preventing vicarious trauma: what counselors should know

These clinical experiences can be compounded by other forms of witnessed trauma, including exposure to repeated violence portrayed in the news and social media. 34 0 obj <>stream There was a significant relationship between results from the PCL-5 and all three STSS subscales. hb```g@( ;aR/vY . That stress is very valid and natural, and sometimes it can lead to post-traumatic stress disorder (PTSD) or other mental health difficulties, like depression and anxiety. Develop positive relationships with other crisis counselors. It breaks the connections between individuals and their social environment. Journal of Aggression, Maltreatment & Trauma, 21, 646664. Overall, the two variables (caseload and supervision) correlate with the dependent variable, VT symptoms (r = .273, R2 = .074). This secondary exposure to trauma often results in the professionals experiencing the, Within the context of their new constructivist self-development theory, the authors discuss therapists' reactions to clients' traumatic material. Get regular updates directly in your inbox. Loving-Kindness Meditation packs a punch when it comes to health and happiness. Table 1 outlines the VT symptoms of participants as measured by the STSS in descending order. Book ReviewCollege Counseling and Student Development: Theory, Practice, and Campus Collaboration, Reflections on Power From Feminist Women Counselor Educators, Evaluating the Impact of Solution-Focused Brief Therapy on Hope and Clinical Symptoms With Latine Clients, Guidelines and Recommendations for Writing a Rigorous Quantitative Methods Section in Counseling and Related Fields. Health carerelated manifestations can include excessive worrying (e.g., that a patient missed an appointment because they are hurt or have died), delays in completing the charts of patient encounters that involve upsetting stories, overreacting to unexpected environmental noises (e.g., overhead pages in the clinic, telephones ringing in examination rooms), experiencing visual images of examining an abuse-related injury in a setting outside of work, or finding it difficult to watch previously tolerable entertainment (e.g., shows or movies involving crime and violence). Demographic measure. People tend to reflexively orient to past experiences, mostly in the hopes of being better equipped to protect themselves. PTSD Checklist for the DSM-5 (PCL-5). (2010). Participants were asked to complete a brief demographic questionnaire and two surveys, the PTSD Checklist for the DSM-5 (PCL-5), developed by Blevins, Weathers, Davis, Witte, and Domino (2015), and the Secondary Trauma Stress Scale (STSS), developed by Bride, Robinson, Yegidis, and Figley (2004). Intrusive thoughts are an aspect of normative responses to stress, sometimes considered "sensory flashpoints.". This can include recognizing factors that decrease vulnerability, assessing VT, and intervening (Sommer, 2008). Counselors in all settings work with clients who are survivors of trauma. The patient has been feeling more anxious recently and worries that something might happen to the children in her family if she is not constantly watching them. Unaddressed vicarious trauma can compromise a physician's ability to provide care or professional services and can affect their own personal health and relationships. To connect, you can consider trusted social outlets, shared hobbies, or group activities such as exercise classes. And, although empathy is implicated, anomalies aside, it is hard not to empathize by virtue of our human-ness in some fashion when we see others hurt or hear about it. But you're not alone. The data can contribute to our understanding of VT and subthreshold PTSD symptoms among counselors and provide a framework for working with counselors during supervision and in preparing CITs. Examining PTSD treatment choice among individuals with subthreshold PTSD. Additional symptoms of VT experienced commonly by participants included feeling emotionally numb (80.5%), becoming easily annoyed (79.1%), having difficulty concentrating (75.5%), and feeling discouraged about their future (75.5%). Orienting is based on what we are preoccupied with and tend to focus on, and VT can influence that response. Therapist vicarious trauma and burnout when treating military sexual trauma. (Ogden and Fisher, 2015). Education on the significance of professional supports, such as adequate supervision and manageable caseloads, is fundamental for CITs to be prepared to lessen the hazard of developing VT symptoms and subthreshold PTSD symptoms. Vicarious trauma, or counselors developing trauma reactions secondary to exposure to clients traumatic experiences, is not uncommon. 23. Traumatology, 20, 5056. 