Suggested APA style reference: Bicknell-Hentges, L., & Lynch, J. J. (200 , !"rch#.

Everything counselors and supervisors need to know about treating trauma . P"$er %"sed &n " $resent"ti&n "t the A'eric"n (&unseling Ass&ci"ti&n Annu"l (&nference "nd )*$&siti&n, (h"rl&tte, +(.

Everything Counselors and Supervisors Need to Know About Treating Trauma

P"$er %"sed &n " $resent"ti&n "t the 200 A'eric"n (&unseling Ass&ci"ti&n Annu"l (&nference "nd )*$&siti&n, !"rch , -2-, (h"rl&tte, +&rth ("r&lin".

Linds"y Bicknell-Hentges "nd J&hn J. Lynch

Bicknell-Hentges, Linds"y is " Pr&fess&r &f (&unseling "nd Psych&l&gy "t (hic"g& St"te .ni/ersity. She h"s &/er 20 ye"rs &f e*$erience c&unseling "nd su$er/ising c&unsel&rs 1ith tr"u'"ti2ed clients "nd h"s c&nducted rese"rch f&r the l"st ,3 ye"rs &n %&th the i'$"ct "nd tre"t'ent &f tr"u'" in her r&le "s " c&unsel&r educ"t&r "t "n ur%"n instituti&n. Al&ng 1ith her c&-$resenter, the "uth&r h"s $u%lished se/er"l "rticles "nd %&&k ch"$ters &n "ddressing tr"u'" 1ithin sch&&l "nd clinic"l settings "s 1ell "s $resenting nu'er&us in/ited "ddresses "nd 1&rksh&$s &n tr"u'" &n the l&c"l "nd st"te le/el. Lynch, J&hn J. is "n Ass&ci"te Pr&fess&r &f (&unseling "nd Psych&l&gy "t (hic"g& St"te .ni/ersity. 4ith "l'&st -0 ye"rs &f e*$erience "s " c&unsel&r "nd su$er/is&r 1&rking 1ith tr"u'"ti2ed clients in " 1ide /"riety &f settings, he h"s ser/ed "s " direct&r "nd clinic"l direct&r &f gr&u$ h&'es, " st"te1ide shelter syste', "nd " residenti"l tre"t'ent $r&gr"' f&r "%used "nd neglected y&uth. 5r"1ing fr&' his r&le "s su$er/is&r &/er "t le"st ,00 indi/idu"ls 1&rking in si'il"r settings, 5r. Lynch currently ser/es "s the (&&rdin"t&r &f the Sch&&l (&unseling Pr&gr"' "t "n ur%"n instituti&n 1ith $ri'"rily Afric"n A'eric"n students 1h& li/e "nd 1&rk in the ur%"n setting.

Understanding Trauma: Adaptive and Pathological esponses (&unsel&rs "nd su$er/is&rs 1&rking 1ith tr"u'"ti2ed indi/idu"ls need t& underst"nd %&th the e'&ti&n"l6%eh"/i&r"l '"nifest"ti&ns &f tr"u'" "s 1ell "s the $hysic"l i'$"ct &f $sych&l&gic"l tr"u'" 1ithin the %&dy. H&1e/er, integr"ting the c&'$le* liter"ture int& "ctu"l $r"ctice is difficult. !"ny "uth&rs e*$l"in /"ri&us "s$ects &f the f&ll&1ing '"teri"l in gre"ter det"il, %ut this $"$er is intended t& $r&/ide inf&r'"ti&n th"t is "ccessi%le t& "ll c&unsel&rs 1&rking 1ith tr"u'"ti2ed clients. An indi/idu"l7s re"cti&n t& e'&ti&n"l tr"u'" is c&'$le* "nd difficult t& $redict. A $ers&n7s "ge, $"st e*$&sure t& tr"u'", s&ci"l su$$&rt, culture, f"'ily $sychi"tric hist&ry "nd gener"l e'&ti&n"l functi&ning "re s&'e &f the /"ri"%les rel"ted t& indi/idu"l res$&nse t& tr"u'" (!c8"rl"ne & 9ehud", , :#. ;n "dditi&n, the e'&ti&n"l "nd $hysic"l $r&*i'ity t& "ctu"l d"nger, degree &f $ercei/ed $ers&n"l c&ntr&l, the length &f e*$&sure t& tr"u'", the re"cti&n &f &thers t& the tr"u'", "nd the s&urce &f the tr"u'" (e.g., n"tur"l dis"ster, "%use fr&' $"rent, "%use fr&' str"nger, r"nd&' $ers&n"l /i&lence, c&'%"t, terr&rist "ct# "ls& i'$"ct "n indi/idu"l7s re"cti&n t& tr"u'" (!c8"rl"ne & de <ir&l"'&, , :#. S&'e $e&$le de'&nstr"te resiliency, res$&nding t& tr"u'" in " fle*i%le "nd cre"ti/e '"nner. ;n c&ntr"st, tr"u'" %ec&'es " neg"ti/e, centr"l defining '&'ent in the li/es &f &thers, '"rking the st"rt &f entrenched e'&ti&n"l distress, '"l"d"$ti/e %eh"/i&r, "nd6&r rel"ti&n"l dysfuncti&n. 8&ll&1ing e*$&sure t& " tr"u'"tic e/ent, '&st indi/idu"ls e*$erience te'$&r"ry $re&ccu$"ti&n "nd s&'e in/&lunt"ry intrusi/e 'e'&ries. H&r&1it2 (, 0=# h"s $r&$&sed th"t in '"ny, the re$etiti&us re$l"ying &f the $"inful 'e'&ries "ctu"lly functi&ns t& '&dify the e'&ti&n"l res$&nse t& the tr"u'" resulting in " gr"du"l

