Practicing Counselors, Vicarious Trauma, and Subthreshold PTSD: Implications for Counselor Educators

Bethany A. Lanier, Jamie S. Carney

The purpose of this study was to gain an understanding of the relationship between vicarious trauma (VT) symptoms and subthreshold post-traumatic stress disorder (PTSD) symptoms among practicing counselors. The researchers determined the frequency of VT symptoms and subthreshold PTSD symptoms experienced among practicing counselors and common contributing factors that participants felt contributed to the development of VT symptoms. Implications are presented for counselor educators to determine how they best can prepare students.

 

Keywords: vicarious trauma, subthreshold post-traumatic stress disorder, PTSD, practicing counselors, counselor educators

 

 

Most counselors will likely work with clients addressing trauma (Sommer, 2008; Trippany, White Kress, & Wilcoxon, 2004). Thus, it is important for professional counselors to have an understanding of the dynamics of trauma and interventions to use with clients. Additionally, counselors should be educated on the impact that working with clients can potentially have on them, both personally and professionally. For instance, counselors who work with clients addressing trauma might themselves experience emotional and psychological symptoms, or vicarious trauma (VT). VT has been defined as a disruption in schemas and worldview because of chronic empathic engagement with clients. It is often accompanied by symptoms similar to those of post-traumatic stress disorder (PTSD), which occur as a result of secondary exposure to traumatic material that can result in a cognitive shift in the way the therapist experiences self, others, and the world (Jordan, 2010; Michalopoulos & Aparicio, 2012). Although estimates differ, it has been reported that as many as 50% of counselors are at risk of developing VT (National Child Traumatic Stress Network, 2011).

 

Counseling requires an immense amount of empathetic acceptance on the part of the counselor, which increases the counselor’s vulnerability to taking on their clients’ traumatic experiences (Finklestein, Stein, Greene, Bronstein, & Solomon, 2015). Empathic acceptance and increased vulnerability on the part of the counselor may increase the counselor’s likelihood of developing VT symptoms (Sommer, 2008). VT can have a detrimental effect on all aspects of the counseling process, including both the counselor’s professional and personal life. Practicing counselors experiencing VT have been found to leave the profession early and may also experience emotional and physical disorders, suicidal ideation, strained relationships, increased or continuous burnout, anger, and possible substance abuse (Bergman, Kline, Feeny, & Zoellner, 2015; Keim, Olguin, Marley, & Thieman, 2008). VT is highly detrimental to the counseling process and the care provided to clients. A counselor experiencing VT is more likely to make clinical errors, and VT can negatively impact the counseling relationship (Trippany et al., 2004). The negative implications associated with VT make it imperative that counselors and those who work with them (e.g., supervisors and counselor educators) understand all the factors that lead to the development of VT. This can include recognizing factors that decrease vulnerability, assessing VT, and intervening (Sommer, 2008). One of the initial components to this process is understanding how VT and related symptoms of subthreshold PTSD develop and the variables or experiences that can contribute to higher levels of vulnerability to VT symptoms. Subthreshold PTSD has been defined as the presence of clinically significant PTSD symptoms that fall short of the full Diagnostic and Statistical Manual of Mental Disorders PTSD diagnostic criteria (Bergman et al., 2015).

 

VT and Subthreshold PTSD

 

     As noted, VT can have a detrimental impact on all aspects of the counseling process. A counselor experiencing VT can report many of the symptoms associated with both VT and subthreshold PTSD. VT and subthreshold PTSD have been identified as closely related phenomena. Many counselors who experience VT also meet the criteria for subthreshold PTSD and share similar symptoms (Keim et al., 2008). Counselors who experience VT are in essence experiencing post-traumatic stress symptoms in response to hearing and processing the trauma experienced by their clients (Bercier & Maynard, 2015). Common similar symptoms of VT and subthreshold PTSD include experiencing recurring intrusive thoughts about clients or work, numbing of feelings, hypervigilance or increased anxiety, and a decrease in empathy (Howlett & Collins, 2014; Michalopoulos & Aparicio, 2012; Nelson, 2016).

 

Although there are limitations in the research on the variables that correspond to the development of VT and subthreshold PTSD among counselors, as well as the factors that address these vulnerabilities, the research has highlighted some areas of concern. Understanding these areas is a critical component of addressing the development, assessment, and intervention for VT and subthreshold PTSD, especially for supervisors and counselor educators who train and work with these counselors. One of these variables is years of experience. Although all practicing counselors are at risk for VT and subthreshold PTSD, novice counselors are at an especially elevated risk (Michalopoulos & Aparicio, 2012; Parker & Henfield, 2012). Novice counselors tend to have limited experience with trauma and often have limited training relevant to working with trauma (Newell & MacNeil, 2010; Parker & Henfield, 2012). Further, novice counselors might have trouble establishing boundaries during the early stages of professional identify development, which can contribute to an increase in vulnerability for developing VT and subthreshold PTSD (Howlett & Collins, 2014). Moreover, beginning counselors’ training and personal experiences may not have adequately prepared them for working with individuals dealing with trauma, so in turn they might not have received training on how to address trauma with their clients or identify the development of VT in themselves (Jordan, 2010; Mailloux, 2014; Trippany et al., 2004). It has been recommended that such training should include the key features of trauma, warning signs and symptoms, and strategies to prevent the development of VT and subthreshold PTSD (Newell & MacNeil, 2010).

 

     An essential element of training counselors on strategies to prevent or address the development of VT and subthreshold PTSD includes increasing awareness of the workplace dynamics that may increase vulnerability. Counselors spend a sizeable amount of their time ensuring that others take care of themselves while potentially neglecting their own personal self-care (Whitfield & Kanter, 2014). Neglecting self-care has been found to correspond to an increased rate for developing the negative effects of VT and subthreshold PTSD symptoms (Mailloux, 2014). In an effort to decrease VT and subthreshold PTSD practicing counselors must ensure they are incorporating various types of self-care on a regular basis. Counselors can incorporate self-care activities, such as adequate sleep, social interaction, exercise, a healthy diet, reading, and journaling, into their routine, but all too often practicing counselors let these activities slip (Jordan, 2010; Nelson, 2016).

 

Related to self-care is helping counselors to understand the importance of seeking support from peers and supervisors. Collaboration and consultation with peers and supervisors at the workplace are vital to minimize the adverse effects of VT and subthreshold PTSD (Jordan, 2010). To address possible VT and subthreshold PTSD, practicing counselors require support from colleagues in relation to case conceptualization and identification of impairment (Newell & MacNeil, 2010; Parker & Henfield, 2012; Whitfield & Kanter, 2014). Additionally, counselors should seek supervision specific to trauma to ensure they are not developing VT symptoms and subthreshold PTSD symptoms (Whitfield & Kanter, 2014). One of the concerns, however, is that for many counselors working at counseling sites with high caseloads related to trauma, there are often low levels of clinical supervision (O’Neill, 2010). These sites also can link to another variable that corresponds to higher levels of VT: the caseload of the counselor. For example, counselors with large caseloads are at increased risk of developing VT or subthreshold PTSD because the counselor may not be able to spend adequate amounts of time on each case and might overextend their time addressing case needs (Whitfield & Kanter, 2014). In addition, counselors with caseloads that deal primarily with trauma are at an increased risk of developing VT and subthreshold PTSD, especially if they have limited clinical experience (Bercier & Maynard, 2015; Newell & MacNeil, 2010; Trippany et al., 2004). Recognizing and understanding the contributors to VT and subthreshold PTSD are essential for counselor educators and supervisors to be aware of as they prepare new counselors to enter the field.

 

Counselor Educator and Supervisor Implications

 

When looking at the risk factors associated with VT and subthreshold PTSD, it is clear that a critical component to decrease risk is the training and support provided to counselors. Thus, it is imperative that counselor educators and supervisors be aware of the symptoms and factors that impact the development of VT and subthreshold PTSD. Keim et al. (2008) found that 12% of counselors-in-training (CITs) qualified for a PTSD diagnosis, highlighting the fact that counselor educators and supervisors need to be aware of and educate counselors to recognize the symptoms of VT and subthreshold PTSD. The Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2015) reinforces the importance of this training by specifically requiring that programs educate CITs on trauma-related counseling skills and also engage students in methods to assess and address VT and subthreshold PTSD symptoms in themselves as practicing counselors. To meet this goal, counselor educators and supervisors must more fully understand the causes of VT and subthreshold PTSD (Keim et al., 2008).

 

This study was developed to assess the frequency of VT and subthreshold symptoms among practicing counselors. This included variables that correspond to the development of these symptoms. The data can contribute to our understanding of VT and subthreshold PTSD symptoms among counselors and provide a framework for working with counselors during supervision and in preparing CITs.