2. Jamie S. Carney is a professor at Auburn University. The squared semi-partial correlation for supervision was (-.173)2 = .029, and the squared semi-partial correlation for caseload was (-.150)2 = .02., *p < .05. !z&_z.8!D\NHfUI4Zl}B>8P/&K:*>N]!9Jv(BNuP] }.~!JzT6bSS.@{IWz\=O/exZe|Vf=v,5! Repeated, disturbing, and unwanted memories of the stressful experience? endstream endobj 405 0 obj <>/Metadata 23 0 R/Pages 400 0 R/StructTreeRoot 40 0 R/Type/Catalog>> endobj 406 0 obj <>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 407 0 obj <>stream In the backward regression model, the Intrusion subscale of the STSS was eliminated as the least significant variable, which indicates the more arousal and avoidance symptoms were experienced as VT, the more subthreshold PTSD symptoms were experienced by the practicing counselors. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)? Participants completed questionnaires about, This book explores the role and experience of the therapist in the therapeutic relationship by examining countertransference (the therapist's response to the client) and vicarious traumatization (the, Summary The personal experience of treating rape victims is discussed in this paper from the perspective of vicarious traumatization and information processing theory. With 49.5% of participants reporting VT symptoms and subthreshold PTSD symptoms, it is evident that additional education is needed related to these symptoms among practicing counselors. Resources for practitioners in operations and administration who are serving survivors of torture are as follows: development, integrated care, evaluation, technology, training, working with interpreters, and self-care. Provide ethics review boards with guidance needed to ensure that research proposals address the issue of vicarious trauma throughout the research process. A future study that compares counselors in rural settings and urban settings will be important to understand barriers to coping with and addressing VT symptoms and subthreshold PTSD symptoms. As a result, we live with fears and avoid situations and certain places, but we have no deeper understanding as to why we alter the course of our lives this way. w0VfD2`sssPOpf|` T;GYB[u Here's how to know when to reach out for professional help. Graduate-level education and training in child sexual abuse. For those who struggle with weight, food may hold deeper, unconscious roots and embedded attachments. Counselors in all settings work with clients who are survivors of trauma. Counseling requires an immense amount of empathetic acceptance on the part of the counselor, which increases the counselors vulnerability to taking on their clients traumatic experiences (Finklestein, Stein, Greene, Bronstein, & Solomon, 2015). This finding is significant for counselor educators and supervisors as it indicates that VT symptoms are being experienced by the majority of the counselors in this study. Preventing vicarious trauma: what counselors should know when working with trauma survivors. Vicarious trauma in mental health care providers. There also was a significant relationship between subthreshold PTSD symptoms and avoidance symptoms (r = .759, p < .001), and between subthreshold PTSD symptoms and arousal symptoms (r = .790, p < .001). Secondary trauma, burnout, and compassion satisfaction are among the psychological, Professionals Perceptions of Vicarious Trauma From Working With Victims of Sexual Trauma by Tambria Hunt MA, Louisiana Tech University, 2005 BS, Louisiana State University-Shreveport, 2001, Mental health professionals in a variety of work settings regularly encounter clients who are trauma victims. Typical reports suggested they viewed peer supervision as quite useful for dealing effectively with VT. We become hypervigilant to others' traumatic material often without ever knowing what has happened. Current work setting was reported by 207 of the respondents; 137 (62.3%) identified as school counselors, 24 (10.9%) reported working in a community mental health center, 17 (7.7%) reported working in a higher education center, 16 (7.35%) reported working in a private practice, and 13 (5.9%) reported other, which included settings such as employee assistance programs and crisis centers. Identifying the root cause is key to overcoming it. Keim et al. Although there are limitations in the research on the variables that correspond to the development of VT and subthreshold PTSD among counselors, as well as the factors that address these vulnerabilities, the research has highlighted some areas of concern. Copyright 2023 National Board for Certified Counselors, Inc. and Affiliates. Learning to re-orient away from the things that might continue to effect or invoke VT is important. Counselors can incorporate self-care activities, such as adequate sleep, social interaction, exercise, a healthy