This is an Accepted Manuscript of an article published in Australian Social Work on 2008, available online: http://www.tandfonline.com/10.1080/0312407X.2013.837188 Navigating the Challenges of Trauma Counselling: How Counsellors Thrive and Sustain Their Engagement Joycelyn Linga, Sally V. Huntera & Myfanwy Maplea

a University of New England, Armidale, NSW, Australia Published online: 01 Oct 2013. To cite this article: Joycelyn Ling, Sally V. Hunter & Myfanwy Maple (2014) Navigating the Challenges of Trauma Counselling: How Counsellors Thrive and Sustain Their Engagement, Australian Social Work, 67:2, 297-310, DOI: 10.1080/0312407X.2013.837188 To link to this article: http://dx.doi.org/10.1080/0312407X.2013.837188 Navigating the Challenges of Trauma Counselling: How Counsellors Thrive and Sustain Their Engagement Joycelyn Ling, Sally V. Hunter, & Myfanwy Maple* University of New England, Armidale, NSW, Australia Abstract This qualitative study explored the factors that help counsellors exposed to indirect trauma thrive personally and professionally, and sustain their engagement in trauma counselling work. The existing literature details the challenges of indirect trauma exposure in trauma work. However, the ways in which counsellors are able to derive rewards and maintain their engagement in trauma counselling work are less well recognised. The study used a grounded theory approach, with semistructured interviews conducted with 18 therapists. The study found four main interrelating themes: thriving in trauma work; navigating the empathic journey; empathic stamina and engaging in self-reflexivity; and sustaining interest and commitment. Important factors included attending to both the adverse and rewarding aspects of trauma work, having access to appropriate support structures, and incorporating variability and diversity in the work. This study extends the current understanding of the processes, practices, and strategies that promote the rewarding and sustaining aspects of trauma counselling work. Keywords: Trauma Counselling; Vicarious Traumatisation; Compassion Fatigue; Compassion Satisfaction; Qualitative Research; Counsellor Stress All types of counselling work carry potential risks of an adverse impact on the counsellor. However, trauma counselling work has additional challenges associated with indirect trauma exposure (Bride, Radey, & Figley, 2007; Figley, 2002b; Iliffe & Steed, 2000). Trauma or traumatic events can refer to a wide variety of experiences. In this study, the term “trauma” refers to the DSM-IV-TR (American Psychiatric Association, 2000) definition of a traumatic event, as given here: (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and (2) the person’s response involved intense fear, helplessness, or horror

(pp. 467–468). In the current study, “indirect trauma” is used to refer to when counsellors come to know about clients’ trauma experiences through the process of their counselling intervention with clients. There are a variety of conceptualisations and terms used in the literature in relation to the adverse stress effects from indirect trauma exposure. “Compassion fatigue”, a term adopted by Figley (1995a), refers to indirect traumatic stress, which is characterised by hyperarousal, a sense of hopelessness, isolation, and feeling overwhelmed. The effects of compassion fatigue can have an impact on various domains, including cognition, emotions, physical wellbeing, and interpersonal relationships (Bell, Kulkarni, & Dalton, 2003; Collins & Long, 2003; Figley, 1995a; Iliffe & Steed, 2000; Meyers & Cornille, 2002). The term “secondary traumatic stress” (STS) (Figley, 1995b; Stamm, 1999) has been used to describe the adverse impact of helping or wanting to help traumatised people, triggered by secondary trauma exposure. The terms “compassion fatigue” and “secondary traumatic stress” are often used interchangeably in the literature (Baranowsky, 2002; Salston & Figley, 2003). A related concept, “vicarious traumatisation”, refers to the cumulative effect of engagement with clients affected by trauma, which is manifested in the individual’s experience of the self, others, and the world (McCann & Pearlman, 1990; Pearlman & MacIan, 1995). Not all individuals exposed to trauma develop clinical levels of post-traumatic stress, and similarly not all counsellors exposed to indirect trauma will experience incapacitating effects. As Linley and Joseph (2004) pointed out, “focusing only on the negative sequelae of trauma and adversity can lead to a biased understanding of posttraumatic reactions” (p. 11). A better understanding is needed about the spectrum of indirect trauma exposure experiences and the potential for positive personal and professional outcomes as a result of engaging in trauma counselling work. The literature indicates that negative and positive effects of indirect trauma experiences can coexist. Stamm (2002) argued that there are protective mechanisms for practitioners in relation to secondary traumatic stress. Compassion satisfaction is one such mechanism, conceptualised as the reflection of the efficacy that workers perceive as a result of their work (Figley, 2002a). A related concept, post-traumatic growth (PTG), refers to the positive changes that can occur in the process of coping with a traumatic event (Tedeschi & Calhoun, 1995, 2004). The PTG framework emphasises the capacity of people to respond to adversity in a way that promotes personal or other growth, though a transformational process in the positive sense. Another related concept, positive psychology (Fredrickson, 2003; Seligman & Csikszentmihalyi, 2000), emphasises the strengths and capacities of individuals and communities that facilitate wellbeing and thriving. It is based on the belief that individuals want to live meaningful lives and cultivate the factors that enhance fulfilment. According to Seligman and Csikszentmihalyi (2000), positive psychology changes the focus of psychology “from preoccupation only with repairing the worst things in life to also building positive qualities” (p. 5). Salutogensis, as an approach to health, rationalises that stress and disease are a part of life, and individuals tend towards restoring equilibrium through adaptive coping processes (Antonovsky, 1993, 1996). These perspectives are particularly relevant to the subject matter of this study, as they demonstrate that individuals are able to successfully manage stressors, and are able to integrate and manage potentially negative experiences in such a way that facilitates personal growth. This study aims to explore the indirect trauma experiences of counsellors and the strategies that counsellors use to meet the challenges associated with indirect trauma, that enable them to thrive in trauma work. In addition, the factors that help counsellors to sustain their continued capacity to engage in trauma counselling work will be examined. Method

