Trauma Clients Research Articles

Challenges Encountered by Latinx Bilingual Service Providers Working With Survivors of Intimate Partner Violence

The purpose of this study was to identify the challenges encountered by bilingual service providers working with survivors of intimate partner violence (IPV). Latinx experience IPV at a high rate, and their ability to seek services is affected by multiple factors, including their immigration status, English language proficiency, and lack of familiarity with the U.S. healthcare system. Bilingual service providers working in shelters often treat Latinx in Spanish. While some research exists on the stressors associated with providing IPV services in shelters, nothing is known about how being bilingual affects service providers. This qualitative study was designed to fill this gap. The findings yielded two themes: difficult workload and service provider exhaustion. The disproportionate rate of IPV services requiring services in Spanish and the available staff equipped to serve them often results in high caseloads and additional responsibilities for bilingual service providers. The lack of training in both service provision in Spanish and serving monolingual Spanish-speaking IPV survivors increases the strain of providing quality client care. Emotional and mental exhaustion is a common experience when serving trauma clients; however, it can be compounded for bilingual service providers, who must also use a second language. Agencies must consider the work demands of bilingual service providers to ensure that the expectations are balanced and reasonable. More Spanish-speaking providers are needed to meet the need, and evidence-based training must be developed and widely disseminated.

"This is you teaching you:" Exploring providers' perspectives on experiential learning and enhancing patient safety and outcomes in ketamine-assisted therapy.

This study explores therapists' perspectives on experiential learning, competencies, and training in ketamine-assisted therapy (KAT), a form of psychedelic-assisted therapy (PAT). We aim to understand how therapists' personal psychedelic experiences influence their self-perceived competency and therapeutic relationships regarding KAT. Licensed therapists from Numinus Wellness clinics in Canada and the USA who were trained in KAT were invited to participate in the study. Participation included a 60-90-minute semi-structured interview conducted remotely via secure videoconferencing. The interviews focused on the professional and personal impacts of providing KAT, its mechanisms, and the role of therapists' personal psychedelic experiences in delivering KAT. Data analysis utilized Interpretative Phenomenological Analysis (IPA) and a mix of deductive and inductive coding with Nvivo software. Eight therapists (62.5% female, 37.5% male) were interviewed. All had formal training in KAT, with many also trained in other forms of PAT. All respondents endorsed the value of personal psychedelic experience for deepening understanding of clients' experiences and strengthening the therapeutic alliance. They all also expressed a desire for formal experiential training in KAT, which they viewed as a missing element in their training. Additional themes identified included the importance of relational safety and the therapeutic container, KAT's impact on professional development, competency, and purpose, and navigating risks and challenges in KAT, particularly with complex trauma clients. Our findings highlight the need for enhanced therapist training and evidence-based standardization of PAT programs that incorporate experiential learning. Such training has the potential to optimize safety and therapeutic outcomes.

애착 트라우마 상담 사례연구: 안구운동 민감소실 재처리(EMDR)와 내면가족체계(IFS) 치료의 통합적 적용가능성을 중심으로

The purpose of this study is to present an integrative counseling approach to support the recovery of attachment trauma clients, focusing on the process of creating a sense of safety and building resources to help clients connect with the power of their authentic inner self. This paper examines an integrative counseling approach to help clients recover from attachment trauma by combining the Eye Movement Desensitization and Reprocessing(EMDR) technique with the counseling techniques of the Internal Family System(IFS) therapy. In addition, we examined the integrative counseling approach and the process of recovery through the case of a woman in her 20s who experienced attachment trauma, in order to contribute to providing the best counseling for attachment trauma clients. Based on the results of this study, limitations, implications, and further research are discussed.

Vicarious Trauma: The Next Pandemic?

What is Vicarious Trauma Vicarious Trauma (VT) is ubiquitous and may be defined as the cumulative impact on the therapist of repeated exposure to traumatic client imagery and material. Therefore, VT may be viewed as a natural and inevitable consequence of working with trauma clients. Although only a relatively new area of study, findings suggest that VT effects can have a profound impact on both personal and professional domains of functioning.

