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Quinn Benson

Dr. Bergholtz

Composition II

30 March 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 would likely not 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 (Smith), 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
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to find roughly nine comments after 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

In this section I explain how I found the data used, as well as how I analyzed the data I

collected. 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
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secondary trauma, or worries that they may have secondary trauma themselves, and a post that

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

In this section I present and analyze four comments. The first comment deals with a user

being unsure of his current mental health and struggling with what he assumes is secondary

trauma. The second comment is a user detailing their struggle with secondary trauma and stating

their refusal to talk to anyone about it. The third and fourth comments are by two different users

who, despite dealing with secondary trauma, are unafraid to talk about it with other people. I aim

to use these comments to answer my main question: how prevalent is secondary trauma in

therapists?

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

considering the severity of the symptoms, and had assumed that with the group being therapists

themselves they’d be more open to talking about their struggles. Shockingly, I was only able to

find a few responses that discuss one's personal issues with secondary trauma. The rest of the

posts using the words “secondary trauma” were asking for advice on how to help a client. The

first post I was able to find was written by ENgeek.

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“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).

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 and 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
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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).

“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

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.

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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.

“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

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
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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.

“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

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
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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. This is similar to the previous

comment from the deleted user. Both are comfortable enough speaking within their workplace

about their secondary trauma; however, still managed to procure it. I believe that, while a

positive work environment can be helpful, on its own it does not inherently lower the risk of

obtaining secondary trauma.

When scrolling through the subreddit’s main page, there was a strong lack of posts

mentioning secondary trauma as an issue personally, or as an issue therapists face in general.

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 act of abandoning their own mental health puts therapists at a significantly higher

risk of gaining secondary trauma from their work.

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

organizations can do to help their therapists: providing safe spaces at the place of work and

personalizing relationships between staff (Hesse).

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4. Reflection

This section answers the main research question for this paper: “how prevalent is

secondary trauma in therapists?” 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. 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. Unfortunately, poor mental health and lack of

communication with others put people at high risk of contracting secondary trauma throughout

their work. Those two issues directly put them at a higher risk for secondary trauma, making

secondary trauma unquestionably more prevalent among therapists.

This study cannot accurately predict how prevalent it is amongst therapists, but it

demonstrates that a large population of therapists is at high risk of getting secondary trauma, or

already having it. 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. 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/