Mark Gorkin, MSW, LICSW, "The Stress Doc" ™, a Licensed Clinical Social Worker, is an acclaimed keynote and kickoff speaker as well as "Motivational Humorist ...Read More
Vicarious Trauma as Type “E” Codependency
Alas, succumbing to this self-defeating pattern and propensity may be all too “E”asy, especially when so many of these qualities seem positive, thereby making it difficult or uncomfortable to acknowledge their polar nature. Let’s itemize Ten Key, Double-Edged Characteristics of that “Everything for Everyone, Everywhere, Every Time, and Invariably Exhausted” Type “E” Personality:
1. Empathy, Experience and Emotional Perspective. Feeling another’s pain (whether of an individual or a social group) and wanting to respond actively and compassionately to aid the struggle is an honorable, valuable, and principled mission. A capacity for empathy, an ability to walk in another’s shoes (and especially to feel their bunions) is perhaps the cardinal virtue of “emotional intelligence.” At the same time, an ability to place the problem or struggle in context, that is, being able to identify and understand the multiple factors contributing to the battle is crucial. One needs to see the positives and negatives, the fears and fantasies on all sides; though these dynamics, along with resources and responsibilities, of course, are not necessarily evenly distributed or weighted.
For example, one social worker spoke of leading an emotional support group for public defender attorneys who frequently show signs of vicarious trauma over time when working with rape victims. One attorney nearly reached his breaking point upon becoming a new father to a baby girl. The intensity of his identification with the problem and the victims, along with a more personal vendetta against the perpetrators, skyrocketed. (Of course, if an attorney – male or female – had been sexually assaulted or abused, some therapy focusing on their traumatic history should be a requisite for working with rape victims.)
Experience and Emotional Perspective
When your experience and emotional perspective generates heightened identification and commitment it is especially important to blend some detached concern along with emotional self-awareness if empathy is to remain a vital and virtuous quality and not fuel a vicarious or vicious cycle.
In fact The Headington Institute poses two critical questions bearing on the role of empathy and VT:
a) With what sort of problems or people do you find it especially easy to empathize? and
b) What are some ways that caring about people who have been hurt affects you?
2. Expectations, Egoals, and Early Pain. As the Headington Institute website noted, feeling deeply invested in your work or caretaking with a great sense of professional and/or personal responsibility “can lead to very high (and sometimes unrealistic) expectations of yourself and others….For example, you may take it personally when your work or the work of your organization doesn’t have the impact [or the results] you want. Ironically, your sense of commitment and responsibility can eventually contribute to feeling burdened, overwhelmed, and hopeless in the face of great need and suffering. [You may also] extend yourself beyond what is reasonable for your own well-being or the best long-term interests of beneficiaries, [especially if your self-sacrificing nature believes, albeit unconsciously, people should recognize and respond to your painstaking efforts.]
A kindred issue and a potential stressor inherent in caring work is the notion that your worth is dependent on your “success” rate, that is, your competency as a helping professional depends solely on the performance or outcomes of others. Whether “you did your best” or “all you reasonably could do” is never good enough. And especially when engaging others in the complex, often subjective realm of pain and trauma, psychology, and motivation there may be many intervention and intervening factors beyond a professional’s control, including operational policy and procedure. (For example, when talking VT, an overwhelming “doing more with less” caseload size, insufficient worker input in relevant practice issues and decision-making, quality of supervisory support, as well as organizational productivity “numbers” for both people services and paperwork obligations all need to be objectively evaluated.)
If a caregiver minimizes the uncertainty of this mindscape and landscape, and is quick to perceive a client’s or patient’s limited progress as a personal indictment of provider competence (or of the client’s worthiness), or conversely, believes she should be able to reach and rehabilitate just about everyone on her caseload (or management is quick to use a similar judgmental mindset), then accountability expectations need to be scrutinized.
Egoals and Early Pain
In fact, such expectations may indicate this individual (or organization) is less goal-focused and more egoal-driven, that is, the person’s motivation on some level is not mainly determined by the client or infirmed family member’s needs. What’s troublesome is that the helper’s thoughts, feelings, and actions are often covertly driven by approval, power, and/or status needs and, even more, propelled by punctured pride and a thirst for vindication against previous intimidators or abusers. Actually the motivational foundation is often subconscious (early childhood) wounded pain, shame, and smoldering rage. And this lurking pain can too easily and disingenuously devolve into the rigidly righteous or “heroic” HE MAN or sacrificing or savior-oriented SHE MAN complexes.
Humanitarian work as a profession is often characterized by self-neglect, toughing it out, risk-taking, and denial of personal needs. All of these can contribute to more severe vicarious trauma.
