Professional Psychology: Research and Practice

© 2020 American Psychological Association 2020, Vol. 51, No. 5, 454 – 466
ISSN: 0735-7028 http://dx.doi.org/10.1037/pro0000293

Preventing Vicarious Trauma (VT), Compassion Fatigue (CF), and Burnout

(BO) in Forensic Mental Health: Forensic Psychology as Exemplar

Gianni Pirelli Dana L. Formon

Pirelli Clinical and Forensic Psychology, LLC, Verona, New Colorado Department of Human Services, Pueblo, Colorado
Jersey

Kelsey Maloney
Texas Tech University
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

In this article, we address the concepts of vicarious trauma (VT), compassion fatigue (CF), and burnout
(BO) within the context of forensic mental health. These are related, albeit distinct, concepts that have
been used to describe patterns of negative emotional outcomes in various employment contexts. We
begin with a general review and delineation of VT, CF, and BO before discussing these outcomes across
professions. Then, we discuss these concepts in the specific context of forensic mental health to include
how such issues can impact students, trainees, early career professionals (ECPs), supervisors and
instructors, and practitioners. We then use the subfield of forensic psychology as exemplar, whereby we
outline relevant research and address VT, CF, and BO within the context of criminal, civil, and
administrative matters as well as treatment, teaching, and research contexts. Subsequently, we outline
four areas of consideration for those working in the forensic arena, specifically, (a) identifying potential
risk factors; (b) recognizing, developing, and strengthening protective factors; (c) overcoming self-care
and treatment barriers; and (d) identifying and engaging in therapeutic interventions. Lastly, we set forth
a formal call for research, which we believe is essential to the development of a more meaningful
understanding of the connection between VT, CF, and BO in forensic mental health.

Public Significance Statement

Much research is needed to understand the impact of what is referred to as vicarious trauma (VT),
compassion fatigue (CF), and burnout (BO) in forensic mental health professionals. Doing so will
assist in efforts to ensure clinicians are engaging in their work competently and professionally.

Keywords: vicarious trauma, compassion fatigue, burnout, forensic mental health, forensic psychology

Individuals working in the helping professions often evidence Namely, over 40 years ago, Pines and Maslach (1978) found that
higher levels of empathy and compassion, placing them at risk for increased patient contact time, greater patient-to-provider ratios,
negative outcomes (Figley, 2002; Pines & Maslach, 1978). and more years spent in higher education obtaining a degree was

This article was published Online First February 10, 2020.
X GIANNI PIRELLI received his PhD from the clinical and forensic
psychology doctoral program at The Graduate Center at John Jay
College of Criminal Justice (The City University of New York). He is
Board Certified in Forensic Psychology by the American Board of
Professional Psychology (ABPP) and a Fellow of the American Acad-
emy of Forensic Psychology (AAFP). He leads the group practice
Pirelli Clinical and Forensic Psychology, LLC (www.gpirelli.com),
whereby he conducts a range of evaluations in criminal, civil, and
administrative matters. He also maintains an active research and pub-
lication record, reflecting his particular expertise in the areas of pro-
fessional ethics, forensic psychology practice standards, and guns and
mental health.
DANA L. FORMON received her PhD from Sam Houston State University.
She is currently a Postdoctoral Fellow in Forensic Psychology with the
Colorado Department of Human Services, Court Services Division. Her
clinical interests include forensic assessment and treatment, and the treat-
ment of sexual offenders. Her research interests include positive psycho-
logy for correctional populations, forensic assessment, professional com-
petencies, and competency restoration.
KELSEY MALONEY received her MA in clinical psychology from Sam
Houston State University. She is currently a doctoral candidate in clin-
ical psychology at Texas Tech University. Her current research interests
focus on the interplay of neuropsychology and forensic psychology,
especially in juvenile justice populations with high incidence of trau-
matic or adverse experiences. She has also conducted research on
traumatic brain injury and disruptive behavior disorders, mental illness
stigma, the use of assessment within medical settings, vicarious trauma,
and nonaccidental head injury.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to
Gianni Pirelli, Pirelli Clinical and Forensic Psychology, LLC, 80 Pompton
Avenue, Suite 204, Verona, NJ 07044. E-mail: pirelli@gpirelli.com

454
 PREVENTING VICARIOUS TRAUMA
associated with providers being less likely to feel fulfilled in their
work, more likely to seek other employment, and also more likely
to describe themselves as more tense and distant toward others
both in and out of the workplace. Consistent with this, Figley
(2002) noted that higher expressions of empathy in the workplace
(specifically toward feelings of hurt, fear, anger, and other “neg-
ative” emotions) resulted in the depletion of empathy, leading to
overall poorer mental-health-related outcomes for both therapist
and client.
Professionals who routinely interface with trauma and vio-
lence—such as those working in corrections, the legal system,
medicine, nursing, and mental health— can develop symptoms
related to what is referred to as vicarious trauma (VT), compassion
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
fatigue (CF), or burnout (BO; Munger, Savage, & Panosky, 2015;
This document is copyrighted by the American Psychological Association or one of its allied publishers.
see also Waegemakers Schiff & Lane, 2019). Those working in the
forensic subfields of psychology, psychiatry, social work, and
nursing may be even more susceptible to developing problems
associated with VT, CF, and BO given the intensive nature of their
work. As Abellanoza, Provenzano-Hass, and Gatchel (2018)
noted, BO is particularly problematic among emergency room
nurses. Nevertheless, although the overarching literature associ-
ated with VT, CF, and BO spans several large fields, empirical
research is lacking in the forensic subfields, especially when
compared with other related areas such as police stress. In addi-
tion, and of particular importance, there are limitations in the
empirical literature regarding work-related stress, particularly with
respect to the ways in which the construct has been operational-
ized.
Our review of the extant literature has led us to identify VT, CF,
and BO as related yet distinct concepts that have been used to
describe patterns of negative emotional outcomes in employment
contexts (see Beck, 2011; Geoffrion, Morselli, & Guay, 2016). In
this article, we first provide a general and delineated review of VT,
CF, and BO, followed by a discussion of the relevance of each
across professions. We then address these concepts within the
more specific context of forensic mental health, using forensic
psychology as exemplar, and highlight considerations for those
working in the forensic arena. Lastly, we set forth a call for
research, which we believe is essential to the development of a
more meaningful understanding of the connection between VT,
CF, and BO in forensic mental health, thereby focusing on the
most important goal: preventing their development.
Vicarious Trauma
VT can develop when a practitioner is exposed to the retelling
of a traumatic event by a client. Much like the experience of a
direct trauma, VT may affect a practitioner’s worldview or primary
belief system, cognitions, and emotional needs (Hatcher & No-
akes, 2010; Pearlman & Saakvitne, 1995a). Symptoms can also
mirror those of direct trauma exposure, such as disturbances in
mood, self-identity, spirituality, and cognitive frame of reference
as well as intrusion symptoms (Pearlman & Saakvitne, 1995b).
