Layout a Plan for Reducing the Risk of Secondary or Vicarious Trauma in the Classroom

The Journal of Counselor Preparation and Supervision The Journal of Counselor Preparation and Supervision

Volume 13 Number 2 Article 5

2020

Integration of Trauma Based Education in Counselor Education Integration of Trauma Based Education in Counselor Education

Stevie VanAusdale University of Florida, [email protected]

Jacqueline M. Swank University of Florida, [email protected]

Follow this and additional works at: https://repository.wcsu.edu/jcps

Part of the Counselor Education Commons

Recommended Citation Recommended Citation VanAusdale, S., & Swank, J. M. (2020). Integration of Trauma Based Education in Counselor Education. The Journal of Counselor Preparation and Supervision, 13(2). http://dx.doi.org/10.7729/42.1354

Integration of Trauma Based Education in Counselor Education Integration of Trauma Based Education in Counselor Education

Abstract Abstract In recent years, there has been growing awareness of the widespread prevalence of trauma experiences. Knowledge of the prevalence and effect of trauma has led to a greater need for counselors to be competent and confident in working with clients’ trauma; therefore, a needs exist for counselor educators to prepare students for trauma work. Improving competency and self-efficacy among counselors-in training may lead to better client outcomes and prevent vicarious trauma. The authors provide a brief overview of the prevalence of trauma and the importance of trauma training. Then, they discuss ways counselor educators can infuse trauma education within five counselor preparation courses: counseling theories, assessment, developmental counseling over the lifespan, family counseling, and group supervision for clinical experiences. They also discuss implications for practice and research.

Keywords Keywords trauma, counselor education, training

This article is available in The Journal of Counselor Preparation and Supervision: https://repository.wcsu.edu/jcps/ vol13/iss2/5

In recent years, there has been growing awareness of the widespread prevalence of trauma

experiences. The PTSD Alliance (2016) estimated that 70% of the adult population in the United

States has experienced a traumatic event, and Farell-Sabin and Turpin (2003) reported that 95%

of individuals seeking mental health services have reported experiencing a traumatic event.

Additionally, an estimated 20% will develop post-traumatic stress disorder (PTSD) (PTSD

Alliance, 2016; Farell-Sabin & Turpin, 2003). Trauma is prevalent among children in addition to

adults, with researchers reporting that trauma was associated with 47% of childhood psychiatric

disorders (McLaughlin et al., 2012). Therefore, mental health professionals need to be prepared to

work with clients who have experienced trauma. Thus, the authors present an integrated approach

for teaching trauma-informed care (a counseling approach that includes a trauma perspective) and

trauma sensitive skills to master’s level counselor education students.

Trauma

Trauma is a physiological and psychological experience where an individual experiences

overwhelming fear for their life either literally or figuratively (Van der Kolk, 2014). One can

figuratively fear for their life through witnessing a violent act or accident without being directly

involved, such as witnessing a car accident where a person dies. Amstadter and Vernon (2008)

stated that a person will likely experience a wide range of emotions during a traumatic event, with

the most pressing emotion being fear. The broad nature of trauma makes it difficult to clearly

define because trauma can happen in one event or it can be a chronic situation (PTSD Alliance,

2016). Adding to the complexity of defining trauma is that it is related to the subjective experience,

meaning the effects of trauma can surface even when addressing issues that seem disconnected

from the trauma (Elliot et al., 2005). Examples of traumatic events could be sexual assault, physical

assault, natural or manmade disasters, motor vehicle accidents, murder of a loved one, child abuse,

intimate partner violence, illness or injury, and other dangerous and life-threatening events

(Amstadter & Vernon, 2008; Yeager & Roberts, 2003).

The Adverse Childhood Experience (ACE) study (Felitti et al., 1998) has shaped scholars

understanding about the effects of trauma on physical and mental health throughout the life span.

The ACE study encompassed a survey of 17,337 patients at San Diego’s Kaiser Permanente

facility that focused on childhood trauma experiences, such as childhood physical or sexual abuse,

substance use in the home, intimate partner violence, or divorce (Levenson, 2014). Felitti et al.