The H stands for “Humiliation” and the E stands for “Emptiness” while the S stands for “Self-Sacrificing.” Some people are attracted to healing work to fill their own emptiness and diminished ego or self-esteem; others over time succumb to feelings of exhaustion and emptiness. Remember, burnout is less a sign of failure and more that you gave yourself away! “Expectation, Egoals, and Early Pain” explain much about this erosive spiral.
3. Enthusiasm and Escapism, Exceptionalism and Exorcism. Fire and fervor can be wonderful qualities to spark and fuel any meaningful endeavor, especially one involving service to others. People may be inspired by your energy and ideals. However, unbounded and unrestrained enthusiasm eventually runs into a brick or burning wall. As was noted in the ’60s classic The Phantom Tollbooth, “Fantasy and imagination suggest how the world might be. Knowledge and experience limit the possibilities; melding the two yields understanding.”
As we’ll see in Part II, escape as in “R & R” – Rest and Recreation – is one of the strategies for preventing or recovering from VT. And momentary escape or controlled flights of fantasy can prime the imagination and originality pump. But if escape becomes constant flight along with “rationalization and running away,” then trauma or drama will likely be your travel companion.
When enthusiasm cannot grapple with some limited or restrained possibilities and boundaries, then, according to Headington Institute, “Research on stress and coping suggests that VT will be more problematic for people who tend to avoid problems or difficult feelings, cannot ask for support, blame others for their difficulties, shun self-reflecting mind and soul searching as weakness, or withdraw from others when things get hard.”
Exceptionalism and Exorcism
Sometimes “headstrong” enthusiasm may morph into rigid idealism, eventually fomenting a fundamentalist doctrine. Such an extremist: a) knows there’s only a single axiomatic truth or “one right way,” b), is motivated to escape one’s past pain and shame, or becomes blind to the multifaceted nature of “reality” and “truth,” c) escapes taking responsibility for one’s own actions or errors, d) labels non-believers as sinners if not infidels and enemies, and e) sees strict and virtuous behavior as a passport to entitlement and exceptionalism or infallible judgment and retribution. Alas, with such a doctrinaire paradigm “heaven on earth” may well transmute into “there’s hell to pay.”
Speaking of hell brings us to our final “E” – actually an “E” phrase: “Emotional and Existential Exorcism.” When an individual has a history of personal trauma, especially a trauma that matches or has some parallels with the trauma of the person or people he is assisting (for example, someone who was sexually abused as a child working with rape victims, that is, someone with “intense empathy”) personal therapy and/or careful supervision is essential for balancing emotional involvement and detached concern. Guided awareness is necessary to help manage the emotional identification and countertransference – whereby the helper unknowingly projects his prior painful experience onto the client – thereby confusing the emotional boundaries, needs, and realities of this acutely intimate and mutually vulnerable encounter. (Such identity-boundary confusion and the need for “virtuous and vicarious control” is often a hallmark of codependent relating.) And the Headington Institute adds, “This risk factor may be especially relevant for staff (that) have often survived the same events and suffered similar losses as those they are assisting. In addition, those with a personal trauma history who are (consciously or unconsciously) using humanitarian work primarily to seek their own recovery instead of engaging in personal healing processes, may have a harder time with VT.”
My explanation is that the person infusing his or her recovery issues and needs in this so-called healing process is engaging in an “exorcism,” the ceremony that seeks to expel an evil spirit from a person or place (TheFreeDictionary.com). But the real focus of the exorcism is not the person who recently has undergone trauma. The actual target is the “healer” himself, now engaged in an invariably intense and inverted exorcism, attempting to expel his or her own demons in the guise of purging, purifying, and restoring another. In fact, I have come up with “Three Types of Exorcisms”:
a) emotional exorcism or “emoto-cism”: ridding oneself of present pain, loss, angst and/or rage, and disorientation while attempting to subjugate one’s “Intimate FOE: Fear of Exposure,”
b) existential exorcism or “exis-cism”: ridding oneself of identity confusion and uncertainty about one’s future competence, worthiness, and direction, and
c) echo exorcism or “echo-cism”: ridding oneself of ever reverberating, painful, accusatory overt/covert voices and memories, including “grief ghosts.”
Hopefully, these “Ten Key, Double-Edged Characteristics of that “Everything for Everyone, Everywhere, Every Time, and Invariably Exhausted Type ‘E’ Personality” illuminate potential links between codependency and the propensity for Vicarious Trauma.
Part I of this series examined the realm of Vicarious Trauma and Caregiver Burnout, illustrating its common occurrence among many roles and relations in contemporary society, and how the humanitarian if not heroic efforts of helpers and healers can without sufficient awareness and supervision, become a disguised and hazardous process of codependency.
Part III will focus on the ways family-cultural systems and organizations foster VT amongst its members and how personal helpers and professional healers as well as organizations can prevent the likelihood of Vicarious Trauma and Caregiver Burnout. Until then…Practice Safe Stress!