Vicarious Trauma and the VOTE Index

Abstract: In this article, I reflect on my personal experience participating in the VOTE study and how it will shape my approach to supporting supervisees facing vicarious trauma. I discuss how the findings from the VOTE Index highlight the importance of addressing vicarious trauma within mental health organizations. Beginning with the creation of a trauma-informed organizational culture, I emphasize the need for all members to understand and acknowledge the impacts of trauma on both clients and staff. I also explore systemic change and policy integration, advocating for the implementation of trauma-informed care practices, peer support structures, and policies that prioritize the well-being of mental health professionals. I then shift focus to leadership strategies, offering actionable recommendations for leaders to champion these changes, including fostering supportive supervision practices, advocating for work–life balance, and ensuring access to mental health resources. Finally, I discuss fostering a sustainable, supportive environment, emphasizing the need for ongoing training, wellness programs, and staff check-ins to ensure long-term support. By integrating these strategies, I propose a comprehensive, actionable framework that addresses vicarious trauma at both the individual and organizational levels. I conclude with a call to action for leadership and organizations to take meaningful steps toward creating healthier, more resilient work environments for mental health professionals.

Addressing Vicarious Trauma in the Workplace: A Call for Industry Support

As a supervisor in the mental health field, I have long observed the profound effects that vicarious trauma can have on professionals who work with trauma survivors and people in crisis. I have witnessed firsthand how this “second-hand” trauma affects my supervisees—whether it manifests as emotional exhaustion, difficulty separating work from personal life, or signs of burnout. This phenomenon, commonly referred to as vicarious trauma, is not a new concept, but it has become increasingly urgent as we learn more about how exposure to clients’ traumatic experiences affects mental health professionals (Figley, 2002).

In the spring of 2023, I had the privilege of participating in a study led by Dr. Beth Stelson, PhD, MSW, LSW, MPH, and postdoctoral research fellow at the Harvard T.H. Chan School of Public Health. This study aimed to develop and test the Vicarious Occupational Trauma Exposure (VOTE) Index, a tool designed to measure and identify the specific ways in which professionals like myself are exposed to trauma in the workplace (Stelson et al., 2024). My involvement in the study was particularly meaningful because it focused on identifying and measuring the sources of vicarious trauma exposure rather than merely addressing its symptoms. For years, I have worked with my supervisees to manage the emotional toll of their roles, but understanding the root causes of their exposure to vicarious trauma is a critical step toward systemic change (Lockhart, 2024).

The VOTE Index serves to identify the types of trauma exposure in our work, how frequently we encounter it, and the intensity of that exposure. I find this tool particularly valuable as it not only validates the struggles that my supervisees face but also provides a framework to guide my supervision practices moving forward. I will discuss how I support my supervisees in managing vicarious trauma and explore the need for organizational change to better support the mental health of the workforce.

What I Have Learned From the VOTE Index Research

The VOTE Index categorizes exposure into four domains: clients sharing their trauma histories, receiving and reviewing trauma-related evidence, documenting and reporting trauma, and exposure through colleagues (Stelson et al., 2024). My involvement in the study has not only deepened my understanding of these categories but also highlighted the variability of exposure across different roles within the mental health field. The empirical findings of the study, which included data from over 1,400 substance use disorder (SUD) professionals, revealed strong correlations between vicarious trauma exposure and indicators of secondary traumatic stress, psychological distress, and job satisfaction (Stelson et al., 2024). This connection is critical for me as a supervisor because it provides a clear framework for identifying which aspects of my supervisees’ work contribute to their emotional burden.

Moreover, the VOTE Index demonstrated high reliability, with scores remaining stable over a 2-week period, and its validity was shown to correlate significantly with established measures of secondary traumatic stress (Stelson et al., 2024). This is an important aspect of my supervision practice—having a reliable tool to assess vicarious trauma exposure helps me better understand the challenges my supervisees face, allowing for more targeted interventions.

Supporting Supervisees Through Vicarious Trauma

As a supervisor, my role extends beyond overseeing the day-to-day tasks of my supervisees to prioritizing their well-being and resilience in the face of challenges like vicarious trauma. Recognizing the emotional and psychological toll that this trauma can take on mental health professionals, I aim to create a supportive environment that acknowledges these burdens (Figley, 2002). By cultivating a space where supervisees feel comfortable discussing the impact of their work, I can better understand the sources of their stress and provide the necessary support to help them manage it effectively.

