Are you worried about secondary trauma? You are not alone. Concerns about secondary trauma or secondary traumatic stress (STS) are among the main questions I receive from partners and relatives.* Loved ones are worried about the personal impact of supporting a person with complex trauma.
*I define relatives as anyone who is considered a primary supporter.
Here are the most common statements I hear:
- I feel crazy.
- I don't know what to do or how to help my partner or myself.
- I need a break.
- This is over my head.
- I feel isolated and alone.
- I don't know who to talk to or where to get support.
- My sleep is disrupted.
- I am losing my patience with my kids.
- I have trouble focusing at work.
- I used to be more compassionate and understanding.
- I have lost empathy.
- I'm worried I have trauma from my partner's trauma.
Secondary traumatic stress (STS)
Most often, people associate STS with the helping fields like medical or mental health. STS is also found in those working in in law enforcement, the legal field, educators, and more. Less known, it is a risk factor for unpaid caregivers of those living with chronic conditions.
Secondary traumatic stress (STS) is the experience of tension and distress directly related to the demands of living with and caring for someone who displays the symptoms of post-traumatic stress disorder (PTSD). STS is associated not only with demands of a family member with PTSD but can also be associated with a feeling of empathy for the traumatic experiences of a loved one.Charles Figley. Burnout in Families.
Secondary traumatization has two categories. The first involves family members and close associates who may suffer from their loved one's trauma as a result of the closeness of the relationship. An example would include the spouse of a rape victim...Babette Rothschild with Marjorie Rand. Help for the Helper.
Signs and Symptoms of Secondary Trauma
Tend Academy provides resource on topics related to compassion fatigue and STS. The post Warning signs of Vicarious Trauma/Secondary Traumatic Stress and Compassion Fatigue contains a comprehensive list of signs and symptoms. I'm including a partial list.
|Exhaustion||Emotional exhaustion||Increased use of alcohol and drugs|
|Insomnia||Negative self-image||Anger and Irritability at home and/or at work|
|Headaches||Depression||Watching excessive amounts of TV/Netflix at night|
|Increased susceptibility to illness||Increased anxiety||Decreased social contact or interest|
|Sore back and neck||Difficulty sleeping||Impaired appetite or binge eating|
|Stomach upset||Feelings of hopelessness||Impaired ability to make decisions|
Related terms to secondary trauma
You may also wonder about other terms. What about burn out? Compassion fatigue? What is vicarious trauma?
Burn out is most often used in the context of work environments when employees experience overwhelm, helplessness, and low job satisfaction. Burnout is not necessarily associated with a decrease in compassion. It occurs slowly over time.
However, some relatives of persons with complex trauma may need to leave the workplace on a temporary or permanent basis in order to help with care. In this case, I would consider the home becomes the place of work. This decision, made out of necessity, could lead to experiences of overwhelm, helplessness, and life dissatisfaction. In this case, burnout is a real possibility.
Family burnout is a term used by Charles Figley in the book Burnout in Families. It refers to "the family members' collective commitment to each other and a refusal to work together in harmony as a function of some crisis or traumatic event or series of crises or events that leave members emotionally exhausted and disillusioned."
It is not unusual when families go through prolonged stress without adequate support. Like individual burnout, family burnout is the result of cumulative stress over a prolonged period of time.
This term has recently resurfaced in articles about COVID. One example is Fighting Family Burnout During the COVID-19 Crisis.
Tend Academy defines compassion fatigue as ".. .the profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate." The result is a gradual decrease in compassion and interpersonal connection.
Vicarious Trauma (VT) is sometimes used interchangeably with STS and compassion fatigue. Vicarious refers to indirect exposure to traumatic stories such as hearing about them or watching news stories. The originators of the term used it to describe a shift in worldview in those who work with traumatized populations.
