The Long Term Impact of Trauma On Clinicians Living and Working in a Post 9/11 Practice Environment

Background and Purpose: A number of constructs have been developed to describe the impact of working with trauma survivors, including compassion fatigue, secondary traumatic stress, vicarious trauma, and burnout. For social work and other mental health clinicians living and practicing in a traumatological environment, these terms do not adequately convey the complicated nature of their affective, cognitive and behavioral responses given that they have been exposed to the same collective trauma as their clients. Shared traumatic stress contains elements of compassion fatigue, but also takes into account the clinician's primary trauma exposure. This paper presents the results of a survey exploring the long-term impact of trauma on clinicians practicing and/or residing in Manhattan in a post-September 11th practice environment. Methods: The research design for this study was a single-occasion, cross-sectional survey design. A recruitment letter, project statement, self addressed stamped envelope, and Post 9/11 Quality of Professional Practice Survey (PQPPS) was sent to 1275 masters and doctoral level social workers in direct practice who were members of the National Association of Social Workers (NASW) Manhattan Chapter. The PQPPS consisted of several established research measures in the public domain, as well as demographic, practice, supervisory, training, and 9/11-related personal and professional experience questions. In regard to established instruments, attachment style was operationalized by the Adult Attachment Questionnaire, resiliency by the Connor-Davidson Resilience Scale, traumatic life events by the Life Events Checklist, compassion satisfaction by the Professional Quality of Life Compassion Satisfaction Subscale, and shared traumatic stress was operationalized by the product of scores for the PTSD Checklist-Civilian Version and Professional Quality of Life compassion fatigue/secondary traumatic stress subscale. Results: A total of 481 members of the NASW Manhattan Chapter (38% response rate) replied to the PQPPS mail survey. On a bivariate level, shared traumatic stress was positively correlated with ambivalent attachment, avoidant attachment, traumatic life events, being currently affected by the events of 9/11 (all p<.0001), and perception of the likelihood of another 9/11 event within two years (p=.0004). It was negatively associated with resiliency, life change due to the events of 9/11 (both p<.0001), institute training (p=.0041), compassion satisfaction (p=.0166), and years in the field (p=.0344). On a multivariate level controlling for 19 variables, only ambivalent attachment (p=.0078), avoidant attachment (p<.0001), traumatic life events (p=.0011), resiliency (p=.0168), and institute training (p=.0274) were significant predictors of shared traumatic stress. Conclusion: The results of the PQPPS potentially lays the groundwork for an empirical understanding of shared trauma as a distinct entity, as well as identifying the factors associated with practice in disaster areas. The significance of the PQPPS also extends to the agency and academic arenas. Less experienced clinicians were found to have the highest levels of shared trauma. These findings suggest a crucial role and responsibility for social work schools in trauma education.