Article review 2

Journal of Counseling & Development ■ July 2017 ■ Volume 95 269 © 2017 by the American Counseling Association. All rights reserved.

Received 12/04/14 Revised 03/05/15

Accepted 03/27/15 DOI: 10.1002/jcad.12141

Clinicians’ Experiences of Shared Trauma After the Shootings at Virginia Tech Kristen W. Day, Gerard Lawson, and Penny Burge

This phenomenological study was designed to describe the shared trauma perspectives of 8 counselors who expe- rienced the shootings at Virginia Tech and responded to community mental health needs. Shared trauma, vicarious traumatization, compassion fatigue, vicarious resilience, and posttraumatic growth were examined. Themes derived from interviews included changed perceptions of those who experienced shared trauma and the influence of the experiences on clinicians’ work. Implications for practitioners and for counselor training are presented.

Keywords: shared trauma, counseling, large-scale tragedy, Virginia Tech

Kristen W. Day, Department of Counseling and Psychological Services, University of Richmond; Gerard Lawson and Penny Burge, School of Education, Virginia Tech. Correspondence concerning this article should be addressed to Gerard Lawson, School of Education, Virginia Tech, 1750 Kraft Drive (0302), Suite 2003, Blacksburg, VA 24060 (e-mail: [email protected]).

Nearly every counselor regardless of work setting or specialty works with clients who are survivors of trauma (Trippany, White Kress, & Wilcoxon, 2004). Traumatic events can affect an in- dividual in critical ways, and a mass trauma that affects many people has ramifications for individuals, the groups affected, the larger community, and the clinicians who attempt to help them.

On a wintry day on April 16, 2007, a typical Monday in a rural college town of 40,000, the school week was just beginning at Virginia Tech. Students, faculty, and staff were crossing the campus to attend classes, to go to breakfast, or to just visit with each other. Then, shots rang out.

The shootings that took place at Virginia Tech that morn- ing constituted a mass casualty disaster and affected the entire campus of 30,000 students and the local community. Mental health clinicians from the community responded right away and provided help in numerous ways and settings. “Questions immediately arose about what the psychological impacts of the shootings would be on the survivors, wit- nesses, their families, first responders, and the entire Virginia Tech community” (Norris, 2007, p. 1). The foundation for this study arose from these experiences and these ques- tions. The clinicians in the Virginia Tech community had strong emotive responses that are common among those who work with trauma survivors (Figley, 1995; McCann & Pearlman, 1990; Tosone, 2012). Because many traumatic experiences are large scale and affect whole communities, like the Virginia Tech shootings did, more clinicians are be- ing exposed to the same trauma as their clients at the same time. This research is focused on clinicians’ shared trauma, which is a phenomenon experienced by clinicians who are

simultaneously affected by the same event as their clients (Baum, 2010; Tosone, 2012).

We use the term clinicians to describe mental health pro- fessionals, including a broad cross-section who work with traumatized individuals. Most clinicians, such as those who responded to the shootings at Virginia Tech, are drawn from multiple disciplines: counseling, social work, marriage and family therapy, psychology, and medicine. In this study, we examined the experiences of clinicians who provided clinical and/or supervisory services following the shootings. The results address gaps in the existing literature regarding potential pro- fessional challenges and benefits when clinicians are exposed to the same traumatic events as the clients they serve.

Literature Review The personal and professional impacts on clinicians who work with traumatized clients are multidimensional and include work context, client characteristics, and clinician variables. The helping profession has tended to categorize the impact into four areas: vicarious traumatization (Pearlman, 1999), compassion fatigue (Figley, 1995), vicarious resilience (Hernández, Gangsei, & Engstrom, 2007), and posttraumatic growth (Tedeschi, Park, & Calhoun, 1998). Each of these provide a perspective on how clinicians are affected by trauma work in both challenging and potentially positive ways.

Vicarious Traumatization

According to Pearlman and Saakvitne (1995), long-term em- pathic interaction with clients who have experienced trauma

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can alter the clinician’s ways of experiencing self, others, and the world. Vicarious traumatization is a process of change, leading to distorted perceptions that are due to empathic engagement with clients who have survived trauma (Bride, Radey, & Figley, 2007; Pearlman, 1999). These distorted perceptions can have a detrimental impact on mental health providers’ professional and personal lives as they hear the explicit details of their clients’ traumatic realities (Cunning- ham, 2003; Trippany et al., 2004).

