Wednesday, February 15, 2012

The Effects of Trauma on Clients and Counselors

Examples and Descriptions

September 11, 2001

The most recent of crises engraved into American history, the terrorist attack on the World Trade Center took the lives of over 3,000 people and caused widespread terror that affected millions. Americans have indelible memories of that day, causing considerable stress for many. Direct and indirect exposure continues to cause sickness, depression, and post-traumatic stress syndrome (PTSD) as well as other mental health issues.

2011 Tohoku Earthquake and Tsunami

The March 11, 2011 earthquake and tsunami caused the death of over 19,000 people, ravaged large areas of the Japanese countryside, and continues to cause depression and post-traumatic stress syndrome in the Japanese population. The tsunami caused devastation in other locations, such as this author's state of Hawaii, which sustained millions of dollars of damage and spread fear and anxiety across the Hawaiian Islands.

Major Mental Health Effects of Disasters, Crises, and/or Trauma-Causing Events
Disasters, crises, and traumatic events cause depression, PTSD, generalized anxiety, nonspecific distress, fear, and an acute sense of one's own vulnerability (Satcher, Friel, & Bell, 2007). These same authors found 30% to 40% of disaster victims experienced PTSD in the year following a disaster. At least 10% to 20% of rescue workers and 5% to 15% of indirectly exposed individuals were affected as well. In Japan, a country with one of the highest suicide rates in the world, these rates are up over 30% since the tsunami (McCurry, 2011). General anxiety and depression continues among the Japanese people and children's depression and suicide is higher than normal (Shibahara, 2011). Satcher, Friel, and Bell (2007) found children highly susceptible to PTSD after similar disasters.

The World Trade Center attack plunged America into national crisis and war and altered the perception of personal vulnerability. Direct exposure caused more cases of acute stress, but first responders and caregivers experienced vicarious and/or secondary traumatic stress (Baird & Kracen, 2006; Harrison & Westwood, 2009). Sickness and disease continue to ravage responders and workers from the site. Furthermore, the disaster and the ensuing war's far-reaching effects caused depression, anxiety, and PTSD in military personnel, victims of the attacks, and in the general population (Satcher, Friel, & Bell, 2007). In both examples, the media created an exposure of global magnitude and widened the rippling effect of traumatization.

Counselor's Role in Responding to People

Trained counselors can ameliorate the psychological effects of trauma and disaster, provide crisis intervention, and monitor long-term damage in individuals and in communities (Dingman & Ginter, 1995). As an increasing number of natural and man-made disasters strike world-wide populations and media coverage exposes others indirectly, the effects of trauma spare few. Counseling must also be provided to rescue and other relief workers.

After the Japanese tsunami and the World Trade Center attacks, counselors taught coping skills to people affected with stress and anxiety. They helped normalize emotions under the circumstances, assisted in creating safe situations, and watched for warning signs of trauma-related stress (Baldwin, 2012; Dingman & Ginter, 1995). By offering strategies such as coping skills to the victims of trauma, counselors can decrease the effects of traumatization and help to restore the victim to mental health. Counselors may also be involved in designing proactive preparations as and general planning for disaster relief.

Vicarious Trauma and/or Secondary Traumatic Stress

Research (Arvay, 2001) suggests vicarious trauma (VT) and secondary traumatic stress (STS) are the same psychological constructs. Harrison and Westwood (2009) refer to McCann and Pearlman's (1990) definition of VT as "the cumulative transformative effects upon therapists resulting from empathic engagement with traumatized clients" (p. 203). Baird and Kracen (2006) discuss VT as the "result of exposure to graphic and/or traumatic material" (p. 182). Mental health counselors who engage with traumatized clients may experience the same trauma as their clients, only indirectly, or vicariously through the experience of their client (Baird & Kracen, 2006; Harrison & Westwood, 2009). STS can be a direct or indirect exposure to a traumatic event, and can produce the same symptoms as the more commonly recognized PTSD.

Strategies to Minimize Effects of Vicarious and Secondary Trauma

Internal reflection helps identify early symptoms of vicarious trauma and having an awareness of and acceptance that both VT and STS are normal and treatable (Trippany, White Cress, and Wilcoxon, 2004). Maintaining proactive peer support, actively maintaining a balanced lifestyle with regular self-care and self-awareness lessens the effects of vicarious traumatization "minimizing potential ethical and interpersonal difficulties" (Trippany, White Cress, and Wilcoxon, 2004, p. 36). Other proactive agendas include participating in counselor support groups, educating oneself on the signs and symptoms of vicarious traumatization in counselors, caring for a diverse group of clients, inspiring spiritual awareness in oneself and one's peers, and encouraging appropriate rest and relaxation for mental health counselors (Harrison & Westwood, 2009; Trippany, White Cress, and Wilcoxon, 2004).


Baird, K., & Kracen, A. C. (2006). Vicarious traumatization and secondary traumatic stress: A research synthesis. Counselling Psychology Quarterly, 19(2), 181-188. doi: 10.1080/09515070600811899

Baldwin, D. V. (2012). Disaster Mental Health. Trauma Information Pages. Retrieved January 25, 2012, from

Dingman, R. L., & Ginter, E. J. (1995). Disasters and crises: The role of mental health counseling. Journal of Mental Health Counseling, 17(3), 259-263.

Harrison, R. L., & Westwood, M. J. (2009). Preventing vicarious traumatization of mental health therapists: Identifying protective practices. Psychotherapy: Theory, Research, Practice, Training, 46(2), 203-219. doi: 10.1037/a0016081

McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A contextual model for understanding the effects of trauma on helpers. Journal of Traumatic Stress, 3, 131–149.

McCurry, J. (2011). Japan's slow recovery. The Lancet, 378(9785), 15-16. doi: 10.1016/S0140- 6736(11)61002-7
Saleh, M.A. (1996). Disasters and crises: Challenges to mental health counseling in the twenty- first century. Education, 116(4), 519–528.
Satcher, D., Friel, S., & Bell, R. (2007). Natural and manmade disasters and mental health. JAMA: Journal of the American Medical Association, 298(21), 2540-2542.

Shibahara, S. (2011). The 2011 Tohoku Earthquake and Devastating Tsunami. The Tohoku Journal of Experimental Medicine, 223, 305-307. doi: 10.1620/tjem.223.305

Trippany, R. L., White Cress, V. E., & Wilcoxon, S. A. (2004). Preventing vicarious trauma: What counselors should know when working with trauma survivors. Journal of Counseling & Development, 82, 31-37.

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