What is secondary stress?

Secondary stress is the experience of posttraumatic stress disorder symptoms because of hearing and bearing witness to the trauma and suffering of others. This can show up as intrusive thoughts of the traumas, nightmares, emotional lability, and generally feeling more on edge and guarded. Secondary stress can quickly wear on our ability to have compassion satisfaction and a sense of agency and accomplishment in our work; both of which are necessary for career sustainability.

Experiencing secondary stress is a natural part of professional development within the healing professions because there is an inevitable learning curve and adjustment process to facing the suffering we do. And because in the beginning we are constantly confronted with firsts; the first suicidal client, the first time conducting a prolonged exposure session for childhood sexual abuse, the first death of someone under your care. There is only so much we can do to prepare for firsts because we don’t know how they will impact us. We don’t know until we are in it what of our own “stuff” might get activated. And because firsts happen early in our career, we don’t yet have the experience and clinical acumen to cope as effectively as we can later in our careers.

My experience with secondary stress

I experienced the raw symptoms of secondary stress for the first time at the movies. It was 2010 and I was a research coordinator and psychometrist (meaning I administered tests to assess cognitive functioning) at Walter Reed Army Medical Center in Washington DC. This was in the thick of the Iraq and Afghanistan conflicts and the medical intensive care units were filled with (mostly) young men, my age (I was 22) and even younger, who had been severely injured in combat, with lost limbs and life altering brain injuries. While some of what I saw, and the stories I heard, stuck with me, I thought I was coping well.

Then I went to see the movie District 9. I didn’t make it through to the end and I’ve never tried to watch it again. I’m not even 100% sure what the plot is. What I do remember are the specific scenes that triggered all that I had absorbed and been carrying with me about of the horrors of war, the horrors of what we can do to each other, the horror of seeing young service members’ bodies ravaged, and the hopelessness that this horror was going to continue. In the theater I started sobbing and hyperventilating, desperate to get out of there.

I didn’t know

I didn’t know this was secondary stress. I didn’t have the words to describe what I was experiencing; I was pure emotion: pain, and fear. Unfortunately, our team didn’t have the infrastructure to allow for processing the impact of our work. Such support may have prevented my District 9 reaction. Fortunately, I was already in therapy. I was able to process my experience.

I also recognized that if I was going to continue in this line of work, I would have to figure out how to cope … and not just through the superficial tropes of self-care, like bubble baths and gratitude journals.

This was not the last time I found myself sobbing in public because of secondary stress. Later it would be during my pre-doctoral clinical psychology internship when I was learning how to do trauma therapy, I was still working with combat vets. Now the wounds were generally more psychological than physical. I went to see “American Sniper.” While I was able to make it through the movie, I only made it halfway back to my car before breaking down. Once again I was flooded by the horrors of war and the immense suffering I faced every day.

Why am I telling you all this?

In sharing all of this, I want to destigmatize secondary stress. I want to remind you that it is not your burden to figure it out on your own. I hope that by hearing my stories you can recognize that you are not alone. What you have, or are, experiencing is normal. I want to encourage discussing secondary stress as early in our careers as possible. This will invite opportunities to process it versus risking having it sneak up on you at the movies. Though if it does, that’s normal too. I believe similar experiences to my own are part of the inherent process of becoming a healing professional. And, the severity of this process can be offset through normalization, validation, and honest discussion.

If you are a supervisor, I want to encourage you to directly and explicitly invite your trainees to explore secondary stress. As my grad school mentor told us on day one, “you don’t know what you don’t know.” Our trainees even more so don’t know what they don’t know. It’s our job to set the stage for normalizing and processing ALL reactions that may occur, particularly as our trainees face their firsts.

What do we do about secondary stress?

Talk about it. Write it down in process notes or routine journaling. Bring it to supervision or consultation. Seek out your own therapy.

Usually there is a reason this story (or stories) is the one that is showing up as secondary stress. It might just be because it was a first and that alone triggered feelings of imposter syndrome. Or maybe you felt the panic of not knowing what to do in the moment. Or the fear of not being able to do this job. Or any other developmentally natural response. Even if it’s developmentally normal, we still need to label it and understand it. That’s how we learn and build our confidence and clinical stamina.

Give yourself grace

Or maybe this story activates memories of your own lived experiences, or the experiences of a loved one, or is reminiscent of familiar feelings of helplessness and powerlessness in general, or to being able to facilitate change. Or it calls into question beliefs you hold about yourself, others, the world, your faith, spirituality, etc. Give yourself the grace you would give a client to find out what is going on for you so you can know yourself better and what you need to do to manage this difficult work. You deserve that care and attention just as much as you believe your clients do. And the more you do this inner work earlier on, the more accessible such self-reflection, vulnerability, and openness will be for the duration of your career.

For clinicians: I hope this normalizes whatever experiences of secondary stress you may have had or are currently navigating. I hope it inspires you to feel more confident talking about it with trusted others and processing it to learn what you need to learn from this experience. Even if that is just to reinforce patience, compassion, and grace with yourself as you navigate the challenges of healing professions.

For those seeking healing: Sorry, this one isn’t so much for you. That said, if you did read this and are now wondering, or maybe even worrying, about your provider’s well-being or are now considering holding back what you say in session for fear of how it may impact your provider, please share these concerns with them. Clear the air so you can get what you need out of your care. It is not your responsibility to make sure your provider is ok. That is their job and that is what blogs and resources like this are for!