 

Method

 

Sample

Two hundred and twenty current practicing counselors completed the nationwide survey. Of the 220 participants, 219 participants reported gender; 23 (10.3%) respondents identified as male and 196 (87.9%) respondents identified as female. Of the participants, 217 (98.6%) reported they were over 19 years of age (range 23–65, M = 39). Two hundred and fifteen respondents indicated holding a master’s degree (97.8%). Thus, exclusion criteria removed five respondents from the data set for not meeting degree requirements—participants must have completed a master’s degree in counseling (i.e., school counseling, clinical mental health counseling, rehabilitation counseling, family and marriage counseling). Current work setting was reported by 207 of the respondents; 137 (62.3%) identified as school counselors, 24 (10.9%) reported working in a community mental health center, 17 (7.7%) reported working in a higher education center, 16 (7.35%) reported working in a private practice, and 13 (5.9%) reported “other,” which included settings such as employee assistance programs and crisis centers.

 

Six respondents (2.7%) reported less than one year of cumulative counseling experience, 50 (22.7%) reported 1–3 years of cumulative counseling experience, 31 (14.1%) reported 4–5 years of cumulative counseling experience, 47 (21.4%) reported 6–10 years of cumulative counseling experience, and 72 (32.7%) reported 10 years or more of cumulative counseling experience. Of the 220 respondents, 12 (5.5%) did not report how many years they have been in their current position, 8 (3.6%) reported being in their current position less than one year, 103 (10.9%) reported 1–3 years, 31 (14.1%) reported 4–5 years, 30 (13.6%) reported 6–10 years, and 36 (16.4%) reported being in their current position 10 or more years.

 

Instruments

Participants were asked to complete a brief demographic questionnaire and two surveys, the PTSD Checklist for the DSM-5 (PCL-5), developed by Blevins, Weathers, Davis, Witte, and Domino (2015), and the Secondary Trauma Stress Scale (STSS), developed by Bride, Robinson, Yegidis, and Figley (2004). The demographic questionnaire sought to understand the impact that years of experience, number of contributing factors, and preventive measures have on VT and subthreshold PTSD symptoms. Participants in this study also completed a series of measures assessing the rate of VT among practicing counselors, the number of participants who meet the criteria for subthreshold PTSD, and the impact of the types and number of professional supports on practicing counselors.

 

     Demographic measure. A basic demographic survey was developed and utilized to collect data on each respondent’s age, gender, current position, years of counseling experience, primary type of clientele served, and any licenses and credentials. Text entry was utilized to understand the type and number of professional supports respondents identified: supervision, peer support, years of experience, training specific to trauma, caseload size, and self-care implementation. The demographic survey collected basic information related to the participants’ counseling experience and background to gain an understanding of who chose to participate in the study. Further, the information gained was used to assist in developing implications for counselor educators and supervisors in preparing CITs to recognize VT symptoms and identify the types of professional supports needed.

 

     PTSD Checklist for the DSM-5 (PCL-5). The PCL-5 is a revision of the PTSD Checklist (PCL) that specifically assesses self-report measures of PTSD symptoms as outlined in the DSM-5 (Blevins et al., 2015). The PCL is one of the most widely used measures of PTSD symptoms, and the revised PCL-5 is the only instrument that specifically measures criteria defined in the DSM-5 (Blevins et al., 2015). The PCL-5 is a 20-item survey that corresponds to the 20 PTSD symptoms in the DSM-5 (Bovin et al., 2016). Respondents are asked to rank, from 0–4, how much they have been bothered by the presented symptom within the last month (Bovin et al., 2016). Sample topics include: having difficulty sleeping; feeling jumpy or easily startled; and avoiding memories, thoughts, or feelings related to the stressful event. In a validation study of the PCL-5, Blevins et al. (2015) found high internal consistency (.94), and the measure fell within the recommended range of inter-item correlation of .15 to .50. Test-retest reliability was r = .82 with a 95% confidence interval [.71, .89], and paired t-tests were significant (p < .01) for the PCL-5 between two test validations (Blevins et al., 2015). Cronbach’s alpha for this study indicated high internal consistency (.96) and test-retest reliability of r = .84.

 

     Secondary Trauma Stress Scale (STSS). The STSS, developed by Bride et al. (2004), was used to understand the number of VT symptoms among practicing counselors as well as to determine the relationship between VT symptoms and subthreshold PTSD symptoms among practicing counselors. The STSS is a 17-item self-report measure designed to assess helping professionals who may have experienced secondary traumatic stress and the frequency of intrusion, avoidance, and arousal symptoms (Bride et al., 2004; Ting, Jacobson, Sanders, Bride, & Harrington, 2005).

 

The STSS asks that respondents endorse how frequently an item was true for them in the past 7 days (Bride et al., 2004). Responses range from 1 to 5 in Likert form (1 = never and 5 = very often). Psychometric data for the STSS indicates very good internal consistency reliability with coefficient alpha levels of .93 for the total STSS scale, .80 for the Intrusion subscale, .87 for the Avoidance subscale, and .83 for the Arousal subscale (Bride et al., 2004). Ting et al. (2005) determined in their validation study of the STSS that internal consistency reliability for the 17 total STSS items was very high (.94) and was moderately high for the Intrusion subscale (.79), the Avoidance subscale (.85), and the Arousal subscale (.87), and all three factors were highly correlated with each other (intrusion–avoidance, r = .96; intrusion–arousal, r = .96; avoidance–arousal, r = 1.0), as indicated by a confirmatory factor analysis. Cronbach’s alpha for this study confirmed Ting et al.’s findings, as internal consistency reliability for the 17 total STSS items was very high (.94) and was moderately high for the Intrusion subscale (.80), the Avoidance subscale (.86), and the Arousal subscale (.89). Statements on the Intrusion subscale inquire about respondents’ intrusion symptomology on a Likert scale with statements such as “My heart started pounding when I thought about my work with clients” and “I had disturbing dreams about my work with clients.” The Avoidance subscale asks respondents to respond on a Likert scale to statements such as “I felt emotionally numb” and “I had little interest in being around others.” The final subscale, Arousal, asks respondents to respond on a Likert scale to statements such as “I had trouble sleeping” and “I expected something bad to happen.”

 

Procedures

Upon Institutional Review Board approval, participants were recruited via email through listserv solicitation that included the Alabama Counseling Association, the American School Counselor Association, the American Counseling Association, and CESNET. Participants were provided a link to an informed consent document and the research surveys in Qualtrics. Participation was restricted to practicing mental health or school counselors who had a master’s degree in counseling and had been a practicing counselor for at least 6 months at the time of the survey.

 

Design and Statistical Analyses

The purpose of this quantitative study was to investigate the frequency of VT symptoms and subthreshold PTSD symptoms experienced by practicing counselors. This included the relationship of VT symptoms and subthreshold PTSD symptoms with years of experience, work setting and type of clientele, and the number and type of professional supports utilized by practicing counselors. Descriptive analysis was used to determine what symptoms of VT and subthreshold PTSD practicing counselors experience. A linear regression was used to determine the relationship between VT symptoms and subthreshold PTSD symptoms. Linear regressions were utilized to determine the relationship years of experience, work setting and type of clientele, and professional supports have with VT symptoms and subthreshold PTSD symptoms among practicing counselors.

 

Results

 

Symptoms of VT and Subthreshold PTSD Experienced by Practicing Counselors

Descriptive statistics based on participants’ responses indicated symptoms of VT and subthreshold PTSD are being experienced by practicing counselors. On the STSS, all symptoms were experienced to some degree by 49.5% of the participants. Symptoms were rated significant if they scored higher than “never” on the STSS, meaning they had experienced the symptom to some degree within the past 7 days.

 

The most common symptom of VT experienced by participants was thinking about work with clients when not intending to do so (85.5%), as measured by the STSS. Additional symptoms of VT experienced commonly by participants included feeling emotionally numb (80.5%), becoming easily annoyed (79.1%), having difficulty concentrating (75.5%), and feeling discouraged about their future (75.5%). Experiencing disturbing dreams about their clients (49.5%) and feeling jumpy (56.4%) were the least common symptoms experienced by participants, but 49.5% of the participants experienced these symptoms. Table 1 outlines the VT symptoms of participants as measured by the STSS in descending order.

