Secondary traumatic stress and countertransference in survivor therapists: the role of empathy and differentiation of self

Abstract

The purpose of this study was to expand the present base of knowledge regarding two potentially destructive therapist reactions, secondary traumatic stress (STS) and countertransference, in a sample of mental health professionals currently treating traumatized clients who have also experienced a personal trauma themselves (i.e., survivor therapists). First, I examined the theoretical link between empathy, conceptualized through both cognitive and affective components, STS, and two types of countertransference (overinvolved and underinvolved). Next, the possible interaction between cognitive empathy and affective empathy was explored as a predictor of STS and countertransference. Finally, the Bowen Family Systems Theory construct differentiation of self, a salient factor for individuals in the helping professions, was examined as a moderator of these relationships. 245 survivor therapists from multiple professional backgrounds (e.g., social workers, psychologists, counselors, etc.) participated in the survey. STS and both types of countertransference were positively related and analyzed together. Although cognitive empathy and differentiation of self did not act as two-way moderators of the relationship between affective empathy and therapist reactions, a three-way interaction between affective empathy, cognitive empathy, and differentiation of self emerged. Survivor therapists with high empathy and low differentiation of self had increased risk of STS, and survivor therapists with low empathy and low differentiation of self reported increased risk of underinvolved countertransference. Therapists with high differentiation of self appeared to tolerate high cognitive and affective empathy without increased risk of therapist reactions, reporting the lowest levels of both STS and underinvolved countertransference. Clinical and theoretical indications are discussed. These findings have implications for trauma therapy training, supervision, and the management of inevitable STS and countertransference reactions.