What Missionaries Should Know about Vicarious Trauma

April 19, 2017

vicarious traumaIt was 2006 and I was sitting in a dimly lit room in Rwanda listening to a female genocide survivor tell me her story of rape and torture.

Most of the time her face remained distant, as though she was recounting something that happened to someone else. A fly buzzed around the office table. I could feel my legs perspiring against the wooden chair, the room stifling with heat. A fan whirred in the corner, but I could barely feel it.

At one point this woman broke down, she pressed a dingy white handkerchief against her eyes, as though to hide or remain unseen, as though she could make herself small enough to not feel the shame. Her story was one of many.

Broken bottles used. Days of being held hostage and used. Thoughts of wanting to die, to end the endless line of men. It was horror.

It was trauma on a level I hadn’t known existed.

I held her hand as she wept. I told her she was brave. It wasn’t her fault. She was a survivor. I gave her some money for her rent that was due and to feed the child that sat listlessly in her lap.

I didn’t know what else to do.

To love anyway, in spite of how painful it is.

I was compiling a small book to remember the stories of women who had survived, who wanted to have their lives immortalized before they died from HIV.

That night, I went back to the cramped hotel where I was staying.

The T.V. blaring a Nigerian show where a man was beating his wife. I escaped to the garden, to the cool of the evening, to the smell of acacia trees. I ordered the largest beer I could find. I sat with my journal, wrote, and wept. It had been days of listening to horrific violence. I could barely sleep processing the horrible images.

I locked my door five or six times but still didn’t feel safe.

The next day, I could feel my skin on fire, the back of my neck prickling as I walked down a side street. What if I was raped too? What would I do?

My heart started beating faster as I walked more quickly. Every man looked like a potential threat. I felt a sense of hopelessness at these women’s situations. I wondered how God could allow it all to happen.

These were the occupational hazards of non-profit work in a post conflict zone, that I wasn’t fully aware of when I signed on.

These were the hazards of loving and listening to someone who needed it.

I have names for these things now.

Vicarious trauma (often called “Secondary Trauma”) is the emotional residue of exposure that people have from working with others as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured. It is something that develops over time.

Vicarious trauma (VT) is often a byproduct of having empathy for the people we serve. 

It doesn’t mean you don’t have what it takes or you’re failed. It means you care. 

But as Dr. Robert Grant writes, “Internalizing the pain of another can disrupt personal frames of meaning and lead to feelings of powerlessness.”

That is how I felt so many times- powerless.

Between 40%-85% of “helping professionals” develop vicarious trauma, compassion fatigue and high rates of traumatic symptoms (Mathieu, 2012)

Humanitarian and missions work as a profession is often characterized by self-neglect, toughing it out, risk-taking, and denial of personal needs. All of these can contribute to more severe vicarious trauma. (Headington Institute)

Vicarious trauma can lead to:

  • workaholism (I can work hard enough to control this or make this trauma go away)
  • eroded idealism
  • feeling under-appreciated and under-resourced
  • justification for negative maladaptive behaviors (self entitlement- I was up all night listening to Syrian refugees’ stories of being bombed, that’s why I bit your head off just now; I worked 60 hours this week so I’m getting wasted all weekend)
  • loss of personal beliefs
  • feelings of professional incompetance
  • feelings of losing control
  • intimacy problems
  • decreased self esteem
  • feelings of insecurity
  • intrusive imagery
  • sleep and dream disturbances
  • chronic arousal (nausea, diarrhea, sweating, chronic digestive issues or joint pain)
  • self medication
  • difficulty concentrating
  • inability to become rejuvenated through sleep and recreation
  • crises of faith
  • gravitation towards situations of violence
  • agression
  • abuse towards clients
  • cynicism
  • withdrawal; isolation
  • loss of meaning/direction

Counter-transferential reactions such as numbing, distancing, over-identifying, or rescuing are common amongst those who work with traumatized populations. This is especially true of those who carry unresolved traumas from their own childhoods.