Long-term sequelae of VT may include problematic interpersonal
and romantic relationships as well as decreased sexual desire
(Branson, Weigand, & Keller, 2014). Practitioners are at higher
risk for developing VT if they have experienced direct trauma
exposure, have had less exposure to trauma in their practice or
training, or if they have experienced the same traumatic event as
455
the client, as in the case of a sudden, widespread crisis such as a
mass shooting or natural disaster (Day, Lawson, & Burge, 2017;
Finklestein, Stein, Greene, Bronstein, & Solomon, 2015; Pearlman
& Mac Ian, 1995).
Compassion Fatigue
CF may also consist of symptoms similar to those associated
with direct trauma exposure; however, it differs from VT in that it
does not require exposure to a traumatic event (Hatcher & Noakes,
2010). Instead, CF develops via the process of empathizing with
clients’ emotional pain and suffering without the presence of direct
or indirect trauma exposure (Sorenson, Bolick, Wright, & Hamil-
ton, 2017). Thus, medical and mental health professionals have
referred to CF by the moniker “the cost of caring” (Beck, 2011;
Figley, 1995). Symptoms may develop either gradually or rapidly
and can include the experience of intrusion symptoms, negative
emotional arousal (e.g., experiencing higher levels of anger, hate,
and frustration), difficulty separating work and home life, lower
levels of distress tolerance, emotional outbursts, decreased work
satisfaction, negative self-soothing behaviors (e.g., drinking, social
isolation), and decreased general functioning and productivity at
work and home (Figley, 1995; Gentry, Baranowsky, & Dunning,
2002). Symptoms specific to CF typically not present with VT can
include the inability to process emotional distress related to caring
for others’ suffering, poor clinical decision making, and the avoid-
ance of, and inability to establish, relationships with clients (Sin-
clair, Raffin-Bouchal, Venturato, Mijovic-Kondejewski, & Smith-
MacDonald, 2017; Sorenson et al., 2017).
Risk factors for developing CF include a high desire to eliminate
others’ suffering, issues related to the practitioner’s own unre-
solved trauma history, working with traumatized children, and
experiencing high amounts of natural empathy (Figley, 1995;
Sorenson et al., 2017). In contrast, protective factors that may
prevent the development of CF include greater trait-based emo-
tional intelligence, healthy emotion management (i.e., emotion
regulation), and adaptive, problem-focused coping strategies—as
opposed to avoidance-based coping (Zeidner, Hadar, Matthews, &
Roberts, 2013). Hollingsworth (1993) also suggested that CF could
be minimized by setting firm professional boundaries with clients
to prevent being inundated by others’ distress as well as setting
working hours and engaging in additional training, consultation,
and supervision with experienced professionals.
Burnout
BO has the longest standing conceptual history of the three
terms, and it has also been recognized as one that is cross-national
in nature (e.g., see Sturzu et al., 2019). It has been defined as a
gradual decrease in work engagement because of chronic exposure
to stressful situations (Hatcher & Noakes, 2010), and, similar to
CF, it does not require trauma exposure. That said, BO is distinct
from CF in that it may arise from workplace stress other than that
which is the result of exposure to others’ distress (Beck, 2011;
Figley, 2002; Sorenson et al., 2017). For instance, BO can arise
from workplace stress unrelated to client contact—such as having
a high caseload or limited resources (e.g., lack of job control,
availability of feedback, learning opportunities)—and can result in
the disengagement of one’s work duties (Maslach, Schaufeli, &
 456 PIRELLI, FORMON, AND MALONEY
Leiter, 2001). BO is also distinct from both VT and CF insofar as
it develops gradually over time.
BO is characterized by the presence of three primary types of
problems: (a) physical, mental, and emotional exhaustion; (b)
cynicism and decreased job satisfaction; and (c) inefficiency at
work (Maslach et al., 2001; Salston & Figley, 2003). As Salston
and Figley (2003) noted, those who develop BO commonly expe-
rience low energy, tiredness and sleep disturbance, decreased
feelings of personal accomplishment, depersonalization, and phys-
ical symptoms (e.g., hypertension, headaches). They further indi-
cate that BO can be similar to CF and VT, such that it may result
in behavioral and mood disturbances, impaired relationships, and
feelings of helplessness and hopelessness.
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Those who experience BO may also feel they lack professional
This document is copyrighted by the American Psychological Association or one of its allied publishers.
support from their supervisors, coworkers, and organizations, such
as in the context of accrued compensatory time, additional train-
ing, paid leave, and the extent to which overtime is required
(Etzion, 1984). For these reasons, practitioners who work in inde-
pendent practice settings are also at risk of developing BO given
that professional support may be difficult to secure, and there may
be fewer safeguards against working long hours and weekends and
taking work home (Prosser et al., 1996). Researchers have also
found a negative correlation between BO and empathy, and have
hypothesized that decreased levels of empathy may contribute to
the development of BO (Sturzu et al., 2019; Wilkinson, Whitting-
ton, Perry, & Eames, 2017).
VT, CF, and BO Across Professions
VT, CF, and BO have higher incidence rates in certain profes-
sions, albeit in a nuanced fashion. For instance, CF has been found
at higher rates in the medical and nursing arenas because of high
rates of interfacing with those suffering from various ailments
(Crumpei & Dafinoiu, 2012). Police officers have evidenced rel-
atively high rates of BO, which has been linked to certain types of
job-related exposures such as encounters with emotional victims,
hostility from others, and witnessing death and violence (Violanti
& Gehrke, 2004). Otey (2015) also noted the presence of BO
among lawyers as a result of their notably high work hours and
workloads. VT may also develop in legal professionals who work
with clients who have either committed or have been the victim of
violent crimes (e.g., assault, murder, sex crimes, crimes against
children). Furthermore, lawyers practicing in the areas of civil law,
child protection, family law, and immigration law may also be at
risk of experiencing negative work-related outcomes because of
the effects of “losing” a case on their clients and their clients’
families (Jenkins, 2013). Interpreters, transcriptionists, and re-
searchers handling sensitive topics may also be at risk of devel-
oping work-related stress in this context, particularly if they work
on matters related to violence, abuse, or bereavement (Taylor,
Bradbury-Jones, Breckenridge, Jones, & Herber, 2016). In addi-
tion, mental health professionals have been found to have elevated
rates of CF and VT given the nature of client–practitioner thera-
peutic relationships, the “psychologically toxic situations” they
may be exposed to in the context of the therapy process, and from
interacting with those diagnosed with certain types of psychopa-
thologies (e.g., borderline personality disorder; Dattilio, 2015, p.
