‘We need to be kind to ourselves’: vicarious trauma and burnout

Burnout, vicarious trauma, compassion fatigue.
 
All conditions that many GPs would be familiar with across their broad scope of practice.
 
When it comes to abuse and violence, GPs and other healthcare professionals have an essential role in the assessment and recovery of patients.
 
But this responsibility also has an attached risk for GPs.
 
‘When you hear other people’s stories, you’re more likely to suffer from vicarious trauma,’ Associate Professor Jill Benson told newsGP.
 
Author of the chapter on clinician support and self-care in the recent update of the RACGP’s White Book, Associate Professor Benson has worked extensively with patients experiencing trauma, abuse and violence. She acknowledges it can often be difficult for GPs to recognise and respond to their own feelings.
 
‘Vicarious trauma is something we [GPs] are just not good at it,’ she said.
 
‘We don’t have an answer, we don’t have a pill. We don’t have a particular form of psychotherapy that’s going to be incredibly useful.
 
‘Where we start to take on the trauma stories and internalise those, that is difficult to treat. And it’s quite dangerous for health professionals to suffer from the carrier’s trauma because it can affect not only your professional work, but your personal life.’
 
Associate Professor Benson recognises that ‘a lot’ of people who work with trauma, particularly family abuse and violence, have a personal history which can make them more vulnerable.
 
‘The brain is primed from your own past history,’ she said. ‘Even though that’s what often takes people into this field because they feel like they want to make a difference in something that they’ve experienced themselves, it actually makes them more vulnerable.’
 
Recognising the signs
The first step for GPs is to pay attention to the signs of burnout and emotional exhaustion, particularly depersonalisation − removing oneself from being able to relate to people.
 
‘GPs can experience depersonalisation with patients, but it can also happen with their family,’ Associate Professor Benson said.
 
‘Certainly that’s a sign that we should pay attention to. That feeling that you’re just not doing any good. One of the early signs is that “person fatigue”, you just lose your sense of caring and sense of relationship.’
 
When GPs experience the depersonalisation that can accompany burnout and vicarious trauma, it can be present as a protective mechanism, according to Associate Professor Benson.
 
‘Because empathy actually takes you into that person’s world, and if you’re dealing with people who have been traumatised, going into their world can actually increase your risk of vicarious trauma,’ she said.
 
‘So [there is some] sense in that a little bit of depersonalisation is actually a protective thing because going into their world … takes you to the same place they’ve been at with their trauma.
 
‘It’s actually quite hard to find the place between protecting yourself and that “don’t care” feeling that can make you aware that you’re suffering from burnout and vicarious trauma.’
 
As with management of many conditions, self-reflection on lifestyle habits such as sleep, exercise, diet and socialising, are all important to focus on, as the ‘things that keep us well and safe’.
 
Self-care models
In the White Book, Associate Professor Benson discusses the ‘three arms’ of self-compassion which link with the ABC model – awareness, balance, connection.
 
‘Self-compassion is important because we are often really hard on ourselves. We expect more of ourselves than we should and expect to make more of a difference than we’re able to. We need to be kind to ourselves,’ she said.
 
‘The second thing is that idea that this is not just happening to you as a person … whatever it is, this feeling of hopelessness, of “therapeutic impotence”, is a common thing. [So] debriefing and talking to other people about it, to get that idea that this isn’t just you.
 
‘And [third], being able to switch off − having skills in things like mindfulness, and building up those skills so you can access them quickly and be strategic about practicing mindfulness.’
 
Associate Professor Jill Benson warns of the dangers of taking on patients’ trauma, as it can impact both GPs’ professional and personal life.

The ABC model begins with self-awareness, and ‘checking in’.
 
‘Going back to being aware of the early warning signs and your own personality and your own past and stories,’ Associate Professor Benson said.
 
‘Then making sure that you’re balancing your work and non-work and set good boundaries between them. Then the connection − we know that the greatest healer of anything is our connection with other people.’
 
Part of the ABC self-care model is having a supportive team and taking time out when needed.
 
‘We need to surround ourselves with a good team who are all on the same page,’ Associate Professor Benson said.
 
‘Make sure you’ve got the ability to debrief, a peer support network. Those things that we don’t do as doctors and other health professionals is have a break and not take work home – we’re just not good at that.
 
‘Encouraging other people to support you doing that is also something we’re not good at … when I work in teams if someone is getting hopeless, I would say, “You need to go and look after yourself because that’s going to affect the team”.’
 
The perils of hopelessness
One of the elements of working in a team is having a sense of accomplishment, and Associate Professor Benson warns of the dangers of hopelessness impacting the team when vicarious trauma and burnout is being experienced.
 
‘That sense of not being able to make a difference can be hard to get when you’re working in something like family and domestic violence,’ she said.
 
‘It’s important to stay hopeful, because one of the things that can happen is that you can lose that hope and hopelessness is actually really infectious in a team.
 
‘And that sense of there not being hope can [also] be transferred to the patients.’
 
Working in an area like abuse and violence, Associate Professor Benson reminds GPs that although it can be easy to get ‘caught up in the process’ having an awareness of the bigger picture is important.
 
‘An acknowledgement that life is difficult,’ she said.
 
‘And that we’re not the total answer to anyone’s problems … and we need to make sure we keep going back to what that story is about and not get caught up in the bureaucracy, and all the other things that can distract us from what our purpose is.’
 
The fifth edition of Abuse and violence: Working together with our patients in general practice (White Book) is available on the RACGP website.
 
Associate Professor Jill Benson’s chapter also lists a number of resources to assist GPs with support and self-care strategies.
 
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abuse and violence burnout self-care vicarious trauma White Book