(1998) found that 40% of participants experienced two or more ACEs and 12.5% of participants

indicated that they experienced four or more ACEs. The ACE study exposed the widespread

background of ACEs. The researchers also found a profound correlation with ACEs and significant

health issues later in life (Felitti et al., 1998). The results of the ACEs study are considered the

turning point for trauma awareness (Levenson, 2014); however, the majority of the participants

were White, employed, and educated; and therefore, a need exists for replicating the study across

various groupings of class, education, race, and ethnicity. Since this landmark study, researchers

have continued to further examine the effects of ACEs through several studies (Hughes et al.,

2017). In addition to further evidence about health outcomes, researchers have also found that

contrary to past assumptions, children have the mental capacity to remember traumatic events that

occur in early childhood (Buss, Warren, & Horton, 2015). Furthermore, researchers have also

recently discussed expanded the classification of ACEs to be representative of experiences

worldwide, including organized crime, arranged marriage, witnessing criminal acts, bullying, and

sibling violence (Anda, Butchart, Felitti, & Brown, 2010).

The effects of trauma on the mind and body are explained in Van der Kolk’s (2014) book

The Body Keeps the Score. Van der Kolk’s work highlights the critical effects of traumatic stress

on an individual’s overall physical and emotional wellness (Wilkinson, 2016). Van der Kolk

discusses the importance of understanding that traumatized individuals continue to live their lives

as if the trauma is still happening (Wilkison, 2016). Understanding that clients may not have

awareness that the traumatic event has ended is important because this helps counselors to not

internalize the client’s trauma story, which helps prevent vicarious trauma.

Vicarious Trauma

Vicarious trauma is defined as one’s cumulative exposure to clients working through

traumatic events (Adams & Riggs, 2008). This type of trauma is a significant concern for mental

health professionals, considering the high prevalence of individuals who have experienced a

traumatic event, as well as the high number of individuals in counseling that have a trauma history.

The presence of vicarious trauma among helping professionals creates a need for greater

understanding of the occurrence, assessment, treatment, and prevention of this type of trauma. The

limited understanding of how vicarious trauma occurs is through the counselor hearing and

experiencing the traumatic event with their client (Cohen & Collens, 2012). McCann and Pearlman

(1990) coined the term vicarious trauma after realizing there was a specific symptomology

happening to practitioners who worked mainly with survivors of violence.

In examining the presence of vicarious trauma, McCann and Pearlman (1990) found novice

therapists (N=188) reported being significantly affected by the trauma stories of their clients. In

contrast, experienced counselors appeared to have developed ways to better cope with exposure to

trauma narratives. Adams and Riggs (2008) also found therapists in training reported higher levels

of distress when working with client with trauma histories. Another possible contributing factor is

past personal history of trauma. Pearlman and Mac Ian (1995) found that novice therapists with a

trauma history experienced more significant distress doing trauma work with clients that have

experienced trauma. However, the researchers also reported that these therapists were not

receiving supervision, or they had not received trauma training. Thus, training and supervision in

trauma work may help reduce the occurrence of vicarious trauma.

Researchers reported that the development of competency is a crucial strategy in alleviating

vicarious trauma and distress (Baker, 2012; Pearlman & Mac Ian, 1995; McCann & Pearlamn,

1990; Farrell-Sabin & Turpin, 2003; Cohen & Collens, 2012). Specifically, Baker (2012) found

that among 11 master’s level clinicians that had trauma histories and were currently working with

client’s that had traumatic experiences, the majority of participants thought a course dedicated to

trauma work and coping with reactions to trauma work would have normalized their experiences

and provided an opportunity for them to develop self-care practices. As an emerging professional

it is important to grow awareness of vulnerabilities, establish support networks, and develop self-

care plans (Killian, Hernandez-Wolfe, Engstrom, & Gangsei, 2016). Thus, offering trauma training

for counselors-in-training may help promote self-efficacy in working with clients who have

experienced trauma.

Counselor Self-Efficacy

A person’s perceived self-efficacy is a predictor of behavior (Bandura, 1977). Application

of self-efficacy to the counseling field is important when considering how to improve a counselor’s

belief in self. Greene et al. (2016) described the concept of counselor self-efficacy as a counselor’s

judgments of self as an effective clinician. When counselors believe in their abilities, they are

likely to have more positive client outcomes (Reese et al., 2009). Thus, in relation to working with

clients who have experienced trauma, providing training experiences for students to develop

knowledge, skills, and confidence in working with this population may facilitate positive client

outcomes with future clients.

Wachter Morris and Barrio Minton (2012) examined new professionals’ (N = 193)

experiences with crisis intervention preparation in both their master’s program and after graduation

and found that one third of the participants had no crisis intervention preparation in their master’s

program. Additionally, participants who took a crisis course rated their didactic experience, self-

efficacy at graduation, and current crisis self-efficacy higher than the participants who did not have

a crisis course. Furthermore, individuals that had some level of crisis preparation rated self-

efficacy higher than individuals with no preparation. Although this study focused on crisis and not

trauma training, the two topics are sometimes grouped together in training programs; and therefore,

this study may be relevant to trauma training.

