As detailed in Chapter A2, a high proportion of clients of AOD services have experienced trauma, and it is important that symptoms of trauma-related disorders such as PTSD be managed and, if appropriate, treated while the person is undergoing AOD treatment. Clinicians who work with traumatised clients describe their work as being extremely rewarding [1612, 1613]; however, hearing the details of clients’ trauma can be distressing and, in some cases, lead to vicarious traumatisation or secondary traumatic stress. The majority of AOD workers are themselves trauma survivors and although this lived experience may enable them to empathise with their clients, it also places them in a position to be triggered by clients’ trauma [386, 404].
Consistent with international research [1614], a survey of AOD workers from across Australia found that 20% were suffering from secondary traumatic stress [404]. The symptoms of vicarious trauma are similar to those that a person experiences with PTSD (described in Chapter A4). It can lead to negatively altered perceptions of both the world and oneself, and make AOD workers feel hypervigilant, isolated, frustrated, guilty, overprotective of loved ones, and desensitised or detached following repeated exposure to trauma narratives [1615]. Other signs may include [1616, 1617]:
- Physical symptoms: fatigue, rapid pulse, unexplained aches.
- Emotional symptoms: anger, hypersensitivity, helplessness.
- Cognitive symptoms: preoccupation with clients, self-doubt, cynicism.
- Behavioural symptoms: isolation, hypervigilance, changes in sleep/appetite.
- Relational symptoms: minimising concerns, mistrust, projecting blame.
- Spiritual symptoms: loss of meaning, questioning of beliefs.
Although the primary cause of vicarious trauma is secondary exposure to trauma material, vicarious trauma may be exacerbated by personal and work-related risk factors such as a personal history of trauma exposure; having experienced a greater number of trauma types; personal stressors; maladaptive coping behaviours; workload; organisational gaps; losses at work; and fewer hours of clinical supervision [404, 1618]. Importantly, findings from an Australian study indicate that secondary traumatic stress may be prevented by monitoring of workers’ caseloads and the provision of adequate clinical supervision (described later in this chapter [404]). As in the case for burnout and compassion fatigue, the use of active coping and holistic self-care strategies (described below) are also important for preventing and managing vicarious trauma.