Secondary Traumatic Stress in the Family
Jeanie Morgan

Term coined and defined by Figley (1995), secondary traumatization is “a syndrome of symptoms nearly identical to PTSD” that arises from “exposure to knowledge about a traumatizing
event experienced by a significant other” (p. 8).

Etiology/Definition

• Secondary traumatic stress refers to the presence of PTSD symptoms caused by at least one indirect exposure to traumatic material.
• Compassion fatigue, a less stigmatizing way to describe secondary traumatic stress, has been used interchangeably with that term.
• Vicarious trauma refers to changes in the inner experience of the therapist resulting from empathic engagement with a traumatized client. It is a theoretical term that focuses less on trauma symptoms and more on the covert cognitive changes that occur following cumulative exposure to another person’s traumatic material. The primary symptoms of vicarious trauma are disturbances in the professional’s cognitive frame of reference in the areas of trust, safety, control, esteem, and intimacy.
• It’s telling that the term secondary survivors is a little too broad: it can refer to professionals who hear traumatic stories, friends of trauma survivors, and I’ve also heard it incorrectly used to describe children who witness domestic violence (they are direct survivors, since any threat to a child’s caretaker is experienced as a threat to the child)
• National Child Traumatic Stress Network, Secondary Traumatic Stress Committee. (2011). Secondary traumatic stress: A fact sheet for child-serving professionals. Los Angeles, CA, and Durham, NC: National Center for Child Traumatic Stress.

DSM Dx?

• There is no DSM dx of STS or VT
• DSM5 is the first edition to include secondary exposure in the definition of PTSD

Possible DSM5 Dx

• Posttraumatic Stress Disorder A. Exposure to actual or threatened death, serious injury, or sexual violence in one (ormore) of the following ways: 3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, theevent(s) must have been violent or accidental. 4. Experiencing repeated or extreme exposure to aversive details of the traumaticevent(s) (e.g., first responders collecting human remains: police officers repeatedlyexposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. B. Intrusions C. Avoidance D. Negative alterations in cognitions and mood E. Marked alterations in arousal and reactivity associated with the traumatic event(s), F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The disturbance is not attributable to the physiological effects of a substance (e.g.medication, alcohol) or another medical condition.

Other DSM5 Dx:

• Acute Stress Disorder
• Other Specified Trauma- and Stressor-Related Disorder This category applies to presentations in which symptoms characteristic of a trauma- and stressor-related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the trauma- and stressor-related disorders diagnostic class. The other specified trauma- and stressor-related disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific trauma- and stressor-related disorder. This is done by recording “other specified trauma- and stressor-related disorder” followed by the specific reason (e.g., “persistent complex bereavement disorder”).

Prevalence

• Prevalence in family members? Unknown.
• Studies of STS/VT tend to focus on working professionals not families
• Women greater than men