diet, reading, and journaling, into their routine, but all too often practicing counselors let these activities slip (Jordan, 2010; Nelson, 2016). (2017). This series is coordinated by Caroline Wellbery, MD, associate deputy editor. Journal of Human Behavior in the Social Environment, 11(34), 177194. This phenomenon is known as vicarious trauma" (VT) and it may be what you are experiencing now. Of the 220 participants, 219 participants reported gender; 23 (10.3%) respondents identified as male and 196 (87.9%) respondents identified as female. How the internet broke on 9/11. In an effort to decrease VT and subthreshold PTSD practicing counselors must ensure they are incorporating various types of self-care on a regular basis. My heart started pounding when I thought about my work with clients. Newell, J. M., & MacNeil, G. A. doi:10.1300/J137v11n03_09, Trippany, R. L., White Kress, V. E., & Wilcoxon, S. A. For this reason, vicarious In addition, through modeling appropriate supervision, CITs will comprehend the supervisory process and seek post-degree supervision. I wanted to avoid working with some clients. WebSeeking supervision and your own therapy can help decrease instances of vicarious trauma and decrease your caseload if it is heavy with clients who have experienced trauma. This study adds to the current literature reported by Bride (2007) that 50% of child welfare counselors experience traumatic stress symptoms within the severe range. KlG\"Y{"A``5`l>i k+$@l-I-e !HKc`bd`Tq Though it might not feel like it at the time, trauma may lead to new growth in your relationships, beliefs, or worldviews. hbbd```b``] DrH . Trainees should be encouraged to self-monitor and discuss their responses with supervisors. In this backward linear regression model, the PCL-5 served as the dependent variable with years of experience, work setting and type of clientele, and the number and type of professional supports serving as the independent variables. Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Bethany A. Lanier, NCC, is an assistant professor at the University of West Georgia. The negative implications associated with VT make it imperative that counselors and those who work with them (e.g., supervisors and counselor educators) understand all the factors that lead to the development of VT. A 35-year-old patient, J.P., presented to my office with difficulty sleeping and anxiety about job performance. The semi-partial correlation between adolescents and subthreshold PTSD symptoms was .159, while the semi-partial correlation between sexual assault/domestic violence and subthreshold PTSD symptoms was .187. %PDF-1.6 % Collaboration and consultation with peers and supervisors at the workplace are vital to minimize the adverse effects of VT and subthreshold PTSD (Jordan, 2010). The Great Resignation and its Impact on SOT Programs: A Way Forward, Trauma-Informed Care: Movement Towards Practice, The National Cambodian American Town Hall Meeting: a community dialogue on eat, walk, sleep for health. 10.1002/j.1556-6678.2004.tb00283.x First citation in article Crossref, Google Scholar (2019). For example, in a rural setting, the counselor may not have adequate supervision and may be overloaded with cases, which can decrease the amount of self-care they are able to implement. Mass Violence Fatigue: What's Normal and What's Not? Vicarious trauma, themes in research, and terminology: A review of literature. 0 WebOrganizational Prevention of Vicarious Trauma. Families in Society: The Journal of Contemporary Social Services 84(4): Preventing Vicarious Trauma: What Counselors Should Know When Working With Trauma Survivors. Journal of Counseling and Development 82(1): 3137. Understanding the symptoms of VT and subthreshold PTSD experienced by participants was important, as previous studies have indicated that those who experience VT symptoms also experience subthreshold PTSD symptoms (Jordan, 2010). According to a 2019 review, the symptoms of vicarious trauma can include: Vicarious trauma may also be linked with compassion fatigue and burnout. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Statements on the Intrusion subscale inquire about respondents intrusion symptomology on a Likert scale with statements such as My heart started pounding when I thought about my work with clients and I had disturbing dreams about my work with clients. The Avoidance subscale asks respondents to respond on a Likert scale to statements such as I felt emotionally numb and I had little interest in being around others. The final subscale, Arousal, asks respondents to respond on a Likert scale to statements such as I had trouble sleeping and I expected something bad to happen.. Participation was restricted to practicing mental health or school counselors who had a masters degree in counseling