Chapter 05 7/14/10 9:08 AM Page 57

Professional Burnout, Vicarious Trauma,

Secondary Traumatic Stress, and Compassion
Fatigue: A Review of Theoretical Terms,
Risk Factors, and Preventive Methods for
Clinicians and Researchers
Jason M. Newell and Gordon A. MacNeil

The emotional and psychological risks associated with providing direct social work ser-
vices to vulnerable populations have been largely overlooked in social work educational
curriculum and agency training (Cunningham, 2004; Courtois, 2002; Shackelford,
2006). These risks should be conceptualized as occurring in two separate forms:
trauma-related stress and professional burnout. Vicarious trauma, secondary traumatic
stress, and compassion fatigue are conditions related specifically to work with trauma
populations, while professional burnout is considered a more general phenomenon
which may occur within any social service setting. The forms of trauma-related stress
conditions and professional burnout are often erroneously discussed either interchange-
ably or grouped together as one condition in the literature. It is best to conceptualize
each of these conditions separately in order to have a comprehensive understanding of
these complex phenomena. It is important that direct practitioners and educators
understand the risk factors and symptoms associated with these phenomena in order to
identify, prevent, and/or minimize their effects. As a best-practice initiative, it is appro-
priate that information on these conditions be infused into social work curricula as a
first-line preventive measure for the training of inexperienced social workers who may
be more vulnerable to the effects of these conditions (Lerias & Byrne, 2003). Informa-
tion on these topics should also be included as part of agency training for practitioners
already working in the field. This article provides a brief review of professional burnout,
vicarious trauma, secondary traumatic stress, and compassion fatigue, including the
risk factors and symptoms associated with these conditions. Particular attention is paid
to the inclusion of this material and the practice of self-care in both macro and micro
social work education, as well as agency-training curriculum.

Jason M. Newell is assistant professor of social work in the Department of Behavioral and Social
Sciences at the University of Montevallo. Gordon A. MacNeil is associate professor of social work
at the University of Alabama. Address correspondence to Jason Newell, The University of Monte-
vallo, Department of Behavioral and Social Sciences, Station 6190, Montevallo, Alabama 35115;
tel.: 205-665-6190; e-mail: [email protected]

© 2010 Lyceum Books, Inc., Best Practices in Mental Health, Vol. 6, No. 2, July 2010
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58 Best Practices in Mental Health

Keywords: professional burnout; secondary traumatic stress; compassion fatigue

Introduction
Social workers are dedicated to providing services to vulnerable populations,
including the abused, neglected, mentally ill, and the elderly. It has been suggested
that in order to effectively intervene with vulnerable clients, one must develop a
strong working relationship that involves knowing about the client’s life and the
events (both past and present) that have led to the current state of disequilibrium
(Figley, 2002a; Pearlman & Saakvitne, 1995). Such service inevitably involves lis-
tening to, and to some degree absorbing, the pain associated with the individual,
family, or group’s suffering (Morresette, 2004; Rothschild & Rand, 2006). The
chronic day-to-day exposure to clients and the distress they experience may
become emotionally taxing on social workers or other helping professionals,
resulting in the experience of conditions known as secondary traumatic stress, vic-
arious trauma, compassion fatigue, or, ultimately, professional burnout.
The emotional and psychological risks associated with being a provider of
direct social work services to vulnerable populations and professional self-care in
response to these risks have been overlooked issues in social work practice, train-
ing, and education (Courtois, 2002; Dunkley & Whelan, 2006; Figley 2002b);
however, within the last two decades, the social services community has acknowl-
edged the existence of these risks and the possibility that they may be an underes-
timated occupational hazard for those providing social work services (Pryce, Shak-
leford, & Pryce, 2007). Indeed, many social workers find they are unable to meet
the emotional and professional demands associated with direct practice (Bride,
2007; Maslach & Leiter, 1997; Maslach, Schaufeli, & Leiter, 2001). Despite the
Council on Social Work Education’s requirement that self-care be a part of the
social work curriculum (CSWE, 2008), many graduating social work students
have very little idea of how to identify the signs and symptoms of these problems
or how to utilize self-care as a preventative measure (Lerias & Byrne, 2003; Shack-
elford, 2006). Clearly, such a lack of awareness increases their vulnerability to the
effects of these conditions. It is vitally important that social workers and other
helping professionals providing services to vulnerable populations understand the
risk factors and symptoms associated with professional burnout, vicarious
traumatization, secondary traumatic stress, and compassion fatigue. Toward this
end, the current article reviews risk factors and symptoms associated with these
conditions, provides strategies for addressing the conditions, and suggests areas
where this information might best fit into educational and training curricula.

