Ethical competency when working with intimate partner violence among clinicians affected by trauma

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Vicarious trauma (VT) is the internal and psychological change that occurs due to exposure to and empathic engagement with traumatic material. VT changes the ways in which clinicians view and interact with the world around them, and these changes are lasting and pervasive. While many of the predictors of VT are known, researchers have not yet explored the ways in which VT impacts clinical functioning. Beyond VT, many clinicians have experienced a personal history of trauma, and more specifically a personal history of intimate partner violence (IPV). Clinicians with a personal history of IPV may experience countertransference reactions, or over-identify with clients with a similar trauma history. Both VT and a personal history of IPV might impact ethical decision making. Ethical decision making involves using personal morality as well as professional guidelines to ensure the best quality care for clients. Ethical decision making can be impacted by clinicians’ interpersonal reactivity, or their ability to engage in self-reflection and not become emotionally reactive. It has been proposed that VT and a personal history of IPV impact clinicians’ emotional functioning, but it is unclear the extent to which ethical decision making is impacted by VT or a personal history of IPV.
In order to assess this link, the present study examined the ways in which clinicians differed in their interpersonal reactivity and ethical decision making when using vignettes to imagine working with either a survivor or perpetrator of IPV. The results of this study concluded that mental health workers demonstrated more ethical competence when working with a survivor of IPV than with a perpetrator of IPV, and this finding was consistent across the domains of boundaries in therapy, knowledge, comfort, and skill in ethical dilemmas, assessing for risk, and identification with the client. When examining VT separately, VT was a predictor of interpersonal reactivity, such that clinicians who were high in VT also endorsed high personal distress when working with a survivor of IPV. Additionally, VT was a significant predictor of empathic concern and personal distress when working with a perpetrator, such that as VT increased in therapists, the empathic concern for perpetrators decreased while their personal distress increased. Further, VT was found to be a significant predictor of ethical competence, such that mental health workers low in VT demonstrated better ethical competence than those high in VT both when working with a survivor of IPV and a perpetrator of IPV. A personal history of IPV was found to be a predictor of empathic concern when working with a survivor and when working with a perpetrator of IPV.

Vicarious Trauma, Ethical Competency, Intimate Partner Violence, Clinicians, Therapists