Initial Distress, Changes in Distress, and Reasons for Ending Therapy in Clients Affected by Sexual Trauma

ABSTRACT This study compared pre-treatment distress and the changes in that distress over the course of therapy between sexual trauma clients and non-sexual trauma clients. Reasons for therapy ending were also examined. Data for this study were collected at 139 university counseling centers. Psychological distress was measured using the Counseling Center Assessment of Psychological Symptoms; presenting concerns were determined using the Clinician Index of Client Concerns; and reason for end of treatment was measured using a standardized Termination Form. MANOVA was utilized to test differences in psychological distress at the start of therapy and a MANCOVA was used to examine psychological distress over the course of therapy. Chi-square tests were used to examine if different reasons existed for why treatment ended. Clients that experienced sexual trauma presented to treatment with significantly higher levels of distress but demonstrated greater distress change. No statistical differences in reasons associated with the end of treatment.

Practical guidelines for online Narrative Exposure Therapy (e-NET) – a short-term treatment for posttraumatic stress disorder adapted for remote delivery

ABSTRACT Background: Online therapy has become increasingly desirable and available in recent years, with the current COVID-19 pandemic acting as a catalyst to develop further protocols enabling therapists to conduct online treatment safely and efficaciously. Offering online treatment potentially means that treatments are available to clients who would otherwise have no access, closing the gap in the provision of mental health services worldwide. Objective: This paper focuses on practical guidelines using online Narrative Exposure Therapy (e-NET). It aims to be an addition to the general manual of NET to enable therapists to deliver online treatment. The face-to-face version of NET is a well-known short-term and evidence-based treatment for posttraumatic stress disorder; e-NET is currently being tested in several additional trials. Methods: The differences between NET and e-NET are elaborated and depicted in detail. Results: Difficulties encountered in e-NET delivery, e.g. confidentiality, dealing with interruptions, comorbid symptoms among others, are similar to those that occur during face to face interventions but the solutions have to be adapted. Dissociation is often regarded as a challenge in face-to-face treatment, and requires particular attention within the online setting. Therefore, tools for addressing dissociation in this particular setting are presented. Conclusions: These practical guidelines show the advantages as well as the challenges therapists face when conducting e-NET. They aim to empower therapists working with trauma clients to conduct e-NET confidently and safely.

Cost of Caring: Vicarious Trauma Among Guidance Counselors and Psychologists

This study sought to describe the lived experiences of vicarious trauma among guidance counselors and practicing psychologists. There were ten practicing registered guidance counselors and psychologists from Region 1 who served as respondents for this study who worked with trauma clients and had manifestations of vicarious trauma. An in-depth semi-structured interview protocol was used as the main data-gathering tool. Audio-recorded interviews were done on a one-on-one manner after permission was sought from the respondents and confidentiality ensured. Interviews were transcribed and using interpretative phenomenological analysis, main themes and sub-themes were identified. Findings revealed that respondents’ lived experiences of vicarious trauma included engagement behaviors, changes in worldview, and physiological and psychological symptoms. The respondents ascribed meanings to their experiences namely, inner strength/grit, reality check, nurturance of the transcendental motive, recognition of psychological boundaries, emotion management, openness to experience and change, sense of appreciation, professional growth, and deepening of spirituality. Recommendations were given for guidance counselors and psychologists and organizations. Suggestions for future studies were likewise recommended.

Assessment of risk factors and occurrence of osteoporotic fractures among low impact trauma clients in West Bengal, India

Management of osteoporotic fractures becomes challenging because of its multiple associated factors as well as poor bone quality. Therefore, assessments of the risk factors of osteoporotic fractures among low impact trauma client is a matter of great concern which can be addressed properly to reduce their occurrence in future. Thirty patients with single or multiple fractures were selected purposively for descriptive survey study between January 2018 to December 2018. Their ages varied from 41 to 80 years. There were 26 female and four males. 24 patients have single fracture and six had multiple fractures following low impact trauma. The demographic parameters were studied by structured interview schedule, and the research variable, the risk factors were studied by interview, biophysical assessment and records of BMD value through DEXA and serum level of vitamin D. Socio-demographic variables like age, sex, body weight, Body mass index (BMI), etc. were selected and their relationship were assessed to find out the risk factors of fragility fractures in society by research variables like risk factors of osteoporotic fractures. For statistical analysis of determination of association between such factors and fragility fractures, non-parametric Fisher exact test and Odds ratio was used. In our study, osteoporotic fractures occurred majority (86.66%) among female maximally among 60-69 years age group. Whereas in relatively younger age (40-60 years), abnormal BMI (low or high) is responsible for fragility fracture as 46.6% of such fractures occurred in this group as 20% fracture are associated with underweight and 40.66% with overweight BMI. Tobacco smoking increases the risk of fragility fractures twice (as relative risk ratio 2) and rheumatoid arthritis increases the six-fold (as relative risk ratio 6). All 100% had history of fall. Level of serum vitamin D, low DEXA scan value (less than -2.5) and fall on ground resulting in low impact injuries shows strong association between those and fragility fractures. On the other hand, all the risk factors remain same for the recent and old fractures. Several risk factors need to be addressed properly apart from medical managements to reduce the risk of occurrence of osteoporotic fractures.

