A Cautionary Tale
By Adrian R. Magnuson-Whyte, PhD, LMHC, NCC, DCMHS
Without a doubt, all of us are bombarded by trauma. We cannot escape its existence or its impact on us, whether it is from our own personal history, the traumas of our clients, or the self-imposed traumas of our society. However, as I have learned vicariously through my experience with “Bob,” it’s important for mental health counselors to manage how we respond to trauma. By understanding and assessing the risk factors for trauma and burnout we can prevent a premature end to a satisfying career.
Bob was a relatively recent addition to my small group of postgraduate supervisees who are working towards full licensure as clinical mental health counselors. He had recently returned to the field of counseling.
Until five years ago, he had had a small, profitable counseling practice for more than a decade that focused on clients seeking to reach their full human potential. These clients were generally fully functional people (us?) who did not warrant a DSM-IV-TR diagnosis and who usually paid cash. Bob was good, his clients responded, and his practice thrived.
Then the financial downturn of 2008 arrived, his clients’ sense of financial well-being collapsed, and his cash practice folded within three months. Bob was unemployed until he found a job working in a local school district.
Fast Forward to 2012
Bob was itching to rejoin the counseling field. In the time he had been away from it, however, the field of counseling in Washington State had changed forever. But the new requirements didn’t deter Bob. He had his master’s degree in Counseling, he passed a more thorough FBI background check, he asked me to be his clinical supervisor, and he obtained his associate’s credential.
However, Bob had changed. His experience of losing his practice when his once financially secure clients pulled back their spending habits had radically changed which client populations he wanted to serve. In 2012, Bob was not interested in working with high-functioning individuals; he wanted to work with the underserved, the disenfranchised. These people had not been wealthy before 2008, so the financial downturn of 2008 was something they may have only heard about. Bob wanted to change the world; he just needed an opportunity. How could I say, “No”?
What Was Happening Six Feet Across From Me to This Man?
I sat across from Bob in his tiny office. It was much smaller than his previous counseling office, but comfortably equipped. He had approximately 10 regular clients and was paying the bills. At this stage of his development, things were looking very promising. I did not feel uneasy in bringing up the subject of burnout for exploration during a supervision session, so I dived in.
“It is probably a little early to talk about this subject, Bob, but I wanted to introduce it as an important matter to be aware of, for the future, you understand. I want to talk about burnout.”
Bob’s face turned bright red, and he almost instantly began confessing what was going on in his personal and professional life. In the three months since beginning his practice under my clinical supervision, he had not slept well, he was arguing with his spouse, and he was terrified of showing up at the office. He was even more terrified of me disapproving of his reaction to returning to professional counseling.
Bob proceeded to have a full-blown panic attack in front of me before I had even started the third sentence of what I had intended to talk about. What was happening six feet across from me to this man who had been a counselor longer than I had?
After giving Bob some time and helping him regain control of his breathing, Bob was able to begin to share, a little. He admitted to having a romantic sense of what it would be like to work with clients suffering from major mental and emotional issues: He would be changing the world, one client at a time. He would be working with clients who needed his help. He would be a “real” counselor.
However, it started to go wrong with his very first client, a Vietnam War veteran who was as traumatized as they come. Bob was unable to shake the man’s rage and was scared by him. He felt threatened and could not sleep. True, he felt compassion, but it was overwhelmed by the fear. Then he met with his second client.
Bob was traumatized by the psychological and spiritual changes that listening to many of his clients’ stories brought upon him. He was confused. He was supposed to be helping them, and yet their stories were devastating to him. Bob was questioning his beliefs in a God that would allow this to happen to people.
The underlying problem that had escaped both Bob and me was that he was traumatized before he had even started practicing clinical counseling again.
We Failed the First Test of Trauma—Awareness
The manner in which the vast majority of clients from his previous practice had changed their priorities when financially challenged had felt like a betrayal to him. They had abandoned him—many without a single word of explanation or even a phone call to cancel their scheduled appointments.
Both Bob and I, as his supervisor, had failed the first test of awareness of burnout or vicarious trauma. We had forgotten that burnout is a process that is cumulative and that its psychological and spiritual changes take place over time. I had forgotten to guide Bob and to really take the time to understand his history, both personal and professional.
As his potential supervisor, I had been swayed by the romantic image of Bob returning to counseling, but working with my preferred client populations (veterans and the disenfranchised). Clearly, Bob had learned his lesson and was no longer going to waste his professional abilities on those whiny functional clients. He was going to join me in the trenches. Welcome, Bob, the mud’s warm—just be careful of that trench foot!
Assessing for Risk Factors for Vicarious Trauma and Burnout
In addition to understanding that vicarious trauma or burnout occurs over time, we had not assessed the following risk factors:
- Individual personality and coping strategies/styles: How do you experience others’ trauma, as well as how do you rest, play, and recuperate?
- Personal history: Have you experienced trauma and/or loss? If so, how do you perceive its impacts in your life?
- Social support: Do you have a community that understands and supports you?
- Spiritual resources/concerns: Do you have a strong connection to a spiritual or philosophical source of meaning that helps explain trauma and how to comprehend it?
- Current life stressors: What else is going on in your life now, i.e. financial, marital, etc.?
- Work style: How you work, and how you think about your work, can help contribute to or mitigate the negative impacts of vicarious trauma.
We had also jointly failed to assess the overall situation of Bob returning to the field of counseling, but with a different client population. We should have talked about the likelihood that these challenges would occur, and I should have made it clear to Bob that when they did, he could reasonably expect my support. In the absence of such reassurances, his response was to fear being rejected for not being able to handle the challenges by himself.
After sitting down with Bob and a mutually trusted colleague, it was possible to jointly work through the above risk factors and develop a plan of action. Regrettably, the conclusion reached was that it would be best for him to find alternate employment. There were too many risk factors that could not be mitigated and overcome in a manner that would be healthy for him and for his clients.
Bob is currently being supported in his efforts to discover meaningful work in another setting and is being encouraged to seek counseling for himself. It is unlikely he will ever be a counselor again.
While I cannot in good conscience fall on my sword and accept 100 percent of the responsibility, I can accept that we jointly failed the task of being aware of vicarious trauma and planning for its inevitability. We did not find a sense of balance that would help Bob manage the inevitable stresses associated with hearing other people’s pain and suffering. Nor did we make sure he was connected with community, spiritual, and philosophical resources that would have helped him find a sense of meaning in his clients’ suffering.
As I have learned through the experiences of Bob, we can actually plan on how we can manage vicarious trauma and burnout. For Bob, it is probably too late. For my other supervisees and myself, planning on how to manage vicarious trauma is now mandatory.
I would ask that Bob’s loss not be in vain. Consider planning for burnout and vicarious trauma before it becomes a devastating reality.
Adrian R. Magnuson–Whyte, PhD, LMHC, NCC, DCMHS, has been a counselor since 2001. He obtained his license in 2004 and was awarded the AMHCA Diplomate in 2012. He has been in private practice since 2005 and specializes in working with veterans and disenfranchised individuals in the Olympic peninsula town of Shelton, WA. The current president of the Washington Mental Health Counselors Association, he has been actively involved in the abolition of the Registered Counselor category and the inclusion of client privilege into the Washington RCW.