The dynamics of the therapeutic relationship existing between the therapist and the patient has historically been a topic of interest for researchers in the field of mental health. A large body of the research has been dedicated to the exploration of the therapeutic relationship in the context of working with trauma victims. Studies have indicated that as patients share the details of their trauma, therapists can experience parallel states of guilt, anger, shame, or hopelessness. The response triggered within the therapist, can vary in intensity and impact, and can be described as a certain type of trauma exposure response. The term “vicarious trauma” has often been used to describe those reactions. In its essence, vicarious trauma results from the empathetic engagement of the therapist with their client and their trauma narrative. In some cases where the therapist internalizes aspects of the trauma, the therapist may be prone to experiencing vicarious trauma.

So how does the phenomenon of vicarious trauma occur?

Research related to empathy within the framework of the therapeutic relationship indicates that mirror neurons play a major role in our perception and consequentially, our experiences. Mirror neurons are responsible for the automatic, implicit, and unconscious internal mimicking experience that occurs when we observe the actions, emotions, or sensations of other people. Because of the work of mirror neurons, the therapist is able to recognize, identify with, and internalize the patient’s trauma narrative and therefore feel the client’s psychic pain.

Vicarious trauma in Art Therapy

In the context of art therapy, the therapist’s attunement to the client’s needs takes place on several levels. Unlike traditional forms of talk therapy, visual representations of our client’s traumatic experiences are depicted and shared. Therefore, the artwork serves as an additional source of emotional engagement, which allows the therapist to not only hear about, but also see the visual manifestation of the trauma in the artwork. Ideally, the therapist will develop an “attuned response”, which can provide the client with a safe, holding environment and an opportunity to reenact and give new meanings to psychological and emotional injuries. This can be done through proposing constructive directives or allowing the client to safely test and explore self and relational aspects such as trust, self-esteem, and security through the art making process.

Therapists’ role in addressing vicarious trauma

As a client, it is not your responsibility to manage your therapist’s emotional state or responses. You do not have to hold back or minimize your pain in order to protect your therapist.

It is important to note that in cases where empathetic engagement leads to vicarious traumatization, the therapist’s lack of awareness of his/her own feelings is often a key contributing factor. This could occur when the therapist minimizes, disregards or denies certain feelings that may result through working with patients who have experienced trauma. Vicarious traumatization, if not attended to, can cause the therapist to burn out, and could potentially affect his/her personal and professional relationships with others. It is the therapist’s ethical responsibility and obligation towards clients to address such powerful emotional responses. Here are some ways that therapists can do so:

1. Carve out some time between sessions for reflection and grounding back into your role
2. Engage in your own therapy
3. Accept the breaks that you are given and normalize asking for breaks
4. Incorporate a strength-based approach when working with trauma clients
5. Incorporate movement in your routine (yoga, running…etc.)
6. Engage in response art (art that captures your emotional response to the client)
7. Make sure you have a balanced case load and regularly engage in clinical supervision

Helpful resources:

Book:

“Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others”

Articles:

https://www.psychiatrictimes.com/view/vicarious-trauma-clinicians-fostering-resilience-and-preventing-burnout

https://www.huffpost.com/entry/therapists-vicarious-trauma_l_5d14d548e4b0d0a2c0ad55a5