Treating Complex Trauma Survivors: A Trauma-Sensitive Yoga (TSY)-Informed Psychotherapeutic Approach

ABSTRACT Trauma-sensitive yoga (TSY) is a body-oriented yoga practice, intentionally designed to help complex trauma survivors recover by developing self-awareness, self-regulation, and a benevolent relationship with their bodies. There is a growing body of evidence supporting TSY’s efficacy in reducing participants’ posttraumatic stress disorder (PTSD) symptoms and facilitating holistic trauma recovery beyond conventional psychotherapies. Given the promise shown by TSY as an adjunct trauma intervention that is consistent with a trauma-informed approach, it is timely to discuss how counselors can integrate TSY into their psychotherapeutic interventions to optimize trauma recovery. This article begins with a review of the TSY literature, followed by recommendations for counselors to weave TSY-informed interventions into psychotherapy with complex trauma clients, further illustrated in a case vignette.

Dancing with demons: working with vowed religious clergy who are also sex offenders

This article discusses the case of a male vowed religious clergy, who was also in residential treatment for sexual misconduct and interpersonal difficulties. Importantly, this client also had a childhood history of sexual trauma. The case, difficult and complex in its own right, posed unique clinical challenges. The first author and therapist, a Catholic, feminist, woman often works with child trauma clients. Thus, the experiences of transference and countertransference were particularly important therapeutic considerations working with this client. Themes of power, sex, shame, guilt, and blame needed to be explored and processed in depth from the client’s and therapist’s perspectives both during session and supervision. Concurrent issues include personality disorders, physical disability, and psychosexual disorders. This client was referred by their religious institution and took part in a mandated fourteen to twenty-week residential programme. Therapeutic modalities include trauma-informed, attachment-oriented, and psychodynamic individual and grouporiented psychotherapy.

Integrating self-care into clinical practice with trauma clients

ABSTRACTSelf-care is recognized as an important aspect of social work practice. Beginning in educational settings, developing social workers are encouraged to learn about and practice self-care. However, self-care is typically promoted through strategies and approaches outside of the practice context. Social workers are oftentimes encouraged to use individualized self-care plans, which often feature a variety of relaxation and secondary techniques; focus on self-awareness and self-reflection; and have proper use of supervision. Although these strategies are invaluable, they do little to directly benefit the social worker during direct practice or while in session with a client which is a time period when clinicians are particularly vulnerable to distress or burnout. The importance of real-time self-care strategies is particularly critical for clinicians, especially those who engage in trauma work, given the sensitivity of topics that clients may have endured or benefit from assistance in processing. Further, little information has been published on the use of self-care techniques during a session with a client or in a clinical context. The purpose of the present paper is to discuss self-care strategies that can be useful both outside of and within a clinical setting and present a model of such strategies that focus on integrating self-care in clinical practice particularly for those engaging in trauma work. The paper will conclude by discussing the relevancy of the developed model in practice.

Empathy and coping as predictors of professional quality of life in Australian Registered Migration Agents (RMAs)

Threats to professional quality of life such as compassion fatigue constitute a risk for those working with trauma-exposed individuals. Research has investigated professional quality of life in first responders, mental health practitioners, and medical personnel, but the impact on Registered Migration Agents (RMAs) who work with trauma-exposed refugee clients has not been evaluated. This study examined the prevalence of secondary traumatic stress, burnout and compassion satisfaction in 188 RMAs, and the roles of empathy and coping strategies. More than one-third of the sample members were potentially at risk of compassion fatigue (under two-thirds indicated compassion satisfaction). Regression results suggested that compassion fatigue was significantly related both to lower empathy and to maladaptive coping; while adaptive coping and high empathy significantly predicted compassion satisfaction. Results indicate a potential occupational hazard for RMAs working with trauma clients; suggesting tailored interventions to reduce the risk of deleterious compassion fatigue on RMAs.