“Transforming vicarious trauma means something deeper than just coping with it. Remember that, over time, one of the key components of vicarious trauma is that it changes in your spirituality. You can come to question your deepest beliefs about the way life and the universe work, and the existence and nature of meaning and hope. Humanitarian workers may be confronted on a daily basis with some of the most troubling questions we as humans will ever encounter – ‘Why is there so much suffering in this world?’ ‘Is there a God? If so, how could God allow such terrible things to happen?’ ‘Why do people do such awful things to each other?’ ‘Why them, and not me?'” (Headington Institute)

Vicarious trauma often leads to Compassion Fatigue which is a reduced capacity to remain interested in or bear the suffering of another. It involves feelings of having nothing left to give. As demands increase so does a person’s resentment at having to continually give.

“It can lead to such intense feelings of powerlessness and apathy about social change that it causes people to drop out of the social justice field altogether. This is burn-out.” -Alessandra Pigni

But we still want to be able to empathetically serve those who are in conflict zones.

How do we not turn away, but continue to love in the face of suffering?

So how can we prevent and heal vicarious trauma?

Awareness

Train yourself on the signs and put a preventative self care plan in place. Be aware of your warning signs and triggers. The Headington Institute has some great materials on Vicarious Trauma. You can also take a self-test to see where you are on the vicarious trauma spectrum.

Limit exposure to traumatic input

Know when you are getting triggered or overwhelmed and excuse yourself from horrific stories, message, images. Put up some boundaries around your work and when and how you will unplug.

Work/life balance

Leisure activity is extremely helpful in dealing with trauma work. Setting boundaries and unplugging is so important.

Exercise

It is essential to detox stress, get out of the head, and back into one’s body. Try a variety of intense cardio (spinning, running) and yoga relaxation

Get your own therapy

A significant percentage of individuals involved in trauma work are also trauma survivors. We can only enter into the suffering of others insofar as we are healing from our own suffering. Don’t wait for things to build up. Process as you go along. Regular reflection keeps pace with the insidious effects of trauma.

Good coping strategies

These are things that help you take care of yourself – especially things that help you escape, rest, and play.

Finding meaning and hope

Transforming vicarious trauma means identifying ways to nurture a sense of meaning and hope. What gives life and work meaning, and what instills or renews hope? Why did you get into this work? Why do you do it now and what do you love about it? Where can you find beauty amidst this suffering? Focusing on giving your best (even if on some days, it’s just the best you can do that day) rather than only on outcomes can help give you a healthier perspective. How do the people around you maintain their vitality, resilience in the face of suffering?

Spiritual connection

Develop cognitive schema’s which recognize the miraculous standing next to the tragic. Journaling can help with this. In response to the 3 C’s (I didn’t cause it, I can’t change it, I can’t control it) try the 3 P’s (Pause, Pray and Proceed) Spending time with God processing your pain through listening prayer and releasing it to Him is very helpful. (I do this kind of work with my clients)

People

Connecting with other colleagues or peers to process or play is so important.
You can use group exercises like the “garbage can.” Group members sit around a garbage can and throw into it wadded pieces of paper which have written on them toxic feelings developed in the work place- something that has stayed with them, they verbalize and throw in the can. Allow 3-4 go rounds. At the end there can be cross talk and discussion.

There is no way to avoid stress and overload [completely] in this work, but the trick is to know your own warning signs and recognize early the need to make adjustments to your work and personal care strategies (HI)

As for myself, I gradually learned better self care coping strategies and how to process my pain with safe people. It’s made all the difference. I now love to give back by helping other missionaries and humanitarian workers be healthier to sustain their work on the field.

How are you dealing with vicarious trauma?

**Download my new self-care plan to help you avoid vicarious trauma 

  • Researcher

    Thanks for this post. I have added it to my list of recommended reading as we look to begin a trauma healing ministry in Deaf communities.

    • You are so welcome! It’s such an important topic. We need to prepare ourselves with information as we enter this vital work of serving others.