393).
Although much of the research across professions has focused
on the development and effects of VT, CF, and BO among work-
ing professionals, Crumpei and Dafinoiu (2012) aptly noted that
trainees are also potentially at risk. Furthermore, ECPs have been
found to be at increased risk of experiencing work-related emo-
tional stress as a result of factors demands, less time for self-care,
and fewer available professional resources (Dorociak, Rupert, &
Zahniser, 2017). Indeed, the work environment itself can play a
role in the development of VT, CF, and BO. For instance, those
working in correctional settings are prone to develop negative
psychological consequences from the relatively high rates of
trauma in incarcerated men and women (Substance Abuse and
Mental Health Services Administration, 2014; Wolff, Huening,
Shi, & Frueh, 2014).
VT, CF, and BO in Forensic Mental Health Contexts
The mental health arena is unique in that providers are tasked
with regulating their own behavior and emotional well-being in the
context of their professional competence. For example, as stated in
the American Psychological Association’s (2017) Ethical Princi-
ples of Psychologists and Code of Conduct, Standard 2.06, Per-
sonal Problems and Conflicts:
(a) Psychologists refrain from initiating an activity when they
know or should know that there is a substantial likelihood
that their personal problems will prevent them from per-
forming their work-related activities in a competent manner.
(b) When psychologists become aware of personal problems
that may interfere with their performing work-related duties
adequately, they take appropriate measures, such as obtain-
ing professional consultation or assistance, and determine
whether they should limit, suspend, or terminate their work-
related duties. (p. 5; see also Standard 10.10, Terminating
Therapy)
Although this standard highlights the importance of practitioners
recognizing and maintaining their own psychological health, Wise
(2008) reminded us that “we frequently fail to effectively intervene
with ourselves or with our colleagues prior to the point at which
impairment leads to improper behavior” (p. 636). This issue is
particularly relevant for forensic health providers and examiners
for whom direct and VT exposure can be relatively common.
Moreover, as Varela and Conroy (2012) outlined in their publica-
tion on forensic competencies, there are both general and special-
ized competencies relevant to those who engage in forensic mental
health assessment (FMHA), intervention, consultation, research,
supervision-training, and management-administration. Although
they did not specifically cite VT, CF, or BO in the six aforemen-
tioned areas, the overarching relevance of these issues is captured
in some of the knowledge, skills, and attitudes that Varela and
Conroy identified as forensic competencies.
Students, Trainees, and Early Career Professionals
Wise (2008) also reminded us that psychology graduate students
must demonstrate professional competency in relation to their
emotional health as well—and, as such, emphasized that “emo-
tional well-being is clearly entwined with professional function-
 PREVENTING VICARIOUS TRAUMA
ing” (p. 629). Indeed, students and ECPs may be at particular risk
for developing VT because of the increased stress of balancing
multiple roles and having fewer resources in place to cope with
adverse experiences (Hatcher & Noakes, 2010; Kadambi &
Truscott, 2003; McKinley, Boland, & Mahan, 2017; Pakenham &
Stafford-Brown, 2012). Given that developing VT can result in the
provision of poorer patient care as well as suicidality and other
adverse issues among practitioners (Dattilio, 2015; Pakenham &
Stafford-Brown, 2012), there is a need to provide students and
trainees with education and training on preventive and intervention
strategies in relation to VT in particular (Beaumont, Durkin, Hol-
lins Martin, & Carson, 2016). Of course, it is also necessary to
educate students, trainees, and ECPs on issues related to CF and
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BO. Perhaps this information can be imparted during the course of
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suicide and violence risk assessment trainings for mental health
students—a time when awareness is heightened and risk and
mitigating factors are being addressed, front and center (e.g., see
Cramer, Johnson, McLaughlin, Rausch, & Conroy, 2013).
Supervisors and Instructors
Kennedy and Scriver (2016) provided recommendations for
presenting sensitive forensic and legal information in lectures for
medical students, which is applicable to those in the forensic and
psychology and law arenas. These recommendations include not
allowing the avoidance of relevant topics such as child abuse or
rape, but instead creating space to discuss these sensitive topics;
providing students with advanced notice of lectures that will
include sensitive topics; providing relevant resources for follow-up
postlecture; and having a plan in place to address student disclo-
sures. Additionally, they recommended that the lecturers be mind-
ful of their own reactions to sensitive topics and seek support in
this regard. As with other groups, VT can develop with supervisor
and instructor groups, and self-care should be prioritized and
promoted in psychology programs for this reason (Kennedy &
Scriver, 2016; Simms, 2017).
Practitioners
For general mental health providers, BO and CF seem to be
more correlated with organizational stressors, role confusion, and
early career demands than exposure to clients’ traumatic symp-
toms during the course of therapy (Devilly, Wright, & Varker,
2009; Dorociak et al., 2017; Hatcher & Noakes, 2010). Studies
investigating the presence of VT, CF, and BO in practitioners have
generally focused on sex offender treatment providers (SOTPs; see
Farrenkopf, 1992; Kadambi & Truscott, 2003; Moulden & Fire-
stone, 2007) or have at least included them as a subgroup (Hatcher
& Noakes, 2010). In their review of the literature of SOTPs,
Moulden and Firestone (2007) found that a number of factors
commonly thought to be associated with increased risk of VT in
SOTPs were actually not supported, such as the presence of
personal trauma, a high trauma caseload, or type of treatment
modality. In contrast, they found the following to be related:
“intrusion, avoidance, hyperarousal, intrusive thoughts, avoidance
behaviors (e.g., substance abuse), suspiciousness of self and oth-
ers, hypervigilance, psychological correlates (e.g., depression,
anxiety, and irritability/frustration)” (p. 68). However, Farrenkopf
(1992) noted that clients of SOTPs are mandated to treatment and,
457
as such, may pose a threat to others. In that study, 24 SOTPs with
10 to 30 years of experience served as the participants; most were
male (83%), doctorate-level providers (71%), and reported “dimin-
ished hopes and expectations in working with sex offenders”
(54%). In addition, participants reported the following experi-
ences: “hardening or dulling of emotions” (42%), “frustration with
the correctional system or society” (38%), increased hypervigi-
lance and suspicion (29%), and “generalized high stress, exhaus-
tion, depression, or burnout” (25%). Nevertheless, SOTPs have not
been found to experience significant levels of VT, CF, or BO
compared with their general mental health provider counterparts
(Hatcher & Noakes, 2010; Kadambi & Truscott, 2003), although
Kadambi and Truscott (2003) found SOTPs had higher rates of
depersonalization.
