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Supervision for Trauma-Informed Practice.
Abstract
To become trauma-informed, a system of care must demonstrate an understanding of the complexity of trauma and recognition of it as both interpersonal and sociopolitical. Although awareness of the need to enhance systems of care to become trauma-informed has been growing in recent years, even when trauma is not the main focus of service, training of all professional, administrative, and secretarial staff is essential to transform an agency to become trauma-informed. One vehicle for training the professional staff is supervision designed to enhance the knowledge and skills of practitioners who provide services to clients who have experience trauma. This article discusses how the principles and strategies of supervision can be adapted and applied to foster the professional and personal growth of practitioners and enhance their mastery of trauma-informed care. Supervision of trauma-informed care shares with other types of supervision the major components of educational, support, and administrative guidance and oversight. However, because constant interaction with traumatized clients may have negative effects on practitioners, some elements of trauma-informed practice supervision require special attention. The article has 3 parts. First, we discuss the goals, nature, and educational, supportive, and administrative functions of supervision in the healing professions. We then review basic assumptions of traumainformed practice, specifically, safety, trustworthiness, choice, collaboration, and empowerment. Third, we identify personal and agency-related challenges and risks to practitioners in learning and executing trauma work and analyze the protective function of supervision in addressing these challenges. We present principles for effective supervision that enhance the ability of practitioners to provide traumainformed services and decrease their risks for vicarious traumatization (i.e., trauma reactions caused by interaction with those directly exposed to traumatic events). Finally, we describe an illustrative case example and suggest directions for future research.
... The trauma-informed practice identifies five principles (Knight, 2018): (1) Safety-is creating an environment that considers the factors which aid an individual to feel capable of being open about their experiences; (2) Trust-develops when the expectations are clear, boundaries are maintained, and behaviors are consistent; (3) Choice-develops by assisting supervisees in the identification of options within supervision and for supervisees in their work with clients; (4) Collaboration-is building an aligned working relationship; (5) Empowerment-trauma-informed principals aid the supervisee in planning, operating, and evaluating their practice. Trauma-informed principles, as a whole, help to promote growth and healing by supporting supervisees in addressing trauma in the lives of others and in their own lives (Berger & Quiros, 2014;Knight, 2018). ...
... Even experienced supervisees may become rigid in their thinking, thereby inhibiting their ability to use their stabilization skills personally and with clients. The supervisor can teach the supervisee about resilience, choice, and control and assist supervisees in identifying how to apply their counseling skills to their own life and with clients, which can help the supervisee gain a sense of control again in their life (Berger & Quiros, 2014). ...
... Utilizing the role of consultant happens when the supervisor and supervisee are in a mutual relationship with knowledge and wisdom shared and not privileged with one role above another (Berger & Quiros, 2014). Applying the consultant role to support supervisees establishes choice in supervision, practice, and personal life. ...
The invasion of Ukraine by Russia in February of 2022 brought light to a lack of trauma-focused supervision methods in current literature. Research on supervision assumes a level of immediate safety for supervisor and supervisee. Through supervision in this crisis of war, we recognized the need for a supervision model that looks deeper into the process of supervision when the clinician is experiencing the same trauma events as their clients. We combined Bernard’s Discrimination Model with trauma-informed care to develop a theoretical model of supervision for immediate and long-term crisis situations. The discrimination model lenses of teacher, consultant, and counselor are outlined through each of the five phases of trauma-informed care: safety, collaboration, empowerment, trust, and choice to present a supervision model that takes into account crisis situations. In addition to proposing a model for integrating trauma-focused practice as a central construct into clinical supervision, case examples are utilized to illustrate the implementation of this model.
... Unfortunately, current literature offers limited guidance regarding the practice of trauma-informed supervision (TIS; Henning et al., 2021;Miller, 2018), despite consistently being cited as essential to trauma counselors (Knight, 2018;Sprang et al., 2019). Authors typically describe TIS in broad strokes, often derived from-and mirroring recommendations of-principles of trauma-informed practice: safety, trust, choice, collaboration, empowerment, and culture, historical, and gender issues (Berger & Quiros, 2014;Jones & Branco, 2020;Knight, 2018;Substance Abuse & Mental Health Services Administration, 2014a,', 2014b. Some (Courtois & Gold, 2009;Pearlman & Saakvitne, 1995) have emphasized the relational aspects of clinical supervision, giving particular attention to countertransference, vicarious traumatization, and parallel process. ...
... Nine clinical supervisors, who self-reported their thoughts and actions during a session with a trainee seeing a client with a trauma history, revealed imprints of their formal training in both areas. From a trauma lens, they enacted a number of trauma-informed care principles (Berger & Quiros, 2014;Jones & Branco, 2020;Knight, 2018). Despite established strong relationships, safety and trust were predominant, as supervisors prioritized attention to their supervisees' manifestations of indirect trauma (e.g., nonverbals, emotional reactions), provided direct guidance, and focused on remaining present and nonjudgmental. ...
... Building trauma awareness and competency requires healthcare providers have access to specifc and meaningful education about the prevalence of trauma secondary to sexual violence and the complex interaction of neurological, biological, psychological, and social efects of this trauma on an individual's identity, personal integrity, and worldview (Harris & Fallot, 2001). Besides educational resources, healthcare providers need opportunities to experience and practice their new awareness and understanding through ongoing supervision in supportive environments (Berger & Quiros, 2014). ...