A constructivist grounded theory approach (Charmaz, 2000) was used to explore counsellors’ accounts of their experiences of indirect trauma exposure. Constructivist grounded theory emphasises the subjective inter-relationship between the researcher and participant, and the coconstruction of meaning. A theory is therefore one of many interpretations that can be derived from the data (Charmaz, 2000). Hence, a reflexive stance was taken towards the interpretation of the data and through the process of analyses. Through this study’s examination of the real-world experiences of counsellors, the findings reflected the issues of interest in a way that has close relevance for the counselling profession. Purposive sampling was used in the initial stages of the current study. As common patterns and themes began to emerge through the analysis of the data, theoretical sampling was utilised to select additional informants to further examine and elaborate on the emerging findings. Dey (2004) described theoretical sampling as involving the selection of sites or sources to generate comparisons for the furthering or refining of ideas. Participant Recruitment The target participant sample was from a range of services that provide professional counselling services, both in trauma-specific and non-trauma-specific areas of practice. After ethics approval was gained from the University of New England review board, participants were recruited through various means including: advertisement of the study through the paper and electronic newsletters of an Australian nationwide umbrella counselling association; advertisement through network meetings with representations from a variety of relevant organisations to inform them of the study and to invite participation from counsellors in their organisations; and direct contact by phone to a range of organisations that offer counselling services. Potential participants were informed that the aim of the study was to explore the experiences of counsellors as a result of working with clients presenting with trauma concerns (secondary trauma exposure in counsellors). A Participant Information Sheet was made available detailing the aims, requirements of participation, voluntary nature of participation and withdrawal without prejudice option, and ethics approval information. The inclusion criteria included: participants had undergone specific professional training in the practice of counselling and were members, or were eligible for membership, of a recognised counselling-related professional organisation; participants were required to be currently engaged in the provision of counselling activities (defined as individual, group, face-to-face, or phone counselling), and had engaged in trauma counselling work. Diversity in the participant sample relating to the amount of trauma counselling experience or length of experience in the field was sought, as was the diversity across the type of service, and counselling approach. This diversity was sought in the current study to represent perspectives from both trauma-specific and non-trauma-specific counsellors. Interviews Eighteen participants were interviewed: 12 individual face-to-face interviews, 2 individual phone interviews, and 1 face-to-face group interview with 4 participants. Interviews ranged from 30 minutes to 1 hour. Interviews occurred over an 18-month period across 2006–08, in metropolitan and outer metropolitan areas of New South Wales, Australia. Details regarding confidentiality, ethics approval, and contact details were reiterated before the commencement of the interview. Semistructured interviews were used for data collection, supported by demographic information, field notes, and memos (Charmaz, 1995). Field notes were made as soon as possible after each interview in relation to the environmental setting, general “vibe” of the interview, and observations of the participant’s nonverbal communication. Initial thoughts regarding