Some studies have examined these issues among other types of
forensic mental health professionals. For example, Brown, Igou-
menou, Mortlock, Gupta, and Das (2017) conducted a systematic
review of work-related stress across 17 studies inclusive of foren-
sic nurses, psychiatrists, occupational therapists, and other “car-
ers.” Although they found moderate levels of stress and BO among
these groups, the authors concluded that the studies “do not sup-
port the theory that forensic staff suffer from higher levels of stress
than non-forensic staff” (p. 234). However, Elliott and Daley
(2013) conducted a qualitative review of the literature and con-
cluded that forensic practitioners did evidence increased levels of
psychological stress and BO. They also noted that younger staff
utilized more coping skills than older staff, despite findings that
younger providers experience relatively more traumatic stress (see
Hatcher & Noakes, 2010; Kadambi & Truscott, 2003).
At least three studies have examined these issues among foren-
sic psychiatrists (Johnson, Worthington, Gredecki, & Wilks-Riley,
2016) and forensic interviewers (Bonach & Heckert, 2012; Perron
& Hiltz, 2006). In line with Dorociak et al. (2017) and Hatcher and
Noakes (2010), Johnson and colleagues (2016) found that early
career forensic psychiatrists reported “higher levels of emotional
exhaustion and depersonalization, whereas older professionals
were more positive regarding their competence and sense of ac-
complishment” (p. 64). Bonach and Heckert (2012) found satis-
faction with one’s organization and job support were associated
with lower levels of BO, and Perron and Hiltz (2006) found a
relationship between such and secondary traumatic stress— both
among forensic interviewers. Contrary to their hypothesis, how-
ever, Perron and Hiltz found that neither length of employment nor
high workload had a significant effect on secondary trauma expe-
rience, although these factors were moderately associated with
BO. They also found that interviewers’ levels of self-efficacy in
the context of their employment were negatively associated with
levels of disengagement and secondary trauma.
VT, CF, and BO in Forensic Psychology
Forensic psychology is a unique profession for examining VT,
CF, and BO given that practitioners see clients across a wide range
of settings that may put them at risk for experiencing increased
distress (e.g., in correctional facilities or independent practice
contexts with lacking professional support). Forensic practitioners
also regularly interface with those who have perpetrated or have
been the victim of crimes as well as those who have been psycho-
logically injured. As such, forensic practitioners are more likely to
 458 PIRELLI, FORMON, AND MALONEY
work with those presenting with challenging personality traits and
disorders, which can be quite taxing and may require the setting of
firm boundaries. That said, intentionally seeking out forensic work
may be a protective factor (see Bartoskova, 2017; Taylor et al.,
2016). To more fully understand the risk and protective factors
inherent within forensic psychology practice in relation to developing
VT, CF, and BO, let us first briefly define the field. The scope of
forensic psychologists’ duties is also important to outline before we
can draw conclusions about the risk of developing adverse emotional
symptoms to work-related stress in the profession.
Forensic psychology, broadly defined, includes the research,
practice, and application of psychology as it relates to the legal
system (Bartol & Bartol, 2019). This can include research on
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psycholegal issues (e.g., sexual recidivism, false confessions),
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preparing amicus curiae briefs to the courts in significant legal
matters, conducting FMHAs (e.g., competency to stand trial, men-
tal state at time of offense, personal injury, employment discrim-
ination), providing psychotherapeutic services in forensic contexts
(e.g., court-ordered sex offender treatment, individual and group
therapy with detained youth), and engaging in expert testimony
(i.e., as treating, evaluating, or content area experts). For illustra-
tive purposes, we will primarily focus on forensic practitioners
who conduct FMHAs.
Forensic practitioners can conduct FMHA in administrative,
civil, and criminal matters. For example, they may be asked to
conduct preemployment and fitness-for-duty evaluations in any
number of employment contexts or assessments of those who have
applied for gun permits and were flagged during the screening
process (administrative). They may also conduct child custody,
personal injury, or employment harassment evaluations (civil), or
violence risk assessments for sentencing and assessments related
to mental health defenses (criminal). Moreover, forensic practitio-
ners can practice in a variety of settings, including, but not limited
to, medical, forensic, or psychiatric facilities; correctional settings;
community mental health settings; and in private practices. They
can also provide services for a variety of people across subgroups,
such as detained persons as well as offenders on probation or
parole, undocumented persons and refugees, and military, correc-
tional, and law enforcement personnel. In fact, forensic practitio-
ners can theoretically interface with almost anyone given that
people of all walks of life in our population may find themselves
involved in an administrative, civil, or criminal matter at any given
time. Indeed, there are very many ways such can arise considering
divorce and employment rates alone (e.g., child custody and work-
ers’ compensation evaluations). For more information regarding
forensic psychology, forensic services, or forensic populations, the
interested reader is referred to Bartol and Bartol (2019), Melton et
al. (2017), and Pirelli, Beattey, and Zapf (2017).
Research on VT, CF, and BO in Forensic Psychology
To our knowledge, there have been no published studies spe-
cifically addressing VT, CF, or BO among forensic psychologists,
although two related conference presentations have addressed such
(i.e., Brovko & Foote, 2011; Foote & Brovko, 2011). As Foote and
Brovko (2011) indicated, symptoms of VT have been observed in
other groups involved in the criminal justice system, such as
judges (Jaffe, Crooks, Dunford-Jackson, & Town, 2003), jurors
(Lonergan, Leclerc, Descamps, Pigeon, & Brunet, 2016; Shuman
et al., 1993), and evaluators of World War II concentration camp
survivors (Hoppe, 1968) and torture survivors (Pross, 2006). Foote
and Brovko also addressed the paradox of forensic psychology and
how this may or may not influence their development of VT.
Namely, on one hand, forensic psychologists are often exposed to
traumatic material and may have to immerse themselves in it—
sometimes from multiple victims—in order to be thorough. On the
other hand, forensic training often emphasizes the concept that
practitioners should avoid overempathizing with examinees to
better adhere to the ideals of objectivity and distinguish between
the therapeutic and evaluative roles (see Greenberg & Shuman,
1997, 2007; the interested reader may also wish to review the
professional literature associated with the concept of what is
referred to as “moral disengagement”).
In their study, Brovko and Foote (2011) surveyed 65 psychol-
ogists involved in forensic work, whom they recruited through the
American Academies of Forensic Psychology, Clinical Psychol-
ogy, and Neuropsychology. They found practitioners reported ex-
periencing a low intensity of VT symptoms overall, and neither
history of personal trauma nor social support significantly pre-
dicted the presence of VT symptoms. Nevertheless, their results
indicated more time spent working in the forensic arena was
correlated with fewer VT-related symptoms, reflecting a potential
resiliency effect. Additionally, although there was no statistically
significant relationship found between positive coping methods
and the presence of VT symptoms, the authors found maladaptive
coping styles (e.g., avoidant or negative coping) to be associated
with the presence of VT-related symptoms, as was spending more
time on trauma cases.
