Is the phrase “vicarious trauma” out-of-date? A relic from another era that tries imperfectly to describe a hazard that affects people in the helping professions? And what words do we use to replace it?

So, where did it come from? When I entered the field of social work, in 1989, “vicarious trauma” didn’t exist. At twenty-five years old, I had a caseload that was half boys who had been physically and sexually abused, half men who had committed sexual offenses. Every day–every hour!–I listened to stories of sexual and physical violence. Day and night I thought about patriarchy, male socialization and oppression, and how these combined forces were devastating the world, boulders barreling down the hill, razing everything, with so few of us to stop them. When I wasn’t wide-eyed and fretting, I had horrible dreams about work, waking me in a panic.

At first my colleagues talked about “burnout,” a condition we shared with anyone in any field who worked hard. Later I heard the phrase “compassion fatigue” and that hit a little closer to home. It explained why my reserves of empathy were running low, but it didn’t explain the range of other afflictions: a wordless misery that didn’t improve with clinical supervision or weekends, unpredictable spikes of anxiety and irritability, endless worrying, gastrointestinal woes, an obsession with male evil, and a sense of separation from loved ones who wanted to be close to me. 

I was used up. 

Then, in the nineties, psychologists Laurie Anne Pearlman and Karen Saakvitne came out with the first books on vicarious trauma: Trauma and the Therapist (1995) and Transforming the Pain: A Workbook on Vicarious Traumatization (1996). Dense with psychological jargon, terms and phrases that gave me an cool clinical distance from my lost humanness, at the time they were nevertheless helpful and clarifying. They used words that resonated with my soul. They called out “the cumulative, transformative impact upon the [professional] of working with survivors of traumatic life events…. The pervasive effect of doing this work on the identity, world view, psychological needs and beliefs, and memory system of the [professional].” 

Pervasive. Cumulative. Transformative. 

Their words explained why I had changed, irreversibly. 

I could not believe I had engaged in this magnitude of self-inflicted damage. Now that I had the words, however imperfect, it was suddenly too real. I quit my counseling job. I left the field for almost three years.

Why are the words “vicarious trauma” so problematic? When I returned to the helping professionals, I had a determination to prove that I could do difficult, soul-battering work while staying physically and emotionally healthy, and I made it my mission to keep the conversation about this commitment alive with my community of fellow travelers. Talking with professionals all over the country, I came to appreciate what we have in common, how much is solved by connecting with authenticity. But I also started to see the limitations of these particular words.

Why did we call it “vicarious” or “secondary”? What is the purpose of that remove, that absence of ownership?

The fields of psychology and social work are notorious for their heavy-handed jargon. It otherizes clients and keeps us at an unhelpful clinical distance. It invents words that valorize the objectivity, elitism, and expertise of the therapist, often at the expense of the client. Take the term “countertransference.” The idea is that the client shows up for session, unwittingly displays their transference, born of neurosis and early psychological imprinting, but that we, objective thinkers that we are–pristine blank slates of mental health, really–only have countertransference as a response. 

Why wouldn’t psychologists and social workers call all of it “transference,” regardless of who starts it? Why shouldn’t we equalize this condition that defines our complex emotional response to each other?

What power do we lose when we name it? Why can’t we be human and vulnerable together?

The term “vicarious trauma” has the same problem. It implies that the professional wouldn’t struggle if the client hadn’t brought their trauma into the room. Clients have the original trauma, it seems to suggest, which then infects us, like a cold or a venereal disease. In fact, we know from the Adverse Childhood Experiences Study and the research that followed it, that psychologists, social workers, and other helping professionals, like all humans, are just as likely to have their own trauma and childhood adversity that shapes who we are. Trauma is trauma is trauma is trauma.  

Toxic stress and co-suffering are the realities. Nowadays I find myself using the more general phrase “toxic stress” to describe the oppressive conditions in which clients often live, wreaking havoc on their bodies, spirits, and nervous systems, as well as the working conditions of helping professionals who join with them. Toxic stress refers to levels of challenge and adversity so intense that they can make all of us physically and emotionally sick. “Toxic stress” isn’t encoded with power differences. In her book Being a Brain-wise Therapist, Bonnie Badenoch coins the lovely term “co-suffering” to describe our work: a way of being with the client, in mutual resonance, as human equals on the same journey. “This sense of partnership rests on humility about the state of our own mind,” she writes.

So, is the phrase “vicarious trauma” really out-of-date?

There are no habits of avoidance.  As I was walking through northeast Portland on my way to a coffee shop to write this post, my mind already sifting over these questions, in just nine city blocks I passed four encampments of people living in tents, then two people huddled in sleeping bags on the bare ground, with nothing separating them from the street noises and chilly weather. 

Like most urban dwellers, each time I neared these folks, partly out of deference to their privacy, I cut across the street. But the bigger meaning of this gesture was the habit of avoidance, common to all people who live in urban chaos: a reluctance to get too close to the realities of outdoor suffering; the looks of pain and fatigue and desperation; evidence of the absence of mercy. The closer we get to the sounds and smells, the visceral emotional realities of being unhoused on the dirty streets, the more the details absorb our psychic energy, imprint us, take up mental space that could be expended differently, clutter our attention with discomfort, even aversion. In the early morning hours, not encumbered by any professional role, I can cut across the street like so many other people.

But to be effective in our professional work with deeply challenged and traumatized clients, there are no such habits of avoidance. We have to come close all the time, in spite of the pain it brings up in us. And we have to be honest about how that intimacy with oppression–theirs, ours; ours, theirs–humbles, pains, and transforms us. We have to name it for the poison that it is, acknowledge it without distance or pretense or hierarchy, or we will never find our way back to each other.