Secondary Trauma: How Working with Trauma Survivors Affects Therapists

Secondary trauma, a relatively recent topic that has emerged in the field of social work, includes the emotional and psychological effects that working with traumatized clients has on therapists. Secondary trauma can seriously impact therapists' personal and professional well-being. Trauma therapists face major ethical dilemmas if their reactions to being traumatized enter into the therapeutic relationship, exposing clients to psychological harm or possibly re-traumatization. As many graduate programs in social work and social service agencies are still unaware of this phenomenon, recommendations are made for how to introduce the topic as priority and how to cope with and prevent secondary trauma.     

Clinical and Supervisory Considerations for Transgender Therapists: Implications for Working with Clients

Transgender therapists have unique and valuable perspectives into how gender organizes the therapeutic process. Currently, in the MFT field, there is discussion of the cisgender therapist's experience in the therapy room, but no known articles on the transgender therapist's experience. This article provides insight into the experiences of transgender therapists around issues of self‐disclosure, social locations of both therapist and client, and clinical supervision. Drawing from our clinical experiences as transmen, we highlight special considerations for working with cisgender, queer, and transgender clients. Implications for supervision of transgender therapists are also discussed. As more gender diverse students seek MFT training, there is an urgent need to acknowledge their perspectives. This article is a call for beginning conversations in this direction.     

Regression,Self-Disclosure,and the Teach or Treat Dilemma: Implications of a Relational Approach for Social Work Supervision

This paper presents a brief review of a relational approach to clinical supervision and argues for its application in social work settings. Although an integral and essential part of practice, clinical supervision is underrepresented in the practice literature. Given this paucity of writings on supervision, the recent book by Mary Gail Frawley-O'Dea and Joan Sarnat, The Supervisory Relationship: A Contemporary Psychodynamic Approach, stands out as a seminal contribution because the authors present a fully developed relational model of supervision that fills a major gap in the development of contemporary relational theory and practice. We selectively review the basic concepts and principles of Frawley-O'Dea and Sarnat's model and apply this supervisory approach to current social work practice. Our focus will be on exploring three controversial and much-debated topics: self-disclosure, regression, and the teach or treat dilemma. Case vignettes from two supervisory experiences will serve to illustrate how a relational approach enhances both the treatment and the supervisory relationship.     

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.     

After the Assault: Cognitive Trauma Therapy with a Single Event Trauma Survivor

This article explores the specific context of a single event criminal assault, (i.e., a stranger non-sexual assault that occurred during a robbery) and shares the theoretical framework that successfully guided the clinician’s assessment, treatment planning, and interventions. Based on a literature review and employing a case study, this article presents the potential norms of trauma aftermath following a single event non-sexual criminal assault. It provides an overview of those theoretical frameworks that have consistently proven effective with this population; this article shares the rationale for selecting cognitive trauma therapy and illustrates its application to an assault survivor.

Social Work with Clients Contemplating Suicide: Complexity and Ambiguity in the Clinical, Ethical, and Legal Considerations

Social workers in agency and private practice settings often work with clients grappling with suicide, either as an acute or chronic situation. Probably more than any other clinical condition, suicide forces the practitioner to confront complex ethical, legal, and psychological questions while managing an urgent circumstance. This article attempts to illuminate the ethical and legal considerations that may arise when a client contemplates suicide. Rather than advancing one answer, we stress that in training and the workplace social workers must fully consider the complexities and ambiguities of a client's experiences as well as their own clinical, ethical, and legal obligations.     

Building Trauma Informed Practice: Appreciating the Impact of Trauma in the Lives of Women with Substance Abuse and Mental Health Problems

ABSTRACT

This paper examines the lifetime interpersonal abuse experienced by a substance abuse treatment sample of 1,955 women with co-occurring disorders. Substantial rates of intimate and community-based interpersonal abuse and other life stressors are documented. Regression analysis shows that while trauma severity is significantly related to trauma distress, its impact on psychological symptom distress and drug severity is quite modest. The implementation of a trauma informed approach featuring trauma-specific treatment, service integration and consumer empowerment is described as a promising practice model for assisting women seeking help in substance abuse treatment programs.     

