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The Need for Universal Trauma Training in Counselor Education

by: Karen Roller, PhD, MFT

Trauma training is not currently a universal requirement in counselor education programs, which puts both untrained counselors and their clients in harm’s way; this is an ethical breach that can be closed by providing all counseling students with adequate trauma training, sensitizing them to the skillful assessment of trauma, principles of culturally-responsive client-centered trauma resolution, and the need for relevant continuing education and self-care to avoid counselor im-pairment and client harm.

This article will address the need for universal trauma training in counselor education, explore the difference between “recovery” and “resilience”, and begin listing common factors in fostering recovery and resilience from trauma for client and counselor wellness. The aim of this article is three-fold: 1) to begin establishing the common factors of adequate trauma training for counselor education curriculum development, 2) to begin developing national standards for counselor education trauma training, and 3) to continue reducing health disparities for marginalized popu-lations who do not readily have access to specialized services outside of community mental health outreach.

Trauma has been described as the body’s natural response to an overwhelming situation (Levine, 1997, 2008, 2010). Due to neurochemical cascades that occur during overwhelming experiences, there are physical, mental, and emotional effects that need to be addressed appropriately and adequately in order for the body to release stored survival energy and return to baseline functioning (Berceli, 2003; https://www.pnirs.org/; Levine, 1997, 2008, 2010; Schore, 1994, 2003), such that the trauma survivor can return attention to developmental tasks across the lifespan. Trauma that resolves without professional intervention often does so in part because the survivor’s social support system provided the necessary empathy and support for that individual’s body to release the stored survival energy in good timing, such that the individual was able to resume attention to developmental tasks rather than get “stuck” in survival mode (Dobson & Perry, 2010; Harvey, 1996; Porges, 2004). Such individuals may be described as “resilient”, often without recognition the role of sufficient social support plays to help them bounce back from a threatening situation (Doidge, 2007).

Resilience has been defined as a “set of qualities that foster a process of successful adaptation and transformation despite risk and adversity” (Benard, 1995), whereas recovery “connotes a trajectory in which normal functioning temporarily gives way to threshold…usually for a period of at least several months, and then gradually returns to pre-event levels” (Bonanno, 2008). Resili-ence to like-kind trauma is more often noted in individuals with a secure attachment history; those who have in-utero substance exposure, an insecure attachment history, and/or score highly on the Adverse Childhood Experiences Scale tend to have a lower threshold for more extreme response to subsequent trauma, with a longer recovery period and more pronounced mental health impacts (Anda, Edwards, Felitti & Holden, 2003; Anson, Chasnoff, Hatcher, Iaukea, Randolph & Stenson 1998; Baker, Blakely, Perry, Pollard & Vigilante, 1995; Blaustein & Kinninburgh, 2010; Bowlby, 1988; Chasnoff, Schmidt, Dchwartz, Telford & Wells, 2012; Cloitre, Cohen, & Koenen, 2006; Cohen, Deblinger, & Mannarino, 2012; Dobson & Perry, 2013; Gold, 2000; Gil, 2006; Heller & La Pierre, 2012; Karen, 1998; Perry, 1997, 1999; Raider & Steele, 2001; Schore, 1994, 2003; Seigel, 1999).

Traumatologists posit that trauma is a fact of life, as is resilience, and are investigating thera-peutic interventions to develop evidence-based practices for recovery addressing single-incident shock trauma (e.g., car accidents); developmental and relational trauma (e.g., in-utero substance exposure, neglect, abuse, betrayal, domestic violence, and oppression); and complex trauma (e.g., violence, war, migration, and natural disasters) across the lifespan, around the world (Albuquerque, Mercante, Nasello, Newberg, Peres, Peres, & Sima, 2007; Ayala & Groves, 2015; Bates, Brown, Money & Moore, 2011; Berceli, 2003, 2010; Blaustein & Kinniburgh, 2010; Briere & Scott, 2012; Briere, F, H. R & Rome, 2015; Beutler, Levant & Norcross, 2005; Chard, Monson & Resnick, 2008; Cohen, Deblinger, & Mannarino, 2012; Fosha, 2000; Freyd, 1996; Gamble, Lev, Perlman & Saakvitne, 2000; Gil, 2006; Heller & LaPierre, 2012; Herman, 1997; Kline & Levine, 2008; Levine, 1997, 2010; MacFarlane, van der Kolk & Weisaeth, 1996; MacKinnon, 2012; Newberg, 2007, 2009, 2012; Ogden, 2015; Rothschild, 2000; Schnur & Sori, 2013; Siegel, 2012; Siegel & Solomon, 2003; Weaver, 2010; http://www.aaets.org/index.htm). Counselors serving a broad spectrum of populations can expect to be assessing and treating trauma survivors throughout their careers, to aid recovery and foster resilience for long-term wellness.