How do trauma therapists experience the effects of their trauma work, and are there common factors leading to post-traumatic growth?

BackgroundRecent studies on the effects of trauma work among trauma therapists have shown that the outcome is not exclusively negative, as trauma therapists also report positive experiences known as post-traumatic growth. Some preliminary understandings have emerged from limited research of individuals’ experience of post-traumatic growth in trauma therapists. This study has therefore been designed to gain insights into trauma therapists’ experiences of their trauma work and to understand the potential factors enabling post-traumatic growth.MethodTo gain an understanding of the trauma work individualistic experience, qualitative approach has been adapted. A total of 10 self-identified trauma therapists who met the inclusion criteria completed a short demographic information sheet and participated in a semi-structured interview. The data was analysed in accordance with the Interpretative Phenomenological Analysis (IPA) and Smith (1996) method.FindingsParticipants’ perceptions about their experience of working with trauma clients indicated four superordinate themes: ‘responding to a client’, ‘noticing growth in self’, ‘making a difference’, and ‘finding their own ways to process the trauma work’.ConclusionThe emerging themes indicate that therapists experience a wave in terms of the trauma work’s impact, rather than simply being a negative or positive type of work. The data indicates that trauma therapists also experience growth from their work, contradicting most prior studies on the impact of trauma work on therapists. The findings are further discussed in relation to the implications for therapists and importance of self-care.

The role of therapy in personal recovery – Trauma clients’ use of resources to continue positive processes following group therapy

Traditionally, there has been a sharp division between ‘personal’ and ‘clinical’ recovery. What role, then, might therapy play in personal recovery? To explore how female adult trauma survivors experience working towards recovery after participation in trauma-specific group therapy, we carried out semi-structured qualitative interviews with 13 clients one year after their completion of a stabilization group approach. A hermeneutic-phenomenological approach was used to analyze interview transcripts. After therapy, the participants consolidated and continued their positive processes of change. Experiences from therapy gave rise to personal recovery processes that were categorized into two main themes: “tapping into pre-therapy resources” and “using therapy-related resources.” Therapy might play an important role in personal recovery through helping clients to rediscover and utilize existing resources, as well as being a source of new resources. The participants were active agents in this recovery, putting their therapies to use in the context of their daily living.

What Lies Beneath: Trauma Events, PTSD, and Alcohol Misuse in Driving Under the Influence Program Clients

The prevention and reduction of alcohol misuse is one of the Grand Challenges of Social Work. Addressing client needs beyond alcohol misuse can improve client outcomes. Driving under the influence program clients (N = 1,248) were screened for trauma events and posttraumatic stress disorder (PTSD). Results found that males more often reported having been assaulted with a weapon or that they caused injury to someone else. Females more often reported sexual assault and other unwanted sexual experience. About 26% overall screened positive for PTSD. Social workers need to be alert to various types of trauma and help clients identify the connection between trauma and alcohol misuse.

From painstaking work to a new way of meeting the world—Trauma clients’ experiences with skill training in a stabilization group approach

Objective: The study explored how former trauma clients experienced the inclusion of skill training in their treatment, their ways of relating to and using these skills, and how this changed over time. Method: Semi-structured qualitative in-depth interviews were conducted with 13 clients within three months of their completion of treatment, and again 11–13 months later. Results: Analysis of the material resulted in three main themes: (1) Being ready to find new ways to deal with trauma-related problems as a motivational starting point at intake, (2) Finding new agency through skills and understanding, and (3) One year on—Meeting the everyday world in a new way. An overreaching theme was the significant effort clients put into their treatments. Conclusions: The results show how skills over time became integrated and were linked to profound changes, including changes in emotional processing and an increased sense of agency. An experiential interrelationship between understanding and action was found, that supports the practice of coupling skill training with psychoeducation in trauma-specific treatment.

