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An Exploration of the Long-Term Experience of Trauma upon Clinicians' Identity
Selwyn Black
In the 'new paradigm' of psychotraumatology, there is little research with clinicians who have themselves become traumatised
as a result of their work with traumatised clients. In order to protect clients, clinicians, and the relevant professions,
there is an ethical imperative to acknowledge and address the issue of clinicians' traumatic experience that emanates from
working with traumatised clients. This research explored some of the processes that give rise to changes in the clinician's
frame of reference and ultimately their sense of identity as a consequence of their traumatic experience.
Traditionally, theorists have investigated the effects of trauma upon the trauma survivor. While acknowledging context and
aetiology, they have focused on observable symptoms. This research offers a new conceptualisation of trauma. It explored the
clinician's experience of trauma and directly related traumatic experience to the processes of identity development.
The research design focused on the members of a Critical Incident Response Team that were involved in helping the survivors and
carers in the aftermath of the Omagh bomb in Northern Ireland (1998) and compared their identity structures with those of a
comparison group of clinicians of similar professional profile who had no involvement in that traumatic incident. The research
specifically explored their identity development and redefinition on account of their vicarious experience of trauma. Their
identity processes were tracked over three phases of research using the Identity Structure Analysis conceptual framework and
semi-structured interviews. A further comparative study was conducted with a surgical team from the County Hospital, Travnik,
Central Bosnia, who worked together in the context of the Bosnian War (1991-1995) and continues to provide care for a traumatised
population recovering from war and genocide. This comparison investigated whether similar features of identity development and
redefinition were present in a professional group who had been directly exposed to trauma and represent a different social and
cultural context.
The current research demonstrated that is possible to estimate the degree of intensity of traumatic experience within the clinician's
unique appraisal of that experience. The results showed that the intensity of traumatic experiences differed between therapists who
had experienced vicarious traumatisation through listening to their clients' traumatic accounts and practitioners who had been
directly exposed to trauma and shared the traumatic experience of their patients. They further indicated that clinicians adopted
differing identity orientations in contending with traumatic experience. Some clinicians adopted a 'defensive' style of contending
with traumatic experience that was characterised by a 'self focused', cognitive orientation that strongly defended against the
negative affect associated with traumatic experience. The 'defensive' style tended towards rigidity in its perspective. Other
clinicians adopted an 'open' style of contending with traumatic experience that was characterised by a more affective orientation that
resonated with the affect exhibited by others. The 'open' style tended towards the possibility of being overwhelmed by the nature of
that affect. Neither orientation was considered to be more vulnerable that the other. The current research showed that both direct and
vicarious traumatic experiences have long-term consequences. The research demonstrated within its three phase longitudinal design that
a period around 15 months after the Omagh bomb represented a time of major reappraisal for therapists of both 'defensive' and 'open'
orientations, and that after 21 months revisions had taken place in therapists' identity structures.
Two further features distinguished the current research. It offers a new conceptualisation of traumatic countertransference that explicates
the process and outcome of countertransference experienced in the traumatic setting. Initial indications show that the assimilation and
integration of traumatic experience are directly shaped by cultural influences - the Northern Ireland and Bosnian cohorts exemplifying
features that are distinct to both culture and traumatic context.
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