Supporting the well-being of supervisees in trauma-intensive sites and the examination of current trauma-informed supervision practices

Monica Sanchez & Yinan Liang

Section Editor:
Kiara Tookes-Williams

Peer Reviewers:
Molly Becker, Olivia Jackson, Jasmine Merlette, Zaine Roberts

Advisor: Antonella Bariani
Opinions expressed by the authors are their own and not necessarily those of APA, Division 56, or any member of the editorial board.

Trauma-informed mental health services are in high demand. Yet, there is a discrepancy in the training and availability of trained clinicians and supervisors in trauma-informed care (Borders et al., 2023; Ellis et al., 2019; Wells et al.,2003). Beginner clinicians are particularly at risk for burnout, secondary traumatic stress (STS), and vicarious trauma due to having little to no trauma-focused training within their programs or practicum sites (Borders et al., 2023; Coleman et al., 2021; Makadia et al., 2017; Sommer, 2008). Trainees of color and those with their own trauma history are especially at risk for secondary effects when not adequately trained for trauma work or when adequate trauma-informed supervision is not available (Borders et al., 2023; Berger et al., 2020). Even our understanding of what constitutes as competent trauma-informed supervision varies throughout our field; thus, more awareness is needed to understand and communicate effective trauma-informed supervision (Berger et al., 2020). Supervisors play a crucial role in mitigating trauma-related outcomes within supervisees and clients, therefore continually examination of supervision practices is warranted.

Trauma and traumatic stress encompass a variety of experiences, can affect people of various identities and backgrounds, can be a single event or chronic condition, and could impact more than one individual (Substance Abuse and Mental Health Services Administration, 2014). Some people have temporary reactions to trauma, while others experience prolonged effects and consequences, such as medical problems, PTSD, substance use, anxiety, and other mood-related disorders (Substance Abuse and Mental Health Services Administration, 2014). It is believed that trauma work can inadvertently have negative impacts on mental health professionals, particularly trainees or those with less trauma-informed training (Makadia et al., 2017). Phenomena such as vicarious traumatization, STS, and compassion fatigue can be experienced by providers doing trauma-intensive work and indirectly being exposed to trauma (Coleman et al., 2021; Sommer, 2008). Vicarious traumatization can appear similar to PTSD, displaying similar symptoms such as negative cognitive distortions of themselves, others, and the world as a result of cumulative exposure to client trauma narratives, but does not include other aspects of PTSD (Coleman et.al., 2021; Makadia et al., 2017; Sommer, 2008). The remaining areas of PTSD, such as intrusions, avoidance, and arousal, are seen more within STS, yet not quite reaching PTSD status and not having a Criterion A trauma (Makadia et al., 2017). Additionally, compassion fatigue refers to a therapist’s emotional exhaustion from their clients, followed by detachment, withdrawal, or even hostility toward the client (Courtois, 2018). Supervisors should ensure supervisees are aware of these risks to mitigate the effects of trauma exposure while maintaining ethical service delivery and prioritizing client welfare.

There can also be positive growth for supervisees within trauma work, especially around resilience and meaning making from helping highly traumatized clients (Coleman et al., 2021). Supervisors should utilize skills such as trustworthiness, creating relational safety within the supervisory relationship, collaboration, validation, and maximizing supervisee autonomy within their supervision time to provide effective trauma-informed supervision (Berger et al.,2020). Self-disclosure of the supervisor’s first experiences of the secondary impact of trauma work can be extremely useful for supervisees when working on strengthening the relationship and validating the difficulties of the work (Borders et al., 2023; Wells et al., 2003). Participating in ongoing supervision is essential to the growth and protection of those engaged in trauma-informed care. Acknowledging the interrelationship between the trauma, practitioner, helping relationship, and the context of where the services are provided can help supervisees with countertransference (Berger et al., 2020). These concepts are important to understand within training programs, especially for the ethical considerations of supervisees’ overall well-being as they begin trauma work.