To assess the individual needs of my supervisees, I begin by maintaining open lines of communication. I make it a priority to create a space where they feel comfortable discussing their emotional experiences and vulnerabilities. Through regular one-on-one supervision meetings, I not only review their casework but also check in on their personal well-being. This practice encourages supervisees to reflect on their emotional responses to their clients’ trauma, allowing me to identify potential signs of vicarious trauma or burnout.

For example, I had a supervisee who worked with individuals struggling with severe substance use disorders. This supervisee, though passionate and committed, began to exhibit signs of emotional fatigue—irritability, withdrawal, and a reduced ability to empathize with clients. After observing these shifts, I initiated a conversation about how they were managing the emotional toll of their caseload. Through this discussion, it became clear that they were absorbing too much of their clients’ distress without taking the necessary steps to process their own feelings. I implemented a twofold approach: First, I recommended they engage in reflective supervision, which emphasizes self-awareness and processing emotional responses, and second, I encouraged them to incorporate more frequent breaks and mindfulness techniques into their routine to recharge.

Had the VOTE Index been available during my tenure as the inaugural program manager for Colorado Crisis Services, I would have integrated it as a key tool to tailor my support for supervisees. The VOTE Index provides valuable insights into the specific sources and intensity of vicarious trauma exposure for each individual, allowing for a more targeted and informed approach. With this tool, I could have better understood which aspects of my supervisees’ roles—whether it was client interactions, case documentation, team meetings, or other work-related stressors—were contributing most to their emotional and psychological stress.

Using these data, I would have been able to adjust their caseloads, redistribute responsibilities, or offer additional support in particular areas, such as debriefing sessions after difficult cases or extra time for self-care. For example, if the VOTE Index highlighted that a supervisee was consistently exposed to traumatic stories from clients but struggled with case documentation as a stressor, I would have been able to modify their documentation responsibilities or ensure they received extra support in those areas. This approach would have helped me provide a personalized, data-driven level of support, ensuring that each supervisee received the care they needed based on their unique needs and vulnerabilities. Instead, I relied on informal methods such as regular check-ins and reflective supervision to understand the emotional toll on my team. However, had the tool been available, it would have certainly enhanced my ability to offer more targeted interventions, making it an invaluable resource in creating a healthier, more sustainable work environment.

Encouraging a healthy work–life balance is crucial to mitigating vicarious trauma, so I take proactive steps to help supervisees understand the importance of boundaries between work and personal life. For instance, I recommend that they engage in regular activities that promote physical and mental health, such as exercise, creative outlets, and social connections. I believe that fostering this awareness of balance helps my supervisees maintain their emotional health in the long run. Through these individualized strategies, I aim to create a supervision culture where emotional support is just as vital as clinical guidance. This approach not only helps my supervisees manage the effects of vicarious trauma but also cultivates a deeper sense of compassion and professionalism in their work.

Creating a Trauma-Informed Organizational Culture

Creating a trauma-informed organizational culture is essential for addressing vicarious trauma effectively and ensuring the long-term well-being of mental health professionals. The impact of vicarious trauma is not limited to individual cases; it is also shaped by the broader organizational environment. Therefore, fostering a trauma-informed culture within an organization involves integrating principles that promote safety, trust, and empowerment at every level of operation.

A key first step is to ensure that organizational leadership understands and recognizes the pervasive impact of vicarious trauma on staff members. Leaders must create an environment where the acknowledgment of trauma is normalized and where employees feel supported in disclosing their experiences without fear of judgment or stigma. This requires training for leadership and staff on the signs and symptoms of vicarious trauma, as well as the development of policies that encourage open communication about emotional and psychological well-being.

Trauma-informed care principles—such as safety, trustworthiness, peer support, and collaboration—should be embedded in the fabric of the organization. These principles help to create a work environment that does not retraumatize employees but instead offers a supportive foundation for processing the emotional challenges of their roles. For example, organizations can implement regular peer support groups, where staff can share their experiences and coping strategies in a confidential, nonjudgmental space. This kind of peer support fosters solidarity and mutual care among colleagues, creating a collective sense of resilience.