 

 

Table 1

 

STSS Symptom Distribution

Items in Descending Order n (%)
I thought about my work with clients when I didn’t intend to. 188 (85.5%)
I felt emotionally numb. 177 (80.5%)
I was easily annoyed. 174 (79.1%)
I felt discouraged about the future. 166 (75.5%)
I had trouble concentrating. 166 (75.5%)
I had trouble sleeping. 165 (75.0%)
I wanted to avoid working with some clients. 162 (73.6%)
I was less active than usual. 156 (70.9%)
Reminders of my work with clients upset me. 155 (70.5%)
My heart started pounding when I thought about my work with clients. 155 (70.5%)
I had little interest in being around others. 149 (67.6%)
It seemed as if I was reliving the trauma(s) experienced by my client(s). 133 (60.5%)
I expected something bad to happen. 132 (60.0%)
I avoided people, places, or things that reminded me of my work with clients. 126 (57.3%)
I noticed gaps in my memory about client sessions. 126 (57.3%)
I felt jumpy. 124 (56.4%)
I had disturbing dreams about my work with clients. 109 (49.5%)

 

 

 

 

Participant responses to the PCL-5, utilized to measure subthreshold PTSD symptoms, suggested practicing counselors are experiencing subthreshold PTSD symptoms. Symptoms were rated as significant if they scored higher than “not at all,” indicating they had experienced the symptom to some degree within the past month. The most common symptom reported to have been experienced by all participants (100%) was repeated, disturbing, or unwarranted memories of the stressful experience. Other symptoms that were reported to have been experienced commonly by practicing counselors included having trouble falling or staying asleep (71.4%), having difficulty concentrating (70.9%), feeling distant or cut off from other people (68.2%), and feeling very upset when something reminded them of the stressful experience (66.8%). Taking too many risks or doing things that could cause personal harm (36.8%); feeling or acting as if the stressful experience were actually happening again (42.7%); and experiencing repeated, disturbing dreams of the stressful experience (49.1%) were experienced least commonly by participants. Table 2 outlines the VT symptoms of participants as measured by the PCL-5 in descending order.

 

 

Table 2

 

PCL-5 Symptom Distribution

Items in Descending Order n (%)
Repeated, disturbing, and unwanted memories of the stressful experience? 220 (100%)
Trouble falling or staying asleep? 157 (71.4%)
Having difficulty concentrating? 156 (70.9%)
Feeling distant or cut off from other people? 150 (68.2%)
Feeling very upset when something reminded you of the stressful experience? 147 (66.8%)
Irritable behavior, angry outbursts, or acting aggressively? 139 (63.2%)
Avoiding memories, thoughts, or feelings related to the stressful experience? 139 (63.2%)
Having strong negative feelings such as fear, horror, anger, guilt, or shame? 134 (60.9%)
Having strong physical reactions when something reminded you of the stressful experience
(for example, heart pounding, trouble breathing, sweating)?
130 (59.1%)
Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)? 127 (57.7%)
Being “superalert” or watchful or on guard? 125 (56.8%)
Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)? 125 (56.8%)
Loss of interest in activities that you used to enjoy? 123 (55.9%)
Blaming yourself or someone else for the stressful experience or what happened after it? 121 (55.0%)
Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)? 119 (54.1%)
Feeling jumpy or easily startled? 116 (52.7%)
Trouble remembering important parts of the stressful experience? 113 (51.4%)
Repeated, disturbing dreams of the stressful experience? 108 (49.1%)
Suddenly feeling or acting as if the stressful experience were actually happening again
(as if you were actually back there reliving it)?
  94 (42.7%)
Taking too many risks or doing things that could cause you harm?   81 (36.8%)

 

 

 

 

Relationship Between VT Symptoms and Subthreshold PTSD Symptoms

     Linear regression models determined the relationship between VT symptoms and subthreshold PTSD symptoms among practicing counselors. In a backward regression, the PCL-5, measuring subthreshold PTSD symptoms, was entered as the dependent variable, and the subscales of the STSS, measuring VT symptoms, were entered as the independent variables. Results indicated that the more VT symptoms were experienced by practicing counselors, the more subthreshold PTSD symptoms were experienced. There was a significant relationship between results from the PCL-5 and all three STSS subscales. The relationship between subthreshold PTSD symptoms and the Intrusion subscale was significant (r = .676, p < .001). There also was a significant relationship between subthreshold PTSD symptoms and avoidance symptoms (r = .759, p < .001), and between subthreshold PTSD symptoms and arousal symptoms (r = .790, p < .001). Avoidance VT symptoms and arousal VT symptoms were the most predictive variables associated with developing subthreshold PTSD symptoms as evidenced in the restricted model regression summary. In the backward regression model, the Intrusion subscale of the STSS was eliminated as the least significant variable, which indicates the more arousal and avoidance symptoms were experienced as VT, the more subthreshold PTSD symptoms were experienced by the practicing counselors. In the full regression model (R2 Full = .656, F = 103.4, p < .001), results suggested a significant relationship, indicating that the more VT symptoms were experienced by practicing counselors, the more subthreshold PTSD symptoms were experienced. Through the restricted regression model (R2 Restricted = .655, F = 155.75, p < .001) and the F change test, results indicated that the restricted model is not worse than the full model because the observed F (.00000892; p = .647) does not exceed the critical F (df = 1,163), which is 3.94.

 

Relationship Among Demographics and Type of Professional Supports Among Practicing Counselors on VT

A backward linear regression model was utilized to determine the relationship between VT symptoms and years of experience, work setting and type of clientele, and type of professional supports among practicing counselors. There were two significant relationships within this regression in the restricted model of the regression. There was a significant negative correlation between VT symptoms and having a manageable caseload, indicating the more manageable caseload the counselor has, the fewer VT symptoms they have. In addition, there was a significant negative correlation between VT symptoms and having adequate supervision, indicating the more supervision received, the fewer VT symptoms experienced. Overall, the two variables (caseload and supervision) correlate with the dependent variable, VT symptoms (r = .273, R2 = .074). This overall correlation is unlikely due to chance (F = 8.159, p < .001). The F change test indicated the observed F (2.008; p = .158) does not exceed the critical F (df = 1, 202), which is 3.89. The semi-partial correlation between caseload and VT symptoms was -.173, while the semi-partial correlation between supervision and VT symptoms was -.150. The semi-partial correlation indicates the uniqueness of the relationship. The squared semi-partial correlation for supervision was (-.173)2 = .029, and the squared semi-partial correlation for caseload was (-.150)2 = .02., *p < .05.

 

Relationship Between Demographics and Type of Professional Supports Among Practicing Counselors on Subthreshold PTSD Symptoms

A backward linear regression model was utilized to determine the relationship between subthreshold PTSD symptoms and years of experience, work setting and type of clientele, and the number and type of professional supports among practicing counselors. With subthreshold PTSD symptoms as the dependent variable and years of experience, work setting and type of clientele, and type of professional supports as the independent variables, a backward linear regression was run to understand the relationship between the variables in the restricted model of the regression. Results indicated a significant relationship between subthreshold PTSD symptoms and those counselors who work primarily with adolescents or with sexual assault/domestic violence survivors. Overall, the two variables (adolescents and sexual assault/domestic violence) correlate with our dependent variable, subthreshold PTSD symptoms (r = .242, R2 = .059). This overall correlation is unlikely due to chance (F = 5.080, p = .007). The F change test indicated the observed F (2.255; p = .135) does not exceed the critical F (df = 1,162), which is 3.94. The semi-partial correlation between adolescents and subthreshold PTSD symptoms was .159, while the semi-partial correlation between sexual assault/domestic violence and subthreshold PTSD symptoms was .187. The semi-partial correlation indicates the uniqueness of the relationship. The squared semi-partial correlation for adolescents was (.159)2 = .025, and the squared semi-partial correlation for sexual assault/domestic violence was (.187)2 = .03. This data indicates that work setting and the type of clientele served by the counselor can influence risk for developing subthreshold PTSD symptoms.

 

Limitations

     One limitation for this study was the high percentage of participating school counselors (62.3%). This could have possibly skewed results as the type of clientele that the practicing counselors primarily worked with exhibited the most influence on symptoms of VT and subthreshold PTSD (i.e., adolescents). Additionally, this large percentage of school counselors could make the implications suggested in this study not as applicable for counselors in higher education settings.

 

An additional limitation of this study was the lack of demographics available to identify if counselors were in a rural setting or urban setting. Although the implications suggested are applicable to all counselors, demographic location could serve as an additional barrier to implementing the professional supports suggested.

