Trauma-Informed Supervision: Supporting Therapists Who Treat Trauma

This article explores the principles, strategies, benefits, and practical applications of trauma-informed supervision.  

Related articles: Assessing and Treating Trauma, Epigenetics and Intergenerational Trauma, Why Therapists Need Therapy.

Introduction

Therapists who specialise in trauma work face unique challenges that can impact their well-being and professional effectiveness. Supervisors play a critical role in ensuring that therapists remain resilient, competent, and supported in their practice. Trauma-informed supervision offers a framework for understanding and addressing the distinct needs of therapists who treat trauma, acknowledging the potential for secondary traumatic stress, vicarious trauma, and therapist burnout.

This article explores the principles, strategies, and benefits of trauma-informed supervision, integrating theory, practical applications, and case examples to equip supervisors with effective tools for supporting their supervisees.

The need for trauma-informed supervision

Trauma work often requires therapists to bear witness to harrowing stories, creating a risk of emotional and psychological strain. This exposure can lead to secondary traumatic stress, characterised by symptoms similar to post-traumatic stress disorder (PTSD), and vicarious trauma, involving shifts in a therapist’s worldview and sense of safety.

Supervisors are uniquely positioned to mitigate these risks by fostering a safe and supportive supervisory environment. Trauma-informed supervision involves recognising the impact of trauma on therapists, prioritising their wellbeing, and promoting sustainable professional practice. It integrates core trauma-informed principles—safety, trustworthiness, collaboration, empowerment, and cultural sensitivity—into the supervisory process.

Principles of trauma-informed supervision

Trauma-informed supervision is guided by principles that ensure supervisees feel supported and understood in their roles. These principles are designed to address the emotional and professional complexities of trauma work while fostering a supervisory relationship that is both nurturing and empowering.

By adhering to these foundational elements, supervisors create an environment where therapists can thrive and maintain resilience in the face of challenging clinical work:

• Safety: Establishing a supervisory relationship where therapists feel physically and emotionally secure.
• Trustworthiness: Building a transparent and consistent relationship that fosters mutual respect.
• Collaboration: Encouraging shared decision-making and active participation in supervision.
• Empowerment: Supporting therapists to build resilience and confidence in their professional abilities.
• Cultural sensitivity: Recognising and respecting cultural and contextual factors influencing both therapists and their clients.

Case study: Establishing safety in supervision

Emily, a newly qualified therapist working with survivors of domestic violence, began experiencing nightmares and heightened anxiety. During supervision, her supervisor created a space for her to express her concerns without fear of judgement. While each client’s story was horrific in some way, one in particular had affected Emily.

She related that her client had described how her partner of eight months had been so attentive in the beginning, “love-bombing” her, but then had begun to be overly curious about everything she was doing when not around him. He demanded instant reply to his texts and calls and had begun suggesting that she didn’t need to see her friends and family so much. The client got concerned the first time the partner shoved her, but then attributed the shove to him being “tired from work and just having had several beers.”

Unfortunately, the  coercive control and intimidation developed until the partner came home from work one day and found that dinner was nowhere near ready. He beat Emily’s client, causing serious bruising and loss of hearing in her right ear. Emily got triggered by hearing this because she had begun a new relationship at about the same time as her client, and she could imagine her current partner behaving similarly to the client’s partner.

Together, Emily and her supervisor analysed the aspects of the client’s case that most affected Emily and worked out how Emily could be particularly attentive to the behaviours of her new partner, ensuring that she would be alert to any forms of coercive control. The supervisor offered psychoeducation about intimate partner violence and what leads up to it. They discussed whether Emily should refer on the client. Emily acknowledged that her partner had not engaged coercive control and decided that she felt safe to continue both her relationship with him and her therapeutic relationship with the client.

Emily was glad she had shared her experiences and agreed to contact the supervisor if any further concerns arose. Together, they developed a treatment plan for the client and a plan for Emily, to manage her general workload. They also incorporated mindfulness practices into her self-care routine. By prioritising Emily’s emotional safety, the supervisor facilitated a pathway for her to regain her professional confidence and separate her professional life from her personal one.