Additionally, establishing clear, structured supervision and mentorship programs is crucial. Supervisors should be equipped with tools and training to recognize the early signs of vicarious trauma in their supervisees, offer emotional support, and guide them toward appropriate interventions. In this context, the VOTE Index could play an important role by offering supervisors specific data on the types and intensity of trauma to which their team members are exposed. These data can inform decisions around caseloads, work assignments, and individualized support measures to prevent burnout and promote mental health.

Another important aspect of a trauma-informed organizational culture is flexibility. Organizational policies should incorporate flexible scheduling, reasonable workloads, and opportunities for staff to take breaks, which can help mitigate the emotional toll of working in a high-stress, trauma-exposed environment. A culture that encourages taking time for self-care, whether through breaks during the day or through longer term sabbaticals, can help to preserve the emotional resilience of staff members.

Furthermore, it is vital to create an organizational structure that promotes work–life balance. This includes developing policies that support employees in maintaining clear boundaries between their professional and personal lives, reducing the risk of emotional exhaustion and burnout. Encouraging employees to take time off when needed, offering mental health days, and integrating wellness programs can help foster a healthier, more sustainable work environment.

Finally, ongoing evaluation and feedback systems should be implemented to assess the effectiveness of these practices. Organizational leaders should actively solicit feedback from staff about the support systems in place and whether they feel that their emotional and psychological needs are being met. This feedback loop allows for continual improvement and adaptation of policies, ensuring that the organization remains responsive to the evolving needs of its employees.

Overall, creating a trauma-informed organizational culture requires a holistic approach that integrates leadership, policies, and practices designed to support mental health professionals in managing the effects of vicarious trauma. By embedding trauma-informed principles into the organizational culture, organizations can foster an environment of safety, trust, and empowerment, allowing staff members to thrive and providing the support necessary to sustain their mental and emotional well-being.

Systemic Change and Policy Integration to Address Vicarious Trauma

Addressing vicarious trauma within mental health organizations requires a multifaceted approach that integrates systemic changes and thoughtful policy development. Although individual supervision and support strategies are essential, organizations must take proactive steps to weave vicarious trauma prevention into the fabric of their operations and culture. By doing so, they foster an environment that not only supports individual well-being but also ensures the long-term sustainability and effectiveness of the workforce.

At the organizational level, it is vital to create and implement policies that directly address the risks associated with vicarious trauma. These policies should prioritize trauma-informed practices, ensuring that every staff member, from leadership to frontline clinicians, understands the emotional and psychological challenges of their work. Training programs should be instituted to equip staff with the knowledge and tools necessary to recognize signs of vicarious trauma and provide appropriate interventions, such as self-care strategies or peer support networks.

In addition, organizations should develop clear guidelines for supervisors and managers that emphasize the importance of creating safe spaces for staff to discuss emotional challenges. Regular check-ins, supervision, and debriefing sessions should be institutionalized as part of the work process, giving employees structured opportunities to reflect on their emotional well-being. This not only reduces isolation but also encourages the normalization of discussing mental health challenges within the workplace.

Furthermore, policies around work–life balance and flexibility are essential. Organizations should allow for flexible work hours, reduced caseloads during periods of high emotional intensity, and mandatory time off to help staff recharge. Such policies demonstrate a commitment to the mental health of employees and reduce the risk of burnout.

Finally, it’s crucial that organizational policies are reflective of an ongoing commitment to vicarious trauma management, not as a one-time initiative but as an evolving aspect of workplace culture. Continuous feedback loops, regular assessments, and adaptations of policies ensure that organizational support remains dynamic and responsive to the needs of the workforce. These systemic and policy-level recommendations form the foundation for creating an environment where staff feel supported, heard, and equipped to manage the emotional challenges of their work. However, for these changes to be effective, strong leadership is necessary to guide and sustain these efforts.

Leadership Strategies

Effective leadership is a cornerstone of creating an environment where vicarious trauma is acknowledged and managed proactively. Leaders have the unique responsibility to set the tone for organizational culture, influencing how staff perceive and respond to the emotional and psychological challenges inherent in their roles. For systemic changes to take root, leadership must not only endorse but actively champion policies that address vicarious trauma, ensuring that these efforts are ingrained into everyday practices.

