Vicarious Posttraumatic Growth in Therapists Working with Severe Mental Illness

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Zachary Arcona, MS

Phenomena like burnout popularly plague mental health (Morse, Salyers, Rollins, Monroe-DeVita, & Pfahler, 2012). Therapists working with clients who have experienced trauma are even more susceptible to the characteristic symptoms of burnout, including exhaustion, cynicism, and feelings of inefficacy (McCormack, MacIntyre, O’Shea, Herring, & Campbell, 2018). When mental health professionals work in settings that increase demands on internal resources, particularly if they perceive their efforts to result in few positive outcomes, it results in chronic stress.  The impacts of enduring chronic stress in the workplace can have negative repercussions for both physical and mental well-being. Examples of the consequences of burnout for therapists include deterioration of mental health (e.g., depression, anxiety), impaired physical health (e.g., sleep problems, neck and back pain, gastrointestinal distress), diminished sense of well-being, impaired memory, and substance abuse (Morse et al., 2012). Although not all professionals exposed to traumatic material develop burnout symptoms, related conditions are also highly prevalent, including compassion fatigue, vicarious traumatization, and secondary traumatic stress. Mental health workers most commonly report emotional exhaustion of the burnout dimensions (McCormack et al., 2018), but the wide-ranging severity of the impact of working with traumatized individuals can include symptoms that mimic posttraumatic stress disorder and ultimately lead to destructive changes in the professional’s view of themselves, others, and the world (Baird & Kracen, 2006).

Melissa LaCelle, MS

A more positive aspect of providing psychotherapy for individuals with trauma is Vicarious Posttraumatic Growth (VPTG), an expansion of Posttraumatic Growth (PTG), which refers to positive changes in one’s person from vicarious exposure to traumatic experiences (Arnold, Calhoun, Tedeschi, & Cann, 2005). PTG can create improvement in five discrete domains: relating to others, new possibilities, personal strength, spiritual change, and appreciation for life.  These improvements can be seen in any number of these domains and do not necessarily appear in all 5 domains simultaneously.  The vast majority of research in this field focuses on those who directly experienced trauma in an attempt to utilize positive psychology principles to encourage survivors of trauma (Calhoun, Cann, Tedeschi, & McMillan, 2000; Tedeschi, 2011).  However, research recently began to shift in focus to include examination of VPTG in those working with trauma.  Qualitative research conducted on psychotherapists and other mental health workers working with trauma has found evidence for positive gains from working with trauma present alongside the previously described negative effects (Arnold, Calhoun, Tedeschi, & Cann, 2005; Hyatt-Burkhart, 2014). Within the realm of VPTG, Cohen and Collens (2013) conducted an important metasynthesis that examined 20 qualitative studies.  They found trauma work can not only create vicarious traumatic stress, but also short- and long-term changes in schemas and day-to-day routines that can be positive in nature.

Sheila Santiago Schmitt, PsyD

The described research sets a basis for the prevalence of VPTG in therapists and others working with survivors of trauma.  However, those working with serious mental illness (SMI) have never been researched assessed to examine the potential presence of VPTG.  People diagnosed with SMI have a higher incident rate of trauma as evidenced by a systematic review of research on SMI cases that found the presence of physical abuse in approximately 47% of cases, sexual abuse in 37%, and post-traumatic stress disorder (PTSD) in 30% (Mauritz, Goossens, Draijer, and van Achterburg, 2013).  Therefore, therapists working with SMI have likely been exposed to patient stories of trauma that could cause both vicarious trauma and growth.  In response, we created a research project that examines VPTG in therapists working with SMI in a psychiatric inpatient state hospital in the Southeastern United States.

The objective of our research is as follows: (1) examine potential correlates of VPTG and Vicarious Posttraumatic Stress, (2) investigate possible connections between VPTG and demographic variables, including age, gender, and level of training, and (3) inspect a correlation between VPTG and the Experienced Threat Scale.

The state hospital engaged in this study employs doctoral-level psychologists, post-doctoral students, interns, and practicum students (3, 0, 1, 4 study participants, respectively). Therapists in all of these groups, except post-doctoral students, completed the batteries following recruitment and all participants were female.  Each participant completed the Posttraumatic Growth Inventory Short Form (PTGI-SF), the Secondary Posttraumatic Stress Scale (SPTSS), the Experienced Threat Scale, the Stress-Related Growth Scale, and a demographics form.  A modified version of the PTGI-SF measured VPTG in accordance with previous literature that used versions of the PTGI when testing this construct (e.g., Lambert & Lawson, 2013). The demographics form included age, gender, years worked with trauma, level of psychology training, religion, percentage of caseload with PTSD symptomatology, a Likert scale (1-10) rating the therapist’s belief of the most severe trauma he/she worked with, and personal experience with PTSD.  An important note of clarification is the difference between PTG and stress-related growth.  PTG postulates that a complete shattering of an individual’s schema is necessary in order for growth to occur, which often entails severe trauma.  However, stress-related growth opines a wider range of experiences can facilitate growth, such that a total shattering of the schema is unnecessary.  This distinction suggests that stress-related growth is more common than PTG; therefore, utilizing measures of both constructs allowed for a more thorough investigation of potential growth in these therapists.