The authors of this manuscript found no studies focused on trauma training; however,

researchers clearly articulate the need for trauma training in reporting that many counselors feel

incompetent to work with client who have experienced trauma (Albaek, Kinn, & Milde, 2018).

The need for trauma training is also emphasized within the American Counseling Association

(ACA) 2014 Code of Ethics, as it states that counselors should work within their scope of

competencies. Thus, due to the high prevalence of trauma, it is crucial that counselors-in-training

have trauma training to develop competency in this area and practice ethically in working with

clients who have experienced trauma. This includes training on working with clients with trauma

history and preventing vicarious trauma.

Integration of Trauma Training within the Counselor Education Curriculum

In recent years, the Council for Accreditation of Counseling and Related Educational

Programs (CACREP) has begun addressing the importance of trauma training. Specifically, the

2009 CACREP standards included within the Addictions Counseling, Clinical Mental Health

Counseling, Clinical Rehabilitation Counseling, Marriage Couples and Family Counseling,

College Counseling, and School Counseling domains a standard about understanding the effects

of crises, disasters, and other trauma causing events on a person. In 2016, CACREP further

extended the standards related to crisis response, disaster relief, and trauma by providing a more

concise standard. According to the 2016 standards, accredited programs are required to teach

master’s and doctoral level students the effects of trauma on individuals, couples, and families

over the lifespan; trauma-informed strategies; and the influence of trauma on individuals with

mental health diagnoses. The inclusion of trauma within the CACREP standards signifies the need

for better integration within counselor preparation programs.

Greene et al. (2016) examined the effects of infusing case studies about trauma, crisis, and

disaster response within a master’s level practicum course involving 24 students. The students

were presented with either audio or video clips of a mock client sharing pieces of the client’s story

with the students then being instructed to reflect on the content to develop a conceptualization of

the treatment for the client. In discussing other topics within the course, including ethics, diversity,

relationship building, risk assessment, disaster counseling, clinical writing, and intakes, the topics

were connected to the case studies to assist students in recognizing the pervasive effects of crisis

and trauma. The researchers measured self-efficacy and crisis self-efficacy through pre, mid, and

post-semester assessments and found statistically significant improvements in self-efficacy and

crisis self-efficacy (Greene et al., 2016). Limitations of the study included not having a control

group and a small sample size that lacked diversity. Similarly, Wachter Morris and Barrio Minton

(2012) found that new professionals with some level of crisis preparation in their master’s program

had higher crisis related self-efficacy, which may also be relevant for trauma training.

CACREP-accredited programs may not have the space in the curriculum to add another

required course (Lee, Craig, Fetherson, & Simpson, 2012). Therefore, programs may use an

infusion model to integrate trauma training within counselor preparation, which might be a more

cost and time effective option for counselor education programs. Abreu, Chug, and Atkinson

(2000) stated an integrated model is the most holistic form of training, but it does not negate the

importance of other program efforts to improve students’ competency. Thus, the integrated model

is one option to use with other strategies to foster student learning.

Integrating trauma training within counselor education involves having a clear

understanding of trauma-informed care. The main tenets of this approach are trust, empowerment,

and empathy (Berliner & Kolko, 2016). Embracing this approach involves considering the effects

of past traumatic experiences on current mental health when working with a client (Levenson,

2014). This requires specialized knowledge and skill that counselor educators may infuse within

counselor preparation programs, including a focus on a variety of trauma topics, including the

effects of trauma on the nervous system, personal reactions to specific traumatic narratives, and

the effects of vicarious trauma.

Counselor educators may seek to address the 2016 CACREP standards (CACREP, 2015)

regarding crisis and trauma through infusing this content within multiple courses within the

curriculum. We propose this strategy because it may not be feasible for programs to introduce

another course within the curriculum. Counselor educators may integrate this material within

several courses; however, we focus on integrating this content within five specific courses:

counseling theories, assessment, developmental counseling over the lifespan, family counseling,

and group supervision during clinical experiences. The benefit of having trauma explored in these

courses is that it provides students with an opportunity to learn how trauma is connected to all

facets of their clients’ lives. Additionally, the repetition may foster self-efficacy. Researchers

found that repeated integration and practice of skills across the curriculum helped increase

students’ self-efficacy (Hill et al., 2008).