Professional Burnout and Social Work Practice

Professional burnout can be defined as a state of physical, emotional, psycho-
logical, and spiritual exhaustion resulting from chronic exposure to (or practice
with) populations that are vulnerable or suffering (Pines and Aronson, 1998).
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Burnout, Vicarious Trauma, Secondary Traumatic Stress, and Compassion Fatigue 59

The actual process of burning out is best described as a progressive state occurring
cumulatively over time with contributing factors related to both the individual,
the populations served, and the organization (Maslach, 2001; 2003a; 2003b).
Burnout is conceptualized as a multidimensional or meta-construct, with three
distinct domains: emotional exhaustion, depersonalization, and reduced sense of
personal accomplishment (Maslach, 1982, 1998; Maslach & Jackson, 1981;
Maslach & Leiter, 1997). A multidimensional approach to burnout provides a
holistic conceptualization of this otherwise complex phenomenon (Lee & Ash-
worth, 1996; Maslach, 1998). Emotional exhaustion is a state that occurs when a
practitioner’s emotional resources become depleted by the chronic needs,
demands, and expectations of their clients, supervisors, and organizations
(Maslach, 1998; Maslach, Schaufeli, & Leiter, 2001). Depersonalization (also
referred to as cynicism) refers to the negative, cynical, or excessively detached
responses to coworkers or clients and their situations (Maslach, 1998; Maslach,
Schaufeli, & Leiter, 2001). This domain is a representation of the change in inter-
personal thoughts and feelings regarding practice with clients that may occur in
the process of professional burnout. Reduction in one’s sense of personal accomplish-
ment occurs when social workers feel inadequate when clients do not respond to
treatment, despite efforts to help them. This domain of the burnout phenomenon
may also occur in response to bureaucratic constraints and administrative
demands that often accompany social work practice, such as dictating client
records or completing required administrative documentation.
Factors contributing to professional burnout may occur at the individual, orga-
nizational, or client levels (or in combination). The single largest risk factor for
developing professional burnout is human service work in general. The emotional
expectations involved with human service work, such as requirements to either
repress or display emotions routinely, as well as the chronic use of empathy, are
strongly associated with the experience of professional burnout (Maslach,
Schaufeli, & Leiter, 2001; Maslach & Leiter, 1997). As many direct practitioners
work within bureaucratic social service agencies, the organization plays a key role
in the professional burnout process. Organizational factors shown to contribute to
professional burnout include excessively high caseloads, lack of control or influ-
ence over agency policies and procedures, unfairness in organization structure
and discipline, low peer and supervisory support, and poor agency and on-the-job
training (Barak, Nissly, & Levin, 2001: Maslach & Leiter, 1997). Organizational
behaviors, such as frequent absenteeism, chronic tardiness, chronic fatigue, evi-
dence of poor client care, and low completion rates of clinical and administrative
duties, should be considered warning signs for burnout (Barak, Nissly, & Levin,
2001; Cyphers, 2001; Lloyd, King, & Chenoweth, 2002). At the individual level,
factors such as conflicting relationships with coworkers, individual personality
and coping styles, and difficulty interacting with and understanding clients and
their situations may also contribute to the experience of professional burnout
(Barak, Nissly, & Levin, 2001; Lloyd, King, & Chenoweth, 2002; Thorton, 1992).
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60 Best Practices in Mental Health

