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Quinn Benson

Dr. Bergholtz

Composition II

25 February 2024

How Prevalent is Secondary Trauma in Therapists?

1. Introduction

Secondary trauma, also known as vicarious trauma, is a phenomenon that occurs when

therapists, or other trauma workers, gain PTSD-like symptoms from their client's own trauma;

avoidance, anxiety, depression, impulsivity, and insomnia amongst others. This can cause

numerous issues between therapist and client. If the therapist develops these symptoms from

experiencing secondary trauma, it could affect the quality of their work. This is extremely

important as therapists work with people who have poor mental health, and if they don’t get the

appropriate help, or get help from someone with more cynical and depressing views, their mental

health won’t get any better. Fortunately, there are numerous precursors to acquiring secondary

trauma: poor mental health, unhealed past traumatic experiences, lack of a support system, being

younger, and even less time practicing self care (Sodeke-Gregson). Luckily there are many ways

to prevent or lower the risk of getting secondary trauma: work-life balance, socializing, being in

nature, practicing physical self-care, and going to therapy (Hesse). Unfortunately there is a lack

of awareness about this phenomenon – even though a large number of therapists, about seventy

percent, are at high risk for contracting secondary trauma (Sodeke-Gregson). This is especially

obvious in online spaces for therapists. Specifically, the subreddit r/Therapists. There is an

extreme lack of mentions about secondary trauma, or vicarious trauma, by name. After searching

for secondary trauma within the subreddit, I was able to find roughly nine comments after
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scrolling for numerous minutes. In this paper, I aim to identify the reasoning behind why

secondary trauma isn’t discussed more frequently in online spaces for therapists, and to mention

preventative measures along with coping skills on personal as well as organizational levels when

faced with secondary trauma.

2. Methods

The online community I used was the subreddit r/Therapists. As of writing this, there are

ninety-seven thousand members. This subreddit only allows mental health professionals –

therapists and people with similar jobs – or students in the process of becoming a professional to

post here. Though, it is all anonymous posting. There is a system Reddit uses in place of likes

and dislikes. Instead of likes, users can “upvote” a comment or post to make it be seen by more

individuals, and there are “downvotes” that do the opposite. There are rules against fighting,

anti-therapy talk, and where to post about burnout. A moderator bot – AutoModerator – makes a

post every week titled “Weekly burnout check in” where therapists or students can comment on

their feelings of burnout or stress within their job (MattersOfInterest). However, there are posts

that mention burnout and other distressing feelings outside of this post. Those posts, specifically

ones that mention vicarious trauma or secondary trauma are where I am collecting my data. This

is because the specific burnout thread weekly doesn’t mention secondary trauma, and instead

mentions its symptoms fairly frequently.

I was able to find posts about secondary trauma within this subreddit through the search

bar feature, and searched the terms “secondary trauma” or “vicarious trauma” specifically. Using

this feature I have been able to find two posts that speak specifically about their experience with

secondary trauma, or worries that they may have secondary trauma themselves, and a post that
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opens up discussion for therapists to talk about their experiences with secondary trauma. I was

able to model my analysis after the “‘Real Men Grill Vegetables, Not Dead Animals’: Discourse

Representations of Men in an Online Vegan Community” article. In the article the authors collect

data and analyze it based on a set criteria (Brookes, Małgorzata). The criteria I am assessing the

data on is: time of post and responses to post (upvotes, downvotes, and/or comments). I aimed to

use these posts and chosen criteria to identify a reasoning for the seeming lack of awareness

about this issue that therapists have, as well as to comment on coping and prevention skills.

3. Data and Results

When looking into this, I originally assumed it would be a frequently discussed topic

considering the severity of the symptoms. Shockingly, I was only able to find a few responses

that discuss one's personal issues with secondary trauma. The first post I was able to find was

written by ENgeek.

“Hey gang, I’m really hesitant to post this due to my own toxic masculinity, but I think

I’m struggling with my secondary trauma. I used to do TFCBT cases for the department

of children’s services. I left a few months ago due to stress and the 24/7 schedule. My

new job is way more chill, but I’m still struggling with nightmares over what I saw and

heard. It was literally every night this week. I don’t have intrusive thoughts or panic

attacks, [it’s the] dreams [that] are getting in my way. I haven’t staffed with anyone (or

even mentioned this at all) because... reasons. Doctors are the worst patients, so I know

better than to just trust my own judgment that this will pass. Is it time to talk to

someone?”​​(ENgeek).
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This post is five years old, with thirty-one upvotes and eleven comments. Considering the

subreddit is still currently active and posts are frequent, this is an old post. When looking at other

posts on the subreddit, this post has very little engagement as well (MattersOfInterest). The

commenter mentions his own issues with toxic masculinity, as well as his symptoms of

secondary trauma specifically. ENgeek mentions specifically that he was hesitant to post because

of his “own toxic masculinity” as well as other unspecified reasons for not mentioning this to

people in his own personal life. Anastasia Pollock, a licensed therapist, theorizes the reasoning

behind people mentioning their own experiences with secondary trauma. “I think that as

therapists, we are just as guilty of holding ourselves to a ‘higher standard’” (Pollock). Looking at

the sentence “doctors are the worst patients,” I am inclined to believe that he is holding himself

to a higher standard as a patient – assuming he should be better than he is. If that is to be held as

truth, then I would also assume he is hesitant to comment on his experience for the same reason.