Counseling Theories

Counseling theories is a foundational course that introduces counselors-in-training to the

conceptualization of client issues. This course would provide an opportunity for students to be

introduced to the process of conceptualizing clients who have experienced trauma. The

introduction of trauma-informed care in a counseling theories course builds foundational

knowledge of the principles that are central to trauma treatment. The counselor educator would

spend a week of class dedicated to trauma-informed care, similar to other theories. In teaching

students about trauma-informed care, the counselor educator emphasizes taking the perspective of

“what happened” versus “what’s wrong with you.” While there is no prescriptive formula on how

to treat trauma, some key principles to emphasize with students are developing and maintaining a

strong, trusting therapeutic relationship that includes normalizing problematic behaviors through

a trauma lens (i.e., helping the client understand the behavior is the body’s way of adjusting in a

typical way to a non-typical experience), embodying unconditional positive regard, and

demystifying the counseling process to help establish clear expectations. Additionally, the

instructor teaches students about the integration of psychoeducation, which involves discussing

the autonomic nervous system and its threat response designed to protect humans, which can

become problematic after the threat has disappeared and continues to be activated. Students also

learn about self-regulation skills (i.e., relaxation techniques), practicing them in class and learning

how to teach them to clients. Helping clients work through trauma memories is also a crucial

component and students learn how processing these memories may look different depending on

their theoretical orientation. Finally, students learn about the focus on post-traumatic growth,

where growth is verbalized through identifying strengthens, new life philosophies, or appreciation

of life (Gentry, Baranowsky, & Rhoton, 2017).

During the course, counselor educators may have students interview counselors in the

community that are engaged in trauma work (Huan-Tang, Zhou, & Pillay, 2017). Potential

interview questions students could ask include (a) What is your theoretical orientation and how

does trauma-informed care fit within your theory? (b) How did you develop your trauma focused

theory? (c) How does trauma-informed care influence your work with clients? The purpose of the

assignment is for students to learn about theories and techniques professionals are currently using

and begin to contemplate how trauma work may influence their theoretical development. After the

interview, students write a reflection paper about the experience and discuss how they might

integrate trauma-informed care within their counseling theory. Conceptualizing clients early in

their counseling coursework may assist students in understanding the effects of trauma and prepare

them to work with clients who have experienced trauma when they begin their clinical experiences.

Assessment

Instructors may also focus on teaching trauma within an assessment course in two areas:

(a) intake (biopsychosocial) interview and (b) instruments designed for assessing trauma.

Regarding the intake interview, instructors can teach students how to ask questions to gather

information about areas that may involve traumatic experiences for clients (i.e., childhood abuse,

intimate partner violence, deaths), as well as how to balance gathering client information while

also building rapport. This may involve brainstorming with the class different ways to ask

questions to gather information about trauma experiences, and then having students practice the

intake interview process in pairs, providing an opportunity to experience the role of the client and

the counselor. Through this experience, students may also become aware of their own triggers, and

areas to address within their own lives through counseling.

In this class, instructors may also introduce students to instruments designed to measure

trauma. This may include various types of trauma assessments (i.e., risk assessments, screening

tools, interviews) that measure different forms of trauma (i.e. domestic violence, abuse).

Instructors may also introduce students to trauma assessments for different age groups (i.e.,

Trauma Symptom Checklist [for adults], Trauma Symptom Checklist for Children [ages 8-16],

Trauma Symptom Checklist for Young Children [ages 3-12]). There are several organizations that

provide extensive lists of trauma assessments (i.e., U.S. Department of Veteran Affairs National

Center for PTSD: https://www.ptsd.va.gov/index.asp). In teaching students about trauma

assessments, instructors can have student critique the instruments, practice administering the

assessments (i.e., ACE Questionnaire: https://acestoohigh.com/got-your-ace-score/) using a

similar process to practicing the intake interview process described above, and discuss how they

would communicate the results of the assessments to clients. Thus, students learn about assessing

client trauma.

Developmental Counseling over the Lifespan

Introducing trauma material within the developmental counseling course can be useful

because the influence of trauma on an individual’s development is a critical piece of client

conceptualization. Van der Kolk (2014) stated that a traumatic event, especially in childhood,

could cause a disruption in development. This disruption often prevents further growth and

requires the clinician to address areas of disruption. During this course, instructors can discuss

various forms of trauma that may occur at stages throughout the lifespan, which may include

childhood abuse, sexual abuse, sexual assault, death, violence, accidents, life altering experiences

(i.e. divorce, losing a job, bankruptcy), or military service. In discussing these topics, instructors

focus on adverse childhood experiences, brain development, prevalence of trauma, and effects of

trauma on different age groups (i.e., children, adults).

