LITERATURE REVIEW

Literature Review – Trauma Felt by a Counselor
Marie C Klemens
Walsh University

Abstract
The purpose of this research is to identify that a counselor can be a victim of trauma, as well as their client. By taking care of oneself in a physical, mental and spiritual manner, they are preparing for a potentially well maintained professional life as a counselor. Knowledge and acceptance of these traumatic occurrences, is the first part of healing. The literature that I had obtained provided the reader, with great knowledge pertaining to the subject matter of vicarious traumatization and counter transference. By identifying both of these subjects as different forms of trauma, I also learned that they have similar qualities. With the knowledge that I am basing this research on and further exploration of this subject matter, counselors can be more prepared for their future.

Literature Review - Trauma Felt by a Counselor The counseling profession is based on the realism as a powerful, but yet private relationship between a counselor and a client, but with ethics being a factor, all efforts are centered on being impartial and having good intentions (Jaffe & Diamond, 2011). Because of the tight relationship between a counselor and his or her client, it is humanly impossible that a client and a counselor will not endure feelings and reactions towards each other (Jaffe & Diamond, 2011). Trauma is the occurrence in which an individual is confronted with an event that will affect them self or other individuals with physical, emotional or mental damage (Tippany, White & Wilcox, 2004). Counselors are trained professionals that are equipped to help an individual survive a traumatic event, without future complications. However, while listening to a client speak a counselor may become mentally unstable (Tippany, White & Wilcox, 2004). A counselor’s initial reaction may result in counter transference or vicarious traumatization (VT) (Tippany, White & Wilcox, 2004). Other people’s misery can be debilitating to a counselor, if that individual is not careful (Tippany, White & Wilcox, 2004). VT can lead to harmful changes that may occur to a counselor over time as they observe their clients misery (Tippany, White & Wilcox, 2004). Counter transference is similar, but directly states the reaction to a client during his or her therapy session; (not just the subject matter) but the individual (Schwartz, 1978). “Despite conceptual similarities, their emphases differ: cognitive schemas versus post-traumatic symptoms and burnt-out, respectively” (Jenkins & Baird, 2002, p 423). As difficult as listening may be to adult terrors, witnessing traumatic experiences, through play therapy, with a innocent child, may increase the counselor’s chance of developing traumatization (Helm, n.d.). With these two possibly occurring, a counselor needs to know how to adjust to uncomfortable situations as well as what behavior to look for when it comes to being traumatized. Finally, a counselor needs to be aware of how to help him or herself when the feeling of anxiety arises. The focus of this paper is to portray that if a counselor is continuously exposed to disturbing experiences without taking care of him or herself, the counselor may develop vicarious trauma or counter transference.
Vicarious Traumatization (VT) Listening to life’s sadness and horrors, and not being able to discuss, what was told to a counselor in privacy, it is no wonder counselors suffer emotionally (Landau, 2009). It makes sense that a clients life’s stressors would bring about anxiety and misery to a counselor, subconsciously as well as consciously (Devilly, Wright & Varker, 2009). VT stems from the constructivist self development theory (CSDT) (Helm, n.d.). Helm states that CSDT explains that continuously being subjected to a client’s trauma can affect a counselor and that a counselors’ reality is based on methods and observations. Understanding this theory can facilitate in and recognize the development of VT (Helm, n.d.). When a counselor experiences VT, he or she is seeing the world in a different sense, with his or her knowledge of the world being manipulated by a counselor’s inner self (Helm, n.d.). Devilly (2009) stated that changes such as these may involve disruption of the cognitive schemas, self, memory system and belief system. VT has a severe impact on a counselor’s mental instabilities (Devilly, Wright & Varker, 2009). This trauma was contradicted stating that clients trauma, does not have a impact and that, a client’s trauma being combined with a counselors, personal empathy and their unknown personal trauma, could cause such distress (Devilly, Wright & Varker, 2009). On a positive note, “Analysis of therapists who work with trauma patients revealed that cumulative vicarious exposure to trauma positively predicted posttraumatic growth” (Brockhouse & Cohen, 2011. p 735). “Empathy was also found to be a positive predictor of posttraumatic growth and moderated the relationship between vicarious exposure to trauma and posttraumatic growth” (Brockhouse, Cohen & Joseph, 2011. p 735). Signs of VT are depression, anxiety, and an inability to cope with his or her clients and his or her counseling profession (Riviere & Kurahashi, 2003).
Counter transference
Counter Transference maybe harmful for some, but may also be a constructive tool when working with others (Rementeria, 2011). Counter transference is considered to be the foundation of psychodynamic speculation and its practices (Walker, 2004). It has been argued that, “ideally, the concepts of transference and counter transference and the infrastructure to make them useful, should be built in from initial staff training to the management of all mainstream settings” (Rementeria, 2011. p. 41). Freud has portrayed counter transference as a repetition of the past, by the client and the counselor that lead to the clinician’s initial reaction towards their client. If counter transference occurs counselors may become a walking, talking bomb that may explode at any time (Conner, 2009). In all reality, those feelings truly belong to the old disorder, referred to as early attachment relationship (Rementeria, 2011). Psychotherapists state that they can avoid counter transference simply because he or she does not practice insight-oriented therapy (Brown, 2012). It has been stated, that if a counselor is working with either cognitive or behavioral therapy and leaving out emotion or connection, will counter act the phenomenon of counter transference (Brown, 2012). Brown, whom eschewed this viewpoint, stated that after being a trauma counselor, argued that while clients are likely to strike a nerve from the counselor, anxiety is of a normal response for any human being. Counselors should act out externally to the patient in a professional and an ethical manner; and the counselor, should not take what is being said personally (Rementeria, 2011).

Transference versus Counter Transference: What is the difference? Transference is a situation in which the counselor becomes an authority figure to the client, and with this authority the client may act on upon with regression, hostility or go the other direction and worship the counselor, which is not good either. (Izzo, 2010). Reasoning behind this acting out is, is the client may have had bad relationships with his or her parental figures, and subconsciously acting out negative or beyond positive feelings toward the counselor. Counter transference is when a counselor acts out towards a patient, because of similar experiences (Izzo, 2010). These reactions are toward the client, as well as the subject matter (Schwartz, 1978). The client maybe telling his or her story, and with this may trigger a counselors old memories, that are better off being left behind (Izzo, 2010).
How can a co-worker intervene?
“Feelings that workers experience as a result of counter transference may affect their clients as well as their clients casework, such feelings are often the concern of the supervisor as well as the counselor” (Schwartz, 1978, p 204). When this should occur, it is up to the supervisor to take the initiative to direct his or her co-worker. This can be done by exploring the implications and effects of counter transference pertaining to a particular case (Schwartz, 1978). Mary Schwartz (1978) conducted a study, with 10 graduate students placing them in situations that were closely related to their own past lives. Schwartz (1978) concluded that by reliving feelings of distress closely related to their own is an effective way for a counselor to get in touch with his or her true feelings. This distress may be of great value for his or her chosen profession (Schwartz, 1978). Individuals all come into their professions with a certain past, which may affect their ability to perform (Schwartz, 1978). Counselors’ are taught to pick up on cues of others. This would also include their co-workers (Schwartz, 1978). Colleagues can also encourage co-workers that are traumatized to take a break from his or her counseling profession (Riviere & Kurahashi, 2003). Colleagues, who had similar work experiences then the trauma victim, will be able to provide sufficient emotional and professional support (Riviere & Kurahashi, 2003). Behavioral signs that colleagues can look for include, cutting therapy sessions short as well as canceling appointments and not rescheduling with a specific individual (Burke, 2008). If a worker can recognize these behaviors, they may be able to make effective use of those particular feelings, when it comes to advising a co-worker in distress (Schwartz, 1978).
Reduce counselor trauma
Trauma counselors should be able to realize and understand that this sort of work will influence him or her mentally as well as professionally (Nelson, n.d.). Being provided with the coping skills and knowledge that a counselor will need is an effective coping mechanism when it comes to the shocking concerns and stories that a client may share. Within our society, there is a definite need to reduce potential traumatization (Rothschild, 2006). Counselors must make choices for themselves as to what will work, and what has been proven to be affective (Rothschild, 2006). Rothschild’s (2006) aim in her writings are to provide clinicians with the proper tools to increase their understanding of and decrease their liability to incidents such as traumatization. These tools include thinking clearly as well as making wise decisions. Rothschild states that the thought process is not just a cognitive exercise, but entails emotions as well. In a study conducted by Bober and Regehr (2005), 259 counselors spent time with victims of crises. Although the belief that coping skills did exist, such as taking care of oneself physically and mentally, the counselors may not have placed such strategies in this particular study. “This cross-sectional design study sought to assess whether therapists believed and engaged in commonly recommended forms of prevention for secondary and vicarious trauma and whether engaging in these activities resulted in lower levels of distress (Bober & Regehr, 2005). Counselors spending time with trauma victims, seems to be the most accurate way of calculating a true score (Bober & Regehr, 2005). This study was conducted in a self-report survey and concluded that the counselors, who spent more hours per week with their clients, had more instances of higher distress (Bober & Regehr, 2005). Counselor’s age being a factor within this study, did not show any indication of change, beyond the normal stress being measured (Bober & Regehr, 2005). Subject matters made a definite difference in the amount of distress, which the counselors were, enduring (Bober & Regehr, 2005).
Signs that indicate traumatization

Trained counselors can be aware of their own behavioral patterns as well as their clients. (Rothchild & Rand, 2006). Signs of trauma may include mental and physical exhaustion, lack of concentration, pessimism, and unhappiness, not only in one's employment, but life itself (Puterbaugh, 2008). Other signs of VT are being disconnected from oneself, sudden beliefs about a changing world, lacking principals that previously existed and a decrease within one’s spirituality as well as depression and isolation (Burke, 2008). Signs that are an indication of counter transference seem to be more visible (Burke, 2008). These signs may not be just emotional, but physical, interpersonal and behavioral (Burke, 2008). These signs include the feeling of anxiety during the session with a client, intensity for no apparent reason, guilt because the client does not seem to be making progress, being helpless, disoriented and feeling of being victimized. With counselors who are able to see these warning signs within his or her counseling profession, the process of counseling can be enlightening and positive (Walker, 2005). Good health should be maintained by all people (Puterbaugh, 2008). Puterbaugh (2008) states that if a counselor is not careful, he or she may develop compassion fatigue. This can develop if a professional fails to maintain a healthy balance of physical and emotional care and professional and personal support (Puterbaugh, 2008). Compassion fatigue is due to an overload of information brought forth by a client’s suffering (Puterbaugh, 2008). In order to identify with a client, a counselor must have a certain amount of empathy (Puterbaugh, 2008). When a counselor over identifies with a client, certain emotional boundaries may be crossed (Puterbaugh, 2008). Puterbaugh concluded in her study that if certain health measures are not taken, then the counselor involved may suffer from traumatization. The general need to take care of one’s own self is of major importance, when he or she is working as a counselor (Puterbaugh, 2008). To gain broader findings, further research should be conducted (Puterbaugh, 2008). Puterbaugh (2008) states that with further research, future findings will provide counselors with more intense training as well as techniques to avoid possible trauma.
Prevention and Treatment Prevention and Treatment involves several steps to heal the trauma that a counselor may endure during his or her lifetime (Riviere & Kurahashi, 2003). Counselors must be able to admit, verbally communicate, and cope with these painful memories in a loving and nurturing environment, as well as to maintain a well balance of physical, mental and spiritual abilities (Riviere & Kurahashi, 2003). These skills can be improved upon by gaining knowledge on the situation at hand and also by partaking in self-care activities as well as relaxed activities (Burke, 2008). Self-care tactics will assist a counselor to step out of the position of being the savior, and step into a position of empowerment for themselves and their client (Brown, 2012). By placing oneself within that mental frame, a counselor will be taking the necessary cautions to protect him or her while working with a client (Brown, 2012). Also plan to see a therapist yourself, to sort out your trauma (Burke, 2008). A counselor in distress should not ignore the symptoms, but deal directly with the disorder (Burke, 2008). Trauma is not uncommon among counselors. Statistics show that 50% of trauma counselors report that they are stressed, and 30% of trauma counselors, state that they feel a great amount of anxiety (Burke, 2008). This stress is brought on by what is stated to a counselor, but also by an individual’s own childhood traumas (Meichenbaum, n.d.). The literature that I reviewed clearly states that vicarious traumatization and counter transference can have harmful effects on a counselor as well as helpful effects. The effects that are harmful can cause him or her to become a better counselor, as well as a more empathetic person, with boundaries. It is up to counselors of today and the future to know their own limits, and be careful when their professional life becomes a health related issue. Counselors are taught to listen and hear, to a client and the problems that the client is currently facing. An individual’s body will tell him or her, when he or she has had enough, it is up to the counselor to listen.

References
Ted Bober, Ted MSW & Regehr, Cheryl PhD (2006). Brief Treatment and Crisis Intervention; Strategies for Reducing Secondary or Vicarious Trauma: Do They Work? Oxford Journals, 6(1), 1-9, DOI: 10.1093; Retrieved from http://btci.edina.clockss.org/cgi/content/full/6/1/1/
Brockhouse, Msetfi R. RM., Cohen, K. & Joseph, F., (2011). Vicarious exposure to trauma and growth in therapists: the moderating effects of sense of coherence, organizational support, and empathy. Journal of Traumatic Stress, 24(6), 735-742. Brown, Susan A. PhD. (2012). Emotional and cultural competence In the Trauma-Aware Therapist. Retrieved from http://www.continuingedcourses.net/active/courses/course074.php
Burke, Patricia A. MSW (2008). Co-occurring collaborative of the state of Maine; an integrated approach to clinician self-care. Retrieved from http://www.attcnetwork.org/explore/priorityareas/wfd/grow/documents/Self-care%20Handouts%20ACT%20011808.pdf
Conner, Michael G. PsyD. (2009). Transference: Are you a biological time machine? Retrieved from http://www.crisiscounseling.com/articles/transference.htm de Rementeria, Alexandra. (2011). How the use of transference and counter transference, particularly in parent–infant psychotherapy, can inform the work of an education or childcare practitioner. Psychodynamic Practice, 17(1), 41–56, DOI: 10.1080/14753634.2011.539351
Devilly, Grant J.Wright, Renee, & Varker, Tracey (2009). Effect of trauma therapy on mental health professionals. .Australian & New Zealand Journal of Psychiatry, 43(4), 373 – 385, DOI: 10.1080/00048670902721079
Helm, Heather M. PhD., LPC. RPTS. (n.d.). Managing vicarious trauma and compassion fatigue. Retrieved from http://www.lianalowenstein.com/artcile_helm.pdf
Izo, Ellie Dr. (2010). Transference and Counter transference in Vicarious Trauma (Video File). Retrieved from http://www.youtube.com/watch?v=ALng_fH9g-Q
Jaffe, Janet Diamond, Martha O., (2011). Reproductive trauma: Psychotherapy with infertility and pregnancy loss clients. American Psychological Association, 159-177, DOI: 10.1037/12347-008
Jenkins, Sharon Rae & Stephanie, (2002). Secondary Traumatic Stress and Vicarious
Trauma: A Validational Study. Journal of Traumatic Stress, 15(5), 423–432
Landau, Elizabeth, (2009). Treating trauma victims, may cause is own trauma. Retrieved from http://articles.cnn.com/2009-106/health/military.psychiatrists.fort.hood_1_trauma-victims-vicarious-trauma-anxiety-recovery-program?_s=PM:HEALTH
Meichenbaum, Donald Ph.D. (n.d.).Self-Care for Trauma Psychotherapist and Caregivers: Individual, Social and Organizational Intervention. University of Waterloo
Waterloo, Ontario, Canada; Retrieved from http://www.melissainstitute.org/documents/Meichenbaum_SelfCare_11thconf.pdf
Nelson, Terri Spahn MSSW, LISW. (n.d.). Vicarious trauma: bearing witness to another’s trauma. Retrieved from http://www.uic.edu/orgs/convening/vicariou.htm
Puterbaugh, Doloras T. (2008). Spiritual Evolution of Bereavement Counselors: An Exploratory
Qualitative Study. The American Counseling Association; Counseling and Values, 52(3), 198 – 210
Riviere, Carol & Kurahashi, Yukie. (2003). Counselors face risk of vicarious traumatization, The Report. Health Sciences Association of British Columbia, 24(1)
Rothschild, Babette & Rand, Marjorie (2006).Help For The Helper: The Psychophysiology of Compassion Fatigue and Victorious Trauma. Contemporary Hypnosis, 23(4), 181–183. W.W. Norton and Company, New York, London
Schwartz, Mary C. (1978). Helping the Worker with Counter Transference. National Association of Social Workers, Inc., 23(3), 204
Trippany, Robyn L., White Kress, Victoria E., & Wilcoxon, Allen S. Preventing vicarious trauma: What counselors should know when working with trauma survivors? Journal of Counseling & Development, 82(1), 31-37, 7p
Walker, Moira. (2004). Supervising practitioners working with survivors of childhood abuse: counter transference; secondary traumatization and terror. Psychodynamic Practice, 10(2), 157 – 207, DOI: 10.1080/14753630410001686753