One of the most valuable tools clinicians have is the ability to connect with their client’s experiences through empathy. Given that the clinicians in the present study were also mem- bers of the Virginia Tech community, empathy was expected to be strong and highly developed. However, the clinicians were also extremely vulnerable, because empathy in a shared trauma setting increases the risk for clinicians developing vi- carious traumatization. McCann and Pearlman (1990) pointed out the multidimensional cognitive and affective connections to the therapeutic relationship that empathy engenders. These connections have the potential of increasing clinicians’ risk of developing vicarious trauma.

Clinicians’ own trauma histories tend to influence how they respond to their clients’ recollections of their traumatic experiences. If the traumatic experiences are similar, clini- cians may have a deeper understanding of and sensitivity to what their clients have experienced. Conversely, this similarity could also hinder clinicians because they may be more likely to experience flashbacks and other recurring images from their own experiences (Rosenbloom, Pratt, & Pearlman, 1995), a particular concern in mass traumas like the shootings at Virginia Tech. Consequences of vicarious trauma, including a heightened lack of self-awareness, contribute to clinicians being more vulnerable to being affected by their clients’ emo- tions (Sabin-Farrell & Turpin, 2003) and by graphic material (Pearlman & Saakvitne, 1995). This is especially pertinent among clinicians whose personal stressors blend into their clinical work, like those who live among and assist with natural disaster and other mass trauma recovery sites such as the Virginia Tech campus (Eidelson, D’Alessio, & Eidelson, 2003; Gill, 2007; Kamps, 2008).

Revisions to the fifth edition of the Diagnostic and Sta- tistical Manual for Mental Disorders (American Psychiatric Association [APA], 2013) addressed the issue of repeated exposure trauma with the addition of a new exposure cat- egory to the posttraumatic stress disorder diagnostic criteria: “Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders col- lecting human remains; police officers repeatedly exposed to details of child abuse”; APA, 2013, p. 271). This new exposure category means that individuals who are exposed to the details of traumatic events through their professional responsibilities are vulnerable to developing posttraumatic stress disorder (APA, 2013).

Compassion Fatigue

Compassion is an essential element in effective mental health practice, “yet as our hearts go out to our clients through our sustained compassion, our hearts can give out from fatigue” (Radey & Figley, 2007, p. 207). The clinician’s empathic stance toward a traumatized client is paired with the secondary exposure to the trauma and desire to relieve the pain of oth- ers (Salston & Figley, 2003; Ting, Jacobson, Sanders, Bride, & Harrington, 2005). The term compassion fatigue was first used when discussing the work-related experiences of trauma nurses (Joinson, 1992; Salston & Figley, 2003) and provides background for our focus on clinicians in the Virginia Tech community. Five key determinants of compassion fatigue are empathy, exposure, poor self-care, inability or refusal to manage work stressors, and dissatisfaction with clinical work (Figley, 1995; Radey & Figley, 2007).

Vicarious Resilience

In the same way that vicarious traumatization and compas- sion fatigue are the result of bearing witness to the suffering of others, a related phenomenon, vicarious resilience, bears witness to the remarkable strength and resilience seen in trauma survivors. Some trauma clinicians who have stayed in the field for years may have established effective strategies for self-care or benefited as a result of vicarious resilience. Following up on their initial research (Engstrom, Hernández, & Gangsei, 2004) and building on the idea that resilience is a pattern of behavior that can be learned, Hernández et al. (2007) undertook a grounded theory inquiry to determine whether clinicians learn resilience from their clients, resulting in new strategies for overcoming adversity. They found that witnessing clients overcoming adversity changed clinicians’ attitudes and emotions. That change was often positive, and when clinicians brought conscious attention to that possibility for positive change, there were enhanced benefits. Hernández et al. suggested that simple awareness of this potential benefit may help counteract fatigue that clinicians seem to accept as inevitable.