Strategies for trauma-informed supervision

Effective trauma-informed supervision requires a blend of empathy, education, and practical interventions. Supervisors must balance addressing the emotional toll of trauma work with fostering professional growth and competency. These strategies aim to help supervisors equip therapists with the tools to navigate their roles effectively while maintaining their own wellbeing.

• Regular self-reflection: Supervisors should engage in self-reflection to examine their biases and emotional responses, ensuring they provide an impartial and supportive environment.
• Assessment of supervisee wellbeing: Begin each session by checking in on the therapist’s emotional state and professional challenges. This practice normalises conversations about wellbeing and reduces stigma.
• Boundary management: Help therapists establish clear boundaries between their professional and personal lives to prevent emotional spillover.
• Education on trauma dynamics: Provide supervisees with a deeper understanding of trauma and its effects to enhance their clinical competency and resilience.
• Vicarious resilience: Highlight positive outcomes from clients’ recovery journeys to inspire hope and reinforce the supervisee’s sense of purpose.
• Balancing support and challenge: Offer empathic support while encouraging critical thinking and growth to maintain supervisee engagement and skill development.

Case study: Addressing vicarious trauma

James, a seasoned therapist working with refugees, reported feeling disconnected and cynical. His supervisor recognised signs of vicarious trauma and encouraged James to explore his emotional responses in supervision. James recalled how passionate he had felt at the beginning of the work, certain that he could make a difference to people who were doing the courageous thing of setting up a life in a new country.

Over time, though, he began to realise just how tough it was for the refugees, many of whom could not find appropriate work even after they learned reasonable English. They sometimes encountered unwelcoming locals, and many still were not certain if they would be allowed to stay permanently. The trauma they had experienced in the old country still affected them, with many cases of PTSD emerging. The sheer weight of the problems and the difficulty of navigating the many governmental agencies and systems made it tough work.

James got increasingly tired, but remembering how his immigrant parents had struggled so hard to give him and his sister a good life in this country, he kept doggedly doing long hours of work. When he found himself making cynical comments about some of his clients, he knew he was dealing with burnout, and some vicarious trauma.

James poured out his story, and the many emotions that went with it, to his supervisor. Together, they implemented strategies such as reduced caseloads, reflective journalling, and peer support groups. James eventually came to accept that, while he was making a difference to many clients, he had to let the refugees own their process of re-settlement. He could not do it all. He regained his sense of purpose and commitment to his work but vowed to retain his new work-life balance to help guard against further vicarious trauma.

Practical applications in trauma-informed supervision

Trauma-informed supervision is most effective when it is applied consistently and adaptively in the supervisory relationship. Practical applications involve concrete actions that supervisors can take to address the needs of their supervisees and enhance their capacity to engage in trauma work sustainably. These practices are designed to integrate trauma-informed principles into everyday supervision.

1. Use of reflective practices: Encourage therapists to journal or use reflective exercises to process their experiences. Reflection deepens self-awareness and enhances emotional regulation.
2. Incorporating psychoeducation: Supervisors can educate therapists about secondary trauma, signs of burnout, and coping mechanisms. For example, teaching grounding techniques or stress management strategies can be particularly beneficial.
3. Promoting peer support: Facilitate opportunities for therapists to connect with peers who understand the unique challenges of trauma work. Peer supervision or consultation groups provide a sense of solidarity and shared learning.
4. Trauma-informed feedback: Deliver feedback in a manner that is constructive and compassionate, focusing on strengths and growth areas without triggering defensiveness.

Case study: Feedback with compassion

During supervision sessions over time, Sara’s supervisor noticed she was struggling with what seemed to be countertransference when working with some male clients. For her part, Sara was aware that she had a “very good” therapeutic alliance with one client in particular: Ross, who was about her age, and whom she found intriguing. Ross had had some traumatic relational experiences and was trying to work through them in therapy.

One day Ross told Sara how very much he appreciated her work with him and said that he wanted to thank her formally. He presented her with a voucher to stay at a five-star hotel, plus vouchers for dinner and breakfast there. Sara gasped, and told Ross that his gesture was enormously generous, and that she had found the work with him rewarding, but that she could not accept the gift on ethical grounds. She then had to process Ross’ disappointment.

