There is no question that working with traumatized patients can be difficult and emotionally demanding. But when did the strain of caring for people who have experienced trauma become a form of trauma itself? Increasingly, that\u2019s how researchers and mental-health organizations describe it, using labels such as \u201csecondary traumatic stress\u201d and \u201cvicarious trauma.\u201d<\/p>\n
The terminology grew out of the trauma boom that swept psychology during the 1980s and 1990s, when the meaning of trauma rapidly expanded. Psychologist Nick Haslam described<\/a> this broader tendency for harm-related concepts to widen over time as \u201cconcept creep.\u201d In the case of trauma, he documented<\/a> how the idea migrated from physical injury to psychological injury, then from extraordinary events toward more ordinary adversity, and finally from events experienced directly to those suffered by other people.<\/p>\n Finally, a reason to check your email.<\/p>\n Sign up for our free newsletter today.<\/p>\n Once trauma no longer required direct exposure, it became possible to describe the person hearing about another\u2019s trauma as traumatized, too. In that context, psychologists Lisa McCann and Laurie Anne Pearlman proposed<\/a> the term \u201cvicarious traumatization\u201d in 1990 to describe changes in therapists who repeatedly encountered clients\u2019 graphic stories of pain and stress.<\/p>\n From there, the number of people considered susceptible to secondary trauma expanded, and the concept has been invoked with increasing frequency<\/a>. The National Child Traumatic Stress Network, a federally funded organization, now describes<\/a> secondary traumatic stress as a \u201ccommon occupational hazard\u201d for professionals who work with traumatized children and warns that listening to their stories can compromise workers\u2019 health and professional functioning.<\/p>\n The concept has also spread well beyond psychotherapists. Teachers can acquire<\/a> secondary trauma from students<\/a>. Journalists can experience<\/a> vicarious trauma from reporting<\/a> on suffering. In 2023, Time announced<\/a> that \u201cthe whole world\u201d was at risk of compassion fatigue because wars, mass shootings, disasters, and social media continually expose ordinary people to other people\u2019s misery.<\/p>\n Academic interest has risen as well. When I restricted Google Scholar results for \u201csecondary traumatic stress\u201d to individual publication years, it returned about 300 results for 2004, 500 for 2010, 1,100 for 2015, 2,900 for 2020, and 4,800 for 2024. The counts are approximate and should not be treated as precise publication totals, but they show how rapidly the concept has grown from relative obscurity to a much larger research literature.<\/p>\n I started paying closer attention to secondary traumatic stress because of another trend I had been reporting on: the national behavioral-health workforce shortage. In a forthcoming essay for City Journal<\/a>, I examine the movement of mental-health clinicians out of public and institutional settings that serve the sickest psychiatric patients and into private practice and telehealth, where they have more control over their caseloads and generally treat less acute cases.<\/p>\n Burnout is commonly cited as a reason for this shift. In a 2026 survey<\/a> of private-practice clinicians who had previously worked in public mental-health settings, 68 percent said burnout and stress from overwork influenced their decision to leave. But stressful, poorly paid, difficult-to-staff jobs have always had high turnover. What is newer is the tendency to interpret occupational stress through the language of trauma. Earlier this year, the Washington Post suggested<\/a> that problems among teachers commonly attributed to burnout may instead be caused by secondary traumatic stress.<\/p>\n Calling it trauma gives the experience a much more serious meaning. Burnout means the job is wearing you down. Trauma suggests injury, and the word has become increasingly tied to claims of lasting changes in the brain and body.<\/p>\n Few books did more to popularize this view than Bessel van der Kolk\u2019s The Body Keeps the Score. Its claims about trauma producing enduring changes in the brain and body have become enormously influential, despite a recent critique<\/a> in the journal BJPsych Bulletin finding that many of its neurobiological claims rely on cross-sectional research incapable of establishing causation and on findings that have not consistently replicated.<\/p>\n That view has also shaped the way Adverse Childhood Experiences, or ACEs\u2014a commonly used framework that ostensibly measures childhood trauma\u2014are now understood and used. The original ACE score was developed to study group-level associations between childhood adversity and later health outcomes. Today, it is often used to screen individual patients and is commonly tied to the theory of \u201ctoxic stress<\/a>,\u201d which holds that repeated adversity can become \u201cbiologically embedded<\/a>\u201d and produce lasting physiological changes. Yet Robert Anda, one of the original ACE researchers, has warned<\/a> that the score cannot measure biological stress exposure, predict individual risk, or serve as a diagnostic tool.<\/p>\n Put these ideas together and the emotional demands of caring for challenging patients take on a much more ominous meaning. If exposure to other people\u2019s trauma is itself treated as potentially harmful to the clinician, then difficult patients can be seen as a threat to a clinician\u2019s own well-being. Combined with the existing shortage of clinicians in public and institutional settings, this raises the possibility that mental-health workers are becoming less tolerant of the very patients who are hardest to treat.<\/p>\n There is also reason to doubt that exposure alone explains who develops secondary traumatic stress. Research on secondary traumatic stress is concentrated heavily in nursing, social work, counseling, and education\u2014all professions dominated<\/a> by women. By comparison, policing is a male-dominated profession whose members routinely deal with murder victims, fatal accidents, abused children, and people who have just experienced violent crimes. Yet a study<\/a> of 235 police officers who worked with trauma victims found remarkably little secondary traumatic stress, with 90 percent scoring in the low range.<\/p>\n Perhaps the way workers interpret the emotional demands of their jobs has something to do with whether they experience those demands as trauma. Despite generations of women fighting the presumption that they were emotionally unsuited to difficult occupations, the helping professions have developed a scientific vocabulary that can suggest that exposure to other people\u2019s suffering is itself psychologically hazardous.<\/p>\n The theory becomes still harder to take seriously when followed to its logical conclusion. A traumatized patient can traumatize her therapist, who can then discuss the traumatized patient with a supervisor. I initially joked that psychology would eventually invent \u201ctertiary trauma\u201d for the supervisor, only to discover a 2015 dissertation<\/a> titled \u201cCounselor Supervisors\u2019 Perceptions of Tertiary Trauma,\u201d based on interviews with supervisors exposed to counselors\u2019 accounts of their clients\u2019 trauma.<\/p>\n \u201cTertiary trauma\u201d remains an obscure psychological idea, which is probably for the best. But if a traumatic experience can be transmitted from patient to therapist and then from therapist to supervisor, there is no obvious answer for where the chain stops.<\/p>\n None of this means we should pretend that listening to gruesome stories is pleasant or that caring for severely disturbed people is easy. But if current trends continue, the safest way to avoid trauma may eventually be to avoid anyone who has encountered anyone who has ever experienced anything painful or miserable. It would almost be funny\u2014but for the reality that the people most likely to be shunned would be those most desperate to be heard.<\/p>\n","protected":false},"excerpt":{"rendered":"There is no question that working with traumatized patients can be difficult and emotionally demanding. 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