Working with the real survivors of life: a grounded theory of managing the demands of trauma work in clinicians working with adult survivors of complex trauma
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Background: There is an emerging literature suggesting that clinicians can go through a process of personal change when engaging in psychotherapeutic work with trauma survivors, which parallels that experienced by clients themselves. The current evidence regarding the relationship between engaging in psychological therapy and compassion satisfaction, vicarious post-traumatic growth and vicarious resilience is inconclusive. A number of methodological weaknesses in the existing literature were identified. The review highlights the need for future research to examine the contextual, demographic and psychological factors which allow therapists to experience positive psychological outcomes from their trauma work. Objective: This study aims to explore vicarious post-traumatic changes in clinicians who work with adult survivors of complex trauma and the role of organisational factors in these changes. Method: Grounded theory methodology was used to analyse interview data with twelve participants (nine female and three male), all of whom had high complex trauma caseloads. Results: The study generated a theory proposing that undertaking trauma work involves the interplay between numerous challenges pertaining to clinicians’ expectations of themselves, therapeutic challenges and organisational neglect. Engaging in trauma work with clients leads to psychological and emotional changes in therapists. A lack of organisational support further contributes to such changes, leaving clinicians feeling isolated and overwhelmed. In order to cope with these challenges, clinicians develop coping mechanisms in the form of emotional detachment and accessing external supports. Alongside this, clinicians identify positive effects of trauma work arising from the therapeutic relationship. These positive outcomes appear to mediate the more negative effects of trauma work, relating to psychoemotional changes and lack of organisational support. Conclusion: These findings suggest a need for a greater understanding of the degree of reciprocity between clients, clinicians and services and the provision of trauma-informed services both for clients and clinicians.