What Is Secondary Traumatic Stress? Signs, Risks and How to Manage It

Secondary Traumatic Stress is something that those in any therapy profession could experience. Working closely with clients and hearing about difficult or traumatic experiences can have an emotional impact, even when the work is effective and rewarding. Yet it is has been my experience that very few hypnotherapists have even heard of it. In this article, we’ll look at what secondary traumatic stress is, how it can affect hypnotherapists, and what you can do to manage it as part of your professional practice.

What is Secondary Traumatic Stress (STS)?

STS refers to trauma that someone experiences indirectly.

People often use this term to refer to vicarious trauma, compassion fatigue, and burnout. Whilst there is some overlap, these terms are different and we will be focusing on STS throughout this article.

When working with clients, we see the ongoing ramifications of the traumatic situations that they’ve experienced in their lives. We hear the details of what they went through during those difficult times; in some cases, in great detail. When acting with empathy towards our clients, we inevitably start to understand what they have gone through. We are experiencing their traumas vicariously.

The Emotional Effects of Working with Therapy Clients

Secondary Traumatic Stress can negatively impact the therapeutic relationship in a number of different ways. Many of the symptoms of STS are consistent with that of Post Traumatic Stress Disorder. Like PTSD, STS affects each person differently.

Avoidance behaviours are quite common. For example, a hypnotherapist with STS might cancel sessions with their clients, or not return phone calls or emails. They may choose not to work with clients who have experienced trauma, depression, or other issues that they perceive to be highly emotional.

To avoid hearing details of trauma that might bring up difficult emotions, therapists might change . how they work. They may ask fewer exploratory questions during the assessment. Or not allow the client adequate time to explain how their problem is affecting them. All of this will affect the therapists’ ability to compile an effective treatment plan for their client.

In addition, a hypnotherapist with STS may not be wholly present when working with a client. Instead, they may feel detached, distracted, and emotional. This can lead to an inability to make decisions, problem-solve or remain objective when trying to help a client.

A hypnotherapist with STS may feel resentment or anger toward their client for making them feel the way they do, although it is not their fault, of course. They may also feel less empathy towards their clients.

All of this can lead to the client feeling unsupported, unheard, frustrated, and alone, all of which can affect rapport. Ultimately, this leads to the client not getting what they need from the hypnotherapy process.

One might think that a hypnotherapy supervisor, whilst at risk when seeing clients, would avoid it when working with a supervisee. However, we still get to hear about their client’s traumas as well as how it is affecting supervisees themselves.

Managing Emotional Stress as a Therapist

The Headington Institute support organisations that provide humanitarian and relief work across the world. They have an STS prevention plan for the first responders and other workers. The plan is accessible to hypnotherapists and would fit nicely into your reflective practice. It consists of seven steps for you to follow. Some will feel very familiar to you, as you no doubt use similar questions and processes with your clients.

1. Make a list of any current risk factors which could result in you experiencing secondary traumatic stress. A personal history of trauma or mental health issues, may put you at a greater risk of developing STS.
2. List any symptoms that you are experiencing that might relate to secondary traumatic stress. This is difficult, as the symptoms of STS can occur as a result of other issues too. These include burnout, stress, depression, anxiety, etc.
3. Write down what things you could do to help you cope better with these symptoms.
4. Then identify what steps you could take that can help with STS. Include both work and leisure time.
5. Now you have a better idea of how you could help with the symptoms and with STS generally. The next step is to set two SMART goals that relate to your answers for the steps 3 and 4. Write them down and work towards them every week.
6. Write a list of obstacles that may prevent you completing the steps you identified in step 5.
7. Finally, make a note of what you could do to overcome these obstacles. What support might you might need to help you accomplish your goals?

Therapist Self-Care

In addition to this STS prevention plan, there are other things that you can do to minimise the risk. These include:

Reflective practice.

Reflect on the work you do with your clients on a regular basis. Alongside assessing what is going well and what you can improve, it helps you recognise when you are taking on too much or behaving in ways that are uncharacteristic for you. If you are thinking or behaving in a way that is uncharacteristic for you, you may need to take a step back.

Professional boundaries.

Ensure that you maintain your professional boundaries. Be mindful of your client caseload and not taking on too much. Factor in breaks throughout your day and try to space out your clients that have experienced trauma. Schedule annual leave for yourself at regular intervals throughout the year.

Supervision/peer support.

Higher levels of social support are linked to fewer symptoms of STS, VT, and burnout. (Dunkley & Whelan, 2006). This can come from from family, friends, supervisors or peers. Talking to other therapists will help you recognise and/or manage STS.

STS questionnaire.

The Secondary Traumatic Stress Scale (Bride, Robinson, Yegidis, & Figley, 2004) consists of 17 statements. These help to assess the level at which someone is experiencing STS. You can download a free pdf version of the STS Questionnaire to use within your reflective practice. Being aware of the early warning signs can help to prevent STS. 

Self-care.

You need to put yourself first and look after your own psychological well-being. Then you will be better placed to deal with clients, especially where trauma is involved. 

A final word about Secondary Traumatic Stress

Now that you are familiar with what Secondary Traumatic Stress is, it is my hope that you will be better placed to be aware of it in your professional capacity as a hypnotherapist. And that you can take the necessary steps to ensure that you enjoy a long and happy career in hypnotherapy.