Secondary Trauma: Qualitative Research with Survivors of Attempted Suicide
Originally published on Youth Suicide Research Consortium's Blog on 12/19/2019
James Spradley, famed cultural anthropologist, wrote that the purpose of qualitative research is to walk in the shoes of our participants: “I want to understand the meaning of your experience, to feel things as you feel them, to explain things as you explain them.”[i] If this is the goal of qualitative research, what do qualitative researchers hazard when they investigate the lives of individuals who attempt suicide?
For the past 10 years, I have dived deep into the qualitative world of adolescents who experience suicidal thoughts and behaviors. Together with a team of clinical social workers, licensed professional counselors, and students training in the health and mental health fields (two of whom are co-authors on this post), we have listened closely and born witness to the pain and suffering of adolescents who are doing their best to survive conditions that are not of their own making.[ii] Over time, we have come to see how repeated exposure to our participants’ suffering—abuse, sexual trauma, poverty, discrimination, attempting suicide—negatively affects our own well-being. Undeniably, each of us is committed to the value offered by a qualitative approach. As Heidi Hjelmeland and Birth Knizek note, “By means of qualitative methodology, we can study dynamic, contextual phenomena, such as suicidal behavior, differently and in greater depth.”[iii] Nevertheless, there is a critical need to understand the impact this research holds for members of a study team.
There is a growing empirical literature on secondary trauma, particularly in the mental health fields. Secondary trauma is defined as “harmful changes that occur in professionals’ views of themselves, others, and the world, as a result of exposure to the graphic and/or traumatic material of their clients,” while secondary traumatic stress is associated with the emergence of PTSD-like symptoms as a consequence of that exposure.[iv] Much of the research on secondary trauma focuses on the occupational hazards associated with being a mental health provider, highlighting how listening to traumatic narratives can put therapists at risk for the development of trauma-related symptoms. For example, in a study by Jason M. Newell and Gordon A. MacNeil,3 the researchers found that along with professional burnout, social workers and other clinicians who worked with trauma populations often experienced intrusive thoughts, nightmares, insomnia, hypervigilance, and avoidance of clients in the future—hallmarks of secondary traumatic stress.[v]
While secondary trauma is certainly a risk for mental health providers, few studies document the experiences of qualitative researchers working with survivors of attempted suicide. To be sure, some level of emotional reactivity is expected in qualitative research, including frustration, sadness, anger, or guilt.[vi] Yet, because qualitative research requires empathetic, repeated listening to the stories our participants tell, this continual exposure can result in secondary trauma.[vii] Given this, it is crucial that research teams develop protocols for managing emotional and psychological safety in the course of qualitative research on suicidal behaviors.
Currently, there are few empirical guidelines published to aid research teams in developing safety protocols for team members’ well-being. To this end, we describe some of the strategies that we have implemented. It is our hope that this can be a starting point for engaging in deeper conversations about ways to carry out qualitative research that is not only ethical and safe for our participants, but for ourselves as well.
● Begin all team meetings with a check-in. In our meetings, this often takes the form of a whip around,[viii] in which each team member says a few words about how they are feeling. This allows the principal investigator (PI) to quickly gauge the emotional pulse of the team and determine how best to follow-up with team members who are struggling.
● Foster open and authentic communication among team members. This empowers individuals to raise issues that are concerning to them and collectively develop strategies to process upsetting situations. Strategy development can be enhanced by having a licensed professional counselor as a member of the research team.
● Encourage team members to journal. This journal can take any form that best suits the individual to aid in de-escalating potentially harmful emotions or reactions to the research. This could be as simple as writing down which emotions they feel in the moment, or as extensive as exploring a personal connection to the experiences of the research participants.[ix]
● The PI should be fully aware of the mental health resources that are available on the university campus (for student members of the research team) and in the community. This allows the PI to make referrals as necessary, and work with team members to access services at reduced or no cost.
● There is a small, but burgeoning literature on minimizing mental health risk among qualitative researchers working on sensitive topics.[x]-[xiii] Make this literature available to team members, and encourage group discussions about integrating this literature into current team processes.
[i] Spradley, J. P. (2016). The ethnographic interview. Waveland Press.
[ii] Gulbas, L. E., Guz, S., Hausmann-Stabile, C., Szlyk, H. S., & Zayas, L. H. (2019). Trajectories of well-being among Latina adolescents who attempt suicide: a longitudinal qualitative analysis. Qualitative Health Research, 29(12), 1766–1780.
[iii] Hjelmeland, H., & Knizek, B. L. (2016). Time to change direction in suicide research. In R. C. O'Connor & J. Pirkis (Eds.), The international handbook of suicide prevention (pp. 696-709). Chichester: Wiley.
[iv] Baird, K., & Kracen, A. C. (2006). Vicarious traumatization and secondary traumatic stress: A research synthesis. Counselling Psychology Quarterly, 19(2), 181-188.
[v] Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue. Best Practices in Mental Health, 6(2), 57-68.
[vi] Kiyimba, N., & O’Reilly, M. (2016). The risk of secondary traumatic stress in the qualitative transcription process: A research note. Qualitative Research, 16(4), 468-476.
[vii] Chen, J. I., Mastarone, G. L., & Denneson, L. M. (2019). It's not easy – Impacts of suicide prevention research on study staff. Crisis, 40(3), 151-156.
[viii] Sugerman, D. A., Doherty, K. L., Garvey, D. E., & Gass, M. A. (2000). Reflective learning: Theory and practice. Dubuque, IA: Kendall Hunt Publishing.
[ix] Malacrida, C. (2007). Reflexive journaling on emotional research topics: Ethical issues for team researchers. Qualitative Health Research, 17(10), 1329-1339.
[x] Polanco, M., Mancías, S., & LeFeber, T. (2017). Reflections on moral care when conducting qualitative research about suicide in the United States military. Death studies, 41(8), 521-531.
[xi] Driscoll, T. R., Hull, B. P., Mandryk, J. A., Mitchell, R. J., & Howland, A. S. (1997). Minimizing the personal cost of involvement in research into traumatic death. Safety science, 25(1-3), 45-53.
[xii] Dickson-Swift, V., James, E. L., Kippen, S., & Liamputtong, P. (2009). Researching sensitive topics: Qualitative research as emotion work. Qualitative research, 9(1), 61-79.
[xiii] Whitt-Woosley, A., & Sprang, G. (2018). Secondary traumatic stress in social science researchers of trauma-exposed populations. Journal of Aggression, Maltreatment & Trauma, 27(5), 475-486.
Lauren E. Gulbas, Ph.D., Jordan Bremer, and Madeline Moore, Steve Hicks School of Social Work, The University of Texas at Austin