Healthcare Training Institute - Quality Education since 1979
CE for Psychologist, Social Worker, Counselor, & MFT!!

Section 7
Techniques for Treating Victims of Terrorism: Vicarious Traumatization

Question 7 | Test | Table of Contents
Read content below or listen to audio.
Left click audio track to Listen, Right click to "Save..." mp3

♦ Tool #5: Five-Point Vicarious Traumatization Self-Assessment Tool
Tool number five is a five-point vicarious traumatization self-assessment tool. Vicarious Traumatization, as you know, is a transformation in one’s inner experience resulting from empathetic engagement with your clients’ traumatic material. Since we all as a nation experienced the trauma of the terrorist attacks, this fact makes the therapist even more at risk for VT, or Vicarious Traumatization.

Before we explore the specifics, here is a list of Hazelip’s 12 principles found in terrorists’ culture. As I read each principle, think about the deep emotional impact they have and have had on you, as a therapist, and on some of the clients that you treat. Then I’ll present the self-assessment tool.

Hazelip’s 12 Principles Found in Terrorists’ Culture
(1) Violence is necessary to overthrow oppression.
(2) There is no limit to the extent of violence justified.
(3) Actions should clearly convey their purpose.
(4) Retaliation killings are counterproductive.
(5) Ruthlessness and extraordinary violence are essential to terrorist success.
(6) Government failures can be used to gain popular support.
(7) Terrorism exposes the repressive side of government.
(8) Terrorists aim to incapacitate government directly or indirectly.
(9) Secrecy is important to terrorist operations.
(10) Systematic planning and executions are critical to terrorist success.
(11) Small-scale, persistent attacks are most effective.
(12) Terrorists are dedicated to destruction for the sake of their cause.

♦ Vicarious Traumatization
With the intensity of such beliefs, and dealing with clients who are affected by the resulting terrorism, therapists are faced with dealing with vicarious traumatization. As stated earlier, VT is a transformation in one’s inner experience resulting from empathetic engagement with clients’ traumatic material. As previously noted, the changes experienced by the therapist may parallel those experienced by the trauma survivors. These changes can result from direct exposure of the therapist with trauma survivors, or indirectly through exposure to graphic descriptions of violence or victimization.

As you know, it is important to emphasize that such responses on the part of the therapist are not viewed as pathological. But just as Post Traumatic Stress Disorder (PTSD) is viewed as a normal reaction to an abnormal event, vicarious traumatization is a normal reaction to the stressful and sometimes traumatizing work with victims. And just as interventions may be very healing for individuals suffering from symptoms of PTSD, therapists may also find relief from symptoms related to vicarious traumatization.

This is particularly true if you are able to identify the ways in which your work impacts you personally. In addition, it is important to note that this framework and philosophical stance supports the professional Codes of Ethics by not blaming clients for traumatizing helpers, but rather, identifies this as an inevitable occupational hazard which may be mitigated. There are several common features of VT. As I list these three features, think of a client who has been traumatized and use this as a self-scoring checklist to increase your self-awareness.

3 Features of Vicarious Traumatization
-- First, the effects are cumulative; the impact of being repeatedly exposed to traumatic material may reinforce gradually changing beliefs about yourself and the world. Ask yourself, were your beliefs about your world changed based on your work with a traumatized client?
-- Second, the effects of vicarious traumatization may be permanent, in that they may result in lasting changes in the way you think and feel about yourself, the world, and others. Has there been a change in the way you think about yourself, the world, or others based on your work with a traumatized client?
-- Third, the effects may be emotionally intrusive and painful, in that certain residual images and feelings may remain with you even after contact with specific material or a particular client has ended. Have you experienced emotionally intrusive images following a session with a client traumatized by the terrorist attacks, for example?

♦ Psychological Needs
According to Stamm, the other parts of the self impacted by vicarious traumatization are your psychological needs.

5 Areas of Psychological Need
a. Safety
b. Trust
c. Esteem
d. Intimacy
e. Control

As you know, everyone possesses all the five needs, but specific areas are more important or central for each individual. Your most important need areas are those most likely to be disrupted by VT.

♦ Safety
Let’s assess your need for safety first.

Two Subcategories of Psychological Needs
a. The need as it relates to yourself, and
b. Secondly, to your experience of others.

Looking first at your need for safety, self-safety is your need to feel safe and invulnerable to harm, while other-safety is the need to feel that important others are safe from harm. Undoubtedly, as a nation, our illusion of safety has been forever shattered by the attacks. If you are a therapist with prominent safety needs, sudden physical assaults such as the rape or mugging of a client can shatter your illusion of invulnerability.

This can also happen with unexpected natural disasters in which clients are subjected to massive physical harm. Disruptions in this may be manifested by your increased fearfulness, a heightened sense of personal vulnerability, excessive or paralyzing concern about keeping your car or home locked, or concern about living on the ground floor.

