Therapists, complex trauma, and the medical model: making meaning of vicarious distress from complex trauma in the inpatient setting

Limited research explores therapists' vicarious exposure to complex trauma narratives within an inpatient medical model promoting emotion regulation and symptom alleviation. This phenomenological study explored subjective interpretations of four senior trauma therapists working in inpatient settings. Data from semi-structured interviews were analysed using Interpretative Phenomenological Analysis (IPA). One superordinate theme: Therapeutic integrity and vicarious growth overarched four subordinate themes: 1) Severity, complexity, and repetition; 2) Personal distress and the medical model; 3) Intrapersonal confrontation; and 4) Growth. Two themes interpret co-existing distress, guilt, self-doubt, and sense-of-failure as internalized responses to the misfit between medical model interventions and complex psychosocial traumatic experiences of clients. The third interprets a personal search for therapeutic and personal integrity when vicarious distress and felt therapeutic futility collide. Fourth, redefining 'self' through intrapersonal honesty, altruism, and relational connectedness with patients distilled psychological wellbeing and growth. Overtime, these participants experienced vicarious psychological distress and loss of therapeutic integrity working within a medical model framework. Further, they perceived it limited recovery and growth in clients. By redefining and prioritizing their therapeutic integrity and relational alliance, these therapists found renewed commitment to trauma work and grateful appreciation of limitations and strengths for autonomy and wellbeing. Clinical implications are discussed.