Las violaciones masivas y sistemáticas de los derechos fundamentales de los reclusos y el estado de cosas inconstitucional

Constructivist self-development theory and recent research suggest therapists experiencing vicarious traumatisation is significant both on a personal and professional level (Trippany et al., 2004). Any detrimental effects on therapists can result in negative treatment effectiveness and workplace organisational dynamics, which could inevitably lead to a negative impact on client care quality (Sexton 1999; Raquepaw & Miller, 1989). This is significant for the client and could have important implications for organisations and therapist wellbeing.

2.11.1. Empathic engagement

Empathy is a complex psychological construct whereby the therapist accurately senses the feelings and personal meanings a client is experiencing; setting aside without prejudice, any views and values they hold themselves and communicate this understanding to the client (Rogers, 1975; Loggia, Mogil & Bushnell, 2008). Described as a ‘gateway of vulnerability’ (Badger, Royse & Craig, 2008), it has been suggested that empathic engagement can make therapists more susceptible to the detrimental effects of vicarious trauma or secondary traumatic stress (Pearlman & MacIan, 1995; Figley, 1995; Pearlman & Saakvitne, 1995a; Jenkins & Baird, 2002; Badger et al., 2008). Although Crumpei and Dafinoui (2012), found no relationship between clinical empathy and secondary traumatic stress, therapists did suffer intrusive and avoidant symptoms. Results of their study suggest that compassion and emotional contagion should be avoided. In contrast, other studies (Figley, 1995; Steed & Downing, 1998; Harrison & Westwood, 2009) discussed later (page 39) found empathic responses beneficial to therapists and clients.

2.11.2. Therapist stress

The effects of secondary trauma and self-reported stress amongst therapists were explored by Chrestman (1999). Questionnaires assessing personal and professional history, psychological symptoms, cognitive schemata, coping behaviours and behaviour changes were sent to participants. Whilst, the study is vague about what counts as ‘extreme’, participants reported such things as

debilitating anxiety, increased symptoms of intrusion and avoidance, increased symptoms of dissociation and sleep disturbance. Therapist distress was found to be significantly different from those therapists who did not experience secondary exposure (Chrestman, 1999). However, unlike vicarious trauma, for many therapists the distress caused after secondary exposure to trauma appeared to be acute rather than chronic (Chrestman, 1999). Whilst most of them recovered, a few therapists described symptoms which resulted in treatment and in some cases career changes. Whilst locating therapists who have left the profession would be problematic and beyond the scope of this research, future research in this area could be useful to identify the exact reasons for change.

Studies by Farber (1979) and Deutsch (1984) found that clients who expressed suicidal ideation, were the most stressful for therapists to work with. Whilst this may be common within the field of mental health and not specific to the area of trauma work, it is an area for concern as this may increase the risk of therapist vicarious traumatisation or burnout. Possibly seen by many as just an inevitable part of working in the field of mental health, expressed suicidal ideation does raise questions as to whether the stress around the welfare of the client is in fact secondary to the welfare of the therapist. Within both studies, the five client behaviours causing therapists the most stress were: (i) suicidal statements or suicidal ideation, (ii) expressions of anger towards therapist or aggression and hostility, (iii) severe depression or agitated anxiety, (iv) apathy or lack of motivation/apathy and depression, and (v) premature termination of therapy (Farber, 1979; Deutsch, 1984). Further studies may be needed to try and identify the reasons why these behaviours can be so stressful for therapists. Speculatively, this may be due to feelings around therapist responsibility and the ‘successful’ recovery of the client. By identifying which components of client suicidal ideation led to increased therapist stress, specific training or supervision needs can be developed to address this whilst supporting therapist wellbeing.

The effects of listening to traumatic material, vicarious trauma and cognitive disruptions experienced by 12 female therapists working with sexual abuse/assault

survivors were investigated by Steed and Downing (1998). Whilst all therapists reported negative effects from the work, they were unable to differentiate whether these effects were down to the trauma therapy or unresolved personal issues. A significant limitation within the study was the participants inability to recall beliefs and cognitive and emotional functioning prior to starting in the field of trauma work.

2.11.3. Negative impact on personal life

Therapists can become permanently altered by their experiences, as they begin viewing the world through a trauma lens (McCann & Pearlman, 1990; Neumann & Gamble, 1995). However, as a relatively new phenomenon, this may be difficult to measure and further research could identify how this change manifests itself. Whilst the impact upon therapists within their professional life is clear within literature (Deutsch, 1984; Chrestman, 1999; Baird & Kracen, 2006), the effects of trauma work are often carried outside the therapy room and are evident in their personal lives.

Several studies acknowledged a negative impact on therapists personal lives, which may be short or long in duration. Examples of therapist changes were; increased vulnerability (Neumann & Gamble, 1995; Eidelson et al., 2003), somatic complaints and sleep disturbance (Neumann & Gamble, 1995; Iliffe & Steed, 2000), hypervigilance regarding safety (Steed & Downing, 1998; Eidelson et al., 2003), intrusive images (Steed & Downing, 1998; Iliffe & Steed, 2000), intrusive thoughts (Neumann & Gamble, 1995; Steed & Downing, 1998) and increased stress levels (Iliffe & Steed, 2000; Eidelson et al., 2003).

Whilst many negative aspects of trauma work were highlighted, Barrington and Shakespear-Finch (2013), suggested the initial shock of the work was more impactful for therapists whose distress levels reduced over time. The authors argued this was because therapists were able to process the traumatic stories, rework their beliefs and effectively incorporate the traumatic material. This resulted in their psychological distress and initial shattering of beliefs quickly ameliorating as they made sense of their experience and grew from it. Their findings concur

with those of Chrestman (1999), who argued most therapists reported acute rather than chronic, negative changes when working with trauma.