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Sexual Violence 4/5: Vicarious Trauma

From disturbed sleep through to physical pain, it is common for therapists to experience stress responses when working with survivors of sexual violence. In the fourth part of her series, Erene Hadjiioannou suggests ways to identify and manage vicarious trauma – helping us stay connected with ourselves, and with our clients.

Therapists working with survivors of sexual violence are required to manage a kind of professional risk strongly associated with this issue, namely vicarious trauma. Vicarious trauma is a form of stress response arising from acute or prolonged exposure via contact with others who have experienced traumatic events. Stress responses vary practitioner-to-practitioner and can include post-trauma symptoms.

Bearing the power of sexual violence to create disempowerment, disconnection, and post-trauma symptoms is therefore not only a task faced by our clients. Managing the impact of therapeutic work is part of being an ethical practitioner as we seek to work within our own margins of competency. Becoming ungrounded psychologically and somatically impinges on our ability to fully support survivors, who are likely to be experiencing this in their own way across the room from us or on their side of the screen.

Try to be aware of how much, at any one time, you personally can comfortably be in contact with the problem of sexual violence. This includes the matter as a clinical issue, a societal issue, and perhaps a personal issue. The power of sexual violence to compromise boundaries sometimes means one’s work cannot be left at work.

For therapists who also support survivors outside of therapeutic work (for example: activism, in relationships, and in local communities) this is especially important to consider. If the demands of our work mean we respond from our own personal survival mode, we are more likely to replicate unhelpful or unhealthy patterns of relating with clients – or end up not meeting their needs at all.

Identify and manage

A helpful first step is to assess how many spaces we personally and professionally occupy that include or centre upon the issue of sexual violence. 

Does walking out of an appointment with a survivor lead to being in an office where talk centres around this work? Does your journey home always include reading about survivor’s struggles on social media and the news? How many of your commitments outside of work include being allied with pushing back against this issue?

If you find that there are too many spaces of this nature for you at any point, try temporarily removing something, or introducing alternative spaces. Making measured and enjoyable contact with others through an alternative shared experience or topic can create a grounding in the safety of relationships and everyday living.

We all have neurophysiological mechanisms to help us survive traumatic stress. Normalising these stress responses is a good first step to mitigating vicarious trauma.

Signs of vicarious trauma can include disturbed sleep, changes in appetite, difficulty focusing, and physical pain. Such psychological and physical responses need attention and comfort to fall back in our control. I find it helpful to bring things right back to basics, to re-establish my normal baseline. This can include tidying your bedroom to make it a relaxing place, keeping favourite foods to hand, and gentle movement or even a massage to help us feel safe in our bodies again. 

Returning to the theme of Connection in the second blog, finding ways to re-establish connection within our own selves can facilitate connection with our clients.

Psychotherapy with Survivors of Sexual Violence: Inside and Outside the Room, by Erene Hadjiioannou, will be published by Routledge in September. 


Erene Hadjiioannou

Erene Hadjiioannou is a UKCP Integrative Psychotherapist. She has worked with adult clients since 2010 in statutory, third sector, higher education, and private settings, and is currently solely based in her private practice, Therapy Leeds. Between 2014 and 2018 Erene created and co-ordinated two specialist services for women with complex needs (offenders, and survivors of sexual violence).

Erene's work is firmly based in relational, humanistic, and empowerment perspectives and she incorporates activism into her work around sexual violence, believing that as practitioners we have a responsibility to advocate in service of our clients and our shared world. You can view her writing and speaking engagements here. Erene is part of a steering group for the Crown Prosecution Service guidelines on pre-trial therapy. She covers this topic, and a range of others, in her book Psychotherapy with Survivors of Sexual Violence: Inside and Outside the Room.

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