incre"se in t&ler"nce f&r tr"u'"tic c&ntent. 4here"s 1ith ti'e '&st $e&$le "ctu"lly he"l %y integr"ti&n "nd "cce$t"nce &f the tr"u'"tic e*$erience thr&ugh this re$etiti&n, &thers de/el&$ the $ersistent $"tterns &f hy$er"r&us"l "nd "/&id"nce &f P&sttr"u'"tic Stress 5is&rder (P>S5#. ;n these indi/idu"ls, the tr"u'"tic 'e'&ry d&es n&t %ec&'e "cce$ted "s $"rt &f their $"st. ;nste"d, e"ch re$l"y &f the 'e'&ry &nly incre"ses sensiti2"ti&n "nd distress (/"n der ?&lk & !c8"rl"ne, , :#. 5iss&ci"ti&n is "n&ther c&''&n res$&nse t& e*$&sure t& " tr"u'"tic e/ent. @5iss&ci"ti&n is " 1"y &f &rg"ni2ing inf&r'"ti&n ...(th"t# refers t& " c&'$"rt'ent"li2"ti&n &f e*$erience: )le'ents &f the tr"u'" "re n&t integr"ted int& the unit"ry 1h&le &r integr"ted sense &f selfA (/"n der ?&lk, /"n der H"rt, & !"r'"r, , :, $. -0:#. >he &/er1hel'ing n"ture &f tr"u'" interferes 1ith the integr"ti&n &f the e/ent int& c&nsci&us 'e'&ry "nd identity in '"ny children "nd "dults. >hese indi/idu"ls '"y 'ent"lly le"/e their %&dies during " tr"u'"tic &r thre"tening e/ent, "ll&1ing the' t& &%ser/e the e/ent fr&' " dist"nce "nd li'it their i''edi"te distress "nd $"in. The Neurobiology o! Trauma Alth&ugh the %&dy &f liter"ture "ddressing the neur&%i&l&gic"l res$&nse t& tr"u'" is c&'$le* "nd s&'e1h"t c&ntr"dict&ry, s&'e kn&1ledge is needed t& underst"nd "nd "$$r&$ri"tely tre"t tr"u'". )*$&sure t& stress &r tr"u'" h"s " dr"'"tic effect &n the Aut&n&'ic +er/&us Syste' (A+S#, 1hich is c&'$&sed &f the Sy'$"thetic +er/&us Syste' (S+S# "nd the P"r"sy'$"thetic +er/&us Syste' (P+S#. >he P+S '"int"ins n&r'"l $hysi&l&gic"l "cti/ity 1hen n&t under stress, decre"sing the he"rt "nd %re"thing r"te "nd %l&&d fl&1 t& the e*tre'ities 1hile decre"sing the %l&&d fl&1 t& digesti/e syste'. >he S+S is "d"$ti/e "nd designed t& $r&tect the %&dy 1hen there is " $ercei/ed thre"t t& sur/i/"l &r %&dy integrity %y "cti/"ting the fight &r flight (&r free2e# res$&nse. 5uring this res$&nse, "dren"lin "nd c&rtis&l le/els incre"se dr"'"tic"lly, $r&ducing hy$er"r&us"l "nd hy$er/igil"nce 1hile $re$"ring the %&dy t& fight &r run fr&' d"nger %y c&nstricting %l&&d /essels "nd $u$ils, decre"sing the %l&&d fl&1 t& the digesti/e syste' "nd incre"sing $ers$ir"ti&n, "s 1ell "s he"rt "nd %re"thing r"tes. ;n "dditi&n, 1hen it is i'$&ssi%le t& &/erc&'e &r flee, the %&dy free2es %y the $r&cess &f diss&ci"ti&n. ;n this res$&nse, the indi/idu"l feels nu'% "nd diseng"ged (s&'eti'es f"inting# 1ith " $ercei/ed sus$ensi&n &f ti'e "nd dere"li2"ti&n, the&retic"lly $re$"ring the %&dy f&r c"'&ufl"ge, incre"sing the ch"nce &f sur/i/"l thr&ugh c&'$li"nce 1ith $rey, "nd6&r cre"ting c&nditi&ns in 1hich de"th is n&t "s $"inful in c"se the $rey d&es n&t 1"lk "1"y. Alth&ugh the S+S stress res$&nse is /it"l f&r sur/i/"l, t&& 'uch S+S sti'ul"ti&n h"s deleteri&us effects &n the %&dy. Since the "ut&n&'ic stress res$&nse is triggered si'il"rly %y %&th $hysic"l "nd e'&ti&n"l $"in, indi/idu"ls 1h& c&ntinu"lly $ercei/e d"nger in their en/ir&n'ents 1ill elicit " c&nst"nt "ut&n&'ic res$&nse &f "lertness, 1hich r"nges fr&' " st"te &f /igil"nce t& terr&r. B&th lengthy $eri&ds &f stress &r e*$&sure t& tr"u'"tic e/ents h"/e %een f&und t& c"use seri&us d"'"ge t& "n indi/idu"lBs he"lth. >he h&r'&nes &f "dren"lin "nd c&rtis&l, rele"sed during stress, %"the the "re"s &f the %r"in in/&l/ed in 'e'&ry "nd res$&nse t& stress (Bre'ner, 2002#. Alth&ugh these h&r'&nes '&%ili2e %r"in syste's critic"l t& sur/i/"l in crisis, e*cessi/e &r re$etiti/e stress c"n le"d t& l&ng-ter' ch"nges in the %r"in

syste's &f 'e'&ry "nd the stress res$&nse in s&'e indi/idu"ls. 8&r e*"'$le, rese"rchers h"/e re$&rted th"t c&rtis&l '"y c"use s$ecific d"'"ge in the %r"in, such "s d"'"ge in the hi$$&c"'$us th"t c"n i'$"ir 'e'&ry f&r'"ti&n (S"$&lsky, , :#. P"rticul"rly intense &r $r&l&nged tr"u'" e*$&sure c"n c"use indi/idu"ls t& h"/e " '&re intense $hysi&l&gic"l res$&nse t& "ll stress. Studies h"/e c&nfir'ed th"t 1hen c&'$"red t& n&ntr"u'"ti2ed c&ntr&ls, indi/idu"ls 1ith P>S5 res$&nd t& re'inders &f tr"u'" 1ith signific"nt incre"ses in %l&&d $ressure, he"rt r"te, "nd skin c&nduct"nce (Pit'"n, Crr, 8&rgue, de J&ng & (l"i%&rn, , =0#. Se/er"l &ther $hysi&l&gic"l res$&nses h"/e %een "ss&ci"ted 1ith chr&nic S+S "r&us"l, including incre"sed irrit"%ility in the li'%ic syste', 1hich is gener"lly in/&l/ed in e'&ti&n"l functi&ning (Siegel, 200-#. >his irrit"%ility results in sti'ul"ti&n &f the fight &r flight res$&nse %y "l'&st "ny e*cessi/e sti'ulus (e.g., s'ells, l&ud n&ises, fl"shes &f light# in tr"u'" /icti's (Sc"er, 2003#. ;n f"ct, e"ch recurrent stress &nly incre"ses sensiti/ity &f the S+S fight &r flight res$&nse "nd /ulner"%ility t& "n*iety "nd de$ressi&n. >he s$ecific i'$"ct &f stress "nd e'&ti&n"l tr"u'" &n the %r"in is " c&'$le* $r&cess de$endent &n '"ny /"ri"%les, %ut $"rticul"rly "ge "nd the $"rt &f the %r"in de/el&$ing "t tr"u'" e*$&sure. Br"in gr&1th during the first three ye"rs &f life is d&'in"nt in the right he'is$here &f the %r"in, 1hich ty$ic"lly $r&cesses n&n/er%"l sign"ls c&''unic"ti&n, including f"ci"l e*$ressi&n &f feelings, $erce$ti&n &f e'&ti&n, "nd regul"ti&n &f the "ut&n&'ic ner/&us syste'. Siegel (200-# st"ted th"t self-s&&thing is " critic"l functi&n &f the right he'is$here th"t c"n %e disru$ted %y e*$&sure t& signific"nt stress "nd tr"u'" in the first ye"rs &f life. As the %r"in gr&1s "nd &rg"ni2es, the higher '&re c&'$le* "re"s %egin t& c&ntr&l the '&re re"cti/e "nd $ri'iti/e functi&ning &f the l&1er $"rts &f the %r"in, such "s the li'%ic syste', in " n&r'"l indi/idu"l. An indi/idu"l7s "%ility t& c&ntr&l their i'$ulses "nd %eh"/i&r"l res$&nse t& str&ng e'&ti&ns reDuires '&dul"ti&n (e.g., l&gic"l thinking "nd $r&%le' s&l/ing %ef&re re"cting# &f the '&re $ri'iti/e $"rts &f the %r"in %y the '&re s&$histic"ted c&rte*. H&1e/er, chr&nic "r&us"l &f the S+S fight &r flight res$&nse c"n h"/e " neg"ti/e i'$"ct &n the de/el&$'ent &f the higher %r"in functi&ns (e.g., l&gic, l"ngu"ge, i'$ulse c&ntr&l, $l"nning#. Si'$ly, the '&re s&$histic"ted "nd c&'$le* the sur/i/"l net1&rk %ec&'es, the '&re difficult it 1ill %e f&r higher c&rtic"l functi&ns t& su%due it during le"rning, c&ncentr"ti&n, "nd rec"ll (Perry, 200,#. Persistent S+S sti'ul"ti&n "ls& incre"ses the risk th"t ch"r"cteristics &f the st"te &f "r&us"l %ec&'e '&re st"%le tr"its. Eese"rch suggests th"t $ersistent hy$er"r&us"l '"y $er'"nently "lter the S+S "dren"lin syste'F 1here"s, $ersistent diss&ci"ti&n '"y "lter the &$&id (e.g., end&r$hins G the %&dyBs n"tur"l '&r$hine# syste'. As the $hysi&l&gy &f tr"u'" %ec&'es %etter underst&&d, '"ny &f the %eh"/i&r"l '"nifest"ti&ns &f tr"u'" e*$&sure '"ke e/en '&re sense. 5ue t& the $er$etu"l st"te &f "r&us"l "nd hy$er/igil"nce, indi/idu"ls c"n struggle 1ith P>S5 "nd &ther "n*iety s$ectru' dis&rders. S&'e tr"u'"ti2ed indi/idu"ls "re dr"1n int& su%st"nce "%use "nd self-destructi/e tensi&n reducti&n %eh"/i&rs in "n eff&rt t& su%due the sy'$"thetic "cti/"ti&n. P&&r "ffect regul"ti&n "nd i'$ulsi/ity "re likely rel"ted t& decre"sed c&rtic"l '&dul"ti&n &f the e'&ti&n"l res$&nse. (&nseDuently, underst"nding the %i&l&gy &f tr"u'" hel$s t& inf&r' "nd guide the tre"t'ent $r&cess.