VT, CF, and BO in Forensic Psychology Practice
Practitioners can encounter cases in criminal, civil, and admin-
istrative matters that lead to problems related to VT, CF, and BO,
as they may involve disturbing fact patterns, images, and reports as
well as people with trauma histories or serious psychopathology,
including character pathology.
Criminal
It may be easiest to think of criminal case examples that can
potentially vicariously traumatize clinicians given the sensational
nature of many violent offenses. Forensic practitioners conduct a
range of evaluations in various types of criminal matters, such as
those related to pretrial and sentencing risk/mitigation, criminal
competencies, and mental health defenses (e.g., insanity, dimin-
ished capacity). In this context, it is not the type of evaluation that
is likely to be the particularly bothersome aspect of the case, but
rather the nature of the offense in question and the characteristics
of the defendant and victim involved. Perhaps the most obvious
examples are especially heinous murders and sex offenses with
very vulnerable victims, such as children. As such, forensic prac-
titioners working in the criminal arena may be susceptible to
develop VT, CF, or BO as a function of the types of cases on
which they work and as a result of their particular roles. For
example, some practitioners may work on particularly sensational
cases that can be disturbing in and of themselves, whereas others
may be affected Hollingsworth, M. A. (1993). Responses of female
therapists to treating adult female survivors of incest. Dissertation
 PREVENTING VICARIOUS TRAUMA
Abstracts International. ProQuest Information & Learning, their
exposure to certain victims—which can lead to both VT and CF.
Moreover, practitioners working in this area can develop BO
depending on the presence or absence of factors that impact their
ability to effectively manage their caseloads and exposures.
Civil
Although working in the civil forensic arena may be assumed to
be less potentially disturbing than criminal work, it is important to
remember that civil cases are, in fact, often associated with inju-
rious acts. For example, civil commitment matters, by definition,
involve those who have either engaged in violent or suicidal
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behavior or who at least pose an elevated risk to themselves,
This document is copyrighted by the American Psychological Association or one of its allied publishers.
others, or property. Nearly half of the states in the country also
have sexually violent predator laws, which allow for the extended
civil commitment of those who have committed particularly seri-
ous sex offenses and who pose a heightened recidivism risk.
Forensic practitioners also conduct evaluations of violent crime
victims in civil tort matters, such as assessing for the presence of
psychological injuries in personal injury cases. Of course, these
types of evaluations do not necessarily have to be associated with
violent crimes, however. For instance, assessments of psycholog-
ical injuries may be conducted in cases related to accidents,
employment-related issues, and even wrongful death matters. In-
deed, there are many areas of civil forensic practice that do not
necessarily involve violence or violent crimes per se (e.g., child
custody and other family court matters, civil competencies).
It is important to note, though, that exposure to violence or the
lack thereof is not dispositive vis-à-vis developing VT, CF, or BO.
Although it certainly may be easier to imagine how pure criminal
cases can affect practitioners, particularly in relation to VT, the
potential for civil matters to have similar or even more serious
effects should not be overlooked. It is also important to recognize
that practitioners may identify with or otherwise relate to those
involved in civil matters more than criminal matters. After all,
criminal offenders generally reflect a more homogenous group
compared with plaintiffs in civil matters, for example.
Administrative
Administrative matters are those cases that may not be part of a
formal legal proceeding but may very well be in the foreseeable
future or at least have the potential to be. It is often the case that
the only actual distinction is that a lawsuit or formal legal com-
plaint has yet to be filed. Although evaluations in these contexts
may not technically meet the formal definition of FMHAs, they are
certainly forensic in nature in many respects. Examples include
preemployment and fitness-for-duty evaluations in a range of
employment contexts, including, but certainly not limited to, law
enforcement candidates and officers; mental health expungements;
evaluations for gun permit applicants; and violence, sexual, and
fire-setting risk assessments for youth, such as those needed to for
treatment planning, residential placement, and suitability to return
to school. Within this context, it may be less likely that the fact
patterns are, in and of themselves, disturbing compared with those
in criminal and civil matters, but the experience of those involved
can hit close to home for the evaluator. Of course, some cases may
be bothersome on their face (e.g., animal cruelty or other matters
459
prompting risk assessments), but, as with civil cases, administra-
tive matters may be more likely than criminal matters to affect
evaluators in a transferential way.
Treatment
Our review of the professional literature showed that VT, CF,
and BO are predominantly discussed in relation to treatment, such
as psychotherapy. To be sure, treatment in forensic contexts pres-
ent the same, if not greater, potential concerns as treatment in
clinical contexts. Forensic psychotherapists work in a wide range
of settings and with a range of people, such as with adult and
juvenile offenders who are incarcerated or who are on probation or
parole and are mandated to engage in treatment (e.g., diversion
programs, sex offender treatment). Practitioners in this arena may
also provide specialized therapeutic services to those involved in
child abuse and neglect, child custody, and parental fitness matters.
Indeed, there are also therapists who treat those involved in civil
lawsuits and related matters, such as workers’ compensation and
disability claimants, and those who are pursuing or may pursue
litigation in employment- and personal-injury-related tort cases.
Although some of these therapists may not always technically be
in a forensic role and can be squarely practicing clinical psychol-
ogy per se, they still interface with the same types of legal matters
and participants as their counterparts who are clearly engaging in
the practice of forensic psychology. Therefore, considerations re-
lated to VT, CF, and BO remain applicable, particularly when the
distinctions between therapeutic and forensic roles are subtle.
Teaching and Research
Academicians and researchers at all levels can be affected by the
content they teach and study— especially when it is obviously
disturbing but also when it has particular relevance to them.
Examples include research on immigration issues, child abuse,
trauma, suicide and end-of-life issues, sex offending, violent
crime, and capital punishment. Just like anyone else, teachers and
researchers can have personal reactions to the topics they address.
Indeed, many people actually gravitate toward particular areas of
study because there is some level of personal relevance to them,
just as practitioners do. Nevertheless, academicians and research-
ers may be more inoculated against developing VT, CF, and
related problems because of the literal and figurative distance they
typically have from their study groups. Still, some are affected
regardless and, in fact, there are those who do actually have closer
or more direct interactions with their study groups.
Considerations for the Prevention of VT, CF, and BO
in Forensic Mental Health
As is clear from our literature review, there is virtually no
forensic-specific research base of published empirical studies from
which to draw when setting forth considerations to prevent the
development of VT, CF, and BO within this overarching arena.
Although we set forth a formal call for research in this regard in
the following section because the need is clear, such is likely to
take many years to develop. Therefore, we first provide four sets
of considerations for forensic mental health practitioners, acade-
micians, researchers, and students and trainees based on what we
 460 PIRELLI, FORMON, AND MALONEY
currently know about the development of these problems among
helping professionals. The four areas are (a) identifying potential
risk factors; (b) recognizing, developing, and strengthening pro-
tective factors; (c) overcoming self-care and treatment barriers;
and (d) identifying and engaging in therapeutic interventions.