Posttraumatic Growth

Considered both a process and a result that can occur within the therapeutic exchange, posttraumatic growth is the devel- opment of positive meaning gained from a traumatic experi- ence (Tedeschi et al., 1998). Growth represents changes in beliefs about oneself, others, and one’s worldview, countering the adverse reactions initially experienced when faced with tragedy (Karanci & Acarturk, 2005). Crises, such as the one at Virginia Tech, can produce distressing cognitive, emotional, and physiological reactions but can also serve as the catalyst for positive change. For those able to reconstruct their lives after experiencing a traumatic event, life is qualitatively dif- ferent (Davis, Wohl, & Verberg, 2007). “Posttraumatic growth

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describes the experience of individuals whose development, at least in some areas, has surpassed what was present before the struggle with crises occurred” (Tedeschi & Calhoun, 2004, p. 4).

Shared Trauma

The phenomenon variously phrased as shared trauma, shared reality, or shared traumatic reality refers to occurrences in which the clinician and the client are simultaneously exposed to a collective trauma, as was the case in our study (Altman & Davies 2002; Baum, 2010; Saakvitne, 2002, Tosone, 2006; Tosone et al., 2003). Clinical work shifts as clinicians are “forced to remain consciously aware” (Saakvitne, 2002, p. 444) of their own vulnerability and how they can influence, and are influenced by, their clients’ experiences as they try to come to terms with their own experiences (Baum, 2012). The ability to mutually influence one another’s subjective experience is higher as clinicians are “deprived of the clinical distance usually afforded them by having a different set of external experiences than that of the client” (Tosone, 2012, p. 626). Faust, Black, Abrahams, Warner, and Bellando (2008) noted, in their work on the impact of Hurricane Katrina, that much of the research has been focused on clinicians who regularly provide service to populations who are directly traumatized, but by an experience not shared by the clinician.

Shared trauma is experienced on micro and macro lev- els, including intrapersonal, interpersonal, communal, and societal (Tosone, 2012). Clinicians may directly experience personal loss, safety concerns, survivor guilt, and/or grief (Bell & Robinson, 2013), and they may also shoulder the responsibility of providing emotional support for their family, friends, and clients (Tosone, 2012). In addition to direct and secondary effects, clinicians, including those at Virginia Tech, could vicariously become traumatized through membership in the community.

The Present Study An emerging area of research (Baum, 2010; Tosone, 2012) is focused on how clinicians are affected by traumatic expe- riences that they and their clients share. The research ques- tions of this study were the following: What were the lived experiences of the clinicians who responded to the shootings on the Virginia Tech campus with regard to the phenomenon of shared trauma with the persons they served? What are the meanings, structures, and essences of these experiences of shared trauma?

Method The purpose of this qualitative inquiry was to understand a phenomenon from the perspective of the clinicians and the meanings they assigned to events. The methodology was centered on the constructivist paradigm with the phenomeno-

logical approach designed to gather data about participants’ experiences being central to the meaning-making process (Seidman, 2012). Because the focus was on examining the individual and collective meaning derived from this event, this form of inquiry “requires methodologically, carefully, and thoroughly capturing and describing how people experi- ence some phenomenon—how they perceive it, describe it, feel about it, judge it, remember it, make sense of it, and talk about it with others” (Patton, 2015, p. 109). Gaining insight into the life, world, or experiences as the participants lived them was an important phenomenological concept of context incorporated into this study through a two-tiered interview process (Bevan, 2014; Giorgi, 1997). We focused on the significance of investigating the phenomenon holistically and in the context of the natural setting as suggested by Hays and Wood (2011). An audit trail was established to document decisions at every step of the process.

Participants and Data Collection

The study was conducted with a purposeful sample of eight volunteer participants (four men and four women) who pro- vided direct clinical and/or supervisory services in response to the Virginia Tech shootings. The participants provided crisis response services following the shootings and continued providing services to those affected on an ongoing basis. This group was composed of those within clinical and supervisory professional capacities in various work settings who were able to provide a broad range of perspectives. Because of the sen- sitivity of the subject matter and small number of participants, only select demographic information regarding professional background, gender, race, and years of experience is repre- sented in this article to protect the participants’ identities.