Research on VT/STS in professionals

• Aparicio, E., Michalopoulos, L. M., & Unick, G. J. (2013). An examination of the psychometric properties of the Vicarious Trauma Scale in a sample of licensed social workers. Health & Social Work, 38(4), 199–206. http://doi.org/10.1093/hsw/hlt017 Barrington, A. J., & Shakespeare-Finch, J. (2013). Working with refugee survivors of torture and trauma: An opportunity for vicarious post-traumatic growth. Counselling Psychology Quarterly, 26(1), 89–105 17p. http://doi.org/10.1080/09515070.2012.727553 Branson, D. C., Weigand, D. A., & Keller, J. E. (2014). Vicarious trauma and decreased sexual desire: A hidden hazard of helping others. Psychological Trauma: Theory, Research, Practice, and Policy, 6(4), 398–403. http://doi.org/10.1037/a0033113 Burns, B. (2016). Court nursing: Facing Vicarious trauma’. Kai Tiaki Nursing New Zealand, 22(4), 34–34 2/3p. Cohen, K., & Collens, P. (2013). The impact of trauma work on trauma workers: A metasynthesis on vicarious trauma and vicarious posttraumatic growth. Psychological Trauma: Theory, Research, Practice, and Policy, 5(6), 570–580. http://doi.org/10.1037/a0030388 Comerchero, V. (2015). Vicarious trauma: Risk factors, symptoms and coping strategies. The School Psychologist Newsletter, 69(1). http://doi.org/10.1037/e515202015-002 Diaconescu, M. (2015). Burnout, Secondary Trauma and Compassion Fatigue in Social Work. Social Work Review / Revista de Asistenta Sociala, 14(3), 57–63. Dombo, E. A., & Gray, C. (2013). Engaging spirituality in addressing vicarious trauma in clinical social workers: A self-care model. Social Work & Christianity, 40(1), 89–104. Finklestein, M., Stein, E., Greene, T., Bronstein, I., & Solomon, Z. (2015). Posttraumatic stress disorder and vicarious trauma in mental health professionals. Health & Social Work, 40(2), e25–e31. http://doi.org/10.1093/hsw/hlv026 Hensel, J. M., Ruiz, C., Finney, C., & Dewa, C. S. (2015). Meta-Analysis of Risk Factors for Secondary Traumatic Stress in Therapeutic Work With Trauma Victims. Journal of Traumatic Stress, (2), 83. http://doi.org/10.1002/jts.21998 Hinderer, K. A., VonRueden, K. T., Friedmann, E., McQuillan, K. A., Gilmore, R., Kramer, B., & Murray, M. (2014). Burnout, Compassion Fatigue, Compassion Satisfaction, and Secondary Traumatic Stress in Trauma Nurses. Journal of Trauma Nursing, 21(4), 160–169 10p. http://doi.org/10.1097/JTN.0000000000000055 Jordan, K. (2010). Vicarious trauma: Proposed factors that impact clinicians. Journal of Family Psychotherapy, 21(4), 225–237. http://doi.org/10.1080/08975353.2010.529003 Mǎirean, C., & Turliuc, M. N. (2013). Predictors of Vicarious Trauma Beliefs Among Medical Staff. Journal of Loss & Trauma, 18(5), 414–428 15p. http://doi.org/10.1080/15325024.2012.714200 McCormack, L., & Adams, E. L. (2015). Therapists, Complex Trauma, and the Medical Model: Making Meaning of Vicarious Distress From Complex Trauma in the Inpatient Setting. Traumatology. http://doi.org/10.1037/trm0000024 Newmeyer, M., Keyes, B., Palmer, K., Kent, V., Spong, S., Stephen, F., & Troy, M. (2016). Spirituality and Religion as Mitigating Factors in Compassion Fatigue Among Trauma Therapists in Romania. Journal of Psychology & Theology, 44(2), 142–151. Rzeszutek, M., Partyka, M., & Go?ab, A. (2015). Temperament traits, social support, and secondary traumatic stress disorder symptoms in a sample of trauma therapists. Professional Psychology, Research and Practice, (4), 213. Shannonhouse, L., Barden, S., Jones, E., Gonzalez, L., & Murphy, A. (2016). Secondary Traumatic Stress for Trauma Researchers: A Mixed Methods Research Design. Journal of Mental Health Counseling, 38(3), 201–216. http://doi.org/10.774/mehc.38.3.02 Smith, L. E., Bernal, D. R., Schwartz, B. S., Whitt, C. L., Christman, S. T., Donnelly, S., … Kobetz, E. (2014). Coping with vicarious trauma in the aftermath of a natural disaster. Journal of Multicultural Counseling and Development, 42(1), 2–12. http://doi.org/10.1002/j.2161-1912.2014.00040.x Williams, A. M., Helm, H. M., & Clemens, E. V. (2012). The effect of childhood trauma, personal wellness, supervisory working alliance, and organizational factors on vicarious traumatization. Journal of Mental Health Counseling, 34(2), 133–153.

Research on VT/STS "Family"

• Baum, N. (2014). Female Receptivity and Secondary Traumatization in the Family. Family Process, 53(2), 225–238 14p. http://doi.org/10.1111/famp.12049 Bell H. (2003). Strengths and secondary trauma in family violence work. Social Work, 48(4), 513–522 10p. http://doi.org/sw/48.4.513 Ben-Porat, A., & Itzhaky, H. (2009). Implications of treating family violence for the therapist: Secondary traumatization, vicarious traumatization, and growth. Journal of Family Violence, 24(7), 507–515. http://doi.org/10.1007/s10896-009-9249-0 Fuller, G. (2016). Non-offending parents as secondary victims of child sexual assault. Trends and Issues in Crime and Criminal Justice, (500), 1. Hensel, J. M., Ruiz, C., Finney, C., & Dewa, C. S. (2015). Meta-Analysis of Risk Factors for Secondary Traumatic Stress in Therapeutic Work With Trauma Victims. Journal of Traumatic Stress, (2), 83. http://doi.org/10.1002/jts.21998 Herzog, J., Everson, R., & Whitworth, J. (2011). Do Secondary Trauma Symptoms in Spouses of Combat-Exposed National Guard Soldiers Mediate Impacts of Soldiers’ Trauma Exposure on Their Children? Child & Adolescent Social Work Journal, 28(6), 459–473. http://doi.org/10.1007/s10560-011-0243-z Meffert, S. M., Henn-Haase, C., Metzler, T. J., Qian, M., Best, S., Hirschfeld, A., … Marmar, C. R. (2014). Prospective Study of Police Officer Spouse/Partners: A New Pathway to Secondary Trauma and Relationship Violence? PLoS ONE, (7). http://doi.org/10.1371/journal.pone.0100663 Whitfield, N., & Kanter, D. (2014). Helpers in Distress: Preventing Secondary Trauma. Reclaiming Children and Youth, 22(4), 59–61.

Assessment Measures

• Professional Quality of Life Measure (ProQOL)
• Self-Care Assessment Worksheet http://www.ecu.edu/cs-dhs/rehb/upload/Wellness_Assessment.pdf
• PCL5

Intervention

• Self Care
• Boundaries
• Support
• Family Therapy
• Cognitive Behavioral Therapy - Exposure

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