Identifying Potential Risk Factors
It can be helpful to identify potential risk factors for developing
VT, CF, and BO as either exogenous or endogenous. Exogenous
factors are those primarily resulting from external factors, whereas
endogenous factors are mainly the result of internal factors, or
those which are person-specific. Some factors can overlap in both
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areas across VT, CF, and BO contexts, whereas others are more
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specific to the development of one type of problem. For example,
exogenous risk factors include those such as working in a helping
profession, particularly with those who are suffering; having in-
creased patient contact and heavier caseloads; working in settings
that are not therapeutic or supportive in nature; and not having a
mechanism in place to identify VT, CF, or BO-related problems
early enough to intervene as well as not having appropriate inter-
ventions available, regardless of when such is identified. Some
mental health-related endogenous risk factors are those such as a
trauma history and maladaptive coping skills.
Of course, there can be more nuanced risk factors at play as
well. For example, both the amount of training and experience one
has and the amount of time spent working on certain matters can
be a relevant consideration in this regard, as ECPs and those who
predominantly work in the trauma arena may be at greater risk for
developing problems. In addition, higher levels of empathy may serve
as a potential risk factor for developing VT and CF, whereas lower
levels of empathy may very well protect against the development of
BO. This may also be the case for transferential issues and, therefore,
the concept of transference deserves some attention here.
The term transference, in and of itself, may evoke a reaction to
some readers depending on the therapeutic modality to which they
subscribe. Some may have a negative reaction, and it may even
essentially be taboo for others. However, most recognize the
importance of the therapeutic alliance or relationship in the pro-
vision (and ultimate effectiveness) of psychotherapeutic interven-
tions. A thorough review of transference and countertransference
is outside of the scope of this article, but let us be clear that we are
referring to the unconscious (or subconscious) redirection of feel-
ings between the patient and clinician (see Falchi & Nawal, 2009,
for a historical review of these concepts). We are confident that
even the reader who finds the term to lack utility (or worse)
recognizes that patients can have reactions to clinicians for various
reasons, and vice versa. For our purposes here, we use the afore-
mentioned terms to convey this sentiment and we believe most
nuances across therapeutic modalities reflect more semantic than
substantive differences in this regard anyhow. Nevertheless, our
consideration of transference and countertransference in the con-
text of VT and CF, in particular, is not a novel one. In fact,
Branson (2019) recently reminded us of Judith Herman’s use of
the term traumatic countertransference over 20 years ago “to
describe the negative metamorphosis of the clinician from thera-
peutic helpmate to pathological rescuer” (p. 4; see also Herman,
1997). As Branson explains, such can lead clinicians to behave
from a standpoint of self-imposed importance, whereby they be-
lieve they are the only ones who can help their patients. As a result,
clinicians may cross personal and professional boundaries in an
effort to provide services for their clients and may even neglect
other work duties, work outside their standard hours, and have
personal contacts with the patients in question. Branson notes the
distinction between countertransference and VT, however:
Both countertransference and traumatic countertransference differ
from VT, as they are the outcome of relationship issues with the client
and dysfunctional boundaries of the clinician. Vicarious trauma is
considered an inevitable part of the helping relationship that facilitates
changes in cognitive schemes and worldview for the clinician exclu-
sively (Iqbal, 2015). (p. 4)
Nuances aside, some have recommended that clinical training
attend to the concept of countertransference regardless of thera-
peutic modality, as heightening such awareness may help practi-
tioners avoid ethical dilemmas (see Gordon et al., 2016). More-
over, in their recently published meta-analyses, Hayes, Gelso,
Goldberg, and Kivlighan (2018) found countertransference to be
associated with psychotherapy outcomes, albeit modestly, but that
countertransference management factors lessened countertransfer-
ence reactions, and successful management in this regard is asso-
ciated with better therapy outcomes. The interested reader is also
referred to recently published professional literature on
attachment-informed therapy (e.g., see Berry & Danquah, 2016;
Parpottas & Draghi-Lorenz, 2015).
As we previously noted, some risk factors may be more
specific to the development of one particular type of problem—
either VT, CF, or BO. For instance, with respect to developing
VT, risk factors include exposure to disturbing information,
stimuli, and particular clinical presentations (e.g., Cluster B
personality disorders); engaging in forensic work generally, but
especially working with traumatized groups and on violence,
suicide, sex offense matters; and having less training and ex-
posure in these areas. Risk factors that may be more specific to
the development of CF can include a high desire to eliminate
others’ suffering; the person’s own unresolved trauma history;
working with traumatized children, and particularly vulnerable
groups; and having high amounts of natural empathy. As for
developing BO-related problems, risk factors include having a
high caseload and limited resources; lacking professional sup-
port from supervisors and coworkers; as well as a lack of
systemic support from employers, including, but not limited to,
issues related to accruing compensatory time, receiving addi-
tional training, having paid leave options, and overtime-related
requirements. Moreover, as we noted earlier in the article, it is
for these reasons that practitioners working in independent
practice settings may also be at risk for developing BO—
particularly given the inherent challenges related to securing
regular, professional peer support and having fewer safeguards
available to avoid working long hours and on weekends and
having to take work home.
Recognizing, Developing, and Strengthening
Protective Factors
The VT, CF, and BO literature includes various protective fac-
tors—in terms of professionals’ own characteristics and self-care
practices (see Wise, Hersh, & Gibson, 2012, for a four-principle
 PREVENTING VICARIOUS TRAUMA
model of self-care). For instance, self-compassion has been noted to
be associated with reduced CF and BO (Beaumont et al., 2016) as
well as the relevance of increased emotional intelligence and emotion
management-related abilities. In addition, Collins and Long (2003)
indicated that compassion satisfaction—the perception of benefits
rather than costs from working with clients and/or their traumatic
symptoms—is also a protective factor in this context, as it is the
opposite of CF and is positively correlated with mindfulness skills
(Thieleman & Cacciatore, 2014). Moreover, CF-related effects may
be minimized by setting firm professional boundaries with clients to
prevent being inundated by others’ distress outside of set working
hours, along with engaging in additional training, consultation, and
supervision with experienced professionals. Moreover, adaptive,
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problem-focused coping strategies are thought to be much better to
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employ in this context as opposed those that are avoidance-based (see,
e.g., Cramer et al., 2019). In addition, organizational job support as
well as supervisory and professional consultation models are lauded
as ways of increasing practitioner and student/trainee support and
reducing VT (Almond, 2014; Bonach & Heckert, 2012; Collins &
Long, 2003; Harrison & Westwood, 2009). Furthermore, practitioners
may find meaning and feel satisfaction from seeing their clients
improve (Collins & Long, 2003; Hernández, Engstrom, & Gangsei,
2010).
