Laura K. Jones
Clinicians often report feeling underprepared to work with trauma survivors. Well over half of the clients being seen at community mental health clinics report having experienced at least one traumatic incident during their lifetime, however, so trauma work is nearly inevitable. Supervision affords a unique opportunity to help prepare and support counselors working with traumatized clients. The supervisory relationship as well as the structure and content of supervision can be used as tools to prepare and ensure the wellbeing of both the client and the counselor.
Hearing stories of abuse, neglect, violence, and loss can be exceedingly difficult for counselors, especially counselors who themselves have a history of personal trauma (Baird & Kracen, 2006). In fact, many counselors who work with survivors can experience symptoms analogous to the posttraumatic stress disorder (PTSD) faced by their clients, with nearly 20 percent of counselors developing clinically diagnosable PTSD as a result (Meldrum, King, & Spooner, 2002, as cited by Sommer, 2008). The potential for such vicarious trauma (VT) is one of the predominant considerations in tailoring supervision for trauma counselors. Supervisors can reduce the potential for VT by providing a collaborative, strengths-based supervisory relationship that integrates ongoing discussions about VT and provides time and space for supervisees to discuss personal feelings and reactions to their work. The use of stories and metaphors has also been suggested as a possible means of facilitating discussions of vicarious reactions and helping supervisees make meaning of their feelings and experiences (Sommer & Cox, 2006).
Trauma-sensitive supervisors should likewise continually monitor supervisees for signs of VT and promote self-care both in and out of the supervisory context. Use of guided imagery, progressive relaxation, and breath work can be used during supervision for supervisees who are expressing considerable stress (Sommer, 2008). Furthermore, given the predisposition for counselors with a personal history of trauma to develop VT, there is considerable debate as to whether supervisors should or ethically can inquire about the trauma history of supervisees (West, 2010). Supervisors are cautioned to weigh strongly the advantages and disadvantages of such an inquiry, taking into consideration the particular circumstances of the individual supervisee.
A second overriding concern in trauma-sensitive supervision is the specialized knowledge needed to effectively assist trauma clients (Etherington, 2000; Sommer, 2008; West, 2010). Information related to trauma assessment, trauma-induced changes in physiology and arousal, dissociation, treatment models, recovered memories, and countertransference are integral to efficacious and beneficent work with traumatized clients. The most prevalent misstep untrained trauma counselors make is pushing a survivor to work with traumatic memories before the client is emotionally and physiologically ready. As such, one of the roles of a trauma-sensitive supervisor is to assess for gaps in the supervisee’s knowledge within these six core areas and provide avenues for training in deficient areas (Etherington, 2000). An assessment of supervisees’ knowledge of trauma theory should occur prior to contracting for supervision so requisite training can be integrated into the supervisory agreement (West, 2010). Assigning regular readings and case presentations covering areas needing further development can facilitate continuing education. In order for supervisors to adequately assess and train trauma counselors, however, supervisors themselves also need to be literate in trauma theory and practice.
Organizational factors also influence the wellbeing of both the trauma counselor and client and thus should be addressed within the supervisory context (Sommer, 2008). Dual relationships whereby the supervisor is also a boss, inadequate time for supervision, supervision not being valued, and caseloads too heavily based in trauma clients can increase the potential for VT and negatively impact the client and counselor. Given the American Counseling Associations Code of Ethics (2005), counselors are obligated to take action when agency policies and practices are damaging to clients or influence the effectiveness of counselors. Therefore, discussions of organizational impediments should occur early in supervision and efforts should be made to mitigate the difficulties.
Ongoing supervision is integral to the wellbeing of trauma counselors and beneficent care of their clients and should be tailored to the particular pedagogical and emotional needs of this population. Balancing traditional supervisory goals with the core components of trauma-sensitive supervision and the individual supervisee’s needs and developmental level can be difficult, yet additional support systems outside of the supervisory relationship can help manage the more restorative, self-care needs of trauma supervisees. Supervisors can assist supervisees in finding and building such networks and in doing so better address the multifaceted demands of trauma-sensitive supervision.
For further reading:
American Counseling Association. (2005). ACA Code of Ethics. Alexandria, VA: American Counseling Association.
Etherington, K. (2000). Supervising counsellors who work with survivors of childhood sexual abuse. Counselling Psychology Quarterly, 13, 377-389.
Sommer, C. A. (2008). Vicarious traumatization, trauma-sensitive supervision, and counselor preparation. Counselor Education and Supervision, 48, 61-71.
Sommer, C. A., & Cox, J. A. (2006). Sexual violence counselors’ reflections on supervision: Using stories to mitigate vicarious traumatization. Journal of Poetry Therapy, 19(1), 3-16. doi: 10.1080/08893670600565587
West, A. (2010). Supervising counsellors and psychotherapists who work with trauma: A Delphi study. British Journal of Guidance & Counselling, 38, 409-430. doi: 10.1080/03069885.2010.503696