 

Discussion

 

The purpose of this study was to develop an understanding of the frequency and characteristics of VT symptoms and subthreshold PTSD symptoms among practicing counselors, which was answered by the first research question. The most common VT symptom experienced by participants (85.5%) was thinking about their work with clients when they did not intend to outside of work. This finding is significant for counselor educators and supervisors as it indicates that VT symptoms are being experienced by the majority of the counselors in this study. All VT symptoms, as measured by the STSS, were experienced by 49.5% of the participants, indicating all 17 VT symptoms measured had been experienced to some degree by the counselors that participated in this study. This study adds to the current literature reported by Bride (2007) that 50% of child welfare counselors experience traumatic stress symptoms within the severe range. In addition, Cornille and Meyers (1999) reported 37% of their sample of child protection service workers reported clinical levels of emotional distress associated with secondary trauma, and Conrad and Kellar-Guenther (2006) reported 50% of child protection workers suffered “high” to “very high” levels of compassion fatigue.

 

In addition to measuring VT symptoms, the first research question was developed to acquire an understanding of the frequency of subthreshold PTSD symptoms experienced by counselors. Subthreshold PTSD symptoms were measured by the PCL-5 and results suggest practicing counselors are experiencing subthreshold PTSD symptoms. Of the 20 items in the PCL-5, all but three were experienced by at least 50% of the participants. All 220 (100%) of participants reported experiencing repeated, disturbing, and unwanted memories of the stressful experience. This finding is similar to that found by the STSS in that over 85% of participants had unwanted thoughts about experiences with clients outside of work. Furthermore, over 70% of participants reported having trouble sleeping and having difficulty concentrating in both the STSS and PCL-5 as symptoms of VT and subthreshold PTSD. Understanding the symptoms of VT and subthreshold PTSD experienced by participants was important, as previous studies have indicated that those who experience VT symptoms also experience subthreshold PTSD symptoms (Jordan, 2010). Additionally, the literature has reported VT symptoms and subthreshold PTSD symptoms as being one and the same (Finklestein et al., 2015).

 

The second research question was developed to gain an understanding of the relationship between VT symptoms and subthreshold PTSD symptoms. A linear backward regression with the PCL-5 measuring subthreshold PTSD symptoms was entered as the dependent variable, and the subscales of the STSS, measuring VT symptoms, were entered as the independent variables. Results from this regression model indicated that the more VT symptoms were experienced by practicing counselors, the more subthreshold PTSD symptoms were experienced. In the backward regression model, the Intrusion subscale of the STSS was eliminated as the least significant variable, which indicated that the more arousal and avoidance symptoms were experienced as VT, the more subthreshold PTSD symptoms were experienced by the practicing counselors, with the Intrusion scale not being significant. This finding is consistent with the extant literature that has reported VT symptoms being analogous to PTSD symptoms (Keim et al., 2008). Furthermore, this finding also is consistent with prior literature that reported counselors who experience VT symptoms also experience PTSD symptoms (Bercier & Maynard, 2015), as found in Bride’s (2007) study in which 34% of child welfare workers met the PTSD diagnostic criteria because of VT.

 

In an effort to answer the second research question, which was interested in the relationship between VT symptoms and subthreshold PTSD symptoms and years of experience, work setting and type of clientele, and the number and type of professional supports, two backward linear regression models were established. The first linear regression model was interested in the relationship between VT symptoms and years of experience, work setting and type of clientele, and the number and type of professional supports among practicing counselors. In this backward linear regression model, the STSS served as the dependent variable with years of experience, work setting and type of clientele, and the number and type of professional supports serving as the independent variables. Results indicate a significant relationship between VT symptoms and having a manageable caseload as well as between VT and utilizing supervision. A negative correlation between VT symptoms and having a manageable caseload indicates that the more manageable a counselor’s caseload, the less likely they were to experience VT symptoms. This finding is consistent with prior studies that indicate a manageable caseload as being a protective factor for counselors that can decrease their chance of developing both VT symptoms and subthreshold PTSD symptoms (Trippany et al., 2004). Additionally, there was a negative correlation between supervision as a professional support and the development of VT symptoms among counselors. Adequate supervision has been identified as a protective factor against the development of VT (Harrison & Westwood, 2009). Both of these findings are important implications for counselor educators and supervisors as they can be initiated in the classroom while CITs are preparing for a career in the counseling profession.

 

The second linear regression model focused on the relationship between subthreshold PTSD symptoms and years of experience, work setting and type of clientele, and the number and type of professional supports among practicing counselors. In this backward linear regression model, the PCL-5 served as the dependent variable with years of experience, work setting and type of clientele, and the number and type of professional supports serving as the independent variables. Results indicated a significant relationship between subthreshold PTSD symptoms and counselors who primarily work with adolescents and sexual assault/domestic violence survivors. These findings are consistent with prior literature that has indicated sexual assault counselors report more VT symptoms and subthreshold PTSD symptoms. For instance, Bride (2007) reported 65% of domestic violence and sexual assault social workers reported at least one symptom of VT, while Lobel (1997) reported over 20 years ago that 70% of sexual assault counselors experienced VT. Additionally, Schauben and Frazier (1995) reported that counselors who work with a higher percentage of sexual assault survivors report more disrupted beliefs about themselves and others, more subthreshold PTSD symptoms, and more VT than counselors who see fewer sexual assault survivors.

 

Implications for Counselor Educators and Supervisors

 

     The results of this study provide counselor educators and supervisors with information to prepare CITs to have an increased awareness of VT and subthreshold PTSD symptoms. This study established evidence that practicing counselors are experiencing numerous VT symptoms and subthreshold PTSD symptoms. In fact, this study found that all VT symptoms measured were experienced by 49.5% of the participants, and 17 of the 20 PTSD symptoms measured were experienced by all participants. Further, in an open-ended question in the brief demographic survey, participants provided the researcher with ideas they felt would increase awareness of VT and subthreshold PTSD and decrease VT and subthreshold PTSD symptoms. Over 40% of responses indicated a desire for more education on VT symptoms and subthreshold PTSD symptoms. With 49.5% of participants reporting VT symptoms and subthreshold PTSD symptoms, it is evident that additional education is needed related to these symptoms among practicing counselors. Keim et al. (2008) suggested educational trainings and workshops be provided to CITs proactively to increase awareness of VT and subthreshold PTSD and to decrease VT symptoms and subthreshold PTSD symptoms among practicing counselors. Counselor educators and supervisors can provide trainings on the signs and symptoms of VT and subthreshold PTSD experienced by counselors to raise awareness of these symptoms and ways to recognize and alleviate them before causing harm to the counselor or client.

 

This study denoted that counselors who work primarily with adolescents and sexual assault/domestic violence survivors are experiencing more subthreshold PTSD symptoms than counselors that do not work specifically with these populations. As counselor educators prepare CITs for practicum, internship, and employment as counselors, it is vital for counselor educators to acknowledge the unique challenges that may stem from working with adolescents and survivors of sexual assault/domestic violence. It is imperative that counselor educators and supervisors integrate specific educational material through coursework related to these populations to best prepare CITs. Evidence-based practices that are effective for counseling these populations should be implemented within counselor education programs, supervision, workshops, and trainings outside of the degree program (e.g., at conferences; Alpert & Paulson, 1990; Mailloux, 2014; Whitfield & Kanter, 2014).

 

Education on the significance of professional supports, such as adequate supervision and manageable caseloads, is fundamental for CITs to be prepared to lessen the hazard of developing VT symptoms and subthreshold PTSD symptoms. By providing sufficient supervision during practicum and internship, counselor educators and supervisors can prepare CITs for coping with VT symptoms and subthreshold PTSD symptoms should they develop. In addition, through modeling appropriate supervision, CITs will comprehend the supervisory process and seek post-degree supervision.

 

Directions for Future Research

     Future studies on VT symptoms and subthreshold PTSD symptoms need to focus solely on clinical mental health counselors or school counselors to develop implications specific to counseling sites. Further research devoted to the development of workshops and trainings to educate counselors on VT and subthreshold PTSD is needed.

 

A future study that compares counselors in rural settings and urban settings will be important to understand barriers to coping with and addressing VT symptoms and subthreshold PTSD symptoms. For example, in a rural setting, the counselor may not have adequate supervision and may be overloaded with cases, which can decrease the amount of self-care they are able to implement. It will be important for future research to explore what barriers to professional supports counselors face in these different demographic communities.

Because of this study’s finding that working primarily with adolescents and individuals who have experienced sexual assault or domestic violence increases counselors’ chances of experiencing VT symptoms and subthreshold PTSD symptoms, a qualitative or mixed-methods study focused on VT among counselors working with these populations is desirable. In an effort to best prepare students who will work with these populations, an understanding of exactly which aspects of working with these clients increase VT symptoms and subthreshold PTSD symptoms is essential.

 

 

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest

or funding contributions for the development

of this manuscript.