The participants practiced either on campus or within the local community at the time of the tragedy and represented an intensity sampling, as those contacted were most directly linked to the recovery efforts and had the ability to provide rich descriptions of their experiences (Marshall & Rossman, 2011; Patton, 2015). The mean age of participants was 32 years, with an average of 14 years of experience in the field. All of the participants held either a master’s or a doctoral degree.

We developed the procedures, interview questions, and analysis plan and process. The study was approved by the institutional review board of Virginia Tech and the ad hoc Committee for Assessment and Research After the Tragedy; the latter was a special committee established at Virginia Tech to add an extra level of oversight and scrutiny to any research proposals involving the campus community following the shootings. The first author was not a part of the Virginia Tech community at the time of the shootings; however, the other authors were.

A first step in data collection was an online demographic survey to collect information and to ensure those who re- sponded to the call for study fit the inclusion criteria.

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Following this step, the first author conducted the interviews and analysis. Two in-depth, face-to-face interviews were conducted with each participant who directly experienced the phenomenon of interest in order to gather such data for analysis. A two-tiered phenomenological interview approach was implemented first to obtain descriptions of context and content, followed by an interview for eliciting meaning (Be- van, 2014). Throughout the interactions with the participants, the focus was on being responsive to the content related to the phenomenon of shared trauma. Data collection included a fused strategy combining an interview guide approach and a more informal, conversational follow-up questioning technique (Patton, 2015).

Interviews were conducted at the primary office of each participant, although alternative locations were offered to preserve confidentiality and ensure participant comfort. Each of the two interviews with each participant averaged about an hour. The interviewer reviewed consent forms and discussed the purpose and nature of the research with the participant. Each participant selected his or her own pseud- onym, which helped protect participants’ confidentiality. Each interview was audio recorded with the permission of the participant. An interview protocol was used to ensure consistency, and the open-ended questioning format used for the first interview allowed for the flexibility to delve deeper into certain responses to enrich the data collection process. The following are some examples of questions from the interview protocol: How did your experience of being part of this community when the shootings occurred inform your clinical work with traumatized clients after the shootings? How did that experience affect aspects of your professional worldview? Having shared a similar experience with your clients, how do you think your clients have or might experi- ence you differently?

Field notes were also used to improve accuracy and encour- age reflexivity throughout the data collection and analysis process. Analytic memos incorporating participants’ specific statements were included in the field notes to bracket or counter previous knowledge and assumptions about the topic of study (Creswell, Hanson, Plano Clark, & Morales, 2007). As suggested by Rossman and Rallis (2011), following each interview, a copy of the transcript was sent to each participant as a member-check system to provide opportunities in which the participants could reflect on their words and emerging findings and make additions and suggestions, thus enhancing the accuracy of the data collection.

Two years prior to conducting the interviews, the first author interned at Cook Counseling Center, the on-campus counseling center at Virginia Tech, and worked at the local New River Valley Community Services Board. These are organizations that employ clinicians who experienced the phenomenon in question. In this way, the first author could “work much more from the participants’ specific statements

and experiences” (Creswell et al., 2007, p. 252), thus rein- forcing efforts to bracket or counter previous knowledge and assumptions about the topic of study (also see Marshall & Rossman, 2011). As a result, she had access to help partici- pants to explore the phenomenon and enough distance to try to maintain objectivity. She incorporated reflexivity regarding her positionality (e.g., her professional role) that could influ- ence the interview process and overall analysis. The second and third authors were faculty members at Virginia Tech at the time of the tragedy, and the second author played a sig- nificant role in the mental health response to the shootings. None of the authors worked with clients in the community on an ongoing basis, as the participants did. Nevertheless, the individual experiences of the authors required deliberate attention to reflexivity to avoid imposing assumptions or interpretations a priori.