Treating Trauma )"rly '&dels &f tre"ting tr"u'", ty$ic"lly in/&l/ed t"lking "%&ut the tr"u'"tic e/ent "s " centr"l c&'$&nent &f tre"t'ent. Eetelling the tr"u'" 1"s /ie1ed "s cur"ti/e "nd necess"ry. Cften the g&"l 1"s t& retrie/e tr"u'"tic 'e'&ries "nd re/ie1 the' in c&unseling sessi&n. H&1e/er, "s n&ted "%&/e, '&re recent rese"rch suggests th"t 1hile s&'e indi/idu"ls d& e*$erience sy'$t&' relief "fter t"lking "%&ut tr"u'", &thers res$&nd 1ith "n e*"cer%"ti&n &f sy'$t&'s (/"n der ?&lk & !c8"rl"ne, , :#. ;n f"ct, e*$l&ring tr"u'"tic 'e'&ries c"n e/en %e d"'"ging t& s&'e clients. @A client is '&st "t risk f&r %ec&'ing &/er1hel'ed, $&ssi%ly retr"u'"ti2ed, "s " result &f tre"t'ent 1hen the ther"$y $r&cess "cceler"tes f"ster th"n he (sic# c"n c&nt"inA (E&thschild, 2000, $. 0=#. As " result, c&unsel&rs "re res$&nsi%le f&r '"n"ging the intensity &f e*$&sure t& tr"u'"tic '"teri"ls during the c&unseling. J&hn Briere (, :, Briere & Sc&tt, 200:# e*tensi/ely studied c&'$le* tr"u'" "nd its tre"t'ent G n&ting th"t the indi/idu"l "nd uniDue 1"ys th"t tr"u'" is $r&cessed i'$"cts the retelling &f tr"u'"tic e*$eriences. Briere de/el&$ed " '&del f&r "ssessing "nd '"ni$ul"ting the intensity &f tr"u'" e*$&sure in indi/idu"l clients s& th"t the intensity re'"ins 1ithin " ther"$eutic 1ind&1 th"t d&es n&t retr"u'"ti2e. 4hen indi/idu"ls "re retr"u'"ti2ed in the c&unseling sessi&n, they ty$ic"lly %egin t& re/ert %"ck t& their &rigin"l '"l"d"$ti/e res$&nse f&r de"ling 1ith the &rigin"l tr"u'". S&'e '"y diss&ci"te, 1hile &thers '"y regress &r rely &n "ddicti&ns t& de"l 1ith the tr"u'"tic '"teri"l. Ad"$ting Briere7s $rinci$les, the intensity &f in-sessi&n tr"u'" e*$&sure c"n %e 'e"sured "t three different le/els. ;n Le/el Cne, the client de'&nstr"tes 'ini'"l e'&ti&n"l sti'ul"ti&n. >he "ffect %eing dis$l"yed is r"ther fl"t. >he indi/idu"l "$$e"rs s&'e1h"t nu'% 1ith " c"l' /&ice t&ne "nd n&n/er%"l %eh"/i&r th"t d& n&t '"tch the c&ntent &f the tr"u'" %eing descri%ed. ;n Le/el >1&, the indi/idu"l is de'&nstr"ting s&'e "ffecti/e sti'ul"ti&n, %ut d&es n&t "$$e"r &/er1hel'ed &r &ut &f c&ntr&l. >he n&n/er%"l %eh"/i&r "$$r&$ri"tely '"tches the tr"u'"tic c&ntent, %ut n&t t& the degree th"t the $ers&n "$$e"rs t& %e re-e*$eriencing the tr"u'". ;n Le/el >hree, the client is e*tre'ely sti'ul"ted 1ith the intensity cl&se t& the &rigin"l res$&nse t& the tr"u'". ;t is "s if s6he is "ctu"lly reli/ing the tr"u'" in the $resent, e/en crying unc&ntr&ll"%ly, g"s$ing f&r %re"th, &r dis$l"ying y&unger &r regressed %eh"/i&rs such "s r&cking "nd thu'% sucking. Cther clients '"y diss&ci"te during the sessi&n &r de'&nstr"te "n incre"se in "ddicti/e &r self-destructi/e %eh"/i&rs %et1een sessi&ns. Pre'"ture ter'in"ti&n "nd &ther signs &f resist"nce '"y &ccur 1hen clients %ec&'e &/er1hel'ed 1ith tr"u'"tic '"teri"l. .sing " $r&cess n&t unlike syste'"tic desensiti2"ti&n, the c&unsel&r is res$&nsi%le f&r '"n"ging the le/el &f e'&ti&n"l sti'ul"ti&n in sessi&ns. 4ith&ut "deDu"te e'&ti&n"l sti'ul"ti&n (i.e., Le/el Cne#, the client re'"ins 1ithin their c&'f&rt 2&ne "nd "/&ids the "ffecti/e sti'ul"ti&n necess"ry t& de/el&$ "n incre"sed t&ler"nce f&r re-e*$eriencing the tr"u'"tic '"teri"l. H&1e/er, clients7 sy'$t&'s ty$ic"lly 1&rsen 1hen they %ec&'e t&& e'&ti&n"lly sti'ul"ted "nd &/er1hel'ed during the sessi&n (Le/el >hree#. As clients gr"du"lly le"rn t& think "nd t"lk "%&ut their tr"u'" 1ith&ut %ec&'ing &/er1hel'ed (Le/el >1&#, they re'"in in the ther"$eutic 1ind&1. >i'e s$ent 1ithin the ther"$eutic