There may also be accompanying behavioral changes, such as installing a burglar alarm in your home or taking a self-defense class. Cognitive changes or schema shifts, may also occur. Where you may previously have believed, for example, "I am safe and secure in my home," you may lose this sense of security, replacing the former belief with "I’m not safe anywhere." Ask yourself: have you treated clients with trauma issues who have created a change in your basic psychological need for safety?

Disruptions in the area of other-safety may surface in the form of increased fears for your children, spouses, pets, or other loved ones, as we hear numerous stories about intentional as well as inadvertent harm done to children and others. After September 11th or the anthrax scares, did you find yourself becoming especially concerned about day-care, for example, and the safety of your children, where previously this may not have been a preoccupying or intrusive concern?

For any of the need areas identified, there may or may not have been a previous awareness of its importance. Here is a self-test. In retrospect, you may recognize the importance of that need area previously; what shifts is the way one previously managed that need area or the ability which was formerly felt to meet that need. Second, let us look at trust issues and how they are affected by working with trauma victims.

♦ Trust
Are you a therapist for whom issues of trust are central? Disasters that stem from errors in judgment, such as an airplane crash, can also lead to serious disruptions in your ability to trust or depend upon others. Accompanying behavioral and schema shifts may also occur, such as disallowing trust to develop in relationships, or developing a belief that "you can’t trust anyone." Again, individuals for whom this need was predominant previously are especially vulnerable to such disruptions.

Your self-trust may also be disrupted. You may experience diminishing capacities for being independent or trusting your own judgment. You may no longer feel able to accurately judge another’s character, and may grow resentful with a sense of resulting inhibition in relationships. Painful questions may arise: "Do I know this person as well as I think I do?" or "Can I judge whether this person is trustworthy or not?" This type of questioning can leave you feeling increasingly uncertain about yourself, particularly when these doubts isolate you by preventing speaking about and challenging your concerns with others.

♦ Regarding Trust of Others
In fact, disruptions in any of the need areas may result in actual or perceived isolation from others, further increasing vulnerability to experiencing vicarious traumatization. One of the most powerful and effective antidotes to vicarious traumatization is a connection with others, a place to talk about your internal experience, and an opportunity to experience interactions which challenge disrupted beliefs. Professional Codes of Ethics encourage seeking supervisory advice and support from colleagues. After September 11th, what professional supports did you create for yourself?

♦ Esteem
Third is the need for esteem. As you know, self-esteem is the need to feel valued by yourself and others. You may experience difficulty maintaining a sense of self-esteem in light of perceived inadequacies in your therapist’s role. Questions may arise: "Am I really competent, even when I don’t feel like I’m helping?" Especially at the time of the terrorist attacks, you may feel overwhelmed with a seemingly endless flow of stories of suffering, and feel unable to address the roots of the problem to prevent further pain.

Esteem regarding others may also become disrupted, as you take in people’s capacity for cruelty and thereby develop a more pessimistic view of others and their motives. Those for whom high regard for others is central will likely find this disrupted by continued exposure to the cruel behavior of people toward one another. This could come about from exposure to situations of intentional injury, such as the terrorist attacks. Experiences with strangers may shift, raising questions as to who is a victim and who is a perpetrator.

Upon seeing a parent and child, or a couple who looks happy at a social gathering, you may wonder "What is really going on?" or "Are they what they seem to be?" Excitement and energy to meet new people and expose yourself to new ideas may be replaced by a sense of cynicism, doubt, and self-protectiveness. Ask yourself where you stand regarding these behaviors and your own self-esteem, especially dealing with clients struggling in the aftermath of terrorist attacks.

♦ Intimacy
Fourth, self-intimacy is the need to feel connected to yourself in a meaningful way. With disruptions in this, you may experience difficulty enjoying time spent alone. At those times, painful feelings may emerge and it may be difficult to find ways of feeling soothed. In the face of this, you may avoid time spent alone, to avoid leaving yourself open to more feelings. You also may find it more difficult to be alone without being lonely or feeling a sense of emptiness. You may have a pressing need to fill time with distractions such as superficial relationships, self-medicating with food, alcohol, or other substances, or engaging in compulsive behaviors such as excessive work or exercise.

The need for intimacy regarding others is the need to feel connected with and close to others. This may also be disrupted. Disruption in this area may lead you to pull back from others as a way of protecting yourself from more pain. A focus on the painful aspects of relationships or the inevitable breaks in connection rather than the possibilities for intimacy lead to distancing from others, further reinforcing a sense of estrangement and isolation. You may also pull away from colleagues who do different work or who view your work differently.

For example, responses such as, "How can you do that work?" or "I couldn’t stand to hear all those stories!" can lead to feeling misunderstood by and disconnected from others. People may seem to judge the clients with whom you work and the validity of what you do.

Disruptions in intimacy with others can leave you less available to friends and family as well. You may feel protective not only from hearing judgment, but also from hearing about more trauma. You may feel less available, interested in, or sympathetic to the difficulties encountered by people in day-to-day life.