Vicarious trauma, also known as secondary trauma or trauma exposure response, appears to be a leading cause in counselor burn-out and compassion fatigue (Aconson & Pines, 1988; Adams, Boscarino, & Figley, 2004; Burk & van Dernoot Lipsky, 2009; Figley, 1993; Figley, 1995; Panos, 2007; Perry, 2014). The risks for vicarious trauma are highest among practitioners with the least training in trauma resolution (Figley, 1995; Herman, 1997; Perry, 2014; http://www.aaets.org/index.htm). Some indicators of the unresolved trauma exposure response are: feeling helpless and hopeless; a sense one can never do enough; hypervigilance; diminished creativity; inability to embrace complexity; minimizing; chronic exhaustion; somatic complaints; inability to listen; dissociative moments; sense of persecution; guilt; fear; anger and cynicism; inability to empathize/numbing; addictions; and grandiosity (Burk & van Dernoot Lipsky, 2009). Any subset of these concerns could result in counselor impairment, and thus merit an organized plan for protection of client and counselor.

Counselor education could develop and adopt standards for student training that would introduce all counselors-in-training to the common factors of both trauma, and trauma resolution, thus laying the foundation for safe entry into a career of serving traumatized clients to foster recovery and resilience while protecting practitioners from vicarious trauma. The highest quality education would include: an overview of trauma research from conception -not birth- (Chasnoff, et. al., 1993, 1998, 2002; 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2012; Karen, 1994; Kelly and Verny, 1981; Perry, 1995, 1997, 2004; Porges, 2004; Schore, 2003; Stern, 1985) to death; discussion of the compounded multicultural implications of trauma (Brown, 2014; Chard, Monson, Resick, 2008; Chasnoff, Messer, Schmidt, Telford & Wells, 2009; Chasnoff, Farina & Leifer, 2004; Chester, Goldman & Robin, 1996; Comas-Diaz, 2006; Harvey, 1996); a survey of intervention modalities (including video examples) to inspire continuing education; and skills practice to assess counselor integration and capacity prior to program advancement.

As the field of traumatology coalesces in response to advances in neuroscience, imaging tech-nology, attachment research, and epigenetics, counseling practices may also enhance efficacy by integrating trauma resolution training in continuing education for licensed counselors (http://www.aaets.org/index.htm; Brown, 2014). Trauma is now recognized to be part of the hu-man condition, and thus is widely-experienced in varying degrees by a majority of counseling clients, but most significantly among the most marginalized. This author postulates that the es-sential common factors derived from various trauma resolution techniques can be integrated into current counseling practices by most counselors with appropriate supervision, thus improving client outcomes and quality of life, as well as reducing relapse rates for many presenting problems, while increasing counselor protection from the work-related hazard of vicarious trauma.

A beginning list of common factors in trauma includes:

  1. the universal nature of overwhelm occurring unexpectedly throughout our development;
  2. the unjust fact of trauma occurring more in systematic oppression of marginalized popula-tions;
  3. the body-based experience of overwhelm impacting brain and emotional development and functioning, especially when left unresolved;
  4. the depletion of positive affect and felt safety in relationships;
  5. relational trauma being harder to resolve due to broken trust in needed others, therefore re-quiring that counselors be trauma-trained in order to do no harm and increase efficacy of treatment.

A beginning list of common factors in trauma resolution counseling may include:

  1. skillfully assessing and accessing client-specific capacity for recovery and resilience in re-sponse to overwhelm via trust-based therapeutic rapport (Ayala & Groves, 2015; Benard, 1995; Blaustein & Kinniburgh, 2010; Cloitre, Cohen & Koenen, 2006; Fosha, 2000; Heller & LaPierre, 2012; Levine, 2010; Najavits & Strupp, 1994; Rothschild, 2000; Seigel & Solomon, 2003; Weaver, 2010);
  2. awareness of the neurodevelopmental impacts of in-utero and early childhood trauma (Chasnoff, et.al., 2002, 2004, 2006, 2007, 2008, 2009, 2010, 2012; Perry, et. al., 1999, 2010, 2012, 2013; Schore,1994, 2003);
  3. leveraging interpersonal neurobiology to co-regulate the client’s nervous system (Amini, Lannon, and Lewis, 2001) through left-eye to left-eye contact (Schore, 2003);
  4. following the client/s pacing unless the client/s accelerate into distress, which is re-traumatizing (Levine, 2003, 2010; Raider & Steele, 2001; Rothschild, 2000; Schore, 2003);
  5. slowing the client and session down when trauma is being processed (Levine, 2003, 2010; Rothschild, 2000; Weaver, 2010);
  6. referencing the client/s body as a resource for soothing, regulating, and discharging over-whelm as part of the corrective emotional experience (Bates, Brown, Money & Moore, 2011; Berceli, 2010; Fosha, 2000; Levine, 2003, 2010; Rothschild 2000; Weaver, 2010).
  7. following the body’s cues for discharge of stored survival energy as evidenced by trembling, especially in the legs as the fight/flight/freeze response is released from the body (Berceli, 2010; Levine, 2003, 2010; Rothschild; 2000; Weaver, 2010);
    h) following the body’s cues for discharge of emotional overwhelm as evidenced by patterns in movement, (e.g. protective and defensive postures, attempts to regain balance and control, changes in breath; micorexpressions of shock, terror) (Berceli, 2010; Levine, 2003, 2010; Rothschild, 2000; Weaver, 2010);
  8. reducing verbal processing to minimum, concrete, here-and-now awareness, talking “through” pain, not “about” pain (Levine, 2008; Weaver, 2010);
  9. the value of accurate empathy and normalization in supporting the body’s natural discharge of overwhelm (Farber & Lane, 2002; Najavits & Strupp, 1994).