the topics, themes, and other ideas were also noted. Notes about recurring patterns, themes, ideas, or questions were also written with each successive interview, including indications of confirmation, refutation, or new perspectives of these recurring ideas. Key questions asked in the interviews included: “What effects or impact did hearing about the trauma material have on you?”, “What outcomes do you think have resulted for you personally and professionally from working with trauma cases (positive and negative aspects)?”, and “What keeps you going in trauma work?” Data Analysis Data analysis involved the constant comparative process (Strauss & Corbin, 1990, 1998) leading to further implementation of data collection until theoretical saturation was reached. Each interview was transcribed manually, de-identified, and analysed by the first author as soon as possible after the interview was completed. Each transcription was examined, and stages of coding were implemented and revised throughout the constant comparative analysis process. Three types of coding (Strauss & Corbin, 1990) were used within the constant comparative process in this study. These were open coding (examining and conceptualising the data), axial coding (connecting the categories and defining the relationships of the codes), and selective coding (integrating the major categories to form a larger theoretical frame). The use of memoing, journaling, and verification of the analysis process and emerging themes were continuously put into practice by the research team. This overall inductive approach allowed the development of a substantive theory conceptualising counsellors’ experiences of indirect trauma exposure, and how counsellors were able to thrive and sustain their engagement in trauma counselling work. Rigour was addressed in this study through various means. Strategies to strengthen credibility included audit trail and negative case investigation. The audit trail in this study involved the use of extensive note-making about the decisions made in the coding process; notes and memos written immediately after interviews capturing the contextual factors involved with data collection and interviewing; memos about personal responses; a clear description of the methodology; and the use of data extracts in the write-up. Negative case investigation and the examination of outlying cases were strategies used to ensure that the emerging categories and themes did not override atypical or contradictory data. Lincoln and Guba (1985) suggested involving participants in giving feedback on the researcher’s interpretation of the data. This process was not utilised in the current study, owing to restrictions on time and resources. However, extensive confirmability checks were carried out in all phases of the study, included the detailed documentation of the procedures for checking the data throughout the study, the use of negative instances, and conducting a data audit that examined the procedures for data collection and analyses, as a means to address the potential for bias. It is acknowledged that the generalisability of the findings of this study is limited, given that findings can only be relevant and applicable for counsellors under the same or similar situations and conditions. Findings Demographic Data Of the 18 participants, 4 were male (22%) and 14 were female (78%). Ages ranged between 20 and 50+ years, with the majority of participants aged in the 30–39 years age group. Participants tended to have either social work or psychology backgrounds. All participants held bachelors degrees, with 45% holding masters degrees or above. The majority of the participants had more than 6 years of experience in the counselling field, with the range from 2 months to 17 years. One-third of the participants worked in regional areas in the state of New South Wales. The service types that the participants worked in included women’s and children’s

centres; domestic violence services; general community health services; community mental health specific services; family counselling services; and youth services. Programs for specific client groups that participants worked in included alcohol and other drugs; mental health; gay, lesbian, bisexual, and transgender youth; gambling; drop-in; afterschool; dual diagnosis; primary healthcare; needle and syringe program, and crisis phone helpline. In terms of client bases, one-third of the participants saw only young people (14–25 years), with one participant having a child client base only, and the remaining proportion seeing either only adults, or adults and children together. Two participants were engaged in private practice as secondary employment. Themes Four main themes were identified that describe how participant counsellors thrived in trauma counselling work, and the factors that helped them to sustain their engagement in trauma counselling work. The themes were articulated as: thriving in trauma work; navigating the empathic journey; empathic stamina and engaging in self-reflexivity; and sustaining interest and commitment. The themes interconnected and influenced each other in relation to how participant counsellors experienced and managed indirect trauma exposure. This reflected the complexity of trauma counselling work and the dynamic nature of counselling practice. Each theme is described below. Direct quotes from participant counsellors are denoted by quote marks and their given pseudonym. Thriving in Trauma Work This theme related to the reasons why counsellors engaged in and continued to undertake trauma counselling work, despite the challenges and demands of the work. The concept of thriving referred to the processes used to manage the impact of indirect trauma exposure, that promote the rewarding aspects and experiences of the work. This in turn enhanced the capacity to continue engaging in trauma work. The findings indicated that participant counsellors perceived trauma counselling work as involving both challenges and rewards. Participant counsellors identified that a predominantly rewarding aspect of trauma counselling work was being able to provide assistance to others. For example, a female domestic violence counsellor with over 10 years’ experience stated:

I like the challenge of it and I think it’s a rewarding field. So it certainly has its frustrations but somehow I and some of the other therapists here seem to be able to see through that and just enjoy it. So I certainly don’t think it’s a job without its rewards. For me there’s a sense of energy of wanting to help someone. (Olivia)

Having the view that trauma counselling work is purposeful influenced the sense of value in engaging in the work and an overall sense of commitment: “I like the work, I’m committed to it, I find rewards in this. That sustains me. The way I’m able to see the work, it sustains itself” (Patrick). Participant counsellors reported that being able to facilitate the empowerment of clients was a powerfully rewarding aspect of the work. Reciprocally, counsellors also gained a sense of empowerment and validation in their own work through supporting the clients’ journey: “Despite that fact that I realise that things aren’t fair, I like to think that I have a hand in participating in bringing about, giving people a service, enable them” (Hayden). Trauma counselling was seen as more than just addressing the trauma concerns of the client. Addressing social issues was a broader and important outcome. For this participant counsellor, who worked in a women’s domestic violence service, her dedication and sense of responsibility to social justice issues was a shielding mechanism from the negative impact of indirect trauma exposure:

I think that one thing that actually protects me in those situations is my commitment, and a commitment to justice and commitment to the service providing an environment and community of people who will support that

woman, and say what happened to you was wrong. (Brooke)

The sense of compatibility with counselling work also helped participant counsellors to engage and thrive in trauma work:

It’s for me, it fits. Part of it is that I enjoy the work, I’ve always chosen this kind of work, so as much as anyone can say they felt called to something or they feel they meant to be something or rather, that’s it for me. (Patrick)

It was demonstrated that participant counsellors perceived the challenges of trauma work in a positive way, as the challenges provided opportunities to engage in meaningful, valued, and rewarding work. Navigating the Empathic Journey The theme of “navigating the empathic journey” described how participant counsellors developed and utilised a range of strategies to manage the challenges of trauma work. The notion of “navigating” reflected the variety of strategies and learning processes involved in developing protective, proactive, and helpful responses to indirect trauma exposure. Participant counsellors identified that being emotionally perceptive was inherent in being a counselling practitioner. It was seen to be both a personal characteristic and a professional necessity: “Well of course my human response is that it’s horrific and sometimes I’m shocked” (Felicia). The attribution of responses as an expected human characteristic normalised the response and the impact. Responses such as shock and sadness were neither unwarranted nor inappropriate in the context of trauma counselling, and were not viewed as atypical: “I don’t think it’s unhealthy to have quite extreme emotional response to extreme trauma” (Sean). Participant counsellors reported that taking the view that adversity can be triumphed over allowed for the belief that trauma counselling makes a difference. This assisted in placing trauma work into a defined and manageable context. For example, a helpful stance was one that emphasised the hope and optimism that trauma can be overcome: “I don’t have to be caught up in deficit-based views about how things damage you but that there is something in human beings that goes beyond that” (Patrick). In contrast to the pathogenic view, salutary outcomes were acknowledged: “recognising the strengths or resilience in getting past things that have knocked them down” (Patrick). In order to manage the demands of trauma counselling, participant counsellors needed to be aware of and manage their own limitations and fluctuations in wellbeing: “I have to know my own limits and be able to help or to help with bringing about change [for clients]” (Hayden). An important means of managing the potential adverse effects of indirect trauma exposure was the awareness and recognition of the likely responses to clients’ trauma material. By normalising and placing the responses in the context of empathy and compassion, participant counsellors were able to understand and therefore manage stress responses more effectively. Empathic Stamina and Engaging in Self-reflexivity All participant counsellors acknowledged the need to balance their emotional demands and expenditure, and limit their exposure to indirect trauma in order to sustain their empathic energy. The term “empathic stamina” arose from the interpretation of participant counsellors’ descriptions of those factors as dynamic and continuous processes. An important means of achieving an effective balance was through setting boundaries that limited the exposure to traumatic material, in conjunction with

containing emotional demands. Maintaining boundaries involved actively moderating the level of emotional engagement with the clients’ trauma material, and acknowledging the limitations of both the self and the role and responsibilities in counselling intervention.

