Vicarious Traumatization, Compassion Fatigue and Burnout: The Hazards of Compassion in Military Mental Health

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By Holly N. O’Reilly, Ph.D.
March 12, 2018

Are you feeling disconnected from those you care about? Wondering who is trustworthy? Or just feeling unsafe? Any of these symptoms could be indicative of vicarious traumatization (VT), which may be easily confused with compassion fatigue or professional burnout. Some clinicians who work with traumatized populations (including those with posttraumatic stress disorder and/or depression) may experience VT, and this may be particularly true for clinicians working with military members. Despite significant experience providing clinical care, many clinicians could benefit from a refresher of information on this important topic and a few suggestions to help prevent it.

VT, also known as secondary traumatization, can be described as indirect exposure to traumatic events through first-hand accounts or narratives of the events and may be experienced by professionals who work with trauma survivors. Symptoms of VT include intrusive imagery, decreased trust in others, feeling disconnected, a sense of loss of control and/or increased safety concerns, typically with a sudden onset or awareness of these issues. VT is similar to but different from burnout, which may be experienced in any profession and is often described as a general fatigue or weariness and feeling overwhelmed or disenchanted  with one’s profession. Compassion fatigue is often described as “having nothing left to give” or as an erosion of one’s level of compassion. Any of these related phenomena may lead to a decrease in empathy for clients and subsequently a decrease in the quality of client care.

Not surprisingly, many clinicians are drawn to helping professions by their heightened sense of empathy and their desire to help others. Over time, this passion and commitment may wane leading to motivational issues that could impact the quality of client care. As professional helpers, we are often encouraged to engage in self-care, but we rarely discuss why it is so important professionally and personally.

Preventing Vicarious Trauma

There are a number of strategies which may be used to prevent VT. Several strategies require cooperation and support from your clinic leadership while others are within your control:

  • Educate yourself about trauma and the consequences of trauma. A greater understanding of trauma will help you understand the impact of trauma and recognize your response to trauma and your work with trauma survivors.
  • Carry a balanced caseload. If possible, try to reduce the number of trauma-related cases you see for psychotherapy. It may be helpful to have a mix of diagnoses among the people on your caseload.
  • Engage in peer supervision and consultation regularly. It is important to have support, especially after a difficult session. Five minutes to “check-in” with someone post-session may be highly effective.
  • Maintain social support and a reasonable work-life balance.
  • Fully utilize your health coping skills. More specifically, try to maintain an adequate amount of sleep, exercise regularly and practice relaxation or meditation. Using your best coping skills will bolster resilience.
  • Check-in with yourself or someone you trust on a regular basis. Recognizing issues early on will allow you to intervene more effectively if necessary.

Treating Vicarious Trauma

Not surprisingly, the treatments for VT are consistent with prevention strategies:

  • Create a fulfilling personal life to counterbalance your level of engagement in clinical work.
  • Psychotherapy with a seasoned clinician may facilitate your ability to reflect on yourself, your personal needs and your response to clinical work.
  • Engage in healing activities. Examples include journaling, artistic endeavors, travel, religion, spirituality, meditation, mindfulness, rest and relaxation, exercise, tai chi, yoga.


The provider resilience app is designed to help providers build resiliency against vicarious traumatization, burnout and compassion fatigue. This resource includes a variety of self-care tools as well as a self-assessment rating so that one may monitor progress over time. Find more information and download instructions on the Defense Health Agency Connected Health website.

Please share any helpful tips and strategies for clinician self-care, whether from your experience or advice you’ve given to your supervisees, in the Comments section below.

Dr. O’Reilly is a contracted clinical psychologist and evidence-based practice subject matter expert at the Psychological Health Center of Excellence. Her specialties include the consequences of traumatic exposure as well as gender studies. 

The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.

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