Forensic work may be protective in some respects, however, as
empathy has often been discouraged in light of the increased scrutiny
and the ideal of striving to be objective, particularly associated with
FMHAs (see Shuman, 1993; Shuman & Zervopoulos, 2010). On the
other hand, some have suggested that empathy is not the problem per
se, but rather the type of empathy at play in a forensic context.
Namely, Brodsky and Wilson (2013) contended that ethical forensic
professionals may, in fact, use moderate empathy during evaluations
as “a potentially useful tool for effective assessments” (p. 192).
Moreover, they suggested that empathy in forensic assessment con-
texts become a subject for empirical study as opposed to solely a
matter of preference or debate. Consistent with this recommendation,
Vera and colleagues (2019) recently investigated the impact of eval-
uator empathy on a forensic interview. In the first experimental study
of its kind, they sought to analyze the effects of empathy employed by
doctoral-level clinical psychology students during interviews with
undergraduate student participants. Ultimately, Vera et al. found that
the expression of empathy affected the evaluators rather than the
examinees. Although their study reflects an initial step in the empir-
ical study of empathy in forensic assessment contexts, it was impor-
tant initial step, nonetheless. As Vera and colleagues noted, the effects
of empathy on examinees may not be as significant as once thought
by Shuman (1993) and others. Furthermore, they concluded,
Overall, our findings highlight the need for more research on evalu-
ator empathy. They also underscore a broader theme of recent field
research addressing forensic evaluations; that is, that evaluators are
not uniform, interchangeable “instruments,” but rather a dynamic
component of the evaluation, such that—at least to some extent—the
outcome of a forensic mental health evaluation may depend on aspects
of the evaluator, not just the evaluee. (p. 65)
Other protective factors may relate to the fact that some evaluators
may find it rewarding when their opinions on psycholegal issues
are considered and appreciated by those in the legal system. It is
also noteworthy that developing technology may reduce some
forms of exposure to traumatic material. For example, software has
461
been developed to automate some review of records and media
associated with child pornography and sexual exploitation (see
Burruss, Holt, & Wall-Parker, 2018).
Overcoming Self-Care and Treatment Barriers
Mental health providers, including forensic practitioners, can
face barriers when seeking help to prevent or reduce the effects of
VT, CF, and BO. Although trainees and psychologists often en-
gage in psychotherapy and may view such positively, at least some
would likely acknowledge that “there was a time when they may
have benefited from psychotherapy but did not seek it out”
(Bearse, McMinn, Seegobin, & Free, 2013, p. 153). Risk factors
for developing CF and BO, specific to treatment providers, may
include increased levels of self-criticalness, self-judgment, and
measuring self-worth in the successes or failures to help others
(Beaumont et al., 2016; Geoffrion et al., 2016). More general
barriers to pursuing psychotherapy include issues related to time,
money, work–life balance, social stigma, and concerns about treat-
ment and self-disclosure (Bearse et al., 2013; Dattilio, 2015; Geof-
frion et al., 2016). Mental health providers may face even greater
hurdles than the general public when seeking therapeutic interven-
tions. For example, they may need to travel greater distances to
receive treatment to maintain confidentiality, have concerns about
being reported to regulatory boards for engaging in certain (po-
tentially unethical) behaviors, and believe they can treat their own
symptoms and problems (Dattilio, 2015).
There is an additional consideration relevant to health care-
related professions, especially forensic mental health: humor.
Brodsky and Lichtenstein (1999) spoke of the potential utility of
humor with involuntary clients; as they articulated it,
Therapist statements reframe the therapy. The burden of carrying the
session is taken off the client. Therapists who naturally see humor in
situations then have ways of bringing in gentle and constructive
humor. When a client makes a characteristically angry and insulting
comment about therapists, they sometimes can show they are not
going to be pushed away by replying, “Goodness, you have come to
know me very quickly and very well.” Because the therapists are
present as human beings, clients tend to become present as active
participants. Statements free us from the confines of therapist role
straightjackets. (pp. 219 –220)
Of course, humor is also a particularly relevant concept insofar
as it is used aside from direct client contacts. In forensic contexts,
the concept of gallows humor is particularly salient, as it pertains
to the use of dark humor when confronted with serious, bother-
some, or grim subject matter. This is certainly not a new concept
and is one that has been applied to health care for quite some time.
Watson (2011) spoke of the use of gallows humor in medicine,
whereby she noted that gallows humor is not a cruel type of humor,
but rather one that is used to address frightening or painful content
in a light or satirical manner (e.g., joking about death, making fun
of life-threatening or otherwise serious or terrifying scenarios). As
such, most (if not all) of us have been exposed to, or have
employed, gallows humor. Indeed, Watson pointed out that gal-
lows humor is likely a form of self-protection or defensiveness
from the effects of potentially upsetting or troubling information or
situations. The interested reader is referred to Watson’s article, as
she outlines the issues related to gallows humor well, including
considerations about whether it should be used and the ethics
 462 PIRELLI, FORMON, AND MALONEY
surrounding such. Moreover, Watson leaves us with a parting
thought, “Are all jokes wrong?” Others have also addressed the
role of humor in medical education and practice (Piemonte, 2015;
Wear, Aultman, Varley, & Zarconi, 2006; Wear, Aultman,
Zarconi, & Varley, 2009), as well as in psychiatric (Sayre, 2001)
and forensic psychiatric settings (Kuhlman, 1988), and its role as
a coping mechanism to allay the effects of CF and VT has also
been considered by some (e.g., see Moran, 2002, and Craun &
Bourke, 2014, 2015, respectively).
Identifying and Engaging in Therapeutic Interventions
The VT treatment literature is relatively sparse. However, there is
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promise in third-wave cognitive– behavioral therapy (CBT) stress
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management interventions for medical students and other health care
providers, such as mindfulness-based stress reduction, compassionate
mind training, mindfulness-based cognitive therapy, and acceptance
and commitment therapy (Pakenham & Stafford-Brown, 2012; Sin-
clair et al., 2017). One promising intervention for reducing CF and
VT, in particular, is the components for enhancing clinician engage-
ment and reducing trauma (CE-CERT) model (Miller & Sprang,
2017). This model rejects the notion that radical self-care can treat VT
and proposes practitioners and supervisors develop concrete emotion
regulation skills. The five components of this model are (a) experi-
ential engagement, (b) reducing rumination, (c) conscious narrative,
(d) reducing emotional labor, and (e) parasympathetic recovery. Al-
though this is a promising intervention, its authors acknowledge that
the next steps related to defining fidelity and empirical testing have
not yet been addressed.