One of the key strategies for leadership is the modeling of self-care and emotional health. Leaders should demonstrate a commitment to their own well-being by openly participating in wellness programs, taking time for self-care, and seeking support when needed. This sets a powerful example, signaling to staff that prioritizing mental health is both acceptable and encouraged. By demonstrating vulnerability and openness, leaders help to destigmatize mental health struggles and create an atmosphere of trust and safety.

Moreover, leadership must invest in training and development for supervisors and managers, equipping them with the tools to recognize and respond to signs of vicarious trauma in their teams. Supervisors play a critical role in mitigating the effects of vicarious trauma, so leadership should provide ongoing education in trauma-informed care, reflective supervision techniques, and strategies for creating emotionally supportive work environments. By empowering leaders at all levels of the organization, the capacity for managing vicarious trauma is amplified across the entire workforce.

Leadership should also advocate for policies that enhance the work–life balance of employees. Providing flexible scheduling options, promoting the use of paid time off, and ensuring adequate staffing levels are essential actions that demonstrate a genuine commitment to staff well-being. Furthermore, implementing regular debriefing sessions after particularly challenging cases or events allows employees to process their emotional responses and share coping strategies, helping to alleviate the weight of trauma exposure.

Creating a culture of open communication is another key leadership responsibility. Leaders should establish regular forums—whether through team meetings, town halls, or one-on-one check-ins—where staff feel comfortable discussing their emotional and psychological challenges. Encouraging transparency around the impact of vicarious trauma allows employees to feel heard and valued, reducing feelings of isolation and burnout.

Finally, leadership must remain adaptable, recognizing that the landscape of mental health work is always evolving, and the needs of staff may change over time. Continuous evaluation and feedback from staff will help leaders identify emerging stressors, challenges, and opportunities for improvement. Leaders should use these data to refine policies, practices, and support systems, ensuring that the organization’s response to vicarious trauma is as effective as possible.

Fostering a Sustainable, Supportive Environment

Creating a sustainable, supportive environment is essential to ensuring that mental health professionals can continue to thrive in their roles while managing the demands of vicarious trauma. This environment is not just about providing immediate relief but about embedding long-term practices and policies that promote well-being and resilience across the workforce. Sustainable support requires an integrated approach that combines organizational structure, individual support systems, and a commitment to ongoing growth and adaptation.

One of the first steps in fostering such an environment is ensuring that support structures are built into the organizational framework. This can be achieved by offering consistent access to resources such as peer support networks, mentorship programs, and regular supervision. These structures provide staff with the opportunity to share experiences, seek advice, and receive emotional support in a safe and structured way. Additionally, encouraging team-based approaches to casework and collaboration can reduce the sense of isolation that often accompanies traumatic work while also promoting shared responsibility for managing difficult emotional content.

Regular and structured debriefing sessions are another essential tool in sustaining support for mental health professionals. These sessions offer staff the chance to process the emotional weight of their work, reflect on their experiences, and receive guidance on how to manage any emotional distress. When conducted regularly, debriefings not only address immediate reactions but also foster a culture of reflective practice, helping staff build the emotional resilience needed for long-term success. To ensure these sessions are effective, it is important that they are facilitated by trained individuals who can guide conversations and provide emotional validation without minimizing or bypassing difficult emotions.

Another critical component of a sustainable, supportive environment is promoting mental health awareness and education throughout the organization. This involves not only providing training on the effects of vicarious trauma but also embedding mental health literacy into the daily work culture. When everyone—leadership, supervisors, and staff alike—has a clear understanding of the signs of vicarious trauma and knows where to turn for help, it reduces stigma and encourages early intervention. Regularly reinforcing the importance of self-care and well-being as part of professional development can help normalize the conversation around mental health, ensuring that employees feel supported in taking proactive steps to care for themselves.

Creating a sustainable, supportive environment also requires attention to the physical workspace. The design of the work environment can have a significant impact on employees’ emotional and psychological health. For example, ensuring that staff have access to private spaces where they can decompress or reflect after emotionally taxing interactions is one way to provide support. Additionally, workspaces that promote collaboration and social connection can help build a sense of community among staff, which can be a powerful buffer against stress and burnout.