Instructors may use “The Body Remembers” by Rothschild (2000), a book that focuses on

the effect of trauma on the development of the brain beginning in infancy, as a resource in the

class. Discussing various trauma topics may help students begin to develop a comfort level with

listening to individuals talk about their traumatic experiences. Additionally, instructors may

introduce beginning level trauma interventions, such as introducing the hand brain model to help

clients understand the parts of their brain that are activated during traumatic experiences and during

flashbacks. Dr. Daniel Siegel has a YouTube video

(https://www.youtube.com/watch?v=gm9CIJ74Oxw) instructors can use to teach students the

different parts of the brain and then give them an opportunity to practice in pairs. Instructors may

also have students read The Body Keeps the Score by Van der Kolk (2014) to gain greater insight

about the neurological and biological effects trauma can have on an individual. Students can

identify three quotes or concepts that were either meaningful, or they disagreed with from the

chapter and discuss them during small and large group class discussions.

Family Counseling

A family counseling course includes content related to understanding how families

function and how family members influence each other. Because there is a high prevalence of

trauma experienced in childhood (Berliner & Kolko, 2016), it is likely that trauma may also affect

family members. A caregiver may also have a past trauma, or the entire family unit may experience

a trauma. It is important for a family to process the trauma collectively because the family system

experiences effects from the trauma either directly or vicariously (James & MacKinnon, 2012).

The healing process for the family is critical because it contributes to healing for the specific family

member who experienced the trauma, allowing this person to develop a sense of safety within their

family or community (Goodman, 2013). Thus, the integration of family role-plays in this course

may help students understand the complex ways family systems are affected by trauma, as well as

provide an opportunity to practice critical thinking. Role-plays focused on trauma histories provide

students with exposure to intense narratives and offer opportunities for developing awareness of

areas that could be potential triggers for students. Due to the intensity of trauma stories, it is

important for students to have an opportunity to work through their emotions before sitting with

actual clients (Huan-Tang, Zhou, & Pillay, 2017).

James and MacKinnon (2012) proposed 10 principles for family therapists to use in

adopting a trauma lens within their practice. The instructor may discuss these principles within the

course to assist students in understanding how to integrate trauma-informed care within family

counseling. Instructors may also address generational trauma (i.e., addiction, traumatic injuries,

systemic oppression, family violence) in this course. The transmission of intergenerational trauma

occurs when a caregiver transmits unresolved traumas to the next generation, creating an unhealthy

pattern within the family system (Isobel, Goodyear, Furness, & Foster, 2019). Instructors may

have students map out trauma experiences across generations through the development of a

genogram from a case study. In creating a genogram of intergenerational trauma, students see

patterns emerge, and they learn how to use genograms with future clients. Goodman (2013)

discussed how to use a genogram with a family while discussing transgenerational trauma and

resilience, which could serve as a resource for the class.

Supervision Course

Counselor educators may also teach students best practices for treating trauma within a

supervision course when students are enrolled in clinical experiences (practicum and internship).

Discussing trauma within supervision of clinical experiences may help students develop stronger

self-efficacy that may lead to better client outcomes. Within the supervision course, instructors

may introduce case studies to help students conceptualize clients and develop treatment plans for

clients with different trauma histories. Case studies help students understanding the effects of

trauma on clients without feeling inadequate in the presence of a client. Additionally, instructors

may have students review their counseling theory paper from theories class and reflect on how

they are integrating trauma-informed care within their theory.

With the foundation from the previous courses, the focus of teaching trauma in the

supervision course is on conceptualization and techniques to work with clients who have

experienced trauma. Greene et al. (2016) found the use of an unfolding case study within practicum

group supervision was positively correlated with students’ counselor self-efficacy at the end of the

semester. Thus, counselor educators may integrate case studies that include an element of trauma

within their courses to help students develop competency in trauma-informed care. This may

include techniques that improve self-regulation and relaxation, involve exposure and restoring

client’s trauma, and cognitive restructuring with psychoeducation (Gentry, Baranowsky, &

Rhoton, 2017).

Another classroom activity involves students assessing a painful memory. Instructors lead

students through seven steps to facilitate this activity: (a) select a painful memory (i.e., being

bullied, a break-up, parents’ divorce, confrontation with friend) they feel comfortable sharing, (b)

identify emotions associated with this memory, (c) recognize where in your body you experiencing

these emotions, (d) identify a negative belief you concluded about yourself as a result of this

experience, (e) reflect on whether this negative belief is actually true, and (f) consider positive

beliefs about the experience. Instructors may have students process the activity as a large group or

in small groups and write a reflection paper about the experience. Students are reminded to practice

self-care during the activity. Discussing vicarious trauma is particularly relevant during clinical

experiences coursework because students are working with clients. Adams and Riggs (2008)

emphasize the importance of teaching students about defense styles and helping students develop

awareness of their styles and learn more adaptive/mature defense styles (i.e., sublimation, humor).