I think if I took it all to heart and couldn’t maintain some kind of distance from it, I think it would destroy you. I think that some part of my training was knowing how to hear it one step away from it and still be able to empathise. I’m often aware that I’m doing that while I’m hearing the story. Consciously think about that. (Felicia)

An “ebb and flow” type of process in which the empathic engagement was adjusted dynamically, in response to the traumatic material was described:

I think I disconnect a bit. I kind of hear the story and parts of me reach out with such feeling for the little child and in another way I kind of pull back, I kind of reach out and pull back I think. (Elyse)

Engaging in self-reflexivity referred to the continuous self-awareness process that was used to monitor and maintain wellbeing. Participant counsellors utilised a range of strategies that promoted their capacity for sustaining empathic engagement in trauma counselling work: “I feel like I have a very good well-worn path, exercise. And having an awareness of my own needs at that level and being attentive to them” (Brooke).

I might think I need to look at my caseload, the configuration, take on different clients, or maybe I may go to the gym more, or maybe I might try and nurture myself and nourish myself a bit more. Because if I know I’m not looked after, I’m going to be ineffective. (Isabel)

All participant counsellors acknowledged the importance of support in maintaining their ability to carry out trauma counselling work. The most commonly cited means were clinical supervision, peer support, and professional development: “I think adequate training is really important, and I think debriefing and supervision and having a team around you are things that really counter it [negative impact of trauma material]” (Marie). Clinical supervision assisted by providing a means for participant counsellors to release and lessen the stress and distress of the work: “What’s been useful for me has been supervision, professional development is key” (Rebecca). “It’s the internal support but the external opportunities as well and under the guidance of people who have been here longer in terms of what’s really good training” (Brooke). Peer support was a means of sharing common responses and had the effect of normalising the challenges of counselling: “In peer supervision there’s the sharing of the feeling of being overwhelmed at times and ‘Oh God, what do I do with this person?’ ” (Elyse). The action of discussing cases with peers helped with processing the trauma material through unburdening or by weakening the intensity of the distress: “What I’ve found is the recounting of the story to people actually helps to dilute the effects” (Hayden). Ongoing self-awareness and monitoring was viewed as an essential process in maintaining the capacity to undertake trauma counselling work. This included monitoring of the response to trauma material, the reflection of practices, and addressing challenges and barriers. If the harmful effects of indirect trauma exposure were not addressed by participant counsellors, future exposure could have further detrimental effects. Sustaining Interest and Commitment The theme of “sustaining interest and commitment” referred to the influences of professional and organisational aspects in sustaining participant counsellors in trauma work. Sustainability referred to the ability of participant counsellors to develop and maintain the conditions or processes that allow them to engage in trauma work over time and maintain their overall wellbeing.

The factors that helped to sustain participant counsellors’ engagement in trauma counselling work included engaging in professional development; having flexibility in the career path; and organisational factors that promoted the sense of autonomy, value, and support. These aspects influenced the capacity of participant counsellors to manage the challenges and demands of trauma counselling work: “I’ve worked parttime counselling and taught at TAFE as well, or run groups as well” (Elyse); the diversity of tasks “is sustaining, because it’s a bit of a mix” (Natalie). The complexity and diversity of trauma counselling work were motivating aspects for participant counsellors. The ability to extend work to broader community levels also promoted the meaningfulness and variability of trauma work. Having opportunities to broaden the scope of intervention strengthened the sense of purpose in engaging in the work:

So I guess started up looking at what the needs are in the community and I made my job more flexible, and education in the schools. So I think the diversity’s been good for me, and not just bogged down. (Lynn)

The rewarding aspects of trauma work were promoted and reinforced when participant counsellors perceived challenges as opportunities for growth by developing new skills and knowledge:

I love the clients that we work with. They’re quite complex and multifaceted individuals and trauma work is quite diverse. There’s always an opportunity for skills to be developed even further, it’s not like you’re doing something that never changes. So the variety is the reason why I stay. (Rebecca) It stretches me, it forces me to think, it forces me to check in with myself, it forces me to go back and read some literature. So it has certain, I suppose the combination of that somehow fits for me. (Patrick)