No Pain, No Gain: Vicarious Posttraumatic Growth Among Australian Child Protection Caseworkers

High turnover rates among Australian child protection caseworkers are prevalent, and decrease the quality and availability of crucial services for children in need (ACOSS, 2014). Vicarious traumatisation (VT) as a result of repeated exposure to others’ trauma is a possible explanation for high turnover in helping professions, and involves adverse changes to cognitive schemas and emotional experience, resembling PTSD. VT may be moderated by benefits of trauma-related work, in the form of Vicarious Posttraumatic Growth (VPTG). Quantitative and qualitative methods are employed to examine the relationship between positive and negative effects of work with trauma clients, and assess the validity of the Posttraumatic Growth Inventory (PTGI) in this population. Quantitative analysis found no significant linear or curvilinear relationship between VT and VPTG, and qualitative results support the idea that the PTGI is applicable in a vicarious context, with some exceptions. Recommendations for modification of the PTGI are discussed.

Secondary trauma among social workers treating trauma clients: The role of coping strategies and internal resources

This study explores the association between coping strategies (problem-focused, emotion-focused, and avoidance), internal resources (dispositional optimism and mastery), demographic and work characteristics, and secondary trauma symptoms among 160 social workers in public agencies treating clients who were victims of trauma. A hierarchical regression analysis revealed that emotion-focused and avoidance coping strategies, previous history of exposure to a traumatic event, and high exposure to traumatic material through clients were associated with increased levels of secondary trauma, while dispositional optimism, mastery, and steady supervision on a weekly basis were associated with a reduction of those symptoms. Theoretical and clinical implications of the findings are discussed.

Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients

BackgroundTherapists who work with trauma clients are impacted both positively and negatively. However, most studies have tended to focus on the negative impact of the work, the quantitative evidence has been inconsistent, and the research has primarily been conducted outside the United Kingdom.ObjectivesThis study aimed to assess the prevalence of, and identify predictor variables for, compassion satisfaction, burnout, and secondary traumatic stress in a group of UK therapists (N=253) working with adult trauma clients.MethodAn online questionnaire was developed which used The Professional Quality of Life Scale (Version 5) to assess compassion satisfaction, burnout, and secondary traumatic stress and collect demographics and other pertinent information.ResultsWhilst the majority of therapists scored within the average range for compassion satisfaction and burnout, 70% of scores indicated that therapists were at high risk of secondary traumatic stress. Maturity, time spent engaging in research and development activities, a higher perceived supportiveness of management, and supervision predicted higher potential for compassion satisfaction. Youth and a lower perceived supportiveness of management predicted higher risk of burnout. A higher risk of secondary traumatic stress was predicted in therapists engaging in more individual supervision and self-care activities, as well as those who had a personal trauma history.ConclusionsUK therapists working with trauma clients are at high risk of being negatively impacted by their work, obtaining scores which suggest a risk of developing secondary traumatic stress. Of particular note was that exposure to trauma stories did not significantly predict secondary traumatic stress scores as suggested by theory. However, the negative impact of working with trauma clients was balanced by the potential for a positive outcome from trauma work as a majority indicated an average potential for compassion satisfaction.

Secondary Traumatic Stress and Disruptions to Interpersonal Functioning Among Mental Health Therapists

Disruptions within interpersonal relationships are often cited as a symptom of secondary traumatic stress (STS) and vicarious trauma among mental health therapists. However, the primary evidence to support these claims is based on theoretical explanations and limited descriptive data. The current study sought to test the theoretical model of STS and to extend prior research by directly measuring interpersonal and sexual disruptions and their association with STS symptomology. The study hypothesized that mental health therapists with higher levels of intrusion, avoidance, and arousal symptoms would also report disruptions in their interpersonal relationships. A total of 320 licensed mental health therapists completed the online study questionnaire. Results of the current study were mixed. Higher levels of STS symptoms showed a significant association with lower relationship satisfaction, lower social intimacy, less use of constructive communication patterns, and more use of avoidance communication and demand-withdrawal communication patterns. These relationships remained after controlling for gender, years of counseling experience, and exposure level to trauma clients. However, no association was found between STS, sexual activity interest, and sexual relationship satisfaction. Implications of these findings are reviewed.