Thus, counselor educators can assess and discuss defense styles during supervision and provide

opportunities for students to develop and practice self-care and wellness.

The activities described above provide counseling students opportunities to develop

knowledge and skills related to trauma through learning about traumatology concepts, becoming

comfortable with hearing trauma stories, developing an understanding of the effects of trauma, and

practicing techniques. Additionally, focusing on trauma early and often in the curriculum can help

foster self-awareness and encourage students to seek counseling to address personal traumas

(Killian, Hernandez-Wolfe, Engstrom, & Gangsei, 2016). Furthermore, integration of trauma

training throughout the curriculum may help students develop higher levels of self-efficacy by

feeling prepared to work with clients who have experience trauma (Sawyer, Peters, & Willis,

2013).

Implications

Integration of trauma training throughout the counselor education curriculum emphasizes

the importance of recognizing and treating trauma, which may help improve client care, the self-

efficacy of counselors-in-training, and the prevention of vicarious trauma. Additionally, teaching

students about trauma is a requirement for CACREP-accredited programs (CACREP, 2015).

Through integration of trauma education throughout the counselor education curriculum, students

develop a foundational understanding of the effects of trauma on clients, and its importance related

to various aspects of counseling. This is crucial because psychological trauma is an aspect of client

care that clinicians are exposed to throughout their careers (Webber et. al., 2017).

Counselor educators might be reluctant to integrate trauma training within courses due to

their lack of trauma expertise. Watkins Van Asselt, Soli, and Berry (2016) conducted a session at

an Association for Counselor Education and Supervision (ACES) conference to explore reluctance

counselor educators have related to teaching trauma. The session focused on exploring self-

efficacy and crisis and trauma training. They found that many attendees thought that they needed

more trauma training to feel competent in teaching students about trauma. Participants expressed

apprehension in sharing their concern with colleagues for fear of being judged. Considering these

findings, it is understandable why counselor educators may struggle with integrating trauma

education within their courses. Thus, faculty may need professional development on trauma before

teaching students about trauma. This may involve conference sessions, workshops, or certification

courses (i.e., somatic experiencing, EMDR).

A caution for counselor educators when teaching students about trauma is to be mindful of

the affect this topic can have on students who have their own trauma stories (Pearlman & Mac Ian,

1995; Baker, 2012). Before discussing trauma topics, faculty should be intentional in creating a

safe space and having resources for students if needed. A counselor educator can create safety in

the course through modeling of sharing vulnerabilities or professional experiences with trauma

and dedicating time at the beginning of the course focused on building trust between the instructor

and the students, and the students with each other through intentional conversations. Instructors

may also use mindfulness by having students identify a place or image where they feel safe and

calm; visualizing the place with specific feelings, scents, and tactile sensations; and associating a

word with the place that allows the positive sensations to be present for students during times of

potential triggers. Similar to the process of protecting against vicarious trauma in the counseling

room, instructors should strive to minimize students being triggered in the classroom through

consistent reminders for students to be doing regular honest self-reflection of their own

experiences. It is also helpful for counselor educators to allow students the space to have candid

conversations and to empower them to practice self-care. While engaging in trauma work with

clients can be difficult, it can also be rewarding when clinicians are properly trained. A clinician

may experience vicarious resilience, growth, and transformation experienced through engagement

with a client’s resilience (Michalachuk & Martin, 2018). Therefore, training students to work with

clients who have experienced trauma is both important and meaningful.

Future research may focus on evaluating the effectiveness of teaching trauma across the

counselor education curriculum. This may include the effect of training on students’ perceived

competency level, including knowledge, awareness, and skills. Additionally, researchers may

compare the effectiveness of this approach to teaching a dedicated course on trauma.

Scholars have recognized the need for training counselors-in-training on trauma to increase

students’ competency and self-efficacy in working with clients who have experienced trauma.

Additionally, CACREP (2015) has incorporated standards requiring the integration of trauma

content within counselor preparation. Thus, it is crucial for counselor educators to integrate trauma

training within the counselor education curriculum. Through the integration of trauma training,

students may be less likely to experience vicarious trauma, and feel better prepared to work with

clients who have experienced trauma.

References

Abreu, J. M., Gim Chung, R. H., & Atkinson, D. R., (2000). Multicultural counseling training:

Past, present, and future directions. The Counseling Psychologist, 28, 641-656.