Data Analysis

The analysis used in this study was an inductive method in which themes emerge from the data (Patton, 2015). The first stage of analysis was transcribing the audio-recorded interviews and completing field notes (Rossman & Rallis, 2011). The first author listened to the recording and read the transcripts several times before beginning coding and analysis. Next, open codes (descriptive indicators based on the words and actions of the interviewee) were identified from the transcripts and provided descriptive indicators of the experiences to elicit participants’ meanings of their experiences. The purpose of this coding was to find units of meaning from the statements and nonverbal cues related to the experiences of shared trauma. Once the open codes were developed, the first author reread the transcripts to cultivate focused codes. Focused coding centralized the descriptive data, combining it with more abstract interpre- tations of the data. The goal of this process was to further filter the prominent features of the data and elicit meaning. In addition, the first author sought to respond to the research questions with the goal of identifying the lived experiences around the phenomenon. Team members joined the analysis to verify that it remained relevant to the participants’ mean- ings and the research questions. They focused on identified individual and across-the-group experiences. Results of the team analysis indicated no substantive differences in the findings.

Next, we grouped units into common themes of the es- sence of meaning of shared trauma. Four categories emerged, which fused the focused codes with interpretation connected to what is currently in the literature. The categories were then developed into themes rooted in the interpretation and abstractions of the primary researcher (Patton, 2015). Themes both included and moved beyond the lived experience of the particular individuals and represent patterns across the data and the essence of the phenomena.

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We took several steps during the study design and data analysis process to ensure the quality and integrity of the research process. Trustworthiness (sometimes referred to as credibility, validity, and rigor) was enhanced by the two- interview process, with the researchers letting findings emerge from the data (Hunt, 2011). We bracketed presuppositions of interpretations of shared trauma to minimize as much as possible attention to their “past experiences, biases, preju- dices, and orientations that have likely shaped interpretation and approach to the study” (Creswell, 2013, p. 250). It was important to concentrate on and be open to the meanings that emerged from the participants (Patton, 2015). We discussed the analysis process and practiced self-reflection at multiple stages of the project to reduce any presuppositions. Triangu- lation among researchers was a central strength, resulting in thick description of the findings that indicated multiple reali- ties, thoroughly reflecting participants’ perspectives and being contextually relevant as suggested by Hays and Wood (2011).

Results The following results present a composite summary of all the participants’ experiences, including transcripts from the first and second interviews and field notes from all meetings. In particular, we addressed the experiences of shared trauma in clinicians, including how meaning was made and how this experience influenced the participants’ understanding of their work. Direct quotes are used to illustrate the follow- ing themes that emerged from the data analysis process: (a) changed perception of those who have experienced shared trauma and (b) the influence of experiencing shared trauma on clinicians’ work.

Changed Perception of Those Who Have Experienced Shared Trauma

The first theme identified was the changed perception of the participants due to the comprehensive effects of their shared exposure to trauma. The shared traumatic experience was compounded as participants were all directly affected by the same trauma as their clients at the same time. The percentage of time spent with traumatized clients and other members of the community who were traumatized increased as these professionals were working and living within the context of the violence while it was occurring. Although the intensity and level of direct exposure varied, the reactions among those interviewed were comparable. As Sam observed,

I think that is what made that whole experience different; counseling people who were traumatized by that event made it different than some other trauma they might have experienced because we shared the same experience so it’s kind of like we started on the same page [regarding the shootings], you know we didn’t have to explain it, it’s like you just knew.

In addition, the shared trauma was comprehensive in scope because the trauma infiltrated providers’ professional and personal lives as they were members of the community affected by the traumatic event. Given the context, it became apparent that managing emotional reactivity to the work and the overall event and leaving thoughts of the job at the job were not feasible immediately following the shootings. Bill shared,

The shootings have impacted everyone; that was powerful to see and in some ways made it more difficult because normally my strategy to leave work at the office didn’t work because you go out into the community and are reminded of the same things you are trying to get away from.

One of the prominent commonalities participants high- lighted was experiencing difficulty separating their own experience and subsequent feelings from their clients due to their shared trauma and familiarity with the pain expressed by others. As John described,

I was more knowledgeable of the [victims] that were involved, but I think it made it a little more difficult to separate from the client and to just kind of be there with them and probably feel a lot of the same things they were feeling.

Boundaries were challenged and stretched to accom- modate the influx of clients affected by the shootings. Ac- cording to Sam,

It was very difficult to draw the line between being the kind of therapist, and being kind of removed in just feeling what they are feeling and forget the boundary thing. . . . I cried more with my clients, I hugged more clients.

