P


CLINICAL EDITOR’S COMMENTS: The author poses helpful questions so play therapists can evaluate and adjust their self-care practices.


lay therapists often describe their work as highly gratifying. Yet, most play therapists are routinely exposed to the traumatic experiences of children, whose innocence,


vulnerability, and suffering can evoke poignant reactions among helping   repeatedly imagining the events that befell their clients or avoiding stimuli that remind them of clients’ traumatic experiences. Furthermore, increased awareness of issues related to childhood victimization can cause therapists to reassess their beliefs about the world, human nature, spirituality, and ambient danger. Despite the rewards of providing play therapy, indirect trauma exposure can impact play therapists’ thoughts, emotions, behaviors, worldview, work-related enthusiasm, and sense of 


Secondary Traumatic Stress (STS) More than two decades ago, authors began describing how indirect trauma exposure or empathic engagement with others who have experienced traumatic events may lead to helping professionals’ own adverse reactions (Elwood, Mott, Lohr, & Galovski, 2011; Everly, Boyle, & Lating, 1999; Figley, 1995; Mitchell, 1983; Pearlman and Saakvitne, 1995). These and other authors used the overlapping – but not identical – terms compassion fatigue, vicarious traumatization, and secondary traumatic stress (STS) to describe this phenomenon. The phrase STS, which is the focus of this article, has been used to convey posttraumatic stress disorder (PTSD) symptoms, exposure-related distress, alterations to cognitive schema, and/or changes in functioning. In an effort to standardize use of the term, Sprang, Ford, Kerig, and Bride (2018)      therapists empathically experience the psychobiological impact of trauma on clients, including both the traumatic event(s) they experienced and their subsequent trauma symptoms.


Many STS reactions are expected, transient, and normative, whereas some responses may represent signs of impairment or pathology. In the Diagnostic and Statistical Manual, Fifth Edition (DSM-5; APA, 2013), the PTSD stressor criterion was expanded to include individuals with indirect but repeated or extreme exposure to details of traumatic events during their work. This broadened criterion legitimized the possibility that play therapists may experience PTSD as a result of their work-related trauma exposure.


Prevalence  that prevalence and incidence studies have yielded widely varied STS    


 2007) in survey-based research. Distress is often endorsed more than           research involving trauma-exposed populations reported moderate to   STS among play therapists are lacking, research on other child-focused professionals suggests that full PTSD criteria are met relatively rarely but subthreshold symptoms are commonly endorsed (Bride et al., 2007).


Risk Factors for STS  not well understood. Common STS research variables include: • Work-related contributors: frequency or ratio


(i.e., the proportion


of trauma-related to non-trauma-focused work) of trauma-related exposures, years of experience, or caseloads involving high acuity, complexity, or dangerousness


• Training and supervision variables: lack of formal trauma training, absence of trauma-informed supervision, non-use of evidence-based treatments


• Organizational factors: organizational culture or perceived lack of organizational support


• Individual variables: personal trauma history or use of maladaptive coping skills


Across multiple studies, STS has often been associated with work-related exposure to trauma and personal history of trauma. Yet, contradictory results have also sometimes emerged (e.g., exposure has been found to be unrelated to STS, and years of experience has been correlated both positively and negatively with STS). In a recent meta-analysis of risk factors for STS among professionals, younger clinicians and those with less experience showed higher risk of STS, though effect sizes were very small (Hensel, Ruiz, Finney, & Dewa, 2015). Small effect sizes were found for trauma exposure variables (e.g., high caseload, caseload frequency, caseload ratio, and therapists’ trauma history) and increased STS. Trauma training, work-related support, and social support were found to have subtle relationships to lower STS levels. Although more research is needed to understand STS risk factors, play therapists should consider the influence of these variables on their work and stress levels.


www.a4pt.org | June 2019 | PLAYTHERAPY | 17


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