Nevertheless, many organizations and training programs tend
to emphasize brief staff trainings or group sessions and work-
shops over more formal and in-depth CBT-based interventions
(Public Health England, 2016; McKinley et al., 2017). Although
organizational- and team-level interventions have certainly been
considered to be important components of initiatives focused on
reducing BO and the like, individual-level interventions remain an
important part of such as well (Abellanoza et al., 2018). Indeed,
Cramer and colleagues (2019) have recommended empowering
health care workforces and implementing a multilevel approach to
facilitating coping and well-being.
A Call for Research on VT, CF, and BO in Forensic
Mental Health
As Branson (2019) noted, “what to call the phenomena of
clinicians being physically, cognitive, emotionally, mentally, so-
cially, and/or spiritually affected by bearing witness to other’s
trauma is a source of perplexity” (p. 2), as various terms and
associated definitions have been used to describe such (e.g., sec-
ondary traumatic stress, CF, BO, countertransference, traumatic
countertransference, posttraumatic stress disorder, emotional con-
tagion, and shared trauma). Although these nuances are certainly
important, we have reviewed the concepts of VT, CF, and BO and
discussed their potential applications to forensic mental health
contexts. Admittedly, much of what we have set forth is based on
extrapolating from other professional areas and some level of
hypothesizing, as the published empirical literature is generally
scant in most forensic arenas and essentially nonexistent in foren-
sic psychology specifically.
Research on VT, CF, and BO is not particularly new per se, but
it simply has not extended into the forensic mental health arenas,
including, but not limited to, the subarea of forensic psychology.
As noted, we found no published studies on VT, CF, or BO
specifically addressing these phenomena in forensic psychologists
and only one unpublished study in this regard, which was pre-
sented in two conference presentations (i.e., Brovko & Foote,
2011; Foote & Brovko, 2011). Moreover, the extant research
related to other forensic clinician groups is limited for various
reasons, such as small sample sizes (e.g., Almond, 2014; Beau-
mont et al., 2016; Charlemagne-Odle, Harmon, & Maltby, 2014;
Collins & Long, 2003; Farrenkopf, 1992; Flarity, Nash, Jones, &
Steinbruner, 2016; Happell, Pinikahana, & Martin, 2003; Harrison
& Westwood, 2009; Hernandez-Wolfe, Killian, Engstrom, &
Gangsei, 2015; Kelty & Gordon, 2015; Perez, Jones, Englert, &
Sachau, 2010; Perron & Hiltz, 2006), the sole use of survey
methods (e.g., Bearse et al., 2013; Burruss et al., 2018; Farrenkopf,
1992; Guy, Poelstra, & Stark, 1989; Kadambi & Truscott, 2003;
Perron & Hiltz, 2006; Thieleman & Cacciatore, 2014), the sole use
of qualitative methods (e.g., Almond, 2014; Geoffrion et al., 2016;
Slater & Lambie, 2011), and the use of convenience sampling
(e.g., Charlemagne-Odle et al., 2014; Harrison & Westwood,
2009; Thieleman & Cacciatore, 2014). Of course, these studies
have been important, their limitations notwithstanding, because
they have set the foundation for future research in this area.
Nevertheless, those conducting research on these issues in rela-
tion to forensic mental health moving forward would be wise to
read Branson’s (2019) delineation of the terms and definitions.
Moreover, Branson reminds us of the numerous additional limita-
tions present in the extant research literature, such as (a) the
incorrect use of terms, (b) the combination or interchanging of
similar terms into one study variable, and (c) lack of validated
surveys for VT. Again, we acknowledge that we may very well be
guilty of using these terms and concepts interchangeably in this
article but reiterate that our scope has been predicated on the fact
that neither VT, nor CF, nor BO has been empirically studied very
much in forensic mental health contexts. As such, our aspiration is
that this article will serve as a formal call for research in this
regard, and the following areas of study are important to pursue:
(i) Identifying the prevalence and incidence of VT, CF, and
BO among forensic mental health professionals, including
practitioners, academics, researchers, students, and train-
ees.
(ii) In addition, as Brovko and Foote (2011) aptly pointed out,
it would be important to gather data from those who left the
forensic arena because of their adverse reactions to such
work, generally, or as a result of VT, CF, and BO-related
issues, specifically.1
1
Although there are always limitations to research, lacking information
about those who may very well have been most significantly affected by
forensic work (i.e., those who left the field as a result of their reactions to
such) is akin to the “file drawer problem” Rosenthal (1979) coined in his
seminal publication. Although practically different, there is a potentially
significant conceptual limitation to gathering and analyzing data that may
be biased from the onset, albeit unintentionally.
 PREVENTING VICARIOUS TRAUMA
(iii) Identifying the correlates of VT, CF, and BO in relation to
the presence of risk and protective factors in the aforemen-
tioned subgroups. This area of inquiry should include in-
vestigation into the specific attributes of the forensic men-
tal health subgroups in question (i.e., practitioners,
academics, researchers, students, trainees) as well as envi-
ronmental and case-specific factors (e.g., working with
perpetrators vs. victims; engaging in defense vs. plaintiff’s
work in the civil arena; the potential effects of factors
related to adversarial allegiance as well as cognitive bias
vis-à-vis clinical-forensic decision making).
(iv) In addition, investigating both the use and potential role
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specific coping mechanisms may have in mitigating the
This document is copyrighted by the American Psychological Association or one of its allied publishers.
development of VT, CF, and BO-related problems, such as
“gallows humor.”
(v) It would also be useful to survey forensic medical and
mental health educational and training programs through-
out the country to ascertain if and how the prevention of
VT, CF, and BO is incorporated in their curricula. Al-
though experimental methods, such as those employed by
Vera et al. (2019) in their investigation of forensic evalu-
ator empathy, may not be possible in the study of VT, CF,
and BO, their recognition of the importance of field re-
search is well-taken. Although generally more difficult to
conduct than survey studies, field studies are often more
informative and, therefore, useful. As such, it would be
beneficial for researchers to conduct field studies on VT,
CF, and BO among forensic mental health professionals.
(vi) Investigating the potential (moderating) impact transferen-
tial issues may have on the development of VT, CF, and
BO-related problems among both treating and evaluating
forensic clinicians.
In conclusion, more research on VT, CF, and BO in forensic
mental health is desperately needed. At least ostensibly, those
working in this arena may be quite vulnerable to developing such
problems; therefore, we need to gain a better understanding on the
specific prevention measures that can be taken by practitioners,
academics, researchers, students, and trainees in forensic mental
health. Once we have a better understanding of the actual inci-
dence and prevalence of these problems across forensic subgroups,
we can begin to develop a more nuanced perspective on the
particular factors that are distinctly associated with VT, CF, and
BO in the forensic arena.
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Received April 14, 2019
Revision received October 28, 2019
Accepted November 30, 2019 䡲