Some participants attempted to actively avoid remind- ers of the shootings within their professional and personal contexts. John described his effort to “stay away from clients who were involved in 4/16 [the date of the shootings]” given his in-depth involvement in the immediate aftermath of the shootings. Linda reported,

I was not able to leave it at the door initially just because it took up so much of my time, I didn’t talk to my family about it, I didn’t watch news, I probably haven’t watched more than 2 hours of coverage on Tech nor do I tend to watch any kind of horrific thing, there is enough of it going on day to day.

Several participants claimed that they avoided watching the coverage of the tragedy or questioned sources much more than they had prior to the shootings. Many found convers- ing with those outside of the Virginia Tech community to be daunting and tended to avoid such conversations concerning their work environment. Simba reported,

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I just didn’t talk about it and I didn’t like talking about it outside of here but as soon as people kind of found out where you work they always had questions and I just gave a cursory answer and I just moved on.

Media coverage added a layer of exposure, especially when that coverage was experienced as misrepresentative and harmful. Jane addressed her distaste for the media:

I figured out I don’t like dealing with the media, because I felt like they were in it for their own thing . . . and that in the process of doing that they were hurting students, they weren’t always real nice to other people, so I figured out I didn’t want to deal with the media anymore . . . I gave that up completely.

Because an immediate, and somewhat protracted, response was needed and expected by local mental health systems, avoidance of personal processing was another component of this shared exposure that arose among the clinicians. As Jane explained, “I think we were, and me personally, were so involved in what we were doing at the time that I didn’t have time to think about my own response.” It seems that many practitioners temporarily disregarded their own processing of the trauma as a means of being able to best meet the needs of their clients.

The Influence of Experiencing Shared Trauma on Clinicians’ Work

Clinicians with shared trauma have a unique perspective when working with their clients. Deion noted, “As mental health professionals, we’re really one of the only groups of people that get a more comprehensive sense of the tragedy,” further stating, “You have got a whole picture which I think can be very overwhelming to deal with at times.” Having such a holistic vantage point can be challenging as clinicians are inundated with others’ stories regarding the trauma, which can produce some strong reactions. Deion continued, “That’s not an image I want or that’s not an image that is going to help me sleep at night . . . I definitely would have been sleeping better tonight not hearing that.”

There were also benefits accrued from hearing several persons’ perspectives pertaining to the trauma. Some practi- tioners derived a sense of clinical confidence after they were exposed to the trauma and felt more comfort and awareness addressing this tragedy and trauma in general with their clients. Linda noted,

I am definitely more able to just talk about what the trauma is, I don’t shy away from that conversation whereas in some of my earlier clinical practices, it was so horrible that it was hard for me to talk about, because putting it into words for me made it very real for me to discuss their situation with them and I don’t think there is any conversation around a trauma that I would shy away from now.

All participants spoke of a heightened sense of awareness of trauma that influenced their assessment and therapeutic techniques. In addition, having a common experience with their clients enhanced existing relationships with clients and their ability to develop rapport with new clients, whether they were traumatized or not. Bill reported, “I think that I’m more interpersonal in general with the things that I do . . . I see it as more of a change in me and the way that I relate to people since [the shootings].” This sense of collectivity extended beyond the therapeutic relationship. Respect and apprecia- tion for the community that arose immediately following the shootings was very evident. Deion stated,

Nothing happens in a vacuum so everything we do happens in this social context . . . problems happen in a social context, why don’t the solutions happen that way, too, so I think that idea got even strengthened for me by seeing the power that society, community could have coming together.

Communal support was also apparent in the workplace. Many participants spoke of putting differences aside during the immediate aftermath to best meet the needs of their clients and the community. There appeared to be a “band of brothers” mentality in which these professionals initially relied on one another for support and consultation as the work demand and intensity increased. When referencing his relationship with a supervisee, Bill reported, “I think we got closer. We were dealing with these really important issues, difficult issues with clients and it made us more connected to each other. I think that was a good experience.”

Two of the clinicians noted how their desire to improve their self-care increased when they had to care for their clients immediately following the shootings with little time to tend to their own needs. In the aftermath of the tragedy, one clini- cian noted that the intensity of need was still high; as a means of surviving, he began to set limits. Primetime stated, “I am trying to do more self-care, trying to stay more connected with colleagues, friends, family, getting more time away, be- ing able to sort of recharge I think has been very important.”