ENgeek assumes that as a therapist he should be better and not struggle with this secondary

trauma, even though a large number of therapists experience the same thing (Sodeke-Gregson).

“I wanted to reach out and see whether or not I need to reach out to work with someone

on some vicarious trauma that I might have picked up along the way as part of my work

as a therapist. I’ll preface this all by saying that whenever I’ve gone to workshops or

heard people talk about vicarious trauma, secondary PTSD, etc. I never felt like it was

something that I [had experienced] personally. However, during a recent training, the

facilitator made a comment that really resonated with me and was the first time I had ever

thought I might need to work with someone on some of my own vicarious trauma. The

thing that grabbed my attention was when the facilitator mentioned times when you

might struggle with issues related to concentrating, staying on task, or losing your train of
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thought. This I had experienced a little bit lately. And I say this as someone who has

never been diagnosed with ADHD, or really struggled with the symptoms in the past. All

that said, what are your thoughts?” (“Vicarious trauma?”)

This post is two years old with thirteen upvotes and nine comments. This unknown

commenter is asking for advice on whether they should seek help for secondary trauma. They

comment on symptoms of secondary trauma and focus on their experience and specific

symptoms. In contrast to the previous extract, this user seems to have zero hesitancy for

communicating about their secondary trauma. This could be for a multitude of reasons, but due

to the poster talking about attending various workshops and training, I would assume it is

because of their workplace. The article “Vicarious Trauma, Secondary Traumatic Stress or

Simply Burnout? Effect of Trauma Therapy on Mental Health Professionals” mentions that a lot

of therapists who are noted to have secondary trauma also have issues within their workplace

(Devilly, Grant et al.). I believe that the lack of hesitancy or worry about talking about their

secondary trauma comes from the workplace discussing the issue regularly.

“After hearing an absolutely horrific tale of abuse that I will never repeat, I had intrusive

thoughts that included visuals of what I imagined the abuse looked like (or one major part

of it at least). I avoided all triggers that reminded me of it which was impossible and

heartbreaking for the reason that a supportive figure in my daily life was a trigger. I had

these sort of fake flashbacks intensely for 6 months or so. It started to get better but I still

feel sick when I'm reminded of it and have occasional intrusive thoughts since, but I no

longer need to avoid triggers. This originally happened 3 years ago. I did not seek any

help and promised myself to never talk about it because I did not want to transfer the

horrific image to anyone else's brain so I waited it out on my own. That's what I went
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through that I'd call vicarious trauma. ETA the intrusive images started as multiple times

a day, almost constant and consuming my thoughts. Then it dwindled to several times a

week and continued to weaken from there. I did my best to shake the images out. They do

reappear at times like right now as I write about it but usually not without a trigger, so

maybe once or twice every few months. Just to give context to frequency.” (Its_all-good)

This comment from by iwantyour99dreams from a year ago is a part of a larger comment

thread originally posted by Its_all-good. The poster’s comment has 12 upvotes, and the original

post has 25. This commenter states they “did not seek any help and promised myself to never

talk about it because I did not want to transfer the horrific image to anyone else's brain so I

waited it out on my own” as well as stating that their experience with secondary trauma was

three years old at time of posting. From their wording, it can be inferred that the poster struggles

with feelings of guilt in their life, which leads to them not wanting to put their problems onto

other people. This is something that therapists regularly struggle with (Pollock). Feelings of guilt

tend to come from poor mental health, which is an indicator for someone being susceptible to

secondary trauma (Smith). This feeling of guilt could be another reason why therapist’s aren't

talking about their own issues with secondary trauma.

“For me I recognized it by experiencing intrusive thoughts and feelings about my clients

outside of work in a way which would interfere with being fully present in my real life. I

am really struggling right now with transference/ countertransference with a certain client

of mine and I feel more attached to him than others; sometimes it feels like our sessions

are moving a plot forward like in a TV show that [is] ultimately not going to end well. He

has horrific trauma and I relate to him in a way thats not appropriate to self disclose,

especially because it's so raw for him. But when he talks about his experiences I find my
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own anxiety, hypervigilance and "stuff" getting pulled up after the sessions. In our

sessions I have to fight against the urge to take care of him and instead focus on how to

empower him. And after those particular sessions where he really gets honest, vulnerable

and cries like a kid I have to pull it together to be the rock to his wave.” (Its_all-good).