 

 

 

References

 

Alpert, J. L., & Paulson, A. (1990). Graduate-level education and training in child sexual abuse. Professional Psychology: Research and Practice, 21, 366–371. doi:10.1037/0735-7028.21.5.366

Bercier, M. L., & Maynard, B. R. (2015). Interventions for secondary traumatic stress with mental health workers: A systematic review. Research on Social Work Practice, 25, 81–89. doi:10.1177/1049731513517142

Bergman, H. E., Kline, A. C., Feeny, N. C., & Zoellner, L. A. (2015). Examining PTSD treatment choice among individuals with subthreshold PTSD. Behaviour Research and Therapy, 73, 33–41.
doi:10.1016/j.brat.2015.07.010

Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489–498. doi:10.1002/jts.22059

Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). Psychometric properties of the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans. Psychological Assessment, 28, 1379–1391. doi:10.1037/pas0000254

Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52, 63–70. doi:10.1093/sw/52.1.63

Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. R. (2004). Development and validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice, 14, 27–35. doi:10.1177/1049731503254106

Conrad, D., & Kellar-Guenther, Y. (2006). Compassion fatigue, burnout, and compassion satisfaction among Colorado child protection workers. Child Abuse and Neglect, 30, 1071–1080.
doi:10.1016/j.chiabu.2006.03.009

Cornille, T. A., & Meyers, T. W. (1999). Secondary traumatic stress among child protective service workers: Prevalence, severity and predictive factors. Traumatology, 5, 15–31. doi:10.1177/153476569900500105

Council for Accreditation of Counseling and Related Educational Programs. (2015). 2016 CACREP standards. Alexandria, VA: Author.

Finklestein, M., Stein, E., Greene, T., Bronstein, I., & Solomon, Z. (2015). Posttraumatic stress disorder and vicarious trauma in mental health professionals. Health & Social Work, 40(2), 25–31.
doi:10.1093/hsw/hlv026

Harrison, R. L., & Westwood, M. J. (2009). Preventing vicarious traumatization of mental health therapists: Identifying protective practices. Psychotherapy: Theory, Research, Practice, Training, 46, 203–219. doi:10.1037/a0016081

Howlett, S. L., & Collins, A. (2014). Vicarious traumatisation: Risk and resilience among crisis support volunteers in a community organisation. South African Journal of Psychology, 44, 180–190. doi:10.1177/0081246314524387

Jordan, K. (2010). Vicarious trauma: Proposed factors that impact clinicians. Journal of Family Psychotherapy, 21, 225–237. doi:10.1080/08975353.2010.529003

Keim, J., Olguin, D. L., Marley, S. C., & Thieman, A. (2008). Trauma and burnout: Counselors in training. In G. R. Walz, J. C. Bleuer, & R. K. Yep (Eds.), Compelling counseling interventions: Celebrating VISTAS’ fifth anniversary (pp. 293–303). Ann Arbor, MI: Counseling Outfitters.

Lobel, J. A. (1997). The vicarious effects of treating female rape survivors: The therapist’s perspective (Doctoral dissertation). Retrieved from Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 57, 11-B.

Mailloux, S. L. (2014). The ethical imperative: Special considerations in the trauma counseling process. Traumatology, 20, 50–56. doi:10.1177/1534765613496649

Michalopoulos, L., & Aparicio, E. (2012). Vicarious trauma in social workers: The role of trauma history, social support, and years of experience. Journal of Aggression, Maltreatment & Trauma, 21, 646–664. doi:10.1080/10926771.2012.689422

National Child Traumatic Stress Network, Secondary Trauma Stress Committee. (2011). Secondary traumatic stress: A fact sheet for child-serving professionals. Los Angeles, CA: National Center for Child Traumatic Stress. Retrieved from https://www.nctsn.org/resources/secondary-traumatic-stress-fact-sheet-child-serving-professionals

Nelson, T. S. (2016). Therapist vicarious trauma and burnout when treating military sexual trauma. In L. S. Katz (Ed.), Treating military sexual trauma (pp. 257–274). New York, NY: Springer.

Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: A review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. Best Practices in Mental Health, 6(2), 57–68.

O’Neill, L. K. (2010). Mental health support in northern communities: Reviewing issues on isolated practice and secondary trauma. Rural and Remote Health, 10, 1369.

Parker, M., & Henfield, M. S. (2012). Exploring school counselors’ perceptions of vicarious trauma: A qualitative study. The Professional Counselor, 2, 134–142. doi:10.15241/mpp.2.2.134

Schauben, L. J., & Frazier, P. A. (1995). Vicarious trauma: The effects on female counselors of working with sexual violence survivors. Psychology of Women Quarterly, 19, 49–64.
doi:10.1111/j.1471-6402.1995.tb00278.x

Sommer, C. A. (2008). Vicarious traumatization, trauma-sensitive supervision, and counselor preparation. Counselor Education and Supervision, 48, 61–71. doi:10.1002/j.1556-6978.2008.tb00062.x

Ting, L., Jacobson, J. M., Sanders, S., Bride, B. E., & Harrington, D. (2005). The Secondary Traumatic Stress Scale (STSS): Confirmatory factor analyses with a national sample of mental health social workers. Journal of Human Behavior in the Social Environment, 11(3–4), 177–194. doi:10.1300/J137v11n03_09

Trippany, R. L., White Kress, V. E., & Wilcoxon, S. A. (2004). Preventing vicarious trauma: What counselors should know when working with trauma survivors. Journal of Counseling & Development, 82, 31–37. doi:10.1002/j.1556-6678.2004.tb00283.x

Whitfield, N., & Kanter, D. (2014). Helpers in distress: Preventing secondary trauma. Reclaiming
Children and Youth
, 22(4), 59–61.

 

Bethany A. Lanier, NCC, is an assistant professor at the University of West Georgia. Jamie S. Carney is a professor at Auburn University. Correspondence can be addressed to Bethany Lanier, 1601 Maple Street, Carrollton, GA 30116, blanier@westga.edu.

Exploring School Counselors’ Perceptions of Vicarious Trauma: A Qualitative Study

Mashone Parker, Malik S. Henfield

The purpose of this qualitative study was to examine school counselors’ perceptions of vicarious trauma. Consensual qualitative research (CQR) methodology was used. Six school counselors were interviewed. Three primary domains emerged from the data: (a) ambiguous vicarious trauma, (b) support system significance, and (c) importance of level of experience. Supervision, discrepancies with burnout, and implications for counselor educations and school counselors are discussed.

Keywords: vicarious trauma, consensual qualitative research (CQR), school counselors, support system, counseling experience

Trauma occurs after a person experiences an event that involves or threatens death or serious injury, or a threat to self or other’s well-being (Trippany, White Kress, & Wilcoxin, 2004). Exposure to traumatic events and psychological stress has been found to be associated with significant physical and mental health concerns (Briggs-Gowan et al., 2010). Children and adolescents, particularly those growing up in poverty-stricken areas, are increasingly susceptible to traumatic events such as bullying (Lawrence & Adams, 2006; Newman, Holden, & Delville, 2005), community violence (Fowler, Tompsett, Braciszewski, Jacques-Tiura, & Baltes, 2009), and abuse (Reilly & D’Amico, 2011). For example, children ages 12–17 have been found to be more than twice as likely as adults to be victims of serious violent crimes (Snyder & Sickmund, 2006). Furthermore, every year millions of children and adolescents in the U.S. are exposed to violence in their homes, schools and communities (Finkelhor, Turner, Ormrod, Hamby, & Kracke, 2009). In addition, according to recent reports, homicide and suicide were found to be the second and third leading causes of death for persons ages 15–24 (U.S. Department of Health and Human Services, 2008–09).

Whether working in a school or mental health setting, there is a chance that a professional counselor will work with an individual who has experienced trauma (Trippany et al., 2004). School counselors, however, by virtue of working in schools, have even more direct contact with youth who may have been exposed to traumatic events. As a result, they are likely to be the first counseling professionals with whom traumatized students come into contact. Functioning as the first line of intervention for students in crisis makes the school counseling position one of vital importance to students’ positive development (Chambers, Zyromski, Asner-Self, & Kimemia, 2010). Exposure to students who have experienced trauma puts school counselors at particular risk for internalizing students’ emotions associated with traumatic events. This process of internalization is otherwise known as vicarious trauma (VT), which is associated with professionals developing harmful changes in their view of themselves, others and the world (Baird & Kracen, 2006).