Social Work Practice with Trauma Populations

A great deal of social work practice relates to addressing client’s crisis situa-
tions (crisis intervention) or helping clients deal with trauma that occurs in the
aftermath of crisis. Providing trauma-intervention services places these workers
at risk for traumatic responses themselves (Farrell & Turpin, 2003; Hesse, 2002;
McCann & Pearlman, 1990; Palm, Polusny, & Follette, 2004). Three common
terms cited in the literature describe the negative psychological reactions social
work professionals may experience when working with traumatized clients: vicar-
ious traumatization (VT), secondary traumatic stress (STS), and compassion fatigue
(CF) (Rothschild & Rand, 2006). Although these conditions are distinct from each
other, these terms are often erroneously used interchangeably in the literature.
Vicarious traumatization refers to “a process of [cognitive] change resulting from
[chronic] empathic engagement with trauma survivors” (Pearlman, 1999, p. 52).
Vicarious traumatization represents the resulting cognitive shifts in beliefs and
thinking that occur in social workers in direct practice with victims of trauma.
Examples of changes in cognition when one experiences vicarious traumatization
include alterations in one’s sense of self; changes in world views about key issues
such as safety, trust, and control; and changes in spiritual beliefs (Pearlman,
1998; Pearlman & McCann, 1995; Pearlman & Saakvitne, 1995).
Secondary traumatic stress relates to the “natural and consequential behaviors
and emotions resulting from knowing about a traumatizing event experienced by
a significant other [or client] and the stress resulting from helping or wanting to
help a traumatized or suffering person [or client]” (Figley, 1995, p. 7). STS results
from engaging in an empathic relationship with an individual suffering from a
traumatic experience and bearing witness to the intense or horrific experiences of
that particular person’s trauma (Figley, 1995). The symptoms of secondary trau-
matic stress mirror the symptoms of post-traumatic stress disorder (PTSD) experi-
enced by the primary victim of trauma. The experience of secondary traumatic
stress may include a full range of PTSD symptoms, such as intrusive thoughts,
traumatic memories or nightmares associated with client trauma, insomnia,
chronic irritability or angry outbursts, fatigue, difficulty concentrating, avoidance
of clients and client situations, and hypervigilant or startle reactions toward stim-
uli or reminders of client trauma (APA, 1994; Bride, 2007; Rothschild, 2000;
Figley, 1995).
Vicarious traumatization and secondary traumatic stress have similar defining
features, which may be challenging when attempting to clearly understand the
pathologies of these conditions. A helpful distinction between them is to concep-
tualize vicarious traumatization as a cognitive change process resulting from
chronic direct practice with trauma populations, in which the outcomes are alter-
ations in one’s thoughts and beliefs about the world in key areas such as safety,
trust, and control (McCann & Pearlman, 1990; Pearlman, 1998; Pearlman &
Saakvitne, 1995). Secondary traumatic stress, grounded in the field of trauma-
tology, places more emphasis on the outward behavioral symptoms rather than
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Burnout, Vicarious Trauma, Secondary Traumatic Stress, and Compassion Fatigue 61

intrinsic cognitive changes (Figley, 1995). Like vicarious trauma, secondary trau-
matic stress occurs as a result of direct practice or exposure to victims of trauma.
The focal features of STS are the behavioral symptoms that mirror the PTSD pre-
sented in the primary victim(s) of trauma, not changes in cognition. In order to
best understand these two conditions, it is helpful to think of vicarious traumati-
zation and secondary traumatic stress as two different disorders with similar fea-
tures, which may occur either independently of each other or as co-occurring
conditions.
Compassion fatigue, also used interchangeably in the literature with secondary
traumatic stress and vicarious trauma, is best defined as a syndrome consisting of a
combination of the symptoms of secondary traumatic stress and professional
burnout (Adams, Boscarino, & Figley, 2006; Bride, Radney, & Figley, 2007; Figley,
1995). Compassion fatigue recently emerged in the literature as a more general
term describing the overall experience of emotional and physical fatigue that
social service professionals experience due to the chronic use of empathy when
treating patients who are suffering in some way (Figley, 2002b; Rothschild &
Rand, 2006). The chronic use of empathy combined with the day-to-day bureau-
cratic hurdles that exist for many social workers, such as agency stress, billing dif-
ficulties, and balancing clinical work with administrative work, generate the expe-
rience of compassion fatigue (Figley, 1995,, 2002b). Much like professional
burnout, the experience of compassion fatigue tends to occur cumulatively over
time; whereas vicarious trauma and secondary traumatic stress have more imme-
diate onset. For mental health professionals who treat victims of trauma, sec-
ondary traumatic stress may contribute to the overall experience of compassion
fatigue; however, mental health professionals who treat populations other than
trauma victims (such as the mentally ill) may also experience compassion fatigue
without experiencing secondary traumatic stress.
For clinicians currently in trauma practice, there are risk factors which may
contribute to the development of vicarious traumatization, secondary traumatic
stress, and compassion fatigue. It has been suggested that practitioners with a pre-
existing anxiety disorder, mood disorder, or personal trauma history (particularly
child abuse and neglect), may be at greater risk of experiencing these conditions
(Lerias & Byrne 2003; Dunkley & Whelan, 2006; Gardell & Harris, 2003). Profes-
sionals with high caseloads of trauma-related situations despite having little clin-
ical experience practicing with trauma clients are particularly vulnerable to the
effects of these conditions (Lerias & Byrne, 2003; Pearlman & MacIan, 1995).
Lastly, the individual use of maladaptive coping skills in response to trauma work,
such as suppression of emotions, distancing from clients, and reenacting of abuse
dynamics, are identified warning signs for these conditions (Dunkley & Whelan,
2006; Farrell & Turpin, 2003; Schauben & Frazier, 1995).
At the macro level, there are several organizational features that have been
identified as risk factors for these conditions. These factors include organizational
setting and bureaucratic constraints, inadequate supervision, lack of availability
of client resources, and lack of support from professional colleagues (Dunkley &
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62 Best Practices in Mental Health