In the case of complex trauma, 'stories' are communicated through emotional and somatic reactions, often more so than language. This lack of verbal retelling does not mean the effect on the supporting person is not as impactful as audible or visual witnessing. In fact, the emotions and nervous systems of those closest to the trauma survivor can mimic those of the trauma survivor potentially leading to traumatic stress symptoms.
While partners and relatives may hear stories about the trauma a loved one endured, even more, supporters witness the implicit memories of their loved one.
Perhaps you recognize yourself in these descriptions or maybe you have concerns about a friend, family member, or client who is a supporter of a trauma survivor. You might wonder 'Why isn't secondary traumatic stress applied to relatives of those with complex trauma?'
Here are a few reasons:
- There is not yet language to describe the roles of partners and relatives. In fact, there is difficulty with language to describe complex PTSD because it is not an official diagnostic category in the DSM-V.
- Society undervalues caregiving and supporting.
Together, 8.1 million informal caregivers provide an estimated 70 to 80 percent of all homecare in this country, free of charge. Every year, they are saving the public purse an estimated $24 to $31 billion — no small amount.Canada relying too heavily on unpaid caregivers - at a cost
- Society tends to view caregiving as acceptable in a narrow lens. Caregiving is frequently associated with health challenges of later life such as Dementia or with illness like cancer. Yet, caregiving is not restricted by socially acceptable parameters.
While increasing attention has slowly been drawn to mental health issues, rarely do we hear about the family members who support those facing these challenges. . . As a result, family caregivers of individuals with mental health issues often cope in silence.Silenced by stigma: Caregiving for those with mental health conditions
- Your role as a supporter is fluid and may change as the complex trauma symptoms of your loved one ebb and flow. Mine certainly have.
There are no easy or quick answers to the challenges facing partners and relatives of trauma survivors. To close, here are a few thoughts:
- We have a long way to go in recognizing and supporting partners, family, and friends of persons with complex trauma. With very little available in terms of information or support, relatives are left to struggle on their own. As of 2020, there is one research study specific to complex PTSD (not PTSD) on the topic of relative's support as an important part of complex trauma symptom management.
- We need to move away from reliance on online handouts and articles as the sole source of support for families. Supporters need to experience support to manage their own overwhelm. Even if nothing is available in person, demonstrations of experiential tools like the one shown in my blog post can help.
*Steven C. Hayes, originator of Acceptance and Commitment Therapy writes about the limitations of what is called 'cognitive restructuring and reappraisal' in his book A Liberated Mind. He challenges the concept of cognitive tools (pamphlets, information, positive thinking) as the sole strategy when facing health challenges of a loved one and instead advocates for mindfulness and acceptance skills.
- Tailored psychoeducation about complex trauma is needed. Ideally, education would be presented in an in person/in real life online format. Information must discuss the core characteristics of complex PTSD: negative self-concept, disturbances in relationships, and affect dysregulation. Ongoing information about treatment and treatment progress is also needed.
- Involvement in treatment, for example through family oriented meetings with practitioners, can alleviate distress for all. We must consider how to pivot from treating complex trauma in adults as an individual issue towards a family systems or holistic one.
- Therapeutic intervention may be needed in some cases especially if the supporting partner or relative has a trauma history. However, it should not be the only available option for a number of common sense reasons including cost and accessibility to clinicians adequately trained in complex trauma.
- Psychoeducation, validation, a combination of mindfulness, somatic resourcing and cognitive tools, along with regular communication and support will organically lessen overwhelm and create a sense of personal agency for supporters whether they involve a therapist. These services could be provided by trained staff or consultants working in collaboration with clinicians.
Complex PTSD is a new and growing area of clinical and academic study. Unfortunately, this means those in supportive roles are often left to navigate this topic on their own. From a lived experience and family systems perspective, lack of support for the partners and relatives impedes progress for the trauma survivor. There can be no separation.
If you are interested in expanding services within your practice or organization to support partners and relatives of adults with complex trauma, please consider scheduling a consultation with me. I offer strategic advisorship, written materials, and complex trauma aware education for individuals, organizations, and communities.