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Working in the field of traumatic stress can have a profound impact on our lives in both negative and positive ways. As Herman (1992) elucidated, impartiality is virtually impossible when confronting the egregious inequity of traumatic life events; compassion and effective work require that we alter our political, emotional, and relational world in the light of our work with survivors. The staff at the Traumatic Stress Institute/Center for Adult & Adolescent Psychotherapy (TSI/CAAP) has been instrumental in educating clinicians, researchers, and policy makers about the potential personal costs of working with trauma survivors. Rather than pathologize the impact of traumatic life events on individuals and those who treat them, the TSI/CAAP staff have created a non-pathological model to explain and respond to both clients' and therapists' needs. In their workbook, Transforming the Pain, they distill two previous theoretical treatises, Trauma and the Therapist (1995) and Psychological Trauma and the Adult Survivor (1990), into a highly accessible and practical workbook detailing specific ways to prevent and ameliorate deleterious effects upon the professional.

The book is organized into an introduction, five succinct chapters, a complete reference section, annotated bibliography, and listing of TSI/CAAP resources. In the introduction, the authors explain their background and recommended approach to using the workbook. In Chapter 1, the relevant concepts, definitions, signs, and predictors of vicarious traumatization are described. Vicarious traumatization is defined as the occupational hazard that professionals experience when fundamental assumptions about the world and self's controllability, benevolence, trust, and esteem are betrayed. Unlike countertransference, vicarious traumatization refers to the destructive but normative generalized response to trauma work, rather than a personal response to a particular client situation. There is an outstanding, succinct synopsis of constructivist self development theory that describes how traumatic life events may affect client's and professional's inner and social worlds.

The remainder of the book details strategies to assess, prevent, and remediate the potential ill-effects of trauma work upon the professional. Chapter 2 provides self-assessment questions that help professionals examine their work and personal lives in terms of the constructivist self-developmental theory. The next chapter reviews strategies to address and transform vicarious traumatization by changing concrete aspects of one's professional, organizational, and personal life. Chapter 4 includes 18 powerful exercises to assess, address, and transform vicarious traumatization. The final chapter summarizes strategies to help professionals maintain their commitment to taking care of themselves in the face of trauma. A detailed reference section and annotated bibliography is also included that will inspire readers to pursue other books on self-care and vicarious traumatization.

The exercise section of the book is especially noteworthy. I have seen Laurie Pearlman use these exercises with Colombian clinicians and assumed it was her dynamic style that made these exercises so effective. Recently, I tried two exercises in the classroom with neophyte therapists and was stunned that I was equally effective. Supervisors, teachers, and workshop leaders will benefit from using these exercises with appropriate groups.

Transforming the Pain is a superb introductory resource for all trauma professionals including police, clergy and crisis workers. It is an accessible book I repeatedly recommend to students and colleagues grappling with the impact of trauma work. Although much of the practical advice seems so sensible and obvious, many of us forget to assess our own needs and health given the quick pace of our lives. This clear compilation of exercises, self-assessment tools, and advice is an important reminder of the need to take care of ourselves in order to enhance our professional and personal effectiveness. It is a useful book for all professionals who engage in trauma work to reread periodically during their professional development.


Herman, J.L. (1992). Trauma and Recovery. New York: Basic Books

McCann, I.L. & Pearlman, L. A. (1990). Psychological trauma and the adult survivor: Theory, therapy, and transformation. New York: Brunner/Mazel.

Pearlman, L.A. & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors.
New York: Norton.