Among professional organizations, the National Child Traumatic Stress Network (NCTSN) offers nine core competencies and resources for staff and mental health providers to help prevent secondary traumatic stress of providers and the support and supervision of others (Borders et.al., 2023; Griffin, 2022). The nine core competencies are outlined in a self-rating tool on STS in trauma-informed supervision (Griffin, 2022). Each competency has a set of skills that the supervisor rates as being “not part of my skill set yet, doing OK but need more training, or I have confidence in my skills in this area” as a way to rate one’s supervision capabilities and skills (Griffin, 2022). Another resource they provide is a cross-disciplinary guide for supervision, which also touches on the STS core competencies described above (Griffin, 2022). Although these resources center on the topic of STS, these resources could be useful in the development, conceptualization, and adaptation of other guides, resources, models, interventions, and theories to support trauma-informed services and supervision.

There are many considerations in trauma-informed supervision regarding the prosperity of the supervisee, client welfare, and risk. Supervisors should keep a close eye on supervisees with a similar trauma history to their clients, especially knowing the prevalence of trauma (Borders et.al., 2013). When planning for supervision, areas such as psychoeducation, emotional regulation, validation of supervisee, and self-care will be natural topics, yet a supervisor should be flexible to ensure their supervisee can feel safe within supervision (Borders et.al., 2023). Observation of the supervisee’s in-session interactions and reactions can provide insight about a supervisee’s discomfort and areas of growth. Supervisees can be overwhelmed by the intensity of trauma work and could present to supervision either with a lack of affect, avoidance, or a charged emotional state (Borders et.al., 2023). With parallel processes, supervisors can model appropriate behaviors that can be translated within sessions, including verbiage, interventions, safety assessment, validation, and attending to emotions (Borders et.al., 2023). A study that explored practices of supervisors trained in trauma and clinical supervision reported that some supervisees described achieving greater emotional regulation, feeling more validated, and greater self-control after experiencing trauma-informed supervision practices (Borders et.al., 2023). Further research could capture supervisee voices during the implementation of trauma-informed supervision and the impact of their experience.

Supervision could also become a space where the supervisee discloses their own traumatic experiences and their relevance to the client’s conceptualization. However, supervision is not a personal therapy space for the supervisee. This goes beyond the supervisor’s role by engaging in multiple roles where the supervisee wishes to directly address or process their personal traumatic experience (Berger et al., 2020). Although it is important to discuss aspects of a supervisee’s personal experiences and countertransference, the supervisor must appropriately redirect the conversation to center the well-being of the client (Berger et al., 2020). The supervisor should aim to provide appropriate resources or suggest necessary referrals, help the supervisee in their ability to monitor motivation or intentions when making ethical decisions with self-disclosures, and normalize stress responses related to their own experiences (Berger et al., 2020; Griffin, 2022). However, supervisors must also maintain the emotional safety of the supervisee and their ability to emotionally regulate and self-reflect on best practice (Berger et al., 2020). The supervisor can hold space for the supervisee but must work to maintain that boundary and prevent multiple roles to ensure ethical practice.

With supervisees of diverse backgrounds, additional considerations of the supervision and context will be important to provide culturally competent support. Supervisors should examine ways in which their own beliefs and assumptions uphold discrimination, particularly with instances of lack of cultural awareness throughout supervision (Berger et al., 2020). Recognizing that diverse supervisees may face compounded stressors and effects of trauma work related to systemic oppression, discrimination, or microaggressions, supervisors should practice active listening, validation, and consider the unique challenges of marginalized identities (Berger et al., 2020). This will entail creating space for open dialogue, acknowledging power dynamics, tailoring support to meet individual needs, advocating for equitable policies within the organization, and modeling self-care strategies with trainees to translate skills into action (Berger et al., 2020). Discussions around diversity are part of trauma-informed care and should be reflected within supervision for culturally competent practice.

Recent studies are exploring a foundation for potential models of trauma-informed supervision, such as the Contextual Model of Trauma Treatment within supervision (Ellis et.al., 2019). This model approaches clients and supervisees as “a whole person” who is “shaped by genetics, relationships with caregivers and others, and other life experiences that impact self and worldviews and clinical capacities,” giving a more holistic view to support the supervisees’ overall well-being (Ellis et al., 2019). The aims of this supervision experience include a collaborative working alliance, fostering a flexible trainee-guided conceptualization of skills and treatments, and developing practical professional skills across multiple domains (Ellis et al., 2019). This attends to the relational aspects of the model and continually checks for the growing needs of the supervisee, while also providing practical ways to provide therapeutic interventions for clients.