and had been a practicing counselor for at least 6 months at the time of the survey. The purpose of this study was to develop an understanding of the frequency and characteristics of VT symptoms and subthreshold PTSD symptoms among practicing counselors, which was answered by the first research question. At times, hearing these stories may overwhelm them and lead them to experience, to a lesser extent, the same feelings faced by the trauma survivors in their care. Vicarious trauma typically involves a shift in the world view of the helper. The Vicarious Trauma Institute defines vicarious trauma as the indirect exposure to trauma through a first-hand account or narrative of a traumatic event.. WebPreventing Vicarious Trauma: What Counselors Should Know When Working With Trauma Survivors Robyn L. Trippany, Corresponding Author Robyn L. Trippany Department of g/ But you can also engage response art, music, or writing, which have all been shown to dilute the intensity of VT, as well as transform such emotions (Drapeau et al., 2022b). %PDF-1.5 % However, here are a few of the symptoms associated with vicariously seeing or hearing others traumata from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: When we feel the things associated with VT, we need to release that negative energy from our body and mind. I had little interest in being around others. ANITA RAVI, MD, MPH, MSHP, FAAFP, JESSICA GORELICK, LCSW, MA, AND HARIKA PAL, MD, PurpLE Health Foundation, New York, New York. This finding is consistent with prior studies that indicate a manageable caseload as being a protective factor for counselors that can decrease their chance of developing both VT symptoms and subthreshold PTSD symptoms (Trippany et al., 2004). Additionally, this large percentage of school counselors could make the implications suggested in this study not as applicable for counselors in higher education settings. 32 0 obj <> endobj Reviewed by Michelle Quirk. In an effort to answer the second research question, which was interested in the relationship between VT symptoms and subthreshold PTSD symptoms and years of experience, work setting and type of clientele, and the number and type of professional supports, two backward linear regression models were established. Available from ProQuest Central; ProQuest Central; ProQuest Dissertations & Theses Global. There is general recognition and agreement in the literature regarding the R5O,YrYBw_'@oK" This included the relationship of VT symptoms and subthreshold PTSD symptoms with years of experience, work setting and type of clientele, and the number and type of professional supports utilized by practicing counselors. xcd```d`LM V'`Iv002qySu74#` D e Understanding these areas is a critical component of addressing the development, assessment, and intervention for VT and subthreshold PTSD, especially for supervisors and counselor educators who train and work with these counselors. The body keeps the score: Brain, mind, and body in the healing of trauma. (_UA) TNd @[E7 R@re (d&@NjT\ZxCgtpP,X=dB Retrieved from https://www.nctsn.org/resources/secondary-traumatic-stress-fact-sheet-child-serving-professionals. Vicarious trauma is more complicated than secondary traumatic stress in that it focuses on the theory of what is occurring within the context of trauma counseling The purpose of this article is to describe vicarious trauma and summarize the recent research literature related to this construct. endstream endobj startxref Repeated vicarious exposure to clients trauma can affect counselors personal and professional w. This phenomenological study was designed to describe the shared trauma perspectives of 8 counselors who experienced the shootings at Virginia Tech and responded to community mental health needs. I had disturbing dreams about my work with clients. Journal of Counseling & development 82 (1), 31-37, 2004. Ting et al. Materials are edited to retain confidentiality. Many counselors who experience VT also meet the criteria for subthreshold PTSD and share similar symptoms (Keim et al., 2008). To help prevent compassion fatigue and foster compassion satisfaction, use these strategies: Focus on the four core components of resilience (adequate sleep, healthy eating, regular physical activity, and active relaxation). Becoming mindful of what you are taking in. The results of the pilot study revealed the presence of vicarious trauma in general populations outside of health care. Applying Ambiguous Loss Theory to Torture Survivors: A Conversation with Pauline Boss. Vicarious trauma can result in a change of worldview and disturb a person's sense of justness and safety of the world. Vicarious trauma is part of a spectrum of responses to trauma exposure, including secondary traumatic stress, caregiver fatigue, compassion fatigue, and burnout. (2015). Keim et al. Torture occurs within a cultural and social context. doi:10.1177/153476569900500105. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Relationship Between Demographics and Type of Professional Supports Among Practicing Counselors on Subthreshold PTSD Symptoms. (2008) found that 12% of counselors-in-training (CITs) qualified for a PTSD diagnosis, highlighting the fact that counselor educators and supervisors need to be aware of and educate counselors to recognize the symptoms of VT and subthreshold PTSD. Perhaps now is the time you can do something for yourself, too. Taking too many risks or doing things that could cause you harm. An additional limitation of this study was the lack of demographics available to identify if counselors were in a rural setting or urban setting. A counselor experiencing VT can report many of the symptoms associated with both VT and subthreshold PTSD. http://onlinelibrary.wiley.com/doi/10.1002/j.1556-6678.2004.tb00283.x/abstract, Use the link below to send us a question about membership requests, possible resource, or resource request. 257274). Fung, B. Perhaps you are reading this now because someone told you something disturbing, or you saw something that you cannot shake from your memory. Journal of Family Psychotherapy, 21, 225237. These sites also can link to another variable that corresponds to higher levels of VT: the caseload of the counselor. All VT symptoms, as measured by the STSS, were experienced by 49.5% of the participants, indicating all 17 VT symptoms measured had been experienced to some degree by the counselors that participated in this study. Growing up with a parent who has alcohol or substance use disorder can lead to negative effects on your mental health and more. Although the implications suggested are applicable to all counselors, demographic location could serve as an additional barrier to implementing the professional supports suggested. Counselor Educator and Supervisor Implications. It separates the bonds of communities. The F change test indicated the observed F (2.008; p = .158) does not exceed the critical F (df = 1, 202), which is 3.89. Burnout doesn't happen overnight but instead occurs over time. Loss of interest in activities that you used to enjoy? Vicarious trauma, burnout, and impairment . 6 Must-Read Books for Complex Trauma Survivors, 3 Tips to Keep Your Catastrophic Thoughts at Bay, The Impact of Childhood Trauma on Adult Functioning, Women and PTSD: Using a Trauma-Informed Approach to Heal, Intimate Violence Undermines Trust in Oneself, How to Get Things Done When You Have No Motivation. (2021, December 6). ), Treating military sexual trauma (pp. The Constructivist Self-Development Theory (CSDT) is applied to vicarious trauma, and the implications CSDT has for counselors in preventing and managing, Counselor educators have an ethical responsibility to prepare counselors and supervisors to detect and resolve vicarious traumatization in themselves and their supervisees. doi:10.1002/j.1556-6978.2008.tb00062.x, Ting, L., Jacobson, J. M., Sanders, S., Bride, B. E., & Harrington, D. (2005). Vicarious trauma: Proposed factors that impact clinicians. With high rates of trauma reported in LGBTQIA+ communities, having access to safe, welcoming spaces is important for helping people heal and live as. %%EOF Source: magele-picture/Adobe Stock Photos. Pl23\@(L4OO75?/.JgsL cf# '93NZB #B8vWz0iG|1^~M4H FN#:suZgH&2u\UCV^3h]CI~./qhZ?|TM7LmwJiMcGT7+xRMK8gP']Dh2a90R])'j7t2}L"wy2M3__mpjYcrlGyrU-`j!E[(rsE7 haSFZ)--`V: V"\sPGz) wGpC hE@ 6S If youre a clinician looking for support, reaching out to a therapist can be a great starting point. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)? Dissociation is a natural mechanism your body uses to help you survive trauma. Strategies that can directly reduce your anxiety. By addressing the signs of STS, counselors can prevent jeopardizing their professional performance. doi:10.1093/sw/52.1.63, Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. R. (2004). Of the 20 items in the PCL-5, all but three were experienced by at least 50% of the participants. The purpose of this quantitative study was to investigate the frequency of VT symptoms and subthreshold PTSD symptoms experienced by practicing counselors. Therapy is generally recommended to those affected by vicarious trauma. A therapist can provide time and space for individuals to discuss how experiences of trauma survivors have had an impact. The relationship between subthreshold PTSD symptoms and the Intrusion subscale was significant (r = .676, p < .001). The semi-partial correlation between caseload and VT symptoms was -.173, while the semi-partial correlation between supervision and VT symptoms was -.150. WebAustralasian Journal of Disaster and Trauma Studies, 2013 (1), 3744. The Professional Counselor, 2, 134142. In particular, symptoms experienced by the rape therapist and challenges to her schemas about the world and others are explored. Vicarious trauma, or counselors developing trauma reactions secondary to exposure to clients' traumatic experiences, is not uncommon. Try reflectively examining what you have been orienting to lately. Seeking supervision and your own therapy can help decrease instances of vicarious trauma and decrease your caseload if it is heavy with clients who have experienced trauma. Your goal is to always focus on distinguishing things that are healthy for you, and, by doing so, you build competence in your ability to selectively choose the things to take in daily. Reminders of my work with clients upset me. It will be important for future research to explore what barriers to professional supports counselors face in these different demographic communities. %PDF-1.5 % 2. Likewise, there is wide variation in the types of assistance sought to address such effects, depending on a host of factors ranging from service accessibility to beliefs about health and healing. While vicarious trauma and PTSD are not the same, the symptoms [of PTSD and vicarious trauma] can be quite similar, explains Rebecca Phillips, a licensed professional counselor in Texas who specializes in trauma. The PCL-5 is a revision of the PTSD Checklist (PCL) that specifically assesses self-report measures of PTSD symptoms as outlined in the DSM-5 (Blevins et al., 2015). Symptoms of vicarious trauma resemble the effects of direct trauma in some ways. Being superalert or watchful or on guard? Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. ChatGPT: Why Is It Making People So Nervous? From violent scenes depicted Reclaiming 52 0 obj <>/Filter/FlateDecode/ID[<3EA7B2AEE19248FC9E79BDBC2B5B133A><9763DABACFD0E9428701387DADE399B8>]/Index[25 47]/Info 24 0 R/Length 123/Prev 134676/Root 26 0 R/Size 72/Type/XRef/W[1 3 1]>>stream The contents of this website are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services, Administration for Children and Families. Tip 57: Trauma-informed care in behavioral health services. [%8N0 j ;30`d``^`o( e The STSS, developed by Bride et al. Counselor Education and Supervision, 48, 6171. Are You Suffering From Empathy Deficit Disorder? Four things stop angry partners from changing: victim identity, conditioned blame, temporary narcissism, and negative attributions. ), Compelling counseling interventions: Celebrating VISTAS fifth anniversary (pp. However, there's hope. Sensorimotor Psychotherapy: Interventions for Trauma and Attachment (Norton Series on Interpersonal Neurobiology) (Csm ed.). Trauma (PTSD) can have a deep effect on the body, rewiring the nervous system but the brain remains flexible, and healing is possible. It is imperative that supervisors assist counselors in For some people, this includes dealing with depression. The PCL-5 is a 20-item survey that corresponds to the 20 PTSD symptoms in the DSM-5 (Bovin et al., 2016). Generic Tyzek. Counselors spend a sizeable amount of their time ensuring that others take care of themselves while potentially neglecting their own personal self-care (Whitfield & Kanter, 2014). 457 0 obj <>stream Suggestions for dealing with vicarious For people who are experiencing stress from a family member or loved ones trauma, certain types of therapy may be particularly helpful, such as: Maybe you feel like you arent allowed to connect with a traumatic event or feel guilty that you do. Helpers in distress: Preventing secondary trauma. Journal of Counseling & Development,82(Winter), 31-37. doi: 10.1002/j.1556-6678.2004.tb00283.x. The purpose of this article is to describe vicarious trauma and summarize the recent research literature related to this construct. doi:10.1016/j.chiabu.2006.03.009, Cornille, T. A., & Meyers, T. W. (1999). By providing sufficient supervision during practicum and internship, counselor educators and supervisors can prepare CITs for coping with VT symptoms and subthreshold PTSD symptoms should they develop. Mailloux, S. L. (2014). The vicarious effects of treating female rape survivors: The therapists perspective (Doctoral dissertation). The F change test indicated the observed F (2.255; p = .135) does not exceed the critical F (df = 1,162), which is 3.94. (2015). WebPreventing vicarious trauma: What counselors should know when working with trauma survivors Counselors in all settings work with clients who are survivors of trauma. Further, novice counselors might have trouble establishing boundaries during the early stages of professional identify development, which can contribute to an increase in vulnerability for developing VT and subthreshold PTSD (Howlett & Collins, 2014).
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