Adams, S. A., & Riggs, S. A. (2008). An exploratory study of vicarious trauma among therapist

trainees. Training and Education in Professional Psychology, 2(1), 26-34.

doi:10.1037/1931-3918.2.1.26

Albaek, A. U., Kinn, L. G., & Milde, A. M. (2018). Walking children through a minefield: How

professionals experience exploring adverse childhood experiences. Qualitative Health

Research, 28, 231-244. doi:10.1177/1049732317734828

American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author.

Anda, R. F., Butchart, A., Felitti, V. J., Brown, D. W. (2010). Building a framework for

global surveillance of the public health implications of adverse childhood experiences.

American Journal of Preventative Medicine, 39(1), 93-98.

doi:10.1016/j.amepre.2010.03.015

Baker, A. A., (2012) Training the resilient psychotherapist: What graduate students need to know

about vicarious traumatization. Journal of Social, Behavioral, and Health Sciences, 6(1),

1-12. doi:10.5590/JSBHS.2012.06.1.01

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral

change. Psychological Review, 84, 191-215. doi:10.1037/0033-295X.84.2.191

Barden, S. M., & Greene, J. H. (2015). An investigation of multicultural counseling competence

and multicultural counseling self-efficacy for counselors-in-training. International Journal

for the Advancement of Counselling, 37(1), 41-53. doi:10.1007/s10447-014-9224-1

Barrio Minton, C. A., & Pease-Carter, C. (2011). The status of crisis preparation in counselor

education: A national study and content analysis. Journal of Professional Counseling, 38,

5-17.

Berliner, L., & Kolko, D. J. (2016). Trauma informed care: A commentary and critique. Child

Maltreatment, 21, 168-172. doi:10.1177/1077559516643785

Buss, K. E., Warren, J. M., & Horton, E. (2015). Trauma and treatment in early childhood: A

review of the historical and emerging literature for counselors. Professional Counselor:

Research & Practice, 5(2), 225-237.

Campbell, R., Raja, S., & Grining, P. L. (1999). Training mental health professionals on violence

against women. Journal of Interpersonal Violence, 14, 1003-1013.

doi:10.1177/088626099014010001

Cohen, K., & Collens, P. (2013). The impact of trauma work on trauma workers: A

metasynthesis on vicarious trauma and vicarious posttraumatic growth. Psychological

Trauma: Theory, Research, Practice, and Policy, 5, 570-580. doi:10.1037/a0030388

Corbin, T. J., Purtle, J., Rich, L. J., Rich, J. A., Adams, E. J., Yee, G., & Bloom, S. L. (2013).

The prevalence of trauma and childhood adversity in an urban, hospital-based violence

intervention program. Journal of Health Care for the Poor and Underserved, 24, 1021-

1030. doi:10.1353/hpu.2013.0120

Council for Accreditation of Counseling and Related Educational Programs. (2009). Standards.

Retrieved from https://www.cacrep.org/wp-content/uploads/2017/07/2009-Standards.pdf

Council for Accreditation of Counseling and Related Educational Programs. (2015). Standards.

Retrieved from http://www.cacrep.org/wp-content/uploads/2012/10/2016-CACREP-

Standards.pdf

Elliott, D. E., Bjelajac, P., Fallot, R. D., Markoff, L. S., & Reed, B. G. (2005). Trauma-informed

or trauma-denied: Principles and implementation of trauma-informed services for

women. Journal of Community Psychology, 33, 461-477. doi:10.1002/jcop.20063

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V.,…

Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many

of the leading causes of death in adults: The adverse childhood experiences (ACE)

study. American Journal of Preventive Medicine, 14, 245-258. doi:10.1016/S0749-

3797(98)00017-8

Gentry, E. J., Baranowsky, A. B., & Rhoton, R. (2017). Trauma competency: An active

ingredient approach to treating posttraumatic stress disorder. Journal of Counseling &

Development, 95, 279-287.

Greene, C. A., Williams, A. E., Harris, P. N., Travis, S. P., & Kim, S. Y. (2016). Unfolding case-

based practicum curriculum infusing crisis, trauma, and disaster preparation. Counselor

Education and Supervision, 55, 216-232. doi:10.1002/ceas.12046

Goodman, R. (2013). The transgenerational trauma and resilience genogram. Counselling

Psychology Quarterly, 26, 386-405.