In Canada, despite increasing awareness of the prevalence of sexual violence and recognition of the need for trauma-informed healthcare services, there continue to be significant deficits in the implementation and integration of trauma-informed care. In this theoretical article, the authors examine, from a national perspective, the factors that may impact the feasibility of trauma-informed care. They consider the issue of sexual violence in Canada and the principles of trauma-informed care. A critical analysis of the broader health-system characteristics is also presented. The authors conclude by proposing key opportunities for advancing trauma-informed care and services within this country’s context.
... Vicarious traumatisation can also directly impact upon professionals' capacity in their work, causing struggles to engage with survivors' accounts and mental and physical exhaustion 6 . These understandably affect the wellbeing and quality of life of staff and their ability to continue to support survivors (Ortlepp and Friedman, 2002;Bober and Regehr, 2006;Berger and Quiros, 2014). Sharpen's (2018) exploration of services for women experiencing multiple disadvantage noted the influence of professionals' vicarious traumatisation, with practitioners attesting to the need for services to 'recognise and respond to the impact of secondary trauma on staff'. ...
This report is the third evaluation of the Stovewood Trauma and Resilience Service who have been developing services for adult and child survivors of CSE (child sexual exploitation) with the vision of building a trauma-informed Rotherham.
This evaluation builds upon previous evaluations undertaken by Sheffield Hallam in 2018-2020, the First Year Evaluation and ‘Travelling Through Trauma’. This report ‘Travelling though Trauma: Voices in Partnership’ whilst providing an update, primarily focuses on the survivor voice and experience, consulting with survivors who have benefitted from the work of the TRS.
The evolving needs of one student, Mia, offer an opportunity to explore how disability and trauma interact with a transition to a new school. As Mia's behavior becomes increasingly worrisome within months of starting middle school, her teachers, one-to-one paraprofessional, and school leadership team face several dilemmas in the early stages of creating a trauma-informed school. The focus of this case is on three key elements: the degree to which Mia's team understood her needs and proactively prepared for her transition; the role of Mia's paraprofessional prior to, throughout, and after the transition; and the readiness of the school leadership team to address necessary systemic changes for the school to implement trauma-informed multi-tiered systems of support.
Education in self care is a core focus for beginning generalist social work trainees to boost trauma awareness, or the ability to recognize and respond to emotional responses from direct practice with clients with a history of trauma, and oppression,as well as for diminishing worker burnout. This paper presents a description and assessment of an asynchronous teaching module comprised of a video lecture, quiz and assignment piloted with beginning graduate-level social work students in the United States to situate self care as a component of professional development toward trauma-informed and ethical care. The module aimed to translate knowledge and skills in self care directly to practice and framed targets of self care including emotional regulation, and meaning-making. It provided students opportunities to identify self care practices at the individual level on their own, as well as agency-based self care practices in consultation with their field supervisors. The module was piloted with 57 master’s students enrolled in beginning generalist practice courses and the outcomes of a survey and thematic analysis suggests it warrants consideration as a tool for promoting competency regarding self care in an asynchronous, easily transportable format for online or hybrid learning.
Objective
Psychologists are primary care professionals responsible for providing treatment to people exposed to trauma. However, there has been limited research exploring psychologists’ perceptions of their practice and trauma-informed care when treating people exposed to trauma. The current study aimed to investigate: 1) psychologists’ perceptions of assessing and treating trauma-exposed clients; and 2) psychologists’ perceptions of trauma-informed practice and their need for further training in this area.
Method
Surveys were completed by 99 psychologists, and the data were analysed using thematic analysis.
Results
Psychologists reported the importance of further trauma-related training and showed an inconsistent understanding of trauma-informed practice.
Conclusions
Changes in tertiary education for psychologists were recommended to assist future psychologists to develop competency and confidence in assessing and treating trauma-exposed clients. It was also recommended that psychologists with insufficient knowledge in this field to undertake further training in this area.
Trauma focused cognitive behavioural therapy (TFCBT) is recommended as a first line treatment for post traumatic stress disorder (PTSD). Unfortunately, it is not widely available, often resulting in long waits for sufferers. We attempted to overcome this through a pilot feasibility study of brief training and supervision with a group of mental health professionals (MHPs). The MHPs attended a structured weekly clinical supervision group adhering to a cognitive therapy model of supervision. Eleven PTSD sufferers were treated during the pilot phase. Davidson Trauma Scale scores dropped by a mean of 36.5 points (95% C.I. 12.8, 60.5) over the course of treatment. Group Clinical Supervision for TFCBT appears to have the potential to offer a clinically and cost-effective model of maximizing treatment availability for PTSD sufferers.
For the past 30 years, researchers and practitioners have been concerned about the impact of work stress experienced by social workers. Although research on burnout has been a useful field of exploration, a new concern has arisen about work stresses specifically associated with work with victims of trauma. The concept of vicarious trauma provides insights into the stresses of this particular kind of work. Like the burnout research, early research on vicarious trauma has identified both personal and organizational correlates. In this article, the authors review the growing literature on the organizational components of vicarious trauma and suggest changes in organizational culture, workload, group support, supervision, self-care, education, and work environment that may help prevent vicarious trauma in staff.
A book on social work supervision is desperately needed to bridge the gap between the demands of the field and the absence of literature. Social Work Supervision: Contexts and Concepts aims to provide readers with basic knowledge of theories, research, and practice of supervision. The book addresses the needs of social work supervisors, frontline practitioners, students, and educators and contains a comprehensive literature review of the historical development, theories and models, and empirical research studies of the subject. Equally important, this is a book from practice experience in supervision that enhances the competence of supervisory practice. It will help social workers, supervisors, and administrators to realize and revitalize their “mission” in social work, that is, to benefit clients.