This comment from by tiessa73 from a year ago is a part of a larger comment thread

originally posted by Its_all-good. The poster’s comment has 21 upvotes, and the original post has

25. This user mentions struggling with their own mental health issues – anxiety and

hypervigilance – after sessions with a specific client. Struggling with mental health issues while

also talking to clients who struggle with the same mental health issues is a direct cause for

secondary trauma (Smith). This user also mentions in a reply to themself that they are “definitely

discussing this one in supervision” (Its_all-good). This shows that despite the workplace having

staff that the user can go to for issues with secondary trauma, mental health issues alone are the

precursor for this user. However, the user is able to communicate about their issues with

secondary trauma.

Outside of these comments, and when scrolling through the larger subreddit as a whole, I

was unable to find more examples of secondary trauma in therapists from personal experiences.

This could be for a myriad of reasons, but I propose that because of the examples given that the

main reason for lack of posts is therapists holding themselves to a higher standard and neglecting

their own mental health struggles as well as feeling guilty for asking for help if they need it

(Pollock). This goes directly against everything that people use to cope with secondary trauma,

or prevent it in the first place. Amy Hesse states numerous personal coping mechanisms in her

article: work-life balance, physical self-care, being in nature, spirituality, socializing, therapy,

and normalization of the occurrence of secondary trauma (Hesse). She also mentions things
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organizations can do to help their therapists: providing safe spaces at the place of work and

personalizing relationships between staff (Hesse).

4. Reflection

This paper shows that the reactions to secondary trauma are significantly more nuanced

than if they communicate about it openly or not. Especially considering that every individual

experiences different symptoms and levels of severity. These comments do show the different

levels of severity in secondary trauma that therapists face and what it could potentially do to their

clients. Specifically commenter tiessa73 who shows how her own mental health issues and issues

with secondary trauma are causing her to employ more effort than regular to talk with her client

successfully. More studies need to be conducted to see how aware therapists are about secondary

trauma in their own lives, and then even more to deduce what causes therapists to not talk about

their issues with secondary trauma. However, I do believe that I was able to pinpoint a specific

reasoning for lack of openness about secondary trauma in the therapists lives. Poor mental health

that presents as guilt or anxiety can cause people to isolate themselves when they are in need of

counseling, as well as factors like toxic masculinity that can halt masculine people specifically

from communicating with others about their struggles. I believe that if people were more open

about their experiences with their own mental health that topics such as secondary trauma

wouldn’t be so unknown, and people would be able to receive help before even becoming at risk

for secondary trauma in the first place. This can be done in numerous ways, but it starts on a

personal level by assessing one’s own mental health before choosing to work around people who

have faced numerous different traumas in their life.

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Works Cited

Brookes, Gavin, and Małgorzata Chałupnik. “‘Real Men Grill Vegetables, Not Dead Animals’:

Discourse Representations of Men in an Online Vegan Community.” Discourse, Context &

Media, vol. 49, 2022, p. 100640–, https://doi.org/10.1016/j.dcm.2022.100640.

Devilly, Grant et al. “Vicarious Trauma, Secondary Traumatic Stress or Simply Burnout? Effect

of Trauma Therapy on Mental Health Professionals.” Australian & New Zealand Journal of

Psychiatry. 2009. https://journals.sagepub.com/doi/full/10.1080/00048670902721079

ENgeek. “Secondary trauma question.” Reddit, R/Therapists, 2019

https://www.reddit.com/r/therapists/comments/bsaj6c/secondary_trauma_question/

Hesse, A.R. “Secondary Trauma: How Working with Trauma Survivors Affects Therapists”.

Clinical Social Work Journal 30, 293–309 (2002). https://doi.org/10.1023/A:1016049632545

Its_all-good. “What does vicarious trauma feel like?” Reddit, R/Therapists, 2023.

https://www.reddit.com/r/therapists/comments/xter9a/what_does_vicarious_trauma_feel_like/

MattersOfInterest. “R/Therapists.” Reddit. https://www.reddit.com/r/therapists/

Pollock, Anastasia. “Secondary Trauma: A Therapist’s Guide.” GoodTherapy, 14 Aug. 2013,

www.goodtherapy.org/blog/secondary-trauma-therapists-guide-0814135.

Smith, Annemarie J M et al. “How therapists cope with clients' traumatic experiences.” Torture :

quarterly journal on rehabilitation of torture victims and prevention of torture, vol. 17, 3

(2007): 203-15.

Sodeke-Gregson, Ekundayo A et al. “Compassion satisfaction, burnout, and secondary traumatic

stress in UK therapists who work with adult trauma clients.” European Journal of

Psychotraumatology vol. 4. 30 Dec. 2013. https://pubmed.ncbi.nlm.nih.gov/24386550/

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“Vicarious trauma?” Reddit, R/Therapists, 2022.

https://www.reddit.com/r/therapists/comments/u0w56d/vicarious_trauma/