Secondary Traumatic Stress in the Hypnotherapy Profession

Secondary Traumatic Stress is something that anyone in the therapy profession could experience, yet it is has been my experience that very few hypnotherapists have even heard of it. In this article, it is my aim to rectify that, discussing what it is, how it might impact your work with clients, and how you can limit your chance of experiencing it.

Secondary Traumatic Stress (STS) refers to trauma that is experienced indirectly.

When working with clients, we see the ongoing ramifications of the traumatic situations that they’ve experienced in their lives. We hear the details of what they went through during those difficult times; in some cases, in great detail. When acting in an empathetic way towards our clients, we inevitably get a taste of what it must have been like to have gone through what they have. We ourselves are experiencing their same traumas vicariously.

The term has often been used interchangeably with vicarious trauma, compassion fatigue and burnout. Whilst there is some overlap, these terms are different and we will be focusing on STS throughout this article.

How Secondary Traumatic Stress Might Affect Your Hypnotherapy Practice

Secondary Traumatic Stress can negatively impact the therapeutic relationship in a number of different ways. Many of the symptoms of STS are consistent with that of Post Traumatic Stress Disorder (PTSD), and like PTSD, everyone who experiences STS, will be affected differently.
Avoidance behaviours are quite common, for example, a hypnotherapist with STS might cancel sessions with their clients, not return phone calls or emails, and may choose not to work with a client who has experienced trauma, depression or other issues that they perceive to be highly emotional.

Due to not wanting to hear details of trauma or anything else that might bring up emotions, they might change how they work with their clients. They may ask less exploratory questions during the assessment, and not allow the client adequate time to explain how their problem is affecting them. All of this will affect the therapists’ ability to compile an effective treatment plan for their client.

In addition, the hypnotherapist with STS may not be wholly present when working with a client; feeling detached, distracted, and emotional. This might lead to an inability to make decisions, problem solve or remain objective when trying to help a client.

A hypnotherapist with STS may feel resentment or anger toward their client for making them feel the way they do, although it is not their fault, of course. Their ability to feel empathy towards their clients may also be reduced.

All of this can lead to the client feeling unsupported, unheard, frustrated, and alone, all of which can affect rapport. Ultimately, this leads to the client not getting what they need from the hypnotherapy process.

One might think that a hypnotherapy supervisor, whilst at risk when seeing their clients, would be exempt from such a thing when working with a supervisee. However, we still get to hear about their client’s traumas and how it is affecting both their client and themselves.

How To Reduce The Risk of Secondary Traumatic Stress

The Headington Institute, who support organisations that provide humanitarian and relief work across the world, put forward an STS prevention plan for the first responders and other workers. The structure of the prevention plan makes it accessible for hypnotherapists to use and would fit nicely into your reflective practice. It consists of seven steps for you to follow. Some of it will already feel very familiar to you, as you no doubt use similar questions and processes with your clients.
  1. Write down any important risk factors that might be present at the moment which could result in you experiencing secondary traumatic stress. If you have a personal history of trauma or mental health issues, you may be at a greater risk of developing STS
  2. Write down any symptoms that you are experiencing that might relate to secondary traumatic stress. This is a difficult one as the symptoms of STS can occur as a result of other issues too such as burnout, stress, depression, anxiety, etc.
  3. Write down what things you could do to help you cope better with these symptoms.
  4. Write down what steps you could take, during work as well as in your spare time, that can help with STS?
  5. Now that you have a better idea of how you could help with the symptoms and with STS generally, set yourself two SMART goals that relate to your answers for the steps 3 and 4 that you can do on a weekly basis. Write them down.
  6. Write a list of any obstacles that may get in the way of you carrying out the things you set for yourself in step 5.
  7. Write down what you could do to overcome these obstacles and what support you might need to help you accomplish your goals.
In addition to this STS prevention plan, there are other things that you can be doing to minimise the risk of STS including:
  • Reflective practice. Reflect on the work you do with your clients on a regular basis. In addition to assessing what is going well and what can be improved upon, it helps you to recognise where you might be taking on too much, thinking or behaving in a way that is uncharacteristic for you, and need to take a step back.
  • Professional boundaries. Ensure that you maintain your professional boundaries. Be mindful of your client caseload and not taking on too much. Factor in breaks throughout your day and try to space out your clients that have experienced trauma. Schedule annual leave for yourself at regular intervals throughout the year.
  • Supervision/peer support. Increased levels of social support, whether that’s from family, friends, supervisors or peers, are associated with reduced levels of symptoms associated with STS, VT and burnout (Dunkley & Whelan, 2006). Talking to other therapists will help you recognise and/or manage STS.
  • STS questionnaire. The Secondary Traumatic Stress Scale (Bride, Robinson, Yegidis, & Figley, 2004) consists of 17 statements that are used to assess the level at which someone is experiencing STS. Here is a link to a pdf version of the questionnaire that you can download and make use of within your reflective practice. Being aware of the early warning signs can help to prevent STS. 
  • Self-care. You need to put yourself first. If you look after your own psychological well-being, you will be much better placed to deal with clients, especially where trauma is involved. For tips on therapist self-care, see this article 
Now that you are familiar with what Secondary Traumatic Stress is, it is my hope that you will be better placed to be aware of it in your professional capacity as a hypnotherapist and can take the necessary steps to ensure that you look after yourself.


Guest Blogger: Sarah Mortimer

Sarah Mortimer is an experienced clinical hypnotherapist and qualified hypnotherapy supervisor, based in Bristol. She specialises in anxiety, phobias and insomnia. She is Research & Supervision Officer for the Professional Hypnotherapy Network (PHN) and a member of the team involved in organising the annual UK Hypnosis Convention. She is also a classroom assistant on the Hypnotherapy Practitioner Diploma at the Anglo European College of Therapeutic Hypnosis. For more information, visit her website at

Bride, B.E., Robinson, M.M., Yegisis, B. & Figley, C.R. (2004). Development and validation of the STSS. Research on Social Work Practice, 27, 33
McNeil, A. D. (2012) Identification and Prevention of Secondary Traumatic Stress in Mental Health Professionals Who Work With Child Sexual Abuse Victims. Doctoral Projects. 35.
Dunkley, J. & Whelan, T. (2006). Vicarious traumatisation in telephone counsellors: internal and external influences. British Journal of Guidance and Counselling, 4, 451- 469.