1ind&1 n&t &nly gr"du"lly incre"ses their t&ler"nce f&r e*$&sure t& the tr"u'"tic '"teri"l, %ut "ls& f"cilit"tes the $&siti/e integr"ti&n &f the tr"u'"tic 'e'&ries 1ithin their $ers&n"l hist&ry "nd identity. Such integr"ti&n "ll&1s the re$etiti&us re$l"ying &f the $"inful 'e'&ries t& %egin t& '&dify the e'&ti&n"l res$&nse t& the tr"u'". C/er ti'e, this $r&cess %egins t& re$l"ce the $ersistent $"tterns &f hy$er"r&us"l "nd "/&id"nce 1ith he"ling integr"ti&n "nd "cce$t"nce &f the tr"u'"tic e*$erience. (&unsel&rs 'ust "ssu'e res$&nsi%ility f&r $r&tecting P>S5 clients fr&' retr"u'"ti2"ti&n during tre"t'ent. ;n "dditi&n t& 1"tching f&r &/ersti'ul"ti&n, regressi&n, "nd diss&ci"ti&n in the sessi&ns, they sh&uld check f&r "n incre"se in &ut-&f-sessi&n sy'$t&'s &r "ddicti/e res$&nses. >he g&"ls &f tr"u'" tre"t'ent sh&uld include hel$ing $&&rly defended clients de/el&$ '&re "deDu"te c&$ing str"tegies (e.g., rel"*"ti&n tr"ining, stress reducti&n e*ercises, c&gniti/e '&dul"ti&n &f "ffect thr&ugh self-t"lk# $ri&r t& "sking the' t& ree*$erience the tr"u'" in sessi&ns. Str"tegies fr&' di"lectic"l %eh"/i&r ther"$y (Lineh"n et "l., , # such "s $r&%le'-s&l/ing, %eh"/i&r ch"nge "nd e'&ti&n"l regul"ti&n c"n "ls& %e i'$le'ented t& "ssist in "ffect regul"ti&n "nd i'$r&/ing rel"ti&nshi$ skills. (&unsel&rs c"n regul"te the intensity during sessi&ns in se/er"l 1"ys. ;ntensity c"n %e incre"sed 1hen in Le/el Cne %y "sking: "ffect Duesti&ns (i.e., @H&1 1ere y&u feeling 1hen...HA#F f&r s$ecific det"ils &f the tr"u'"F f&r the' t& descri%e the tr"u'" ste$-%y ste$F f&r /isu"l, kinesthetic, "udit&ry, etc. 'e'&ries &f the e/entF "nd 1h"t h"$$ened t& their %&dy. Si'il"rly, c&unsel&rs c"n decre"se the intensity 1hen in Le/el >hree %y: "sking c&ntent Duesti&ns n&t s$ecific"lly rel"ted t& tr"u'" (e.g., @H&1 &ld 1ere y&u "t th"t ti'eHA#F using " hy$n&tic /&ice t&ne t& c"l'F "sking the client t& st&$ t"lking "%&ut the tr"u'" "nd "nch&r the' t& the $resentF re$e"ting "nd re$hr"sing 1h"t the client h"s Iust s"idF getting client t& &$en eyes "nd descri%e the current settingF using rel"*"ti&n "nd %re"thing techniDues in sessi&nF "nd "sking the client t& t"lk "%&ut neutr"l e/ents in the $resent n&t rel"ted t& the tr"u'".

Table ": egulating #ntensity ;ncre"se Ask "ffect Duesti&ns Ask f&r s$ecific det"ils &f tr"u'", ste$-%y-ste$ Anch&r in Ask f&r sens&ry (/isu"l, kinesthetic, "udit&ry, &lf"ct&ry# 'e'&ries &f tr"u'" the e/ent Ask "%&ut their fe"rs Ask 1h"t h"$$ened t& their %&dy 5ecre"se Ask c&ntent Duesti&ns n&t rel"ted t& tr"u'" .se c"l'ing /&ice t&ne Anch&r in St&$ client fr&' t"lking "nd "nch&r in the $resent the $resent Ee$e"t "nd re$hr"se 1h"t the client h"s Iust s"id <et client t& &$en eyes "nd descri%e the current setting .se rel"*"ti&n "nd %re"thing techniDues in the sessi&n Ask the client "%&ut "cti/ities %ef&re "nd "fter $resent sessi&n &r &ther e/ents n&t rel"ted t& the tr"u'" >re"ting tr"u'" is " /ery fluid $r&cess. <i/en the '"ny /"ri"%les rel"ted t& the i'$"ct &f tr"u'", tr"u'"ti2ed indi/idu"ls "re e*tre'ely di/erse. (&nseDuently, c&unsel&rs need t& %e "cti/e, /igil"nt, "nd directi/e in '"n"ging the degree &f client e'&ti&n"l sti'ul"ti&n. ;f, initi"lly the client '&/es i''edi"tely fr&' Le/el Cne t& Le/el >hree, the c&unsel&r 'ust i'$r&/e c&$ing "nd &nly %riefly t&uch tr"u'"tic '"teri"l 1ith&ut &/er1hel'ing the client. >he $r&cess is $"r"llel t& the use &f syste'"tic desensiti2"ti&n in the tre"t'ent &f &ther "n*iety dis&rders. As the client is "%le t& t&ler"te $r&cessing '&re tr"u'"tic in-sessi&n c&ntent, &ther tr"diti&n"l c&gniti/e %eh"/i&r"l (e.g., ch"llenging dist&rted %eliefs, i'$le'enting %eh"/i&r"l ch"nge, setting u$ c&ntingency $r&gr"'s# "nd di"lecti"l %eh"/i&r ther"$y str"tegies c"n then %e utili2ed t& "ddress sy'$t&'s such "s "n*iety, de$ressi&n, "nd self-destructi/e &r "ddicti/e %eh"/i&rs.