The main aspects identified by the participant counsellors were professional development opportunities, the variability in the career path, and organisation structural factors. Discussion This study explored how counsellors managed the challenges of indirect trauma exposure and sustained their engagement in trauma counselling work. The findings of this study demonstrated that participant counsellors benefited from acknowledging and expecting to experience stress effects from indirect trauma exposure, as well as being able to derive and enhance the rewards from engaging in the work. The findings did not suggest that facilitating adaptive outcomes prevented adverse outcomes; instead, as Linley and Joseph (2004) noted, personal growth could potentially modulate the sense of distress. This process allowed counsellors to maintain their capacity to engage in trauma work despite the stressful experiences. When participant counsellors felt that the emotional expenditure involved in trauma counselling work was worth it, then their perspectives about indirect trauma exposure were more optimistic and the effects were less detrimental. It was also indicated that placing indirect trauma experiences in a strengths-based perspective, in contrast to a deficits-based approach, was helpful to counsellors by promoting optimism and hope. Further, by perceiving trauma and client trauma concerns as understandable and manageable, counsellors were able to take an objective and constructive view of their own therapeutic responsibilities and capacity to help clients, and therefore could maintain boundaries and an appropriate empathic balance. The information gained from this study was in keeping with the principles of the salutogenic and positive psychology frameworks, in that counsellors described being able to hold robust, optimistic, and realistic views of the stressors experienced in trauma counselling work. They were able to utilise a range of resources (such as supervision, peer support, managing case load, professional development, varying

work activities, own self-care strategies) that allowed them to manage the stressors successfully and thrive in the work. According to Antonovsky (1993, 1996), individuals with a strong sense of coherence, or personal coping style, were more likely to manage situations in adaptive ways than individuals with a weaker sense of coherence. The findings also reflected Fredrickson’s (1998) broaden-and-build theory in that participant counsellors’ successful management of their previous exposure to indirect trauma enhanced their sense of confidence and efficacy. The issue of how counsellors sustained their engagement in trauma counselling work over time was of particular focus in this study. Participant counsellors who were able to engage in a range of activities adjunct to direct counselling work were more able to sustain their interest and capacity to manage the demands of trauma counselling work over time. Variability came in a variety of ways including sideways career movements, taking on alternate activities such as teaching or research, working part-time, or being employed in a secondary workplace. Limitations of the Research Due to the methodology and cross-sectional design of this study, it is acknowledged that the findings are limited in terms of its generalisability, and different experiences may be evident in a wider sample. The small nonrandom sample size has the potential for selection bias. The interviews relied on self-report, which may be affected by memory limitations and recall bias. The specificity of the area of counselling limits the ability to make statements outside the scope of trauma counselling work. Other limitations of the study relate to the characteristics of the sample group. The counsellors who participated may have been more likely to have experienced greater positive aspects of trauma counselling and hence be more motivated to discuss these experiences. Participants’ response bias may have had an influence on the results (Patton, 2002). Implications of the Research Despite the limitations as discussed above, the findings may be useful in giving some guidance to practice and research. The findings suggested that counsellors may benefit from adopting a perspective of expecting, acknowledging, and proactively attending to the variety of experiences of indirect trauma exposure in order to maintain their empathic capacity in trauma counselling work. This supports Badger, Royse, and Craig’s (2008) recommendations that practitioners should be educated to expect indirect trauma exposure and be resourced to manage their reactions. In addition, counsellors and supervisors may find it useful to identify areas that require more attention or resources, such as professional development; needing to diversify their activities; adequate clinical supervision; and the availability of peer support. The influence of peer and collegial support on the impact of indirect trauma exposure was emphasised in this study and is an area that would benefit from further research. The engagement in multiple jobs or multiple activities within a job also suggested a positive influence on coping with indirect trauma exposure. This is an interesting situation that warrants further research. Conclusions The current study makes an important contribution to the literature by demonstrating ways in which counsellors approached and engaged in practices that assisted them to thrive and sustain their engagement in trauma work. Counsellors who held the perception that the stressors of trauma work were expected, understandable, and manageable, were more able to maintain their empathic balance, and this enhanced the positive aspects of the work. The use of supervision, peer support, and ongoing training were also important support factors. Further, being involved in a range of activities, such as teaching, or policy or program development, as adjunct to direct counselling work, helped counsellors to manage and sustain their capacity to

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