Adapting Social Work in Working with Muslim Clients

Current social work education programmes and textbooks often underestimate the hypothesis that providing effective services to different cultural groups requires cultural understanding. One approach that has been recommended is the localization of social work: using a fundamentally different social work knowledge base and approach with different cultural groups. To date, however, little scholarship considers how to localize social work in working with Muslim communities. On the basis of interviews with over 50 social service providers in Canada who work with Muslim clients, the present article provides insight into strategies and methods that involve localizing social work in Muslim communities, focusing on possible client characteristics, challenges, and needs from the perspective of the practising social worker. Issues of racism, spirituality, acculturation, help seeking, and client expectations of service are particularly relevant. Properly responding to these factors ultimately involves the coordinated efforts of educational institutions, agencies, and social workers, but none of this will be possible without a thorough understanding of cultural values meaningful to Muslim clients.     

A Comparison Study of Low Trauma Disclosure Participants and Their Partners in Army Couples

Intimate partner relationships provide unique conditions for examining how the interpersonal and/or systemic impact of trauma exposure and post-trauma responses can impact both the primary and secondary trauma survivors and the interpersonal dynamics of the couple. The current study explored qualitative and quantitative data from low trauma disclosure individuals (n?=?15) and their partners to understand the experiences of low trauma disclosure to spouses in a sample of Army couples. Contrary to the original hypothesis, the results indicated mixed trauma disclosure partners seemed to be functioning at lower individual and relationship functioning levels than the low or high trauma disclosure partners. Implications for practice and future research also are described.     

Shame in the Clinical Process with LGBTQ Clients

This commentary integrates the literature on the social and psychological dynamics of shame and discusses its relevance to the clinical process, especially with lesbian, gay, bisexual, and transgender and queer clients. It is argued that engagements with shame, especially where sexual desire, sexual orientation, or gender identity is a foremost consideration or conflict, may be the most important factor in producing and maintaining the therapeutic alliance. Shame, a social emotion, is considered in the light of work done in sociology, psychology, neuroscience, and psychoanalysis. Future directions for clinical research are suggested.     

Exploring the Moderating Influence of Delinquent Peers on the Link Between Trauma, Anger, and Violence Among Male Youth: Implications for Social Work Practice

This study’s objective was to explore the influence of delinquent peer exposure, on the relationship between male youths’ histories of trauma, anger, and violent behavior. Using a nationally representative sample of male adolescents aged 12–17 and self report interviews, information was gathered on their levels of exposure to violence, stressful life events (SLE), anger, depression, delinquent peer exposure, and violent behavior. Results of a moderation analyses revealed that youth who reported higher levels of exposure to trauma, anger, and delinquent peers were at an increased risk for anger and for violent offending. Delinquent peer exposure exerted a significant interaction effect on the relationship between anger and violent offending. The implications for prevention and intervention efforts are delineated.     

Trauma: Conscious and Unconscious Meaning

Developmental, constructivist theory is applied to increase understanding of conscious and unconscious dynamics of trauma experience. DSM-IV criteria provide the accepted standard guiding research and practice for trauma. Concern is raised that rigid adherence to diagnostic categories is problematic for trauma survivors. Trauma survivors are unique in both conscious and unconscious experience. Saari's (2002) levels of cognitive integration of experience based on Nelson's (1985) tripartite theory of meaning are employed as an investigative tool. Understanding the individual's cognitive integration of the traumatic event is central to facilitating reintegration and healing post-trauma. The therapeutic dyad co-constructs a narrative that allows reintegration and healing. A case study of a childhood sexual abuse survivor demonstrates how relationship dynamics facilitate co-creation of a healing narrative.     

The Trauma Trifecta of Military Sexual Trauma: A Case Study Illustrating the Integration of Mind and Body in Clinical Work with Survivors of MST

Military sexual trauma (MST) has recently received much attention from the media in contemporary society. With the ever-increasing population of United States service members returning from the Iraq and Afghanistan wars, it is vital for any mental health practitioner to be aware of the epidemic that is sexual assault in the military, the unique trauma experiences of the MST survivor, and treatment implications incorporating multiple psychological theories. This article explores three factors, referred to as the trauma trifecta, in which the effects of MST are exacerbated: the loss of professional and personal identity, the regulatory functions of self harm behaviors, and the retraumatization that many service members endure as a result of the distinctive characteristics of the military culture and its service to veterans. A case study with clinical interventions will be utilized to demonstrate this concept of “the trauma trifecta” and the unique challenges in treating the PTSD symptoms that can result from MST in clinical therapy. Drawing from multiple theories in clinical treatment, this paper illustrates the strengths and limitations of cognitive-behavioral techniques, highlights the integration of feminist theory to illustrate the obstacles of power structures, and mind–body interventions, bridging the gap between talk therapy and body therapy. Through this unique integration of multiple therapies, the case study illustrates the veteran’s reengagement with her body and the reformulation of her identity post MST.     