The experience of shared trauma often detracts from in- ternal resources, as it did for our participants. They examined their experiences and described changes made to accommo- date them. Support from a variety of sources and self-care emerged as strategies that helped with enhanced and intense work demands.

Discussion Changed Perception of Practitioners Who Have Experienced Shared Trauma

One of the primary alterations of perception noted was a heightened sense of professional and personal self-awareness. The clinicians interviewed felt more attuned to identifying

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traumatic experiences of their clients. They were also more aware of their own experiences dealing with trauma, enhanc- ing attentiveness to countertransference, and improving their scope of practice. Without such recognition, clinicians are more likely to overlook personal and clinical blind spots that could hinder treatment.

Clinicians who shared this same traumatic event as their clients struggled to regain personal and professional balance. This is consistent with Faust et al. (2008), who noted the need for clinicians to establish balance between concerns for themselves, their families, and their clients. This balance is a critical element to ensuring that clinicians are truly hearing their clients’ stories. These efforts can serve to maintain the clinician’s personal identity and personal tolerance level for clients (Trippany et al., 2004).

Most participants also became more aware that the con- nection they felt to clients was enhanced, and they were more easily able to understand their clients’ experiences. Three clinicians in our study spoke about their heightened focus on their interpersonal exchanges with clients and conscious intention to view them as individuals to avoid pathologizing and generalizing the clients’ responses. Consistent with To- sone’s (2012) observation that clinicians with shared trauma as clients must work without the usual clinical distance, our participants were required to be more in tune with their emo- tional reactivity, which enabled them to better manage their responses to clients and reduce the likelihood of the negative consequences of trauma work.

Setting boundaries became a higher professional priority for the majority of clinicians in this study. Setting limits was discussed as a means of managing demands and surviving pro- fessionally. This limit-setting is significantly different than what is often encountered in the immediate aftermath of a trauma, where the challenge is in encouraging clinicians to limit their hours worked. Our participants, immersed in the trauma experi- ence personally and professionally for an open-ended period of time, set boundaries to manage their own personal and profes- sional wellness. Diversifying caseloads to reduce the number of clients who are traumatized is an important effort that, if possible, clinicians should make to reduce the likelihood of experiencing therapeutic fatigue (Cunningham, 2003; Pulido, 2007; Trippany et al., 2004). In addition, clinicians have the “professional and ethical obligation to critically self-examine their capacity for the provision of service during both the acute and the chronic phase of recovery” (Faust et al., 2008, p. 5). If clinicians are not ready to provide support to others, they are ethically bound to cease providing services until they are able to do so (American Counseling Association, 2014).

Derived Benefits and Costs Accrued Due to Shared Trauma

The heightened awareness of self-care discussed by partici- pants was derived at a cost. Immediately following the shootings,

most of the practitioners in this study were required to work more hours per week to meet the expanded needs of students, faculty, and staff, including weekends and evenings. As the response and recovery moved forward, practitioners had less time and personal resources available to designate toward self-care efforts. In a time of crisis, it is understandable that clinicians may compartmentalize their own needs in an ef- fort to help clients immediately following a tragedy. But the personal toll of ignoring one’s own emotional reactions can be detrimental if not addressed after the immediate response is over. Self-care is the foundation for work with clients and should be a continual piece of professional and personal de- velopment especially utilized during times of crisis (Venart, Vassos, & Pitcher-Heft, 2007). In this study, the opposite was found: Four practitioners mentioned that they were so focused on tending to their clients’ needs that they neglected their own. Only later, once the crisis response had subsided, did they consider the personal toll this crisis work had taken.

A benefit noted was an enhanced sense of cohesion within the workplace. “Connection to and being embedded within a support system in one’s community has been demonstrated to be an enormous value for mental health and overall quality of life” (Levy, 2008, p. 34). Social support is considered a crucial part of health and well-being and has been linked to faster and more successful posttraumatic recovery as survivors and workers who are simultaneously traumatized are given the space to process and verbalize the internal turmoil and stress typically associated with exposure to trauma (Hobfoll, Freedy, Lane, & Geller, 1990). Secure and healthy attachments to family and friends have also been illustrated to increase the ability to cope with a stressful event (Agaibi & Wilson, 2005).