Hill, C. E., Roffman, M., Stalh, J., Friedman, S., Hummel, A., & Wallace, C. (2008). Helping

skills training for undergraduates: Outcomes and prediction of outcomes. Journal of

Counseling Psychology, 55, 359-370. doi:10.1037/0022-0167.55.3.359

Huan-Tang, L., Zhou, Y., & Pillay, Y. (2017). Counselor education students’ exposure to trauma

cases. International Journal for the Advancement of Counselling, 39, 322-332.

Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., & Dunne, M. P.

(2017). The effect of multiple adverse childhood experiences on health: A systematic

review and meta-analysis. The Lancet: Public Health, 2, e356-e366. doi:10.1016/S2468-

2667(17)30118-4

Isobel, S., Goodyear, M., Furness, T., & Foster, K. (2019). Preventing intergenerational trauma

transmission: A critical interpretive synthesis. Journal of Clinical Nursing, 28, 1100-1113.

James, K. & MacKinnon, L. (2012). Integrating a trauma lens into a family therapy framework:

Ten principles for family therapists. The Australian and New Zealand Journal of Family

Therapy, 33, 189-209.

Killian,K., Hernandez-Wolfe, P., Engstron, D., & Gangsei, D. (2017). Development of the

vicarious resilience scale (VRS): A measure of positive effects of working with trauma

survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 9(1), 23-31.

Lee, T. K., Craig, S. E., Fetherson, B. T. L., & Simpson, C. D., (2012). Addition competencies in

the mental health counseling program standards. Journal of Addictions & Offender

Counseling, 34(1), 2-15.

Levenson, J. (2014). Incorporating trauma-informed care into evidence-based sex offender

treatment. Journal of Sexual Aggression, 20(1), 9-22. doi:10.1080/13552600.2013.861523

Lu, H., Zhou, Y., & Pillay, Y. (2017). Counselor education students’ exposure to trauma

cases. International Journal for the Advancement of Counselling, 39, 322-

332. doi:10.1007/s10447-017-9300-4

McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for

understanding the psychological effects of working with victims. Journal of Traumatic

Stress, 3, 131-149. doi:10.1007/BF00975140

McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler,

R. C. (2012). Childhood adversities and first onset of psychiatric disorders in a national

sample of US adolescents. JAMA Psychiatry, 69, 1151-1160.

Michalchuk, S., & Martin, S. L. (2018). Vicarious resilience and growth in psychologist who

work with trauma survivors: An interpretive phenomenological analysis. Professional

Psychology: Research and Practice, 50(3), 145-154.

Pearlman, L. A., & Mac Ian, P. S. (1995). Vicarious traumatization: An empirical study of the

effects of trauma work on trauma therapists. Professional Psychology: Research and

Practice, 26, 558-565. doi:10.1037/0735-7028.26.6.558

PTSD Alliance. (2016). Post traumatic stress disorder fact sheet. Retrieved from

http://www.sidran.org/resources/for-survivors-and-loved-ones/post-traumatic-stress-

disorder-fact-sheet/

Reese, R. J., Usher, E. L., Bowman, D. C., Norsworthy, L. A., Halstead, J. L., Rowlands, S. R.,

Chisholm, R. R. (2009). Using client feedback in psychotherapy training: An analysis of

its influence on supervision and counselor self-efficacy. Training and Education in

Professional Psychology, 3(3), 157-168. doi:10.1037/a0015673

Sabin-Farrell, R., & Turpin, G. (2003). Vicarious traumatization: Implications for the mental

health of health workers? Clinical Psychology Review, 23, 449-480. doi:10.1016/S0272-

7358(03)00030-8

Van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of

trauma. New York, NY: Penguin Books.

Wachter Morris, C. A., & Barrio Minton, C. A. (2012). Crisis in the curriculum? New

counselors’ crisis preparation, experiences, and self-efficacy. Counselor Education and

Supervision, 51, 256-269. doi:10.1002/j.1556-6978.2012.00019.x

Watkins Van Asselt, K. W., Soli, L. L., & Berry, E. L. (2016). Crisis fearlessness: A call for

trauma competencies in counselor education. The Journal of Individual Psychology, 72,

200-213. doi:10.1353/jip.2016.0017

Webber, J., Kitzinger, R., Runte, J. K., Smith, C. M., and Mascari, J. B. (2017) Traumatology

trends: A content analysis of three counseling journals from 1994-2014. Journal of

Counseling and Development, 95, 249-259. doi:10.1002/jcad.12139

Wilkinson, M. (2016). Review of the body keeps the score: Mind, brain and body in the

transformation of trauma. The Journal of Analytical Psychology, 61, 239-244.

doi:10.1111/1468-5922.12213_1

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