e!erences Bre'ner, J. 5. (2002#. .nderst"nding tr"u'"-rel"ted dis&rders fr&' " 'ind-%&dy $ers$ecti/e: 5&es stress d"'"ge the %r"inH +e1 9&rk: 4.4. +&rt&n & (&'$"ny. Briere, J. (, :#. Psych&'etric re/ie1 &f the >r"u'" Sy'$t&' (hecklist-J0. ;n B.H. St"'' ()d.#, !e"sure'ent &f stress, tr"u'", "nd "d"$t"ti&n. Luther/ille, !5: Sidr"n Press. Briere, J., & Sc&tt, (. (200:#. Princi$les &f tr"u'" ther"$y: A guide t& sy'$t&'s, e/"lu"ti&n, "nd tre"t'ent. >h&us"nd C"ks, (A: S"ge Pu%lic"ti&ns. H&r&1it2, !. (, 0=#. Stress res$&nse syndr&'es. +e1 9&rk: J"s&n Ar&ns&n. Lineh"n, !. !., Sch'idt, H., 5i'eff, L. A., (r"ft, J. (., ?"nter, J., & (&'t&is, ?. A. (, #. 5i"lectic"l %eh"/i&r ther"$y f&r $"tients 1ith %&rderline $ers&n"lity dis&rder "nd drug-de$endence. A'eric"n J&urn"l &f Addicti&n, = (J#, 20 - 2. !c8"rl"ne, A. (., & de <ir&l"'&, <. (, :#. >he n"ture &f tr"u'"tic stress&rs "nd the e$ide'i&l&gy &f $&sttr"u'"tic re"cti&ns. ;n B. A. /"n der ?&lk, A. (. !c8"rl"ne, & L. 4eis"eth ()ds.#, >r"u'"tic stress: >he &/er1hel'ing e*$erience &n 'ind, %&dy, "nd s&ciety ($$. ,2 -,3J#. +e1 9&rk: <uilf&rd. !c8"rl"ne, A. (., & 9ehud", E. (, :#. Eesilience, /ulner"%ility, "nd the c&urse &f $&sttr"u'"tic re"cti&ns. ;n B. A. /"n der ?&lk, A. (. !c8"rl"ne, & L. 4eis"eth ()ds.#, >r"u'"tic stress: >he &/er1hel'ing e*$erience &n 'ind, %&dy, "nd s&ciety ($$. ,33-,=,#. +e1 9&rk: <uilf&rd. Perry, B.5. (200,#. >he neur&de/el&$'ent"l i'$"ct &f /i&lence in childh&&d. ;n, Schetky, 5., & Benedek, ).P. ()ds.#, Textbook of child and adolescent forensic psychiatry, (22,-2-=#. 4"shingt&n, 5.(.: A'eric"n Psychi"tric Press, ;nc. Pit'"n, E. ?., Crr, S. P., 8&rgue, 5. 8., de J&ng, J., & (l"i%&rn, J. !. (, =0#. Psych&$hysi&l&gic "ssess'ent &f $&sttr"u'"tic stress dis&rder i'"gery in Kietn"' c&'%"t /eter"ns. Archi/es &f <ener"l Psychi"try, JJ, 00- 03. E&thschild, B. (2000#. >he %&dy re'e'%ers: >he $sych&$hysi&l&gy &f tr"u'" "nd tr"u'" tre"t'ent. +e1 9&rk: 4.4. +&rt&n & (&. S"$&lsky, E. !. (, :#. 4hy stress is %"d f&r y&ur %r"in. Science, 20-, 0J -030. Sc"er, E. (. (2003#. >he tr"u'" s$ectru': Hidden 1&unds "nd hu'"n resiliency. +e1 9&rk: 4.4. +&rt&n & (&. Siegel, 5. J. (200-#. An inter$ers&n"l neur&%i&l&gy &f $sych&ther"$y: >he de/el&$ing 'ind "nd the res&luti&n &f tr"u'". ;n !. 8. S&l&'&n, & 5. J. Siegel ()ds.#, He"ling tr"u'": Att"ch'ent, 'ind, %&dy, "nd %r"in ($$. ,-3:#. +e1 9&rk: 4. 4. +&rt&n & (&. /"n der ?&lk, B. A., & !c8"rl"ne, A. (. (, :#. >he %l"ck h&le &f tr"u'". ;n B. A. /"n der ?&lk, A. (. !c8"rl"ne, & L. 4eis"eth ()ds.#, >r"u'"tic stress: >he &/er1hel'ing e*$erience &n 'ind, %&dy, "nd s&ciety ($$. --2-#. +e1 9&rk: <uilf&rd. /"n der ?&lk, B. A., /"n der H"rt, C., & !"r'"r, (. E. (, :#. 5iss&ci"ti&n "nd inf&r'"ti&n $r&cessing in P&sttr"u'"tic Stress 5is&rder. ;nB. A. /"n der ?&lk, A. (. !c8"rl"ne, & L. 4eis"eth ()ds.#, >r"u'"tic stress: >he &/er1hel'ing e*$erience &n 'ind, %&dy, "nd s&ciety ($$. -0---20#. +e1 9&rk: <uilf&rd.

