Listening to Trauma - Therapists' countertransference and long-term effects of trauma work, Dr. Annemarie Smith, psychiater Stichting Centrum ’45

Op 3 februari 2009 promoveerde Annemarie J.M. Smith, psychiater bij  Stichting Centrum ’45, aan de Radboud Universiteit Nijmegen.

Traumatische tegenoverdracht - secundaire traumatisering - 'vicarious traumatization'

Onderzoek naar reacties van therapeuten bij de confrontatie met traumatische ervaringen van patiënten, toegespitst op het omgaan met traumatische ervaringen, zowel op de korte- als lange termijn. Ook is gekeken naar de invloed die de werkervaring van de psychotherapeut heeft op het omgaan met deze problematiek.
Centrale vragen zijn: hoe belangrijk zijn de concepten burnout, tegenoverdracht, secundaire traumatisering en 'vicarious traumatization' voor de beschrijving van de ervaring van trauma-therapeuten in hun werk? Hoe specifiek is de reactie van therapeuten op traumatisch materiaal? En: hoe specifiek zijn langetermijneffecten op de therapeut die werkt met getraumatiseerde patiënten?

Twee hoofdstukken uit dit proefschrift

How therapists cope with clients' traumatic experiences

Annemarie J.M. Smith, M.D., Wim Chr. Kleijn, M.Sc., R. Wim Trijsburg, Ph.D., Giel J.M. Hutschemaekers, Ph.D
This article was published in TORTURE, Volume 17, Number 3, 2007


An initial finding of high emotional stress in trauma therapists working in a specialized trauma institute led to three empirical studies on trauma-related therapist reactions. The purpose of these studies was to investigate the relation between high emotional burden and burnout, and the trauma-specific processes described by the concepts "secondary traumatic stress", "vicarious traumatization" and "traumatic countertransference". The initial qualitative/quantitative study examined how a group of specialized trauma therapists (N=63) coped with clients' traumatic experiences. The results on trauma-related reactions were inconclusive. This motivated a qualitative study of expert psychotherapists (N=11). Interviews with expert trauma therapists and other expert therapists were focused on reactions to the confrontation with traumatic experiences and differences between both groups of experts. Results indicated a specific reaction pattern to traumatic situations, but revealed no other differences between trauma specialists and other experts. To further examine trauma-specificity of this reaction pattern, a third study was conducted with psychology students (N=100) using an experimental design. The results suggest the existence of a trauma-specific reaction pattern, characterized by shock, anxiety and the experience of being carried away by strong emotions. The relation of trauma reactions with traumatic situations is endorsed by results on differential reactions to traumatic and interactionally difficult situations, although results suggest that other kinds of situations with high emotional impact may also evoke trauma-reactions. In the discussion the results are considered in relation to the limitations of the studies are followed recommendations for further research. Our results thus far support the high emotional impact of confrontation with traumatic material, but nuances psychopathological or other long-term negative changes that are suggested by the terms secondary or vicarious traumatization.

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Therapist reactions in self-experienced difficult situations: An exploration

Annemarie Smith, Wim Kleijn, Giel Hutschemaekers
This article was published in Counselling and Psychotherapy Research, March 2007


This article escribes a qualitative study of 63 difficult therapeutic situations described by 26 therapists. The study was part of research on specific reactions of therapists to traumatized clients. The research questions for the current analyses focused on the categorization of difficult situations, of short-term therapist reactions, and the exploration of situation-specific reaction patterns. The therapeutic style of the therapist was also explored. Three types of difficult situations were found: 'traumatic situations', 'interactional situations' and 'existential situations'. Therapist reactions were sorted into 20 categories; 10 of them were part of a situation-specific pattern. The therapeutic style of therapists was defined by a first dimension reflecting a continuum of experiencing versus actively intervening and a second dimension of feeling responsible. The relevance for therapist self-reflection, supervision and training is to acknowledge the specific difficulties in different therapeutic situations related to therapist-specific reactions, and to enhance constructive coping in accordance with the therapist's therapeutic style.

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