During the next meeting with her supervisor, Sarah realised that she had multiple emotions. She acknowledged that she found Ross very attractive, even though she did not recognise erotic feelings toward him. She sometimes felt “pulled” into Ross’ trauma responses, which triggered similar reactions in her. Sara admitted that she felt that Ross was somehow “special” and that he would be able to resolve his relational trauma and come to have a stable, happy partnership. She felt that they had had a particularly strong alliance, and that they had done good work together. She noted that she often felt drawn to doing little extra things to support Ross.  

The supervisor recognised Sara’s responses as countertransference and realised that Sara would probably benefit from some psychoeducation about the nature of transference and countertransference, especially where trauma was involved. Instead of judging her reactions, the supervisor compassionately acknowledged the layers of psychodynamic complexity and helped Sara to decode both Ross’ probable erotic transference to her and Sara’s countertransference to him. They collaboratively explored strategies to help Sara recognise Ross’ signs of transference when they showed up in session and manage her countertransference. This approach empowered Sara to address her countertransference effectively, enabling her to continue working with Ross.

Challenges in trauma-informed supervision

Trauma-informed supervision is not without challenges. Supervisors must navigate their own emotional responses, balance the needs of supervisees with organisational demands, and ensure they remain current with trauma-informed practices. Regular professional development, peer consultation, and self-care are essential for supervisors to maintain their effectiveness.

Case study: Balancing organisational pressures

Linda, a supervisor in a community mental health centre, was tasked with maintaining high productivity rates while supporting her supervisees. Aware that the high levels of turnover in staff were a result of people leaving due to impending burnout, Linda advocated for organisational changes that prioritised therapist wellbeing, such as flexible scheduling and manageable caseloads.

At first, it seemed none of the high-level managers were listening; they continued to assert that the organisation did not have enough funding to make the changes Linda wanted. But Linda continued to press her case, bolstering her arguments with current data on staff turnover and reasons for leaving, as stated in exit interviews, and showing how those statistics were impacting client outcomes. Eventually, by aligning trauma-informed principles with organisational goals, Linda was able to achieve changes at the organisational level which enhanced both staff satisfaction and client outcomes.

Conclusion

Trauma-informed supervision is a vital approach to supporting therapists who work with trauma. By integrating safety, trust, collaboration, empowerment, and cultural sensitivity into supervision, supervisors can enhance the wellbeing and professional growth of their supervisees. Practical strategies such as reflective practices, psychoeducation, and trauma-informed feedback ensure that therapists remain resilient and effective in their roles. Ultimately, trauma-informed supervision not only supports therapists but also contributes to better client care.

Key takeaways

• Trauma-informed supervision prioritises the wellbeing of therapists working with trauma.
• Core principles include safety, trustworthiness, collaboration, empowerment, and cultural sensitivity.
• Supervisors should address secondary trauma, burnout, and vicarious trauma through reflective practices, psychoeducation, and supportive strategies.
• Challenges in trauma-informed supervision require ongoing self-reflection, professional development, and advocacy for systemic changes.
• Effective supervision enhances therapist resilience, professional growth, and client outcomes.

References

• American Psychological Association. (2019). Publication manual of the American Psychological Association (7th ed.). American Psychological Association.
• Knight, C. (2018). Trauma-informed supervision: Historical antecedents, current practice, and future directions. The Clinical Supervisor, 37(1), 7-37. https://doi.org/10.1080/07325223.2017.1413607
• Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: A review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. Best Practices in Mental Health: An International Journal, 6(2), 57–68.
• Omand, L. (2009). Supervision in counselling and psychotherapy: An introduction. Red Globe Press. ISBN: 9780230006324
• SAMHSA. (2024). Tip 57: Trauma-informed care in behavioural health services. Substance Abuse and Mental Health Services Administration. Retrieved on 16 December 2024, from: https://www.samhsa.gov/resource/dbhis/tip-57-trauma-informed-care-behavioral-health-services               
• Skovholt, T.M., & Trotter-Mathison, M. (2010). The Resilient Practitioner: Burnout Prevention and Self-Care Strategies for Counselors, Therapists, Teachers, and Health Professionals, (2nd ed.). New York: Routledge. https://doi.org/10.4324/9780203893326