$andout ": Treating Trauma in Children and Adolescents >he "ge "nd de/el&$'ent"l le/el &f the client dict"tes "n "$$r&$ri"te tre"t'ent $r&t&c&l. >re"t'ent &f the /ery y&ung &r se/erely del"yed (1ith&ut cle"r tr"u'"tic 'e'&ries# $ri'"rily f&cuses &n te"ching self-c"l'ing6rel"*"ti&n str"tegiesF identific"ti&n &f triggers %y "dultsF re"ssur"nce "nd $r&tecti&n fr&' "ffecti/e sti'ul"ti&n. (hildren in l"ter $resch&&l "nd e"rly ele'ent"ry ye"rs 1ith '&re cle"rly identifi"%le "ffecti/e res$&nse t& tr"u'"tic 'e'&ries ty$ic"lly in/&l/es n&n/er%"l '&d"lities &f tre"t'ent ("rt "nd $l"y#, 1hich "ll&1 the child t& e*$ress feelings "nd e*$eriences th"t they c"nn&t /er%"li2eF te"ching self-c"l'ing "nd rel"*"ti&n techniDuesF "ll&1ing the child t& test the l&y"lty &f rel"ti&nshi$ 1ith ther"$ist (this ch"llenging, %ut re$etiti/e testing is " 1"y &f 1&rking thr&ugh the tr"u'"#. Ker%"l y&ung children '"y t"lk "%&ut the tr"u'" utili2ing the ther"$eutic 1ind&1 "s l&ng "s they "re n&t $ressured t& t"lk. All children need re"ssur"nce &f s"fety. )/en /er%"l children '"y t"lk '&re 1hile $l"ying &r 1ith the use &f $u$$ets, d&lls, &r stuffed "ni'"ls. As " result, it is i'$&rt"nt t& $r&/ide "$$r&$ri"te t&ys th"t 1ill "ll&1 the reen"ct'ent &f tr"u'" "s 1ell "s &ther "ge "$$r&$ri"te $l"y '"teri"ls. (hildren ty$ic"lly need hel$ in le"rning t& identify their e'&ti&ns "nd le/el &f sti'ul"ti&n. P"rents &r &ther "dults c"n "ssist in identifying triggers. 8"'ily ther"$y "nd $"rent tr"ining c"n %e used t& guide "dults in 'ini'i2ing "ffecti/e sti'ul"ti&n, tr"u'" triggers, "nd esc"l"ting res$&nses. >e"ch the "dults t& rec&gni2e 1hen the child is triggered, then "ssist in c"l'ing "nd 1"it t& "ddress %eh"/i&rs 1hen the child is "%le t& '"ke use &f the feed%"ck. >he c&unsel&r c"n set u$ %eh"/i&r"l $l"ns th"t set s'"ll g&"ls th"t successi/ely "$$r&*i'"te t"rget g&"ls. An i'$&rt"nt "s$ect &f tre"t'ent is t& hel$ "dults underst"nd the child7s %eh"/i&r s& th"t it is n&t t"ken $ers&n"lly &r /ie1ed "s defi"nce. Adults '"y need t& %e re'inded t& "ffir' regul"rly (c"tch the' d&ing s&'ething $&siti/e freDuently#. >r"u'" in "d&lescents is rel"ted t& "n incre"sed risk &f delinDuency, su%st"nce "%use, high risk %eh"/i&rs, $&&r sch&&l $erf&r'"nce, dr&$$ing &ut &f sch&&l, "nd se*u"l $r&'iscuity (Perry, 200,F Sch&re, , :#. Ad&lescents &ften resist ther"$y "nd try t& "/&id "ny discussi&n &f tr"u'". >hey '"y /ie1 c&unseling (&r $sych&tr&$ic 'edic"ti&n# "s &ne '&re stig'" th"t 'e"ns they "re n&t n&r'"l. >he n&r'"lly heightened n"rcissis' &f "d&lescence is &ften "ccentu"ted in indi/idu"ls 1ith " hist&ry &f tr"u'" "nd disru$ted "tt"ch'ents. .nf&rtun"tely, this n"rcissis' n&t &nly results in "n unde/el&$ed e'$"thy res$&nse in s&'e, %ut "ls& c&ntri%utes t& " sense &f entitle'ent "nd " tendency t& %l"'e &thers, r"ther th"n t"king res$&nsi%ility f&r $ers&n"l ch&ices. (&nseDuently, n"rcissis' c"n i'$ede e'&ti&n"l '"tur"ti&n "s 1ell "s s&ci"l "nd skill de/el&$'ent th"t results fr&' le"rning fr&' &ne7s 'ist"kes "nd g"ining "n underst"nding &f the reci$r&city reDuired in inter$ers&n"l rel"ti&nshi$s. Such indi/idu"ls "ls& "re likely t& &/er-re"ct t& "ny $ercei/ed inIustice, since they tend t& rigidly /ie1 c&nte*t s&lely fr&' their &1n $ers$ecti/e. As 1ith "ll &ther "s$ects &f tr"u'" $re/i&usly discussed, there is signific"nt /"ri"%ility in "n "d&lescent7s res$&nse t& tr"u'". 4hile s&'e h"r%&r gre"t resent'ent "nd %l"'e f&r their $redic"'ent, &ther tr"u'"ti2ed "d&lescents '"y intern"li2e t&& 'uch &f the %l"'e $r&Iected &nt& the' %y "%usi/e "nd6&r neglectful c"regi/ers. >hey '"y try t&

'"int"in "n ide"li2ed /ie1 &f their f"'ily &r $er$etr"t&rs, 1hile %elie/ing th"t they s&'eh&1 deser/ed '"ltre"t'ent. As &ne y&uth e*$l"ined, @But e/ery ti'e he %e"t 'e, ; h"d d&ne s&'ething 1r&ng.A Since distrust is " c&''&n re"cti&n t& tr"u'", c&unsel&rs h"/e t& rec&gni2e h&1 it c"n interfere 1ith " y&uth7s "%ility t& '"ke use &f ser/ices th"t "re $r&/ided. <ener"l distrust is c&'$&unded %y the tendency t& $ercei/e "dults "nd &thers "s either "ll g&&d &r "ll %"d (i.e., s$litting#. >he c&nsistent e*$ect"ti&n th"t trust 1ill %e %etr"yed c"n cre"te " $"ttern in 1hich indi/idu"ls c"n %e ide"li2ed 1hen the y&uth is getting e/erything they 1"nt, %ut then Duickly shift t& %e seen "s c&'$letely untrust1&rthy f&ll&1ing e/en the slightest dis"$$&int'ent. <i/en th"t "ny trust $r&duces "n*iety c&nsidering the risk &f %eing hurt, " y&uth '"y $refer t& '"int"in the s"fer "nd less "n*iety-$r&ducing e*$ect"ti&n &f distrust. An&ther c&nsider"ti&n 1hen 1&rking 1ith tr"u'"ti2ed "d&lescents is th"t "/&id"nce, deni"l, r"ti&n"li2"ti&n, "nd distr"cti&n "re &ften $referred str"tegies f&r de"ling 1ith neg"ti/e "ffect. +&t &nly d& these defense 'ech"nis's n"tur"lly le"d t& tre"t'ent resist"nce, %ut "ll "ls& interfere 1ith the "%ility t& '"ture in de"ling "$$r&$ri"tely 1ith neg"ti/e e'&ti&ns "nd sti'ul"ti&n. (&nseDuently, c&unsel&rs &f these "d&lescents need t& %uild " str&ng ther"$eutic "lli"nce $ri&r t& directly "ddressing tr"u'". ;niti"lly, "d&lescents '"y %e '&re &$en t& discuss @n&r'"lA de/el&$'ent"l c&ncerns such "s $eer rel"ti&nshi$s, cl&thing "nd 'usic, future "s$ir"ti&ns, &r &ther $ers&n"l interests &f the client. S&'e 1illingly eng"ge in ther"$y th"t is "ddressing s&ci"l skills th"t hel$ the' %e '&re successful 1ith their $eers. !"ny, "nd $"rticul"rly '"le, "d&lescents '"y %e '&re &$en t& side-t&-side r"ther th"n f"ce-t&-f"ce c&n/ers"ti&ns. >hey '"y %e '&re "$t t& t"lking 1hile eng"ging in &ther "cti/ities (1"lking, sh&&ting h&&$s, $l"ying c"rds, etc.#. >hr&ugh these less stig'"ti2ed "nd sti'ul"ting c&n/ers"ti&ns, the c&unsel&r %"sic"lly $r&/es their c&nsistency "nd c&''it'ent "nd e"rns the trust "nd res$ect needed t& enter int& '&re thre"tening t&$ics. (&unsel&rs need t& %e 1"tchful &f trying t& '&/e t&& Duickly %ec"use &f e*tern"l $ressures %y indi/idu"ls &r syste's 1ith li'ited underst"nding &f the "$$r&$ri"te $"cing. !"ny c&unsel&rs h"/e %een c&nfr&nted 1ith Duesti&ns such "s, @H"/en7t y&u st"rted de"ling 1ith his se*u"l "%use yetHA Cnce there is "n "deDu"te ther"$eutic "lli"nce, the c&unsel&r c"n %egin t& tr"nsiti&n int& '&re direct discussi&n &f tr"u'", %y first identifying "ny issues rel"ted t& the tr"u'" th"t "re c"using current distress such "s: r"ge, de$ressi&n &r des$"ir, "n*iety &r terr&r. >hr&ugh the identific"ti&n &f triggers "nd te"ching str"tegies f&r c"l'ing, selfs&&thing, "nd "ffect regul"ti&n, c&n/ers"ti&ns "%&ut the &rigins &f the triggers fl&1 '&re n"tur"lly. >he c&unsel&r c"n then %egin t& e*$l&re the client7s /ie1 &f self "nd "ddress dist&rti&ns, including hel$ing the' t& n&r'"li2e "nd %ec&'e less re"cti/e t& dis"$$&int'ent "nd s'"ll inIustices. 4hile techniDues fr&' %&th tr"diti&n"l c&gniti/e %eh"/i&r "nd di"lectic"l %eh"/i&r ther"$y c"n %e integr"ted int& tre"t'ent, c&unsel&rs 1&rking 1ith children "nd "d&lescents 'ust "l1"ys c&ll"%&r"te 1ith $"rents6c"regi/ers, leg"l syste's, te"chers, $hysici"ns, $sychi"trists f&r c&'$rehensi/e "nd c&&rdin"ted c"re. (&unsel&rs "re &ften reDuired t& "d/&c"te f&r &ften 'isunderst&&d tr"u'"ti2ed y&uth. Adults '"y %enefit fr&' hel$ in identifying the e'&ti&n"l &%st"cles th"t '"y %e interfering 1ith " y&uth utili2ing ser/ices r"ther th"n %l"'ing the y&uth (e.g., @4ell, 1e g"/e hi' "ll these &$$&rtunities,