An initial analysis of descriptive data found evidence for VPTG within this small sample size of mental health workers.  First, total scores on the PTGI-SF showed growth to a small degree due to their work, with scores ranging from no growth to a great degree of growth.  Further, different categories on the PTGI-SF yielded significantly different scores.  Both “New Possibilities” (NP) and “Spiritual Change” (SC) had mean scores indicating change to a very small degree while “Relating to Others” (RTO) showed a small degree of change.  “Personal Strength” (PS) and “Appreciation of Life” (AOL) found scores indicating moderate growth.  Due to the varying degrees of PTG within samples, an examination of the range of scores can provide great insight.  Within all subareas of the PTGI-SF, scores varied from no growth to moderate growth (NP), a great degree of growth (RTO, SC, and AOL), and a very great degree of growth (PS).  On the Stress-Related Growth Scale, scores indicated that the therapists experienced growth “somewhat” due to their experiences working with SMI.  Finally, there is little evidence for the presence of secondary traumatic stress within this sample.   While traumatic stress symptoms were initially believed to be a necessary component for VPTG, these results support recent research that indicates the opposite; traumatic stress symptoms are not needed for the development of PTG or VPTG.

Burnout and related problems take a powerful toll on psychologists and other mental health workers.  While the introduction and understanding of PTG to these populations may not fully ease the burden of suffering they carry, the positive nature of growth can provide powerful relief and reframing.  This research begins to set the initial framework by demonstrating that therapists working with SMI can experience VPTG and stress-related growth, even in the absence of posttraumatic stress symptomatology.  This initial small study with a limited sample size needs to be expounded on to create a larger literature base.  For instance, the sample consisted solely of women and the results may not generalize to men. We plan to continue to grow our study and collect a larger sample to help assist in this literature base.  However, additional, more elaborate studies can assist.  For example, a wider examination of correlates to VPTG in these populations would help strengthen and further this field of inquiry.  Previous studies have repeatedly found correlates related to PTG such as social support and positive rumination (Soo & Sherman, 2015; Shand, Cowlishaw, Brooker, Burney, & Ricciardelli, 2015), but have thus far neglected VPTG.  An investigation of these variables could be the next step in the literature development to indicate that VPTG not only exists in this population but can be facilitated with the knowledge of its important correlates.

Arnold, D., Calhoun, L. G., Tedeschi, R., & Cann, A. (2005). Vicarious posttraumatic growth in psychotherapy. Journal of Humanistic Psychology45(2), 239-263. doi:

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

Calhoun, L. G., Cann, A., Tedeschi, R. G., & McMillan, J. (2000). A correlational test of the relationship between posttraumatic growth, religion, and cognitive processing. Journal of Traumatic Stress, 13(3), 521-527. doi:

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McCormack, H. M., MacIntyre, T. E., O’Shea, D., Herring, M. P., & Campbell, M.J. (2018).       The prevalence and cause(s) of burnout among applied psychologists: A systematic review. Frontiers in Psychology, 9, 1897. doi:

Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and  Policy in Mental Health and Mental Health Services Research, 39(5), 341-352.                               doi:

Shand, L. K., Cowlishaw, S., Brooker, J. E., Burney, S., & Ricciardelli, L. A. (2015). Correlatesof post‐traumatic stress symptoms and growth in cancer patients: A systematic review and meta‐analysis. Psycho‐Oncology, 24(6), 624-634.

Soo, H., & Sherman, K. A. (2015). Rumination, psychological distress and post‐traumatic growth in women diagnosed with breast cancer. Psycho‐oncology, 24(1), 70-79. doi:10.1002/pon.3596

Zachary Arcona is a current fourth- year Psy.D. student at Nova Southeastern University in Fort Lauderdale, Florida. He obtained his MS from Nova Southeastern University in Clinical Psychology and his B.A. from Moravian College in psychology and sociology. His clinical interests focus on pediatrics especially those undergoing solid organ transplant, those with medical traumatic stress, and long-term chronic illness. His research interests are post-traumatic growth, medical adherence, and cross-cultural clinical care and outcomes.

Melissa LaCelle is a fourth-year doctoral student at Nova Southeastern University College of Psychology.
Her clinical focus and experiences revolve around the treatment and assessment of severe mental illness, as well as the development of cultural humility through work with diverse populations around the world. Regarding research, her primary areas of interest include substance use treatment, particularly for those diagnosed with both mental illness and substance use disorders, treatment for underserved populations, and the capacity for growth in those with severe mental illness.

Dr. Sheila Schmitt is the Director of Psychology and Clinical Training at South Florida State Hospital (SFSH) since 2007. She oversees the APA-accredited psychology internship program and the training of doctoral practicum students from local universities. Dr. Schmitt earned her doctorate in Clinical Psychology from Minnesota School of Professional Psychology. She completed her internship at Citrus Health Network in Miami, Florida. She has worked in community mental health centers, residential centers, and private practice. Dr. Schmitt is a reviewer for R3 Continuum, where she conducts peer reviews for short-term and long-
term disability cases. She is a member of the Keiser Psychology Advisory Board Committee, the APPIC mentorship program, and is an APA site visitor. Her primary interests include multicultural/diversity issues, violence risk assessments, forensic services, mental health disabilities, and clinical supervision.