Employing a relational model of supervision within training programs for beginner therapists is thought to have advantages in helping the healing process through the relational nature of supervision (Wells et al., 2003). As previously mentioned, attending to supervisee’s countertransference or over-identification with victimhood should be addressed to lessen the impact on the client (Wells et al., 2003). Fundamental concepts within this approach include valuing mutual and collaborative growth, focusing on culture and context, use of self-as-instrument for modeling, countertransference as a way to understand reactions, and a focus on self-awareness (Berger et al., 2020; Well eat al., 2003). The supervisee should feel comfortable bringing up feelings of emotionally overinvesting with clients, particularly with beginner therapists, that could lead them to feel drained, confused, overwhelmed, and exasperated (Wells, et al., 2003). Processing their insecurities is essential within this relation model, understanding that similar to clients, the supervisor must assess the developmental level of the supervisee and work collaboratively to avoid creating potential harm by moving too fast (Wells et al., 2003).

Another proposed method to strengthen the supervision of trainees within trauma-intensive sites suggests a blend of Relational Cultural Therapy and Feminist Multicultural supervision approaches. Gomez (2020) offers personal insight into a multicultural approach to supervision that can incorporate the lived complexities of clients and trainees, especially within trauma settings where other supervisors have excluded it from their training. The article highlights how relational cultural therapy emphasizes the importance of relationships, how disconnection from self and others can cause mental distress, and the use of collaboration to engage and shift power within the relationship (Gomez, 2020). Supervision works similarly, in which the relationship with the client is examined to identify any relational breaches, the therapeutic process, and even the utilization of collaboration between the supervisee and supervisor as a way to empower the supervisee (Gomez, 2020). This supervision approach within trauma-intensive sites could help address concerns about the deep impact of a client’s story on a supervisee, especially in thinking of the supervisor’s role in supporting the supervisee in a collaborative manner that allows the supervisee to also empower their client using collaboration. Clinical sites with a large diversity of clients and trainees could also benefit from this theory, as it enables the growth of conceptualizing trauma within complex situations and contexts.

Future considerations for training programs and research are in high demand. Determining what “quality” supervision and training would be like for trainees needs a foundation for mental health professionals (Makadia et al., 2017). More research on existing practices or the effectiveness of current trauma courses and training could hold insight into areas that need to be developed or determine supervisor competencies (Makadia et al., 2017). Additionally, more research on the experiences and development of trainees within trauma-intensive sites and the progression of their development with trauma-informed supervision could be helpful and provide more guidance (Borders et al., 2023; Gomez, 2020). Although trauma-informed care has unique challenges in risk and exposure to traumatic experiences, special attention to this work is essential and needed within psychology to support clients and clinicians (Berger et al., 2020). Strengthening this research could help ensure the safety of our clients and clinicians, as well as provide more support for trauma-informed practice and supervision.

Monica Sanchez (she/her/ella) is a bilingual first-generation student, child of Mexican immigrants, and is now a third-year doctoral candidate in Counseling Psychology at the University of Georgia. Within her clinical and research interests, she primarily focuses on helping clients heal from traumatic experiences using a decolonial and feminist lens, with a focus on children, families, and immigrants. Currently she provides therapeutic services within the Atlanta VA’s Mental Health Specialty Services Practicum which focuses on the treatment of veterans with PTSD and other comorbid conditions.

Yinan Liang (she/her) is a bilingual international student from China and is now a third-year doctoral candidate in Counseling Psychology at the University of Georgia (UGA). Her primary research interests are resilience, multicultural identity development, and mentorship within higher education, especially within Asian and Asian American communities. Currently, she works as a clinical graduate assistant for Mary Frances Early College of Education and Student Affairs and is an advanced practicum student at UGA’s Counseling and Psychiatric Services. She provides bilingual psychotherapy for Chinese students at UGA and advocates for underserved populations with mental health support.

Citation: Sanchez, M., & Liang, Y. (2025). Supporting the well-being of supervisees in trauma-intensive sites and the examination of current trauma-informed supervision practices. Trauma Psychology News, 20(1), 40-45. https://traumapsychnews.com