Whelan, 2006; Farrell & Turpin, 2003; Catherall, 1999, 1995). It is also impor-
tant for practitioners to consider organizational culture and the affect of agency
culture on individual workers (Catherall, 1995). Generally, organizational or
agency culture is comprised of the assumptions, values, norms and tangible signs
(artifacts) of agency members and their behaviors (Catherall, 1995). This is of
particular importance to social workers practicing within agencies catering specif-
ically to trauma populations (Bell, Kulkarni, & Dalton, 2003; Rudolph, Stamm, &
Stamm, 1997). For example, whether or not an agency culture acknowledges the
existence of VT, STS, and CF as normal reactions to client traumas may signifi-
cantly contribute to the coping ability of individuals experiencing these condi-
tions. An accepting organizational culture helps to alleviate stigmas trauma work-
ers may have about experiencing these reactions, such as feeling inadequate or
incapable of completing work responsibilities effectively (Bell, Kilkarni, & Dalton,
2003).

Self-Care as a Practice Behavior

In addition to understanding work-related stress conditions, it is also important
to have a professional awareness of preventive measures that may be used both
individually and within the organization to address them. Professional self-care is
the utilization of skills and strategies by workers to maintain their own personal,
familial, emotional, and spiritual needs while attending to the needs and demands
of their clients (Figley, 2002b; Stamm, 1999). Suggested individual self-care strate-
gies for burnout include setting realistic goals with regard to workload and client
care, utilizing coffee and lunch breaks, getting adequate rest and relaxation, and
maintaining positive connections with close friends and family (Maslach, 2003a).
There is substantial evidence suggesting that support from professional colleagues
and supervisors may also serve to decrease the effects of professional burnout
(Lakey & Cohen, 2000; Ray & Miller, 1994; Whittaker, 1983; Winnubst, 1993).
Social support from professional colleagues can include concrete support, such as
assisting with excess clerical work or taking on a particularly difficult client, or
emotional support, such as comfort, insight, comparative feedback, personal feed-
back, and humor (Maslach, 2003b; Shinn, Rosario, Morch, & Chestnut, 1984).
The practice of self-care and development of individual coping strategies and
coping skills are also useful for workers experiencing STS, VT, or CF. General bio-
behavioral strategies, such as maintaining physical health, balanced nutrition,
adequate sleep, exercise, or recreation, serve to buffer the effects of these condi-
tions (O’Halloran & O’Halloran, 2001; Pearlman, 1999; Zimering, Munroe, &
Gulliver, 2003). Maintaining general self-care may also involve the use of positive
forms of self-expression, such as drawing, painting, sculpting, cooking, or outdoor
activities (Hesse, 2002). Maintaining spiritual connections through church, med-
itation, yoga, philanthropic activities, and self-revitalization all serve to enhance
general self-care, which buffers the effects of these conditions. For individuals
experiencing secondary traumatic stress, psychotherapy may be a reasonable
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Burnout, Vicarious Trauma, Secondary Traumatic Stress, and Compassion Fatigue 63

treatment option, particularly for those with past trauma history (Gardell & Har-
ris, 2003; Hesse, 2002). Finally, the use of emotional and social support from close
family and friends has been indicated as a useful defense against the symptoms of
STS, VT, and CF (Figley & Barnes, 2005; Phipps & Byrne, 2003; Ray & Miller,
1994; Stamm, 1999).
One way for agency supervisors and administrators to demonstrate their sensi-
tivity to and support in addressing burnout and trauma-related stress is to regu-
larly administer instruments to evaluate the extent to which these conditions exist
within their workforce. Scales such as the Maslach Burnout Inventory, the Sec-
ondary Traumatic Stress Scale, and the Professional Quality of Life scale have
been validated as measures of burnout and traumatic stress (Bride, Radney, &
Figley, 2007; Bride, Robinson, Yegidis, & Figley, 2004; Schaufeli et al., 2001). This
could be done during agency training or continuing education seminars on these
topics. This can legitimize these problems for workers. If indications of burnout
and traumatic stress are detected, efforts to address the problem, such as develop-
ing a support group for the discussion of worker experiences amongst peers
(Catherall, 1999; Pearlman, 1999; Whitaker, 1983) can be initiated.