Compassion Fatigue in the Treatment of Combat-Related Trauma During Wartime

This article utilizes relevant data on the troops serving in Iraq and Afghanistan, and a composite case of a clinician working with combat survivors, in order to illustrate the potential for compassion fatigue in clinicians treating this cohort. Review of the literature on the effects of compassion fatigue related to combat trauma and the impact of collective shared trauma is presented. This is done in order to emphasize the complexity of the provision of war trauma treatment post 9/11 in the context of the ongoing wars. There is an urgent need for the mental health field to continue to develop interventions and educational programs that will help mitigate the deleterious effects of compassion fatigue in clinicians working with this population.     

Trauma management: Chernobyl in Belarus and Ukraine

Although the Chernobyl nuclear disaster happened in the Soviet Union in 1986, we still do not know how the most affected states – Ukraine and Belarus – have managed this tragedy since independence. Drawing on the concept of cultural trauma, this article compares Chernobyl narratives in Belarus and Ukraine over the past 28 years. It shows that national narratives of Chernobyl differ, representing the varying ways in which the state overcomes trauma. Our understanding of post‐communist transformations can be improved by analysing trauma management narratives and their importance for new national identity construction. These narratives also bring new insights to our vision of cultural trauma by linking it to ontological insecurity. The article demonstrates how the state can become an arena of trauma process as it commands material and symbolic resources to deal with trauma. In general, it contributes to a better understanding of how the same traumatic event can become a source of solidarity in one community, but a source of hostility in another.     

Impact of the Most Frequently Reported Traumatic Events on Community Mental Health Clients

This survey of 354 community mental health clients examined the relative impact of client self-reported events that they deemed “most traumatic” for predicting posttraumatic stress syndrome (PTSD) symptom severity. Results of the voluntary survey revealed the most traumatic lifetime events to be (in descending order of frequency): sudden death of a loved one, sexual abuse, physical abuse, suicide attempt, and having been in a serious/life-threatening accident. These factors were then tested for gender differences, and regression models were developed to test the predictive power of traumatic events relative to primary diagnosis, psychosocial well-being, other key psychiatric indicators, and drinking to cope with negative emotions. Results demonstrated that sexual abuse was reported to be among the strongest predictors of PTSD symptom severity. Separate regression models also revealed important gender differences. Implications for social work assessment of seriously mentally ill clients are suggested.     

Recognising Strategy and Tactics in Constructing and Working with Involuntary Social Work Clients

ABSTRACT

This paper reports on the author’s academic work on working with involuntary clients, which began with a knowledge exchange project in Scotland. I reflect back on this work and use it as a way to explore subsequent reflections on the field. These move beyond consideration of the skills required to undertake such work through locating the category of involuntary clients within wider, yet contradictory, governmental discourses on client engagement. These are identified as the strategy that sets the context for such work. But the strategy is enacted through the day-to-day tactics of social workers on the ground; such tactics, enacted in everyday encounters, are constitutive of effective but also ineffective engagement with clients. The discussion goes on to problematise the distinction between voluntary and involuntary clients and to suggest that effective social work practice, whatever the nature of that involvement, requires that clients are recognised at an ethical and relational level.

IMPLICATIONS

• The term involuntary client(s) cannot be taken for granted but is constructed and needs to be understood in particular and often contradictory policy and professional contexts.

• Effective but also ineffective ways of working with involuntary clients go beyond the acquisition or demonstration of particular skills but are embodied in the everyday relational practices of social workers.

• Ethical engagement with involuntary clients proceeds from a sense of mutual recognition.

     

Utilizing Spiritual Lifemaps with LDS Clients: Enhancing Cultural Competence in Social Work Practice

Few people realize that the Latter-day Saints (LDS) or Mormon Church currently ranks as the fourth largest religious denomination in the United States. Although spirituality and religion play a central role in the beliefs, lifestyle, and culture, of many LDS clients, very few spiritual assessment tools have been validated with this population. Utilizing a mixed method design, this study modified an existing spiritual assessment tool—spiritual lifemaps—that may be particularly congruent with LDS client populations. A sample of recognized experts in LDS culture (N = 100) examined how consistent the spiritual lifemap assessment tool was with LDS culture, and how consistent the four sample question sets were with LDS culture. Overall, results indicate that the spiritual lifemap assessment tool is consistent with LDS clients’ beliefs, lifestyle, and culture. This study represents an important step at providing more culturally competent practice with LDS clients.