Most of the practitioners in this study addressed their reli- ance on coworkers. Because of the unique experience these clinicians shared with one another, they had a distinct perspec- tive that allowed them to provide much needed support to one another immediately following the shootings. Providing the space to hear one another’s clinical trials and tribulations can enhance the opportunity to gain a balanced perspective and derive meaning from hardship. It can also reduce the possibil- ity of isolation in the workplace as clinicians preemptively established stronger relationships with one another.

Although one participant stressed that her agency’s col- laborative team work approach contributed to her professional resiliency and unity, results found variability in perceived support from supervisors. Participants who did not feel as supported in this study reported more challenges in the workplace, such as decreased social cohesion and increased stressors associated with caseloads. Being directly involved in the immediate aftermath can naturally separate workers from those not engaged in the response; it is critical to promote networking within the work environment to sustain profes- sional unity once the crisis has subsided.

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Day, Lawson, & Burge

Limitations

The scope of this study is centered on Virginia Tech and surrounding communities. The research methods and results are presented in detail so that readers can analyze their situ- ations to determine the usefulness in their settings. During the time of the shootings. there were a limited number of clinicians at Virginia Tech and within the New River Valley, and fewer worked directly on campus or locally. Although the sample was composed of clinicians from a variety of backgrounds, the experiences they described were not bound to specific professions, rather to their experiences in provid- ing services to individuals who had experienced the trauma. Given the nature of the study, all data were self-reported, and no direct observations could be made. In addition, while there may be limitations of retrospective viewpoints and day-to-day shifts in feelings about past trauma, some time passing between interviews may result in deeper reflection and analysis with regard to the clinicians’ experiences. It is also important to note that the Virginia Tech shootings received intense, pervasive media attention, and this could have affected perceptions and reoriented the experiences of everyone involved. Last, the first author worked as a clinician in the New River Valley 4 months following the shootings; therefore, she held clinical roles at the campus counseling center and New River Valley Community Services Board and had preestablished relationships with some participants.

Implications

On the basis of the findings of this research, counselors should be encouraged to practice regular self-care and conduct an honest assessment of the extent to which they will be able to assist if their community were affected by a traumatic event. When serving in times of crisis, counselors must seek support, supervision, and personal counseling so that their own personal experiences of the tragedy do not impede their work with clients.

When counseling supervisors are trained in and provide trau- ma-informed supervision and monitor the work of counselors to ensure that they are able to adequately serve their clients and not place themselves at risk, more effective support can result. The supervisory relationship, although not therapy, can be a strong contributor to counselors’ recovery processes through support and consultation, which can ameliorate stress symptoms (Pulido, 2007). Finally, counselor educators need to inform counseling students about the potential impact of shared trauma on their work and how to serve others in times of need, while tending to their own personal and professional needs. These are concepts consistent with the Council for Accreditation of Counseling and Related Educational Programs Standards (2009, 2015).

Recommendations for Future Research

It is an unfortunate certainty that interpersonal and community- based trauma are increasing (Broman-Fulks et al., 2006).

Therefore, there is a need for more evidence-based research regarding shared traumatic exposure in different settings. It would benefit researchers in the mental health field to examine how clinicians could professionally and personally thrive in such circumstances.

The results of this Virginia Tech study indicated that our participants and, to a degree, their agencies had never dealt with a community-based trauma of this magnitude. Because of this, they faced challenges such as turnover and burnout, lack of information regarding crisis management, and extended community-recovery efforts. Counselors, supervisors, and counselor educators could benefit from more knowledge, training, and supervision pertaining to effective psychosocial and work environment recovery interventions in the wake of traumatic events.

Unfortunately, communities are increasingly affected by tragedies (Satcher, Friel, & Bell, 2007). In response, clinicians are directly involved in recovery work after crises occur, and shared trauma is a potential consequence of participating in trauma work. As the study’s results indicate, there are potential benefits and challenges derived from shared trauma. In the midst of community-based crises, counselors run the risk of being simultaneously exposed; therefore, it is critical that they are aware of and equipped with the skill sets necessary to counter the costs of trauma work.

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