As peer-reviewed research of trauma interventions expands, counselors will be able to implement appropriate interventions for the developmental needs of their clients in their settings, thus aiding clients in recovery and fostering their long-term resilience to the highest degree possible, while protecting the counselor from the trauma exposure response.

Some trauma resolution models in mental health practice today are: Accelerated Experiential-Dynamic Psychotherapy; Accelerated Recovery Program; Acceptance and Commitment Thera-py; Dialectical Behavioral Therapy; Emotion-Focused Therapy; Eye Movement Desensitization and Reprogramming; Hakomi; Mindfulness-Based Stress Reduction, NeuroAffective Relational Model; Neurogenic Yoga; Neurosequential Model of Therapeutics; Occupational Therapy; Sen-sory Awareness; Somatic Experiencing; Theraplay; Trauma-Focused CBT; and Trauma Releas-ing Exercises. Given the variance in evidence collected to date on this short list, counselors are cautioned from getting minimum training and supervision while expanding scope of competence; over-eager application of a technique without proper theoretical understanding and skills integration can do more harm than good.

Counselor self-care is a common topic of discussion in counselor education, staff meetings and conferences, and yet many practitioners underestimate the importance of following through with a comprehensive plan at effective intervals to foster their own resilience and therefore protect themselves and their clients from the effects of vicarious traumatization. This author is investi-gating common factors for counselor care to effectively process and resolve the clinical presen-tation of trauma in a variety of settings and populations. The field of Somatic Psychology, with governing bodies such as the United States Association of Body Psychotherapists, publishes research on the body-based effects of trauma work and how to discharge the negative effects for counselor well-being. From this lens, a beginning list for ongoing holistic self-care to protect counselors from trauma exposure response would include:

a) ongoing, preventative personal therapy with a qualified role model who integrates trauma resolution in practice (http://usabp.org/), rather than waiting for negative effects to begin;
b) an ongoing psychospiritual embodiment practice to regulate physiology and reduce inflam-mation from stress (Berceli, 2010; http://usabp.org/; Newberg; 2009; https://www.pnirs.org/);
c) ongoing sufficient healthy social support to meet needs for mutuality, connection, ease and joy (Herman, 1997; Newberg, 2009);
d) beneficial nutritional habits to maintain healthy baseline (Newberg, 2009; https://www.pnirs.org/);
e) ongoing access to nature to regulate physiology (http://www.ecopsychology.org/);
f) application of daily mindfulness for self-monitoring and numinous renewal (Newberg, 2009);
g) continuing education and networking with trauma experts to ethically expand scope of competence (http://www.aaets.org/index.htm).

This author is concerned with the rates of compassion fatigue, vicarious traumatization, and lim-ited reflexive self-awareness regarding lack of preventative self-care evident in mental health agency settings and their practitioners. Such tendencies may occur in part because counselor education does not sufficiently prepare and train students for the amount and variety of traumas they will be helping clients process over the course of their careers, and clinical supervision training does not adequately prepare supervisors to empathically and ethically monitor their su-pervisees with regard to trauma resolution. Without sufficient focus on the self of the practitioner and the effects of trauma exposure, counselors are ill-prepared for what they experience in the field, and often wait until they are unhealthy, if at all, to begin integrating self-care in a meaningful way. Not only does this detract from the counselor’s well-being, but it necessarily detracts from the human services that impaired clinician can render. In an age of managed care, when high caseloads and mass trauma effect so many communities, we must organize to take care of those who aim to take care of others, and be embodied role models for those we serve.

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