%ut he Iust did n&t t"ke "d/"nt"ge &f the'A#. P"rents "nd $r&fessi&n"ls "like need t& %e re'inded th"t ser/ices "re useless t& "n indi/idu"l unless they c"n '"ke use &f the'. As " result, the g&"l is t& f"cilit"te th"t $r&cess r"ther th"n %l"'e the /icti'. (&unsel&rs "nd &thers 1&rking 1ith tr"u'"ti2ed y&uth need t& rec&gni2e th"t the ther"$eutic "lli"nce is /ery fr"gile "nd fluid "nd c"n %e d"'"ged %y re/e"ling t&& 'uch, t&& f"st &r &ut-&f-sessi&n l&sses &r dis"$$&int'ents. >hey 'ust c&ntinu"lly "ssess the ther"$eutic rel"ti&nshi$, f&cusing &nly &n re$"iring ru$tures in the "lli"nce until re$"ired. >his cre"tes "n interesting rhyth' "nd @d"nceA 1hen 1&rking 1ith "d&lescents. Eesist"nce re$resents the degree t& 1hich the c&unsel&r &r s&'e "s$ect &f the situ"ti&n is $ercei/ed "s " thre"t. (&unsel&rs de"ling 1ith resist"nce need t& try t& n"'e "nd "ddress the thre"t. 5es$ite the see'ing urgency, tre"t'ent c"nn&t '&/e f&r1"rd until the resist"nce is '"n"ged. >his is " c&ntinu"l, e/&l/ing $r&cess th"t re'"ins "li/e during tre"t'ent. ;t &ften hel$s c&unsel&rs t& re'e'%er th"t '"int"ining trust is the '&st fund"'ent"l "nd centr"l ther"$eutic 1&rk f&r the indi/idu"ls 1h& h"/e %een tr"u'"ti2ed. (&unsel&rs 'ust re'"in sensiti/e t& the $resent c&nditi&n &f the ther"$eutic "lli"nce "nd n&t &/er-res$&nd t& the g&"ls th"t &ther "dults h"/e set &r t& re$&rts &f %eh"/i&r $r&%le's. H&1e/er, it is "d'ittedly " delic"te %"l"nce t& n&t c&llude 1ith the client t& "/&id the key issues "nd yet n&t try t& f&rce the y&uth t& t"lk. Si'il"rly, 1&rking 1ith y&uth $resents uniDue ch"llenges t& issues &f c&nfidenti"lity. ;t is critic"l t& t"lk 1ith the y&uth "nd "dults "%&ut h&1 c&nfidenti"lity 1ill %e "ddressed, '"king sure e/ery&ne underst"nds h&1 @secretsA 1ill %e h"ndled "nd cl"rifying the li'its t& c&nfidenti"lity "t the %eginning &f tre"t'ent. <i/en the tendency &f tr"u'"ti2ed indi/idu"ls t& resist c&unseling "nd $r&Iect distrust, c&unsel&rs 'ust c"refully '&nit&r their &1n c&untertr"nsference "nd e'&ti&n"l sti'ul"ti&n. As s&'e "%used y&uth "tte'$t t& test trust "nd c&''it'ent, they c"n dis$l"ce their "nger &nt& the c&unsel&r trying t& hel$ the'. (&unsel&rs 1&rking 1ith this $&$ul"ti&n c"n e*$ect s&'e 1ell-$l"ced /er%"l @hits %el&1 the %elt.A 4&rking 1ith tr"u'"ti2ed $&$ul"ti&ns incre"ses the stress &n the c&unsel&r "nd le"/es hi' &r her /ulner"%le t& c&'$"ssi&n f"tigue "nd %urn &ut.

e!erences Perry, B. 5. (200,#. >he neur&de/el&$'ent"l i'$"ct &f /i&lence in childh&&d. ;n 5. Schetky & ). P. Benedek ()ds.#, >e*t%&&k &f child "nd "d&lescent f&rensic $sychi"try ($$. 22,-2-=#. 4"shingt&n, 5.(.: A'eric"n Psychi"tric Press, ;nc. Sch&re, A. (, :#. >he e*$erience-de$endent '"tur"ti&n &f " regul"t&ry syste' in the &r%it"l $refr&nt"l c&rte* "nd the &rigin &f de/el&$'ent"l $sych&$"th&l&gy. 5e/el&$'ent "nd Psych&$"th&l&gy, =, 3 -=0.