Flexibility is another important factor in fostering a sustainable environment. Offering flexible scheduling, remote work options, and the ability to take mental health days without stigma or penalty is crucial in supporting employees in managing their workload and personal well-being. This flexibility allows staff to balance their professional responsibilities with self-care, ultimately preventing burnout and ensuring a more engaged and productive workforce.

Finally, to maintain a sustainable, supportive environment, it is essential that organizations regularly assess the effectiveness of their support systems. This can be done through surveys, feedback sessions, or one-on-one meetings with staff to gauge how they are coping with the demands of their work and to identify any gaps in support. By staying attuned to the needs of the workforce, organizations can adapt and evolve their practices to meet changing demands, ensuring that support remains effective over time.

The Path Forward

As mental health professionals continue to navigate the challenges of vicarious trauma, the path forward must be one that prioritizes proactive measures, systemic change, and a commitment to fostering resilience within the workforce. To address the pervasive issue of vicarious trauma, it is essential that both individual and organizational efforts are aligned to create a culture that values well-being, supports mental health professionals, and prioritizes long-term solutions over short-term fixes.

The use of tools like the VOTE Index is a critical step in the right direction. By providing data-driven insights into the specific sources and intensity of vicarious trauma, the VOTE Index allows for more targeted and individualized support for mental health professionals. However, such tools are only effective when integrated into broader organizational strategies. As organizations begin to recognize the widespread impact of vicarious trauma, it is crucial to adopt and integrate comprehensive, trauma-informed policies and practices that address not only the symptoms but also the root causes of emotional distress in the workforce.

Leadership plays a central role in this transformation. Leaders must actively advocate for and implement systemic changes, setting the tone for a supportive organizational culture that values self-care, ongoing professional development, and emotional well-being. This includes allocating resources for supervision, peer support, and training on mental health, as well as fostering a workplace environment that promotes transparency, open communication, and psychological safety. Leaders who model these behaviors create an environment where mental health professionals feel empowered to seek help, reflect on their emotional needs, and access the necessary resources without fear of judgment or stigma.

Equally important is the continued advocacy for policies that support work–life balance, flexible scheduling, and access to mental health care for employees. These policies must be backed by a commitment to creating a sustainable, trauma-informed workforce. Ensuring that mental health professionals are supported by their organizations helps mitigate the risk of burnout and enhances their ability to provide high-quality care to their clients.

The broader mental health community also has a significant role to play. Advocacy at local, state, and national levels is necessary to ensure that mental health professionals are recognized for the emotional labor they perform and that adequate support systems are in place. Collaboration between organizations, academic institutions, and policymakers can help raise awareness of vicarious trauma and lead to the development of national standards for trauma-informed care and supervision.

Finally, the path forward requires a collective, ongoing commitment to self-care and resilience building. Mental health professionals, supervisors, and organizations must continuously evaluate and refine their approaches to supporting staff, ensuring that strategies remain relevant and effective in addressing the evolving needs of the workforce. Regular assessments, feedback loops, and a culture of continuous improvement are essential in creating a lasting impact.

As we move forward, it is vital that the mental health community views the prevention of vicarious trauma as a shared responsibility—one that requires the commitment of individuals, supervisors, and organizations alike. Only through systemic change, leadership commitment, and a sustained focus on support can we create a healthier, more sustainable environment for mental health professionals and, ultimately, the clients they serve.

In conclusion, the fight against vicarious trauma is not one that can be won through isolated efforts; it requires a united approach to advocacy, systemic change, and leadership. By taking concrete steps to support mental health professionals, we ensure that they are not only able to manage the emotional toll of their work but also empowered to continue providing the compassionate care that is at the heart of their profession.

References

Figley, C. R. (2002). Compassion fatigue: Psychotherapists’ chronic lack of self-care. Journal of Clinical Psychology, 58(11), 1433–1441.

Lockhart, E. (2024). How to avoid burnout in corporatized care settings. Psychotherapy.net. https://www.psychotherapy.net/article/how-to-avoid-burnout-in-coporatized-care-settings.

Stelson, E., Sabbath, E. L., Chen, L., Sorensen, G., Berkman, L., & Kubzansky, L. D. (2024). The Vicarious Occupational Trauma Exposure (VOTE) Index: Instrument development and validity and reliability assessment with the substance use disorder workforce. Center for Work, Health, & Well-being. https://centerforworkhealth.sph.harvard.edu/resources