Byrne et al. (2006) indicates that therapists can be at risk of burnout and impairment if they do not manage their professional stress well. Practicing therapists may exhibit symptoms of burnout and may suffer from symptoms of VT (El-Ghoroury et al., 2012). Graduate students in helping fields are vulnerable to stress because of the multiple demands of graduate school, such as academic assignments, clinical practice, and financial restrictions (Myers et al., 2012). Time and financial constraints have been cited as primary sources of stress among graduate students in training (El-Ghoroury et al., 2012). Student trainees may face the additional responsibilities and time demands of clinical work, supervision, and internship. In addition to aforementioned stressors, other common stressors in this population include performance anxiety, competition, program requirements, lack of experience, and professional relationships (Myers et al., 2012). Myers et al. (2012) indicate that students in training have to cope with these stressors and their new roles, while concurrently fostering their skills necessary for providing therapeutic services to clients. Therefore, educators and supervisors need to understand the role of stress among students to provide guidance on effective stress management and self-care (Myers et al., 2012). Without well-established support systems and coping strategies, novice trainees may have difficulties of managing the stress (El-Ghoroury et al., 2012).
Forrest et al. (2008) provide an ecological description by indicating systemic factors for trainee impairment, including faculty interactions (micro), institutional (exo) and national (macro) policies, and hierarchical issues (micro). Societal hierarchical dynamics are unconscious and deeply embedded in the training process. Forrest et al. (2008) further indicates the importance of communication (meso) between academic programs and off-campus training sites such as practicum and internship settings. Besides, program structure (exo) may evoke unnecessary stresses for students. Systematic issues of program policy are often ignored while play a powerful role in student impairment. Forrest et al. (2008) comment that the understanding of trainee impairment should cover an individual level (center) and a contextual system level (micro, meso, exo, macro, and chrono). The authors suggest that trainees not meeting minimum standards of professional competence are influenced by peers (micro), training supervisors (micro), program policies and structures (exo), accreditation (e.g., CACREP; macro), professional associations (e.g., ACA; macro).
In addition to being stressors, financial (micro) and time constraints (micro) may also be important barriers to participation in activities of self-care that may help buffer stress (El-Ghoroury et al., 2012). The existing literature has noted a significant relationship between self-care strategy and stress among therapist trainees (Myers et al., 2012). A wide range of self-care strategies have been found to reduce stress-related symptoms. Self-care strategy is defined as the engagement in behaviors that promote well-being and may include factors such as sleep, exercise, use of social support, emotion regulation strategies, and mindfulness practice (Myers et al., 2012). According to El-Ghoroury et al. (2012), lack of time was the first barrier to using or learning any of these coping strategies. The steadily rising expenses associated with graduate training are also a significant concern for students. Students may need to sacrifice their leisure time for earning a living (e.g., part-time job; micro). Given the significant amount of stress during higher education, elucidating the behavioral and emotional coping strategies by educators (micro) is important for helping them handle stress more effectively.
Social support and engaging in activities that promote social support may be considered an aspect of self-care practice (Myers et al., 2012). Social support has negative correlation with stressful, emotional and physical problems (El-Ghoroury et al., 2012). Graduate program support (micro) and family support (micro) have been found to be related to graduate student stress level (Myers et al., 2012). Students reported less stressful events and health problems when perceived more support from their family and friends (Myers et al., 2012). Besides, consistent, trusting, and supportive faculty-student interactions may help students in managing stress. Support from faculty, advising relationships, and training programs are also critical for students to adapt to new professional roles. Global stress and poor advisor support were found to be associated with burnout and career dissatisfaction in therapist trainees. The importance of mentoring relationships (micro) is highlighted in career development, academic functioning and satisfaction, among student trainees. The top three coping strategies reported are the support from friends, family, and classmates, rather than supervisors. Students who have difficult relationships with their advisors tend to have more stress. The quality of the mentoring relationship is associated with students’ professional outcomes.