If a counselor begins to over-identify with a client’s issues they can experience the client’s pain, sadness or distress (Skovholt, 2001). McCann and Pearlman (1990) found that some counselors experienced symptoms similar to those associated with Post-Traumatic Stress Disorder (PTSD) such as nightmares, anger and sadness related to their clients’ traumatic experiences. Clinicians working with sexual abuse victims, for example, may experience feelings of stigmatization and isolation which may be closely aligned with clients, the actual victims of the abuse (Canfield, 2005). Little is known about counselors’ ability to manage VT (Harrison & Westwood, 2009), but some extant literature can be reviewed.

For example, factors such as level of experience (Way, VanDeusen, Martin, Applegate, & Jandle, 2004) and educational training (Adams & Riggs, 2008) impact the prevalence of VT. Seminal articles examining VT concluded that counselors with more clinical experience have a buffer in preventing VT (Pearlman & Mac Ian, 1995). Adams and Riggs (2008) conducted a study with 129 therapist trainees. The purpose of their study was to explore the relationship between vicarious traumatization among trainees and variables recognized as potentially influential in this process among practicing therapists (i.e., history of trauma, clinical experience, trauma-specific training), and to explore the relationship between defense style and vicarious traumatization symptoms, as well as its possible interaction with the previous three factors in relation to reported symptoms. Consistent with previous research, the researchers found that novice therapists/counselors may be more vulnerable to experiencing VT (Adams & Riggs, 2008).

Level of peer support and supervision also play a role in buffering symptoms of VT (McCann & Pearlman, 1990). Supervision practices that address VT have been encouraged (Woodard, Meyers, & Cornille, 2002). Specifically, trauma-sensitive supervision is seen as helpful in minimizing the effects of vicarious exposure to trauma (Sommer & Cox, 2005). As Sommer and Cox (2005) conclude, multiple perspectives, collaboration, a calming presence and attention to self-care are most helpful when examining the supervisee’s perspective of adequate supervision. Clinicians must work through painful experiences in a supportive environment. McCann and Pearlman (1990) have suggested that weekly case conferences can be helpful for clinicians that use two-hour weekly support groups aimed at conceptualizing difficult victim cases (with client consent) and exploring personal meaning for themselves related to how they respond to the painful experiences of their clients. Other studies have identified coherence and organizational support as being linked to positive responses to stress (Linley & Joseph, 2007).

There is some overlap between conceptualizations of VT and burnout (McCann & Pearlman, 1990). Burnout is described as the result of the stress that working with difficult clients can produce, and is seen as having three content domains: emotional exhaustion, depersonalization and reduced personal accomplishments (Jenkins & Baird, 2002). There lies a feeling of complete overload which in turn may affect the counselor’s work performance. Burnout also can be described as a general reaction to feeling overwhelmed, where vicarious trauma is related to specific traumatic events. Moreover, Trippany et al. (2004) shared that many counselors who work with trauma patients may experience burnout and vicarious trauma simultaneously.

Most research related to VT focuses on mental health counselors and social workers. Little, if any, published research literature has examined this phenomenon among school counseling professionals. Exposure to a child’s trauma is usually described as more challenging for professionals when compared to adult trauma (Figley, 1995). Therefore, school counselors, by virtue of their work setting, may be at great risk for experiencing VT.

The primary purpose of this study was to investigate counselors’ knowledge and perceptions of VT. The information gathered in this project will increase the level of understanding and awareness of vicarious trauma on school counseling professionals, allowing school counselors to implement strategies to ameliorate the effects of vicarious trauma.

Method

Participants
Participants were individuals who met either one of two criteria: (a) persons licensed or certified as a school counselor, and/or (b) individuals endorsed as a school counselor and currently working in a school. Six school counselors ranging in age from 27 to 54 were recruited from schools located in a midwestern state (3 females and 3 males). Participants worked at least part-time with 3 to 14 years of counseling experience. Four of the six participants graduated from a master’s degree program accredited by the Council for Accreditation of Counseling and Related Educational Programs. All participants were European-American. In addition to school counseling experiences, participants had a range of other work experiences including mental health and social work.

Procedures
Due to the exploratory nature of the study, convenience sampling procedures were used to recruit participants (Marshall, 1996). A recruitment e-mail was sent to individuals on listservs serving school counselors in a midwestern state. Those interested in participating in the study replied to the e-mail indicating their desire. Once the e-mail was received by the primary researcher, participants were e-mailed a consent form and asked to sign and return it to the primary researcher. A verbal consent was then given at the beginning of each interview.

One phone or Skype interview was conducted with each participant. Each participant was emailed a copy of their transcriptions verbatim (member checking) to ensure participants’ voices were being heard and interpretations were accurate. Through member checking, participants were able to identify areas that may have been neglected or misconstrued (Lietz, Langer, & Furman, 2006); all participants verified the interviews were accurate. Asking for participant feedback helps build rapport between the researcher and participants and establishes trustworthiness (Williams & Morrow, 2009).

Researchers
As Patton (2002) writes, qualitative researchers are the major instrument of data collection, and their credibility is critical. The research team consisted of two individuals: a counselor education doctoral student (primary researcher) and an assistant professor in counselor education. An advanced counselor education doctoral candidate served as an auditor, whose role was to verify findings developed by the research team (Patton, 2002). One researcher had prior experience performing CQR investigations.

Trustworthiness refers to the quality or validity in qualitative research (Morrow, 2005). Staying aware of biases related to being a human instrument (Patton, 2002), as well as avoiding getting enmeshed in the data are important for qualitative researchers. Biases may arise from demographic characteristics of the researchers or values and beliefs about the topic. One potential bias for the study was one team member being familiar with the research on VT and possibly having preconceived expectations before analyzing data. The use of a research team of two researchers helped foster multiple perspectives (Hill et al., 2005). An external auditor and member checking strategies also were employed to ensure trustworthiness of the data (Patton, 2002).

The purpose of the external auditor in CQR is to ensure that the research team did not overlook important facts in the data (Hill, Knox, Thompson, & Nutt-Williams, 1997). During the data analysis process, the researcher engaged in an audit trail that described the specific research steps. An audit trail is an important part of establishing rigor in qualitative work as it describes the research procedures (Johnson & Waterfield, 2004). This audit trail was given to the external auditor who verified domains and core ideas.

Interview Protocol

Based on a review of current literature on vicarious trauma, a semi-structured interview guide was constructed. The interview guide included demographic questions as well as open-ended topics related to participants’ perceptions and understanding of trauma in relation to its impact on school counselors. Some examples of interview questions used are as follows: How do you define Vicarious Trauma (VT) of counselors? To what degree is VT a problem in the counseling profession? And, who do you believe to be at greater risk for experiencing VT? Specifically, the study was concerned with gaining an understanding of how participants perceived the importance of VT as an issue in the school counseling profession. Interviews were conducted by either Skype or telephone as a cost-effective means of collecting data (Hill et al., 1997). Each interview lasted 30 to 60 minutes. All interviews were taped and transcribed verbatim.

Data Analysis

The data were analyzed according to CQR methodology (Hill et al., 1997). In CQR, the goal is to arrive at a consensus along with other research team members regarding data classification and meaning. Grounded theory was the most influential theory in developing CQR. Although CQR combines aspects of various qualitative approaches, there are some factors that differ and provide its uniqueness. For example, unlike grounded theory, CQR emphasizes the use of research teams rather than one judge (Hill et al., 1997). CQR researchers also code data in domains (i.e., themes), then abstract the core ideas of each participant. Coding of the data was completed individually by the research team. Each researcher read all transcribed interviews and wrote what he or she thought to be the core ideas that captured each interview. Categories were developed from core ideas across all participants within each domain (Hill et al., 2005). These core ideas were identified as pertinent in the lives of these school counselors and were verified by the external auditor. Categories mentioned by all participants (i.e., all six counselors) were thought to be “general.” Those categories with more than half, but not all of the respondents were considered “typical” (i.e., 4–5 out of 6 counselors); those with half or fewer respondents were considered “variant” (i.e., 2–3 out of 6 counselors). Next, a consensus was reached regarding the core ideas captured from the data, followed by the auditor examining the resulting consensus and assessing the accuracy of the coding and core ideas. Finally, the research team reviewed the auditor’s comments to verify all findings (Hill et al., 1997).

Results

This section outlines three domains that emerged from the data: (a) ambiguous VT, (b) support system significance and, (c) importance of level of experience. These findings shed light on participants’ perceptions of the meaning of VT, as well as ways to avoid it and effectively respond to it should it occur.

Vicarious Trauma Ambiguity
In general, participants had an idea of what VT entailed, but for the most part it was ambiguously defined. One participant referred to it as taking on the issues that students or clients have and “carrying those things home.” Also, the counselor explained it was about living the experiences clients are living. Another counselor reported that VT occurs without realization.