On the other hand, a disruption in this area may result in a complete preoccupation with work and related feelings, leaving you always wanting to "talk shop," and resulting in a sense of disconnection from other aspects of relationships. Where do you lie on the intimacy scale regarding intimacy with yourself and intimacy with others that may be affected by your work with trauma clients affected by terrorist attacks? Let us now talk about control.

♦ Control
Control, or power, is the fifth psychological need. As you know, self-control is the need to exert control over your thoughts, feelings, and actions. Disruption in this area may leave you feeling less in control of various aspects of your life. Trauma work raises your awareness of client exposure to a multitude of events which are largely outside of the individual’s control. These may include victims of natural disasters, domestic violence, terrorist attacks, or other crimes. Your resulting feelings of helplessness or terror may parallel the victim’s experience.

In this form of vicarious traumatization, your beliefs about personal power and ability to assert yourself or master a situation are undermined. You may feel increasingly unable to meet the challenges of day-to-day life. In the face of feeling overwhelmed by a perceived lack of control, you may seek situations less likely to present challenges, thereby restricting the types of activities and relationships in which you engage.

Regarding the control of others, you may need to direct or exert control over the behaviors of others. If you find yourself impacted by vicarious traumatization, you may find yourself more controlling and directive in your work and personal life in an effort to recapture some sense of control. Another manifestation of a disruption in this area may be a narrowing or constricting of your world in an effort to exclude situations which are outside of your control. Ambiguity and uncertainty may be increasingly difficult to tolerate, making relationships, including those with clients, increasingly frustrating. You may also feel stronger impulses to exert control over those in your personal life to compensate for a perceived lack of control in your work life.

Ask yourself: do you find yourself with an increased need to control your life and that of others as you possibly experience vicarious traumatization through your work with victims of trauma? Here’s a summary checklist of the vicarious traumatization areas we just discussed: safety, trust, esteem, intimacy, and control.

In summary, if you are a trauma therapist with strong control needs, you will likely question the extent to which you can really control your own behavior. If you have stronger safety needs, you will likely experience work-related strain in terms of an increased sense of personal vulnerability. My colleagues and I have found it is useful in addressing VT to identify and listen for your prominent psychological need areas through self-observations.

This will set the stage for your increased sensitivity to the areas where disruptions are more likely to occur. For example, if you have elevated control needs you may begin to perceive a lack of control in day-to-day life, accompanied by thoughts like "I could leave anytime" or, "you can’t tell me what to do." Feelings of being trapped or angry may accompany your sense of being controlled.
Reviewed 2023

Peer-Reviewed Journal Article References:
Ben-Zur, H., Gil, S., & Shamshins, Y. (2012). The relationship between exposure to terror through the media, coping strategies and resources, and distress and secondary traumatization. International Journal of Stress Management, 19(2), 132–150.

Brugh, C. S., Desmarais, S. L., Simons-Rudolph, J., & Zottola, S. A. (2019). Gender in the jihad: Characteristics and outcomes among women and men involved in jihadism-inspired terrorism. Journal of Threat Assessment and Management, 6(2), 76–92.

Ferguson, N., & McAuley, J. W. (2021). Dedicated to the cause: Identity development and violent extremism. European Psychologist, 26(1), 6–14.

Harris-Hogan, S. (2018). Terrorism, 1888–2018: Some change, but mostly the same. Journal of Threat Assessment and Management, 5(4), 245–247.

Molnar, B. E., Sprang, G., Killian, K. D., Gottfried, R., Emery, V., & Bride, B. E. (2017). Advancing science and practice for vicarious traumatization/secondary traumatic stress: A research agenda. Traumatology, 23(2), 129–142.

Shoshani, A., & Slone, M. (2008). Efficacy of clinical interventions for indirect exposure to terrorism. International Journal of Stress Management, 15(1), 53–75.

QUESTION 7: What five areas of vicarious traumatization affect victims of terrorism? To select and enter your answer go to Test.

This course has covered such topics as: Terrorist Justification and Moving Your Clients from Why to How; Terrorist's Personality, Bell's Typology of Terror, and The Immorality of a Belief; Four Reasons Why Trauma Workers are Especially Vulnerable to Compassion Fatigue; Force Multipliers and Tactics; The Media and Symbiotic Relationships; Vicarious Traumatization and Psychological Needs.

I hope you have found the information to be both practical and beneficial. We appreciate that you've chosen the Healthcare Training Institute at homestudycredit.com as a means for receiving your continuing education credit.

Other Home Study Courses we offer include: Treating Teen Self Mutilation; Treating Post Holiday Let-Down and Depression; Living with Secrets: Treating Childhood Sexual Trauma; Interventions for Anxiety Disorders with Children and Adults; and Balancing the Power Dynamic in the Therapeutic Relationship. 

I wish you the best of luck in your practice. Thank you.  Please consider us for future home study needs at mentalhealthce.com

Test
Section 8
Table of Contents
Top