$andout %: Compassion &atigue 'Secondary Traumati(ation) (&'$"ssi&n is defined "s " feeling &f dee$ sy'$"thy f&r "n&therBs suffering &r 'isf&rtune. (&'$"ssi&n Stress is the feeling &f tensi&n &r de'"nd "ss&ci"ted 1ith feelings &f c&'$"ssi&n. (&'$"ssi&n 8"tigue $r&gresses fr&' (&'$"ssi&n Stress "nd is "n &/er1hel'ing st"te &f tensi&n "nd $re&ccu$"ti&n 1ith the cu'ul"ti/e tr"u'" e*$erienced %y "nd re$&rted %y clients 1ithin the child 1elf"re, Iu/enile Iustice, "nd &ther rel"ted 'ent"l he"lth $r&fessi&n"ls. >his ty$e &f f"tigue results in sy'$t&'s &f distress n&t unlike the clients 1h& e*$erienced the tr"u'" firsth"nd. (&'$"ssi&n 8"tigue differs fr&' %urn&ut. Burn&ut e'erges gr"du"lly "nd gener"lly in/&l/es " st"te &f diss"tisf"cti&n 1ith &neBs $&siti&n rel"ted t& 1&rk en/ir&n'ent f"ct&rs, c"reer ch&ices "nd g&"ls, "nd le/el &f I&% s"tisf"cti&n. (&'$"ssi&n 8"tigue '"y %e " c&'$&nent &f %urn&ut, %ut is essenti"lly " sec&nd"ry tr"u'"tic stress re"cti&n "nd /ic"ri&us tr"u'"ti2"ti&n. >he $r&cess &f (&'$"ssi&n 8"tigue is directly c&nnected t& clientBs 'isf&rtune &r "%use "s it is e*$erienced %y the $r&fessi&n"l. >he $r&fessi&n"l7s &1n life e*$eriences, including c&$ing str"tegies "nd $erce$ti&ns &f life i'$"ct the 1"y " clientBs tr"u'" "ffects the $r&fessi&n"l. (&'$"ssi&n 8"tigue h"s " f"ster &nset &f sy'$t&'s "nd f"ster rec&/ery th"n $r&fessi&n"l %urn&ut. Pr&fessi&n"ls "re "ffected %y he"ring &r re"ding hist&ries &f tr"u'" "nd6&r "%use. >hey '"y "ctu"lly &%ser/e the $hysic"l sc"rs &f "%use. As " client t"lks "%&ut the tr"u'" th"t s6he h"s e*$erienced, intern"l i'"ges "re cre"ted 1ithin the $r&fessi&n"lBs 'ind "nd c"n sti'ul"te intense feelings &f c&'$"ssi&n 1hich c"n result in /ic"ri&us e*$eriences &f the "ctu"l tr"u'". Little rese"rch is "/"il"%le reg"rding 1h& is '&re /ulner"%le t& de/el&$ing sy'$t&'s &f c&'$"ssi&n f"tigue. >here is "ls& li'ited underst"nding &f h&1 c&'$"ssi&n stress de/el&$s int& c&'$"ssi&n f"tigue. H&1e/er, $r&fessi&n"ls 1h& h"/e $&&r %&und"ries (resulting in " l"ck &f differenti"ti&n %et1een self "nd &thers#, h"/e unres&l/ed tr"u'"tic e*$eriences in their &1n li/esF "nd '"y %e e*h"usted fr&' the de'"nds &f their 1&rk c&'%ined 1ith &ther stress "re likely c"ndid"tes. ;n "dditi&n, $r&fessi&n"ls 1h& "re dri/en t& rescue clients &r 1h&se self-1&rth is tied t& %eing liked %y their clients '"y %ec&'e '&re susce$ti%le "fter feeling defe"ted "nd disc&ur"ged 1hen they c"nn&t '"int"in these g&"ls. Pr&fessi&n"ls 1h& "re 1&rking tr"u'" /icti's '"y %egin t& e*$erience 1ithin the'sel/es sy'$t&'s si'il"r t& th&se re$&rted %y tr"u'"ti2ed clients. ;t is "s if they "re $r&ne t& %eing infected 1ith the stress re"cti&ns &f their clients. >hey '"y %egin t& res$&nd "nd c&$e in 1"ys th"t "re "t ti'es si'il"r t& the re"cti&ns &f their clients t& tr"u'". 4&rking t& hel$ their clients rec&/er "nd he"l fr&' tr"u'" &r "%use c"n cre"te stress "nd t"* the c&$ing syste' &f the $r&fessi&n"l. Kic"ri&us tr"u'"ti2"ti&n is the $r&cess 1here%y the e*$erience &f listening, &%ser/ing, inter"cti&n "nd %eing e*$&sed t& tr"u'"tic '"teri"l i'$"cts "n indi/idu"l. Pr&fessi&n"ls 1&rking 1ith tr"u'" /icti's %ec&'e %&th the 1itness "nd "t ti'es $"rtici$"nt t& the reen"ct'ent &f tr"u'". As " result, $r&fessi&n"ls, like their clients, de/el&$ styles "nd 1"ys &f c&$ing t& $r&tect the'sel/es fr&' re$e"ted e*$&sures t& tr"u'"tic '"teri"l. 8&r e*"'$le, nu'%ness '"y set in "fter he"ring st&ries &f tr"u'".

>he h"ll'"rk side effect &f /ic"ri&us tr"u'"ti2"ti&n is the intrusi&n &f the clientBs /i&lent i'"gery int& the $r&fessi&n"lBs th&ughts. >hese i'"ges c"n l"st l&nger th"n the c&nt"ct 1ith the client. >hey c"n interfere 1ith the enI&y'ent "nd $le"sure, e/en se*u"l functi&ning &f the $r&fessi&n"l. 4hen clients t"lk "%&ut "%"nd&n'ent issues "nd these "re issues 1hich '"y t&uch &n the $r&fessi&n"lBs $ers&n"l e*$erience, the $r&fessi&n"l '"y e*$erience intense feelings rel"ted t& the c&n/ers"ti&n. H&1e/er, $r&fessi&n"ls 1h& d& n&t h"/e " hist&ry &f tr"u'" "re n&t i''une t& e*$eriencing these sy'$t&'s since they '"y h"/e " less de/el&$ed $r&tecti/e res$&nse t& tr"u'" 1hich c&uld '"ke the' e/en '&re /ulner"%le t& re"cti&ns t& tr"u'"tic '"teri"l. ecommendations !or Coping *ith and +anaging Compassion &atigue Pr&fessi&n"ls 1&rking 1ith tr"u'" /icti's need t& tend t& their &1n self-c"re. >hey sh&uld e*"'ine 1ithin the'sel/es "ny unres&l/ed tr"u'" issues &f their &1n. ;t is "ls& critic"l th"t they de/el&$ "n underst"nding &f the ch"r"cteristics &f their client $&$ul"ti&n. Kicti's &f tr"u'" "nd "%"nd&n'ent "re &ften sl&1 t& trust "nd resist"nt t& tre"t'ent. >he $erce$ti&ns &f clients e*$&sed t& se/ere &r re$e"ted tr"u'" '"y %e t"inted in " '"nner th"t c"n dist&rt re"lity in " 1"y th"t e/en the hel$ing $r&fessi&n"ls c"n %e /ie1ed %y clients "s "%usi/e. Pr&fessi&n"ls sh&uld "ls& %e "lert t& the sy'$t&'s &f c&'$"ssi&n f"tigue. >hey need t& %e "1"re &f their feelings "nd '&&d st"tes "nd rec&gni2e 1hen "dditi&n"l su$$&rt &r relief '"y %e needed. Su$$&rt c"n c&'e in the f&r' &f t"lking t& fell&1 $r&fessi&n"ls "s 1ell "s l&&king f&r suggesti