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Clinical Psychology Review 23 (2003) 449 – 480

Vicarious traumatization: implications for the mental health of health workers?
Rachel Sabin-Farrella,b,*, Graham Turpinb
a

Department of Clinical Psychology, Nottinghamshire Healthcare National Health Service Trust, Southwell Road, Mansfield, Nottinghamshire NG18 4HH, UK b University of Sheffield, Sheffield, UK

Received 13 September 2002;received in revised form 4 February 2003; accepted 14 February 2003

Abstract It has been suggested that a unique feature of some mental heath practitioners’ work is exposure through their role as therapists to clients’ descriptions of and reactions to trauma, and that these experiences may actually indirectly cause distress and traumatization to the therapist. This proposed phenomenon has beentermed ‘‘vicarious traumatization’’ (VT) and is the focus of the current review. The concept of VT, together with other related concepts such as ‘‘burnout,’’ ‘‘compassion fatigue,’’ ‘‘secondary traumatic stress’’ (STS), and ‘‘work stress’’ are appraised. Psychological mechanisms that might be theoretically involved in VT are considered. The measurement of VT is reviewed alongside the limitedresearch evidence supporting its existence. Factors such as direct trauma exposure and the personal attributes of mental health workers, which have been suggested to be associated with VT, are also assessed. It is concluded that the evidence to support the existence of VT is meager and inconsistent. Future research needs to be directed at distinguishing VT from other sources of distress arising withinthe workplace. Finally, the organizational relevance of VT and its possible implications for the management of mental health workers are critically appraised. D 2003 Elsevier Science Ltd. All rights reserved.
Keywords: Trauma; Vicarious traumatization; Occupational health; Burnout; Compassion fatigue; Work stress; Posttraumatic stress disorder

* Corresponding author. Department of ClinicalPsychology, Nottinghamshire Healthcare National Health Service Trust, Southwell Road, Mansfield, Nottinghamshire NG18 4HH, UK. Tel.: +44-1623-784-910; fax: +441623-784-856. E-mail address: rachel@sabin-farrells.freeserve.co.uk (R. Sabin-Farrell). 0272-7358/03/$ – see front matter D 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0272-7358(03)00030-8

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R. Sabin-Farrell, G.Turpin / Clinical Psychology Review 23 (2003) 449–480

1. Introduction Healthier workplaces have been identified as part of recent government initiatives in the UK (Department of Health, 1998), with one of the aims being to ‘‘ensure that people are protected from the harm to their health that certain jobs can cause’’ (p. 51). The mental and physical health of UK National Health Service (NHS) staffhas also recently been discussed in a government consultation paper (Department of Health, 1999), which highlights the importance of prioritizing good-quality working lives for NHS staff in aiming to provide good quality of care for patients. Similarly, in the United States and other countries around the world, occupational health projects are highlighted as important both for staff well-being,productivity, and performance (National Institute for Occupational Safety and Health [NIOSH], 1999). Research reported by NIOSH (1999) suggests that between 26% and 40% of workers find their jobs often stressful and the effects of work stress on health are well documented. People working in the caring professions are among the occupational groups identified as being at high risk of work stress (Smith,Brice, Collins, Matthews, & McNamara, 2000). Research on occupational stress in health service staff have found levels of stress and minor psychiatric disorder to be higher in the NHS than for other occupational groups in the UK (Borrill et al., 1998; Wall et al., 1997). A number of explanations could be given for the high levels of staff stress and psychiatric disorder in health service staff...