Participants’ past experience was indicative of their understanding of trauma and VT. Specifically, those individuals who had previous social work careers (two participants) or a mental health background (one participant) had a greater knowledge of VT and its effects. They reported having more trauma training in their previous graduate programs when compared to their school counseling programs.

Typically, participants stated that they did not know much about VT, with three counselors reporting it to be synonymous with burnout. One counselor shared that VT was learned after participating in a research study exploring the topic. Another counselor shared that he did not have a clear understanding of VT, but assumes it refers to how he reacts to students with serious issues. Burnout was mentioned sporadically, but for some the concept served as a key feature of their understanding of VT. For example, one participant stated not knowing a ton about the topic, but understanding it as burnout, as did another participant. One counselor shared that VT was viewed as transference and that transference was something often discussed in graduate school.

Support System Significance
In general, school counselors reported that support systems are significant and needed to help alleviate vicarious trauma symptoms, or prevent it from occurring. Typical reports suggested they viewed peer supervision as quite useful for dealing effectively with VT. For example, one participant stated the importance of having others around who are willing to tell you when you are too close to a case. Another participant responded that counselors also have to be willing to accept an evaluation from staff members and others with similar career experience. Similarly, one participant discussed obtaining ongoing support from various avenues within the school environment to prevent her from experiencing VT. This counselor noted providing time for counselors to be with one other in a group setting or one-on-one consulting as a particularly good way to garner support for school counselors. This participant thought supervision would be helpful, but was not sure how to go about seeking it. Essentially, finding time to talk through issues was the most helpful thing to do according to this participant.

Someone or something to help unwind was viewed as a significant means of support. Participants explained that support also can come in the form of family or those not involved with the mental health profession at all. Furthermore, one participant noted that having an outlet such as an athletic or creative activity could be viewed as a form of support as well.

In addition, another participant shared the importance of a supportive work environment. According to this individual, without a healthy work environment VT can easily occur. Other participants also spoke of experiences with administrators and other staff at their workplace. For example, one participant addressed this support, sharing the fortune of having an administrative team to watch one another. They discussed keeping an eye out on issues and problems that colleagues may be experiencing, including VT.

Interestingly, participants also suggested that separation between work and home also has the potential to help alleviate these symptoms. According to one participant, “you must leave your hat at the door,” while another stated that once home, it was necessary to decompress and separate from work. Another school counselor felt as though technology created a hindrance in the separation of school and work. This participant felt that counselors should give themselves permission to separate themselves from work if they so desire. It was recommended that school counselors be given permission to separate themselves from work by not being forced to respond to e-mails and other forms of communication once arriving at home. As this school counselor noted, people have the ability to make contact at any time of day if they are allowed. This participant felt it is important not to give out phone numbers, or only give a personal number to those you trust will not abuse it.

Level of Experience
Generally, participants agreed that level of experience determined counselors’ risks of experiencing VT. Experience was perceived in a number of different ways ranging from formal training to work/life experience, with all participants mentioning how either life or work experiences helped them avoid or overcome VT.

Relatedly, many participants also discussed how either a lack of training or the need for more training could be related to how school counselors experience VT. Five out of six participants discussed the importance of receiving more training, or having an open discussion about their negative reactions to other colleagues or supervisors. Three out of six counselors shared that they had no classes related to trauma from their school counseling training. As one participant stated, not much training was offered and they wished more classes could have been taken on VT. A lack of life experience also was said to place a novice counselor at great risk for VT. One participant voiced concern about a student going straight into a master’s program with little life experience. Concern was voiced about students that go straight from a baccalaureate to a master’s program without taking time to live and work. According to this participant, inexperienced school counselors are unaware of the challenges they will face upon entering the counseling profession and may be more susceptible to VT. Similarly, another participant talked about how her relationship to the profession changed after four years as a school counselor. This school counselor discussed going home really frustrated or angry, feeling like more should have been done for students when starting out as a school counselor. Eventually, this counselor noted that work as a school counselor started to come together and that patience was important when working with children. This school counselor discussed frustration and anger as being signs of VT. This individual also felt that after more experience in the counseling field, symptoms such as these begin to vanish.

One participant mentioned a desire to save the world after graduation, which is typical of most new school counselors, but did not always work in the counselor’s favor. This individual felt that it only made the job more difficult when he realized he could not save every child he encountered. Another participant shared that new school counselors are often shocked because they haven’t seen as many issues as more seasoned counselors. However, this participant also shared that working with the issues kids face became easier each year, and the shock associated with hearing students’ issues decreased.

Discussion

The purpose of this study was to explore school counselors’ knowledge and perceptions of VT. Consistent with the literature regarding preventive and protective measures of VT (Adams & Riggs, 2008), these counselors named newer helping professionals as particularly susceptible to VT. They also discussed factors such as types of support systems and amount of experience with VT as playing a role in preventing VT. This finding is consistent with the research as well, which concludes that as level of support and work experience increase, the counselor is less likely to suffer from VT (Chrestman, 1999; Skovholt & Ronnestad, 2003; Sommer & Cox, 2005). All participants mentioned collaboration with other counselors as a primary means of averting VT. This finding suggests that counselors look to one another for assistance. Forming peer groups and having consultations with other staff within the school environment appeared to be vital in the lives of these participants. McCann and Pearlman (1990) support this notion and have stated the importance of counselors seeking potential sources of support in their professional networks, and that activities such as case conferences can be beneficial to counselors.

Participants proposed that lack of training on the topic made them more susceptible to experiencing VT, which is supported by literature on VT (Pearlman & Saakvitne, 1995). Studies have indicated that as level of experience, education and post-graduate training increases, trauma symptoms in counselors decrease (Adams & Riggs, 2008; Sommers, 2008).

School counselors discussed the difficulty associated with being a beginner counselor and how, with experience, one learns to set boundaries as a method of protecting oneself from VT. They also shared the strong relationship between life experience and being an effective counselor, which is vital to warding off VT symptomology. This finding is consistent with the literature that concludes that newer, more novice therapists may be more vulnerable to experiencing VT (Adams & Riggs, 2008). Many participants discussed how their level of confidence in their work increased over time. Previous literature and findings from the current study suggest that newer professionals may need more support for VT when starting their careers. Scholars have referred to helpful practices such as conferences (McCann & Pearlman, 1990), support groups or supervision (Sommers & Cox, 2005) as useful.

Supervision, although discussed in the literature as an alleviating factor in preventing VT (Sommers & Cox, 2005), was not salient in the current study. Only one participant discussed supervision as playing a role in preventing VT. The other school counselors did discuss that support from peers and administrators were helpful, but not supervision practices. This is worth mentioning, as supervision is one of the key methods counselor educators use to train counselors. It is not known if these counselors viewed support as part of supervision or if they do not see this as being available to them. For example, one participant spoke about an interest in forming peer supervision groups, but did not feel knowledgeable enough to do so.

Some participants stated they did not know much about VT, while others assumed it was similar to burnout. Vicarious trauma and burnout, although sometimes used simultaneously throughout the literature, have some differences in how each is displayed. Burnout may progress gradually, whereas vicarious traumatization can sometimes seem abrupt in onset with little or no knowledge of early recognition (Jenkins & Baird, 2002). Participants who compared VT to burnout did not distinguish any differences in the two constructs. Although not the focus on this study, one participant mentioned personally experienced symptoms related to VT (which this participant described as burnout). This finding suggests that counselors are aware of both VT and burnout. Burnout is a term documented throughout the literature, making it more accessible to counselors’ understanding of occupational stress and hazards.

The findings suggest that counselors feel unprepared to work with trauma cases due to lack of training in their master’s programs. Although the counselors in this study were able to form a working definition of what VT entailed, they wished they possessed more knowledge on the topic. What is important is that these counselors reported that with adequate support from one another they can help prevent or alleviate symptoms of VT. These school counselors also felt that as they become more settled in their profession, they are more apt in dealing with difficult case loads. This suggests that novice counselors should receive more support from colleagues, administrators and others in their professional network. The changes that occur when a counselor experiences VT may have a direct impact on the students they serve, therefore making it salient to address in both the school counseling profession as well training programs.

Implications for Counselor Educators and School Counselors

School counselors make an outstanding contribution to our society through serving our children. An awareness of VT may allow school counselors to implement strategies to ameliorate its effects. The information gathered in this project will increase the level of understanding and awareness of VT on school counseling professionals. VT is a phenomenon that has gained increasing attention in the counseling literature (Hafkenscheid, 2005; Harrison & Westwood, 2009; Sommer, 2008; Way et al., 2004). The findings seem to suggest school counselors feel they lack adequate knowledge and training regarding VT.

