our personhood,” said Dr. Nate Perron, clinical assistant professor and core faculty member at Counseling@Northwestern, the Online Master of Arts in Counseling Program from The Family Institute at Northwestern University. 

Protecting themselves from experiencing STS while providing support can be a balancing act, but one that counselors will need to practice in order to provide the appropriate care for their clients.

According to the Office for Victims of Crime (OVC), “Secondary traumatic stress (STS) refers to the natural consequent behaviors and emotions that often result from knowing about a traumatizing event experienced by another and the stress resulting from helping, or wanting to help, a traumatized or suffering person.”

“Secondary traumatic stress (STS) refers to the natural consequent behaviors and emotions that often result from knowing about a traumatizing event experienced by another and the stress resulting from helping, or wanting to help, a traumatized or suffering person.”

Source: Office for Victims of Crime (OVC). The Vicarious Trauma Toolkit Glossary of Terms. Retrieved May 2, 2022, from https://ovc.ojp.gov/program/vtt/glossary-terms.

For mental health professionals, the risk of STS can be an occupational hazard because counselors can begin to feel feelings that are similar to what their clients experience as they work together. Nearly half of practicing counselors reported experiencing symptoms of STS in a study published in 2019 by The Professional Counselor.

“When we are truly in that authentic place of interacting with someone and engaging them through their trauma, we will most certainly experience some sort of ramification from that in one way or another,” Dr. Perron said.

STS is related to compassion fatigue. However, individuals can have STS without compassion fatigue, which is viewed as a combination of STS and burnout, or emotional exhaustion.

People of all ages and levels of work experience can be affected by STS. And secondary trauma can work in conjunction with stress from their own problems to overwhelm the helping professional. 

“In fact, the final trigger for some people who might seem to be functioning extremely well can be very unique to the individual,” he said. “It might be based on what current life stressors they’re going through themselves at a particular moment, or maybe a loss that they just had, or grief that they’re experiencing within their own life.” 

Anyone can have a bad day or an “off” day, but knowing when an individual is developing secondary traumatic stress is vital for maintaining personal health and well-being. Not everyone is affected in the same way or exhibits the same warning signs.

“It would be really individualized for different people,” Dr. Perron explained. “However, as we look at what signs are used, for instance, in the diagnosis for post-traumatic stress disorder (PTSD), those same types of stress symptoms could be evident with secondary traumatic stress.” 

Signs of Secondary Traumatic Stress

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Dr. Perron highlighted these potential signs of STS: 

Hypervigilance. Worrying intensely or having recurring thoughts.

Nightmares. Waking from dreams with intense dread and fear.

Change in sleep habits. Sleeping too much or too little.

Change in appetite. Eating too much or too little.

New anxieties or fears. Suddenly being afraid of the familiar.

Increasing agitation. More easily losing patience and snapping at others.

Loss of pleasure. Lacking interest in once-favorite activities or hobbies.

Somatic condition. Having a physical response (pain, weakness) to distress.

Inability to do work. Struggling to perform tasks and handle responsibilities.

By addressing the signs of STS, counselors can prevent jeopardizing their professional performance. The American Counseling Association (ACA) reports that negative outcomes associated with vicarious trauma can include low motivation, increased errors, decreased quality, avoidance of responsibilities, perfectionism, and lack of flexibility (PDF, 102 KB). 

There is serious risk in overlooking STS, so counselors need to stay vigilant about proactively looking for dangerous signs.

“I think probably one of the most important factors is a level of self-awareness—that self-reflective process to be able to look internally and recognize, ‘OK, here are my own trigger signs. Here are the warning signs that I’m getting to a bad place,’” Dr. Perron said. 

To engage in that self-reflective process, he recommends that counselors seek their own counseling, lean on colleagues or other professionals in the space, or connect on a deeper level with loved ones to work through problems.

And just as warning signs can vary by the individual, effective coping techniques can vary. Dr. Perron and SAMHSA’s Compassion Fatigue and Self-Care for Crisis Counselors guide offer the following tips for professionals: 

Dr. Perron acknowledges that setting boundaries can be the most difficult coping strategy, but they are critical for the profession. 

“When you exercise empathy as a profession regularly, it’s really tough to say no, but we have to say no at different times to be our best for the people that we do see,” he said.

More information about STS can be found below.

Citation for this content: Counseling@Northwestern, the Online Master of Arts in Counseling Program from The Family Institute at Northwestern University.