According to the Gun Violence Archive, a mass shooting occurs when four or more people, not including the person(s) responsible for the shooting, are shot or killed in a single incident. In 2022, the United States saw over 600 mass shootings with loss of life exceeding 650 people (Gun Violence Archive, 2023). As students working at an outpatient specialty trauma clinic and in a Level 1 trauma center in Colorado Springs, this topic hits close to home following the November 19, 2022 mass shooting at a Colorado Springs LGBTQIA+ nightclub in Colorado Springs. Our community joined together to provide crucial resources and support to those affected by the incident, which included graduate student clinical psychology trainees providing numerous hours of free coping support in the hospital, as well as outpatient therapy. Clinical psychology graduate training involves providing clinical services, which are often free or low-cost, to community members. Given that graduate students also face numerous personal and professional transitions and challenges during training (e.g., managing coursework, balancing multiple practicum placements, conducting dissertations), and are in the earliest stage of their career, it is crucial that training programs provide adequate support to these students who are increasingly at the frontline of service provision following mass trauma.
Mental health challenges are not uncommon in helping professionals. Among human services and education staff located within ten miles of a mass shooting that occurred in 2018, 35% of individuals working with community members had a positive mental health screen a year following the shooting. Additionally, 36% endorsed feeling exhausted by their work as a helper and overwhelmed by the amount of their work. Secondary traumatic stress and burnout also occur among graduate students in helping professions. Among graduate social work students, secondary traumatic stress was significantly and positively correlated with coursework stress, fieldwork stress, and training retraumatization (Butler et al., 2017). Although secondary traumatic stress may not affect the majority of individuals working with trauma populations (Elwood et al., 2011), it is still crucial that graduate programs provide resources to support their students in providing clinical care and managing stress associated with both their coursework and clinical work. Additionally, research has noted that secondary trauma does not completely capture the experience of providing care within a shared traumatic reality, in which clinicians are exposed to the same communal trauma as clients, such as the 9/11 terrorist attack (Tosone et al., 2012). When exposed to shared trauma, providers are at a greater risk of developing primary or secondary PTSD symptoms and compassion fatigue (Tosone et al., 2012). A heightened need for self-awareness/reflection, supervision, organizational resources, and consultation regarding boundaries and self-disclosure is important in these situations, especially for graduate students providing services in the early stages of their career.
Resources and supports that may be beneficial for students include:
-
Education and training around secondary traumatic stress, compassion fatigue, and burnout. It is necessary for programs to inform students of the risk of these phenomena, as well as ways in which to strengthen students’ self-awareness around these experiences. Finding a balance between promoting awareness and understanding while also not perpetuating a self-fulfilling prophecy may be important to consider (Elwood et al., 2011).
-
Support and space for students to practice self-care. In a sample of over 300 students from APA accredited clinical psychology doctoral programs, participants reported working an average of 49.6 hours per week on activities and tasks directly related to their graduate training (Zahniser et al., 2017). Developing protocols within programs to make time and space for students to practice self-care may be preventative of secondary traumatic stress, compassion fatigue, burnout, and other mental health challenges among students, especially when navigating providing services in the context of shared trauma (Butler et al., 2017).
-
Access to health insurance and therapy. Many mental health graduate programs promote students engaging in their own therapy. Graduate students often report high financial stress due to the low financial support received throughout training combined with workloads that typically prevent external employment, hindering their ability to access mental health services (Szkody et al., 2022). Additionally, graduate students may be limited in the services they can access due to professional boundaries (i.e., inability to receive care at their university counseling centers because they complete practicum work at these sites). Supporting students in accessing health insurance and developing relationships with local therapists around graduate programs who are willing to see students on a sliding scale or reduced fee may also help to increase students’ access to quality mental health care.
-
Monitoring of student caseload. Setting limits on student caseload and numbers of specific traumas they are seeing at a particular time may be supportive. Research examining secondary traumatic stress in mental health clinicians providing trauma therapy found that proportion of caseload made up of trauma survivors was positively correlated with secondary traumatic stress (Devilly et al., 2009).
-
Supervision. Particularly in the context of shared traumatic reality, heightened availability of supervision and organization resources (e.g., consultation groups, peer support) is recommended (Tosone et al., 2012). As novel challenges regarding self-disclosure, boundaries, and the need for self-insight can arise, supervision tailored towards a shared traumatic reality is important.
About the Authors
Emmeline N. Taylor, MA is a clinical psychology PhD candidate with an emphasis in trauma at the University of Colorado Colorado Springs. She works in collaboration with the Lyda Hill Institute for Human Resilience as a graduate research assistant and student clinician in a Level 1 Trauma Center and outpatient PTSD clinic. Emmeline’s research interests include intervention implementation, the role of emotion regulation in trauma recovery, and how complex systems strategies can help the field better understand the phenomena of resilience, co-occurring conditions, and trauma recovery. She also works part-time as a remote research assistant for the U.S. Department of Veterans Affairs Palo Alto’s Center for Innovation to Implementation. Please note that the opinions expressed in this piece are my own and do not necessarily reflect the positions of the University of Colorado Colorado Springs nor the U.S. Department of Veterans Affairs.
Sophie Brickman, MA is a clinical psychology PhD candidate 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
Butler, L. D., Carello, J., & Maguin, E. (2017). Trauma, stress, and self-care in clinical training: Predictors of burnout, decline in health status, secondary traumatic stress symptoms, and compassion satisfaction. Psychological Trauma: Theory, Research, Practice, and Policy, 9, 416–424. https://doi.org/10.1037/tra0000187
Devilly, G. J., Wright, R., & Varker, T. (2009). Vicarious trauma, secondary traumatic stress or simply burnout? Effect of trauma therapy on mental health professionals. Australian & New Zealand Journal of Psychiatry, 43(4), 373–385. https://doi.org/10.1080/00048670902721079
Elwood, L. S., Mott, J., Lohr, J. M., & Galovski, T. E. (2011). Secondary trauma symptoms in clinicians: A critical review of the construct, specificity, and implications for trauma-focused treatment. Clinical Psychology Review, 31(1), 25–36. https://doi.org/10.1016/j.cpr.2010.09.004
Gun Violence Archive. (2023). Mass shootings in 2022. Gun Violence Archive. https://www.gunviolencearchive.org/reports/mass-shooting?year=2022
Szkody, E., Hobaica, S., Owens, S., Boland, J., Washburn, J. J., & Bell, D. (2022). Financial stress and debt in clinical psychology doctoral students. Journal of Clinical Psychology, n/a. https://doi.org/10.1002/jclp.23451
Tosone, C., Nuttman-Shwartz, O., & Stephens, T. (2012). Shared trauma: When the professional is personal. Clinical Social Work Journal, 40(2), 231–239. https://doi.org/10.1007/s10615-012-0395-0
Zahniser, E., Rupert, P. A., & Dorociak, K. E. (2017). Self-care in clinical psychology graduate training. Training and Education in Professional Psychology, 11(4), 283–289. https://doi.org/10.1037/tep0000172