Findings from this study also suggest that it would be useful for counselors, especially those working with trauma survivors, to gain more knowledge and awareness on the topic. Counselor educators should offer more training in their counseling programs to increase awareness of VT and other trauma-related topics. For instance, school counselors in the current study expressed a need for more specific training related to VT or trauma in general. Courses related to trauma may be useful for fostering counselor growth (Sommer, 2008). Supervision also can be a reliable source for providing awareness of VT (Sommer & Cox, 2005) since supervision is used to monitor supervisees’ level of functioning and growth (McCann & Pearlman, 1990; Woodard Meyers, & Cornille, 2002).

The counselors in this study expressed the need for support in their work environments. School counselors should maintain collegial relationships as well as offer support to peers within their work environments. Peer groups, weekly case conferences and consultation may be useful for counselors to maintain their wellness and avoid experiencing VT (McCann & Pearlman, 1990). School counselors are in a good position to initiate support for students in their learning environments because they have direct access to children. Therefore, adequate training of school counselors is essential.

Limitations and Future Research

As with all research, there were limitations associated with the current study. First, Skype interviews may have generated pertinent information; however, such interviews were not feasible or accessible to all participants. Subtleties in body language cannot be accounted for during phone interviews. Future studies could include all Skype or face-to-face interviews. Second, given the limited understanding most participants in this study had on the topic, it may have been difficult for them to understand the prevalence of VT in the counseling field. It is possible that what they described as being VT in other school counselors can actually be symptoms of burnout, which the research concludes is different (Jenkins & Baird, 2002).

Conclusion

The current study provided an overview of the phenomenon and also some implications for both school counselors and counselor educators. There has not been much research supporting specific forms of treatment for VT and it should be examined further in the future. Research examining how individuals overcome symptoms of VT may be helpful for counseling professionals. Such research would provide others in the counseling field with a knowledge base that may be helpful in preventing the phenomenon. Since research on VT tended to focus on mental health professionals, social workers or trauma workers, future studies could specifically focus on preventative strategies for school counselors. Such information may elicit responses that capture how school counselors understand and experience VT, which could offer a clearer picture of what training programs can do to recognize and prepare for combating VT prior to entering the profession.

References

Adams, K. B., & Riggs, S. A. (2008). An exploratory study of vicarious trauma among therapist trainees. Training and Education in Professional Psychology, 2, 26–34.
Briggs-Gowan, M., Carter, A., Clark, R., Augustyn, M., McCarthy, K., & Ford, J. (2010). Exposure to potentially traumatic events in early childhood: differential links to emergent psychopathology. Journal of Children Psychology & Psychiatry, 51, 1132–1140.
Baird, K., & Kracen, A. (2006). Vicarious traumatization and secondary traumatic stress: A research synthesis. Journal of Counseling Psychology Quarterly, 19, 181–188.
Canfield, J. (2005). Secondary traumatization, burnout, and vicarious traumatization. Smith College Studies in Social Work, 75, 81–101.
Chambers, R. A., Zyromski, B., Asner-Self, K. K., & Kimemia, M. (2010). Prepared for school violence: School counselors’ perceptions of preparedness for responding to acts of school violence. Journal of School Counseling, 8, 1–35.
Chrestman, K. (1999). Secondary exposure to trauma and self-reported distress among therapists. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (2nd ed., pp. 29–36). Lutherville, MD: Sidran Press.
Figley, C. R. (1995) Compassion fatigue as secondary traumatic stress disorder: An overview. In: Figley, C.R. (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 1–20). Philadelphia, PA: Brunner/Mazel.
Finkelhor, D. Turner, H. Ormrod, R., Hamby, S., & Kracke, K. (2009). Children’s exposure to violence: A comprehensive national survey. Juvenile Justice Bulletin, 1–11.
Fowler, P., Tompsett, C., Braciszewski, J., Jacques-Tiura, A., & Baltes, B. (2009). Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Development and Psychopathology, 21, 227–259.
Hafkenscheid, A. (2005). Event countertransference and vicarious traumatization: Theoretically valid and clinically useful concepts. European Journal of Psychotherapy, Counseling and Health, 7, 159–168.
Harrison, R., & Westwood, M. (2009). Preventing vicarious traumatization of mental health therapists: Identifying protective practices. Psychotherapy: Theory, Research, Practice, Training, 46, 203–219. doi: 10.1037/a0016081.
Hill, C. E., Knox, S., Thompson, B. J., & Nutt-Williams, E. (1997). A guide to conducting consensual qualitative research. The Counseling Psychologist, 25, 517–572.
Hill, C. E., Knox, S., Thompson, B. J. Nutt-Williams, E., Hess, S., & Ladany , N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52, 196–205.
Jenkins, S., & Baird, S. (2002). Secondary traumatic stress and vicarious trauma: A validation study. Journal of Traumatic Stress, 15, 423–432.
Johnson, R., & Waterfield, J. (2004) Making words count: The value of qualitative research. Physiotherapy Research International 9, 121–131.
Lawrence, G., & Adams, F. D. (2006). For every bully there is a victim. American Secondary Education, 35, 66–71.
Lietz, C., Langer, C. L., & Furman, R. (2006). Establishing trustworthiness in qualitative research in social work: Implications from a study on spirituality. Qualitative Social Work, 5, 441–458.
Linley, P., & Joseph, S. (2007). Therapy work and therapists’ positive and negative well-being. Journal of Social and Clinical Psychology, 26, 385–403.
Marshall, M. (1996). Sampling for qualitative research. Family Practice, 13, 522–526. doi: 10.1093/fampra/13.6.522.
McCann, L., & Pearlman, A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131–149.
Morrow, S. L. (2005). Quality and trustworthiness in qualitative research in counseling psychology. Journal of Counseling Psychology, 52, 250–260.
Newman, M. L., Holden, G. W., & Delville, Y. (2005). Isolation and the stress of being bullied. Journal of Adolescence, 28, 343–357. doi:10.1016/j.adolescence.2004.08.002.
Patton, M. (2002). Qualitative research & evaluation methods. Thousand Oaks, CA: Sage.
Pearlman, L. A., & Mac Ian, P. S. (1995). Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Professional Psychology: Research and Practice, 26, 558–565.
Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York, NY: W.W. Norton.
Reilly, R., &D’Amico, M. (2011). Mentoring undergraduate women survivors of childhood abuse and intimate partner violence. The Journal of College Student Development, 52, 409–424.
Skovholt, T. M. (2001). The resilient practitioner: Burnout prevention and self-care strategies for counselors, therapists, teachers, and health professionals. Boston, MA: Allyn & Bacon
Skovholt, T., & Rønnestad, M. (2003). Struggles of the novice counselor and therapist. Journal of Career Development, 30, 45–58, doi: 10.1023/A:1025125624919.
Sommer, C. (2008). Vicarious traumatization, trauma sensitive supervision, and counselor preparation. Journal of Counselor Education & Supervision, 48, 61–71.
Sommer, C., & Cox, J. (2005). Elements of supervision in sexual violence counselors’ narratives: A qualitative analysis. Counselor Education and Supervision, 45, 119–134.
Snyder, H. N., & Sickmund, M. (2006). Juvenile offenders and victims: 2006 national report. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.
Trippany, R., White Kress, V., & Wilcoxin, A. (2004). Preventing vicarious trauma: What counselors should know when working with trauma survivors. Journal of Counseling & Development, 82, 31–37
U.S. Department of Health and Human Services (2008-2009). Child health USA. Rockville, MD: U.S. Department of Health and Human Services.
Way, I., VanDeusen, K. M., Martin, G., Applegate, B., & Jandle, D. (2004). Vicarious trauma: A comparison of clinicians who treat survivors of sexual abuse and sexual offenders. Journal of Interpersonal Violence, 19, 49–71.
Williams, E., & Morrow, S. (2009). Achieving trustworthiness in qualitative research: A pan-paradigmatic perspective. Psychotherapy Research, 19, 576–582.
Woodard Meyers, T., & Cornille, T, (2002). The trauma of working with traumatized children. In C. R. Figley (Ed.), Treating compassion fatigue (pp. 39–55). New York, NY: Brunner-Routledge.

Mashone Parker, NCC, is a doctoral candidate in the counselor education program at the University of Iowa. Malik S. Henfield is an Associate Professor in the counselor education program at the University of Iowa. Correspondence can be addressed to Mashone Parker, University of Iowa, RCE N338 Lindquist Center, Iowa City, IA 52242, mashone-parker@uiowa.edu.