As students in the trauma field, we are hopefully well aware of the prevalence of secondary traumatic stress/vicarious trauma, burnout, and compassion fatigue that trauma-focused providers often experience at some point in their career. These experiences may even be more common for students and less experienced trainees as they begin clinical work. Clinical supervision is particularly important for trainees and has the potential to both prevent secondary traumatic stress (STS) and provide support to trainees experiencing STS (Baird & Kracen, 2006; Cieslak et al., 2013; Quinn & Nackerud, 2019).
While trainees do not always have the opportunity to choose clinical supervisors, it may be helpful for trauma-focused trainees to understand how supervision can enhance capacity for trauma work; this will also benefit trainees who move into the supervisory role at some point in their careers. Research regarding the protective role of clinical supervision against STS specifically identifies trauma-informed supervision as a protective mechanism. In a special issue of The Clinical Supervisor dedicated to trauma-informed practice, Knight and Borders (2018) define trauma-informed as “an orientation to clinical practice and organizational environment that takes into account the possibility that clients and consumers of services may have been exposed to one or more traumatic events.” Trauma-informed supervision shares all of the common factors with clinical supervision and also considers the five tenants of trauma-informed care: safety, trustworthiness, choice, collaboration, and empowerment (Berger & Quiros, 2014). It is recommended that supervisors adopt a trauma-informed approach even if their work is not especially trauma-focused.
In practice, trauma-informed supervision may include fostering a sense of safety and trustworthiness through the development of a supervision contract, with consistency and predictability in supervision sessions (regarding time and content of discussion; e.g., keeping evaluation separate from supervision). It may also include providing psychoeducation about STS (Berger & Quiros, 2014; Jones & Branco, 2020) assessing supervisees’ vulnerabilities and resilience relative to trauma content and personal experiences (Berger & Quiros, 2014; Courtois, 2018; Jordan & Branco, 2018), promoting self-care (Berger & Quiros, 2014; Jones & Branco, 2020) and ensuring that trauma-related caseload is balanced (Berger & Quiros, 2014).
What does this look like? Trauma-informed supervision includes scheduling consistent supervision with clear time boundaries to promote safety. It is also encouraged to enact boundaries between supervision and evaluation, and to utilize a supervision contract to facilitate trustworthiness (Berger & Quiros, 2014). In addition to providing psychoeducation about STS to supervisees, it is recommended for supervisors to assess supervisees for the following reactions associated with STS: sadness, fear, helplessness, powerlessness, somatic reactions, detachment, and decreased personal and professional functioning (Berger & Quiros, 2014). It is further important for supervisors to consider the intersection between supervisees’ identities and trauma exposure; specifically, supervisors should encourage supervisees to consider the ways in which their social identities influence assumptions, biases, and responses to trauma (Varghese et al., 2018). Finally, multiple papers discussing trauma-informed supervision mention asking supervisees about their own trauma histories; a detailed recommendation for inquiring about supervisees’ trauma histories with empathy emphasizes assessing whether such history has been recognized, addressed, and resolved by a supervisee (Courtois, 2018). Of course, there are relevant ethical concerns that come into play when discussing any personal trauma experiences in clinical supervision and these must be carefully considered and monitored.
In summary:
- Trainees exposed to trauma cases are at risk for secondary traumatic stress (STS).
- Clinical supervision can prevent the development of STS and buffer the effects of STS.
- Clinical supervision for trauma-focused trainees (and professionals) appears most beneficial when it is trauma-informed.
- Trauma-informed supervision applies five tenants of trauma-informed care to supervision: safety, trustworthiness, choice, collaboration, and empowerment.
- It is important for supervisors to provide psychoeducation about STS, assess STS reactions in their supervisees, identify and acknowledge supervisees’ trauma histories within the confines of professional ethics, and consider cultural factors that may contribute to the development and maintenance of supervisees’ STS.
About the Author
Sophie Brickman, MA, is a current doctoral student in clinical psychology with an emphasis in trauma at the University of Colorado Colorado Springs. She earned her bachelor's degree from Brandeis University. Her research and clinical interests include posttraumatic growth, trauma memory, and the role of creative writing in trauma healing. Please note that the opinions expressed in this piece are her own and do not necessarily reflect the position of the University of Colorado Colorado Springs.
References
Baird, K., & Kracen, A. C. (2006). Vicarious traumatization and secondary traumatic stress: A research synthesis. Counselling Psychology Quarterly, 19(2), 181-188. https://doi.org/10.1080/09515070600811899
Berger, R., & Quiros, L. (2014). Supervision for trauma-informed practice. Traumatology, 20(4), 296–301. https://doi.org/10.1037/h0099835
Cieslak, R., Anderson, V., Bock, J., Moore, B. A., Peterson, A. L., & Benight, C. C. (2013). Secondary traumatic stress among mental health providers working with the military: prevalence and its work- and exposure-related correlates. The Journal of nervous and mental disease, 201(11), 917–925. https://doi.org/10.1097/NMD.0000000000000034
Courtois, C. A. (2018). Trauma-informed supervision and consultation: Personal reflections. The Clinical Supervisor, 37(1), 38-63. https://doi.org/10.1080/07325223.2017.1416716
Jones, C. T., & Branco, S. F. (2020). Trauma‐Informed Supervision: Clinical Supervision of Substance Use Disorder Counselors. Journal of Addictions & Offender Counseling, 41(1), 2-17. https://doi.org/10.1002/jaoc.12072
Knight, C., & Borders, L. D. (2018). Trauma-informed supervision: Core components and unique dynamics in varied practice contexts. The Clinical Supervisor, 37(1), 1-6. https://doi.org/10.1080/07325223.2018.1440680
Quinn, A., Ji, P., & Nackerud, L. (2019). Predictors of secondary traumatic stress among social workers: Supervision, income, and caseload size. Journal of Social Work, 19(4), 504–528. https://doi.org/10.1177/1468017318762450
Varghese, R., Quiros, L., & Berger, R. (2018). Reflective practices for engaging in trauma-informed culturally competent supervision. Smith College Studies in Social Work, 88(2), 135-151. https://doi.org/10.1080/00377317.2018.1439826