Pack (2013) indicates that on the level of microsystem, support from peer (micro) and agencies (micro) are important as well as the availability of personal therapy (micro). Opportunities to share experiences of working with trauma victims and information about VT needs to be available in all settings (micro). For example, settings should provide peer supervision and training workshops to help therapists ameliorate VT (Pack, 2013). Information on worker rights may assist in supporting therapists to collectively advocate for their work.
Pack (2013) further indicates that on the organizational level, health and safety issues should be addressed within setting policy (exo). The risks of engaging potentially traumatic events need to be explained during the recruitment of new employees. Possible cumulative effects of working with trauma clients should be raised with therapists. Pack (2013) suggests that the risks of VT can be reduced if there a setting (micro) provides sufficient support and collaborative approaches for therapists. Settings can inform trainees the views of trauma practitioners about the trauma therapy. An experienced therapist (micro) may be able to mentor trainees or students. Supervisors have a responsibility for ensuring their trainees have access to education about VT. The culture (exo) of the agency could also be the support for ameliorating VT (Pack, 2013). The culture here includes peer support within daily case meetings and non-hierarchical collaborative decision making. Having a culture which sees VT as a normal part of trauma-related helping would effectively ameliorate VT. The culture can provide sense of security for the therapists while working with traumatized clients (Pack, 2013). This idea suggests that in graduate training program, the culture (exo) and the program (micro) should provide a supportive environment to prevent students from developing VT.
Ethnic minority students may face a somewhat different pattern of stressors during graduate training than non-minority students (Myers et al., 2012; El-Ghoroury et al., 2012). These additional stressors include racial discrimination, racial prejudice, the feeling of isolation, and different cultural expectations (macro, chrono), which negatively impacted school experience. Furthermore, minority students who reported the stressors had higher rates of burnout, depressive symptoms, and reduced quality of life (Myers et al., 2012). The authors also indicate that minority students and international graduate students are actually less likely to use counseling services in response to stressors. Racial minority students often experience more academic stress and less social support than students of Euro-American descent, which may be attributable to race-related stress and vulnerability of developing VT (El-Ghoroury et al., 2012). It is important to consider cultural differences when considering stress among student trainees.
Adams and Riggs (2008) indicate that students with personal trauma history (chrono) are more vulnerable to VT in courses on trauma. At the moments of reexperiencing, students with trauma history described their struggling with coping as avoidance. Students also reported having little control over the experience of VT symptoms. Adams and Riggs (2008) describe these adaptive coping strategies used by students, including suppression, sublimation, and humor. By the end of this course, most students reported developing effective self-care strategies. This finding suggests that although many students with trauma history (chrono) may revisit their own trauma symptoms during trauma courses, the course on trauma (micro) helped students develop successful self-care strategies. Pack (2013) also addresses the importance of personal trauma history, and recommends that agencies should provide personal therapy (micro) for therapists affected by clients’ trauma information due to their own trauma history.
Adams and Riggs (2008) reported that novice clinicians may be more vulnerable to VT. The authors indicate that the level of training and experience working with traumatized patients is related to clinician outcomes. The deficits in trauma-specific training are associated with VT symptoms. Black (2008) indicates that graduate counseling students may have preexisting factors (chrono) in their lives that form a vulnerability to developing VT later in their careers. Therefore, Graduate training programs (micro) should work on preventing students in training from being traumatized or becoming more vulnerable to future VT (Black, 2008). DePrince et al. (2011) indicate that the lack of trauma education at the graduate levels increases the urgency to develop effective training for postgraduate professionals. Training and education practices which support system-wide, culturally responsive practice is important for preventing VT (DePrince et al., 2011). Even if students do not have preexisting events that might predispose them to VT, teaching a course on trauma may prevent students from becoming overwhelmed in training (Black, 2008). Pack (2013) also recommends that training courses (e.g., practicum and internship) need to alert students to the potential risks of affecting their psychological health due to the trauma-related practice. Resources such as theoretical models fostering recovery are needed to ameliorate VT.