Self-Care in Social Work Educational Curriculum

Although there is evidence that professional burnout, vicarious trauma, sec-
ondary traumatic stress, and compassion fatigue all occur in a variety of social
work settings (Conrad & Keller-Guenther, 2006; Gillespie, 1987; Maslach & Flo-
rian, 1988), there is a substantial gap in the literature regarding practical meth-
ods of preventing and treating these conditions. The concepts of burnout and sec-
ondary traumatic stress can be introduced in human behavior and the social
environment (HBSE) courses as a topic highlighting the existence of career life
course trajectories (which run parallel to individual’s personal developmental tra-
jectories). This also highlights the interplay of social environment as key factors
affecting individual behaviors and conditions.
Individual, social, and institutional strategies may be useful in either prevent-
ing or intervening with professional burnout, but there are few tested models for
the treatment of these conditions once they occur (Leiter & Maslach, 2005;
Maslach and Goldberg, 1998; Phipps & Byrne, 2003; Pines & Aronson, 1988;
Rothschild & Rand, 2006). Therefore, social work educators should teach students
the key features, warning signs, and symptoms associated with professional
burnout and STS, as well as self-care strategies and techniques as preventive prac-
tice behaviors. One approach to educating new social work students about profes-
sional burnout is to integrate content in this area across foundation-level micro
and macro social work courses. For example, organizational risk factors for
burnout could easily be infused into macro social work course curriculum. Help-
ing students to understand these organizational risk factors prior to their begin-
ning field education experiences may serve to decrease their vulnerability to pro-
fessional burnout.
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64 Best Practices in Mental Health

Micro social work courses are ideal settings for providing education and skills
training on individual self-care strategies as preventive measures. This material is
also appropriate for any mental health practice course, particularly when infused
with lectures on crisis intervention and crisis management. Lastly, discussion of
these conditions with students in field placement during seminar and practicum
courses may be the best way to integrate this material in a way that is meaningful
to students as beginning practitioners (Cunningham, 2004; O’Halloran & O’Hal-
loran, 2001).
Conclusion
Working in direct practice with vulnerable populations is taxing for social
workers who invest themselves in the provision of services to these clients. It is
important to recognize that professional burnout is a phenomenon that can occur
in most any social work setting, while vicarious trauma, secondary traumatic
stress, and compassion fatigue are unique to direct practice with crisis and trauma
populations (McCann, Sakheim, & Abrahamson, 1998; Schauben & Frazier,
1995; Sexton, 1999). It has been suggested that the best defense against these
conditions is education about them, including a clear understanding of the phe-
nomena themselves, their risk factors, and symptoms (Figley, 1995; Zimering,
Monroe, & Gulliver, 2003). Despite evidence indicating the existence of these con-
ditions in a variety of social work settings, there is little indication that informa-
tion about them is being included in social work curricula (Courtois, 2002; Cun-
ningham, 2003; Shackelford, 2006). A number of reasons for not including
content on this topic can be considered: the limited time to present an already
packed curriculum of “core” material, the reluctance of instructors to present
material that can place practice “in a bad light,” the lack of manualized and tested
interventions to implement and treat these problems, and a desire to focus on
strengths-based orientations to practice. With the increased likelihood that stu-
dents preparing to practice in social work settings will encounter clients experi-
encing crisis and trauma, it seems logical that this topic be addressed as part of
curriculum in schools of social work. Our experience in presenting content on this
topic in practicum seminars suggests that students are somewhat familiar with
these issues, and are thankful for information on how to identify clinically signifi-
cant levels of these conditions, and how to address the problems.
For social workers already practicing in the field, information on these condi-
tions should be included in agency training as well as continuing education
courses. Social workers should be made aware of the emotional and psychological
risks involved with treating vulnerable populations, particularly victims of
trauma (Pryce, Shakleford, and Pryce, 2007), and should be encouraged to advo-
cate for themselves for resources to address the consequences they face in provid-
ing potentially-traumatizing services to difficult populations. Instruments such as
the Maslach Burnout Inventory (MBI) and the Professional Quality of Life scale
(ProQOL) should be administered on a regular basis to assess both organizational
and individual risk of burnout and trauma-related conditions in “high-risk” set-
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Burnout, Vicarious Trauma, Secondary Traumatic Stress, and Compassion Fatigue 65

tings. It is hopeful that the material presented in this article will be useful for social
work educators as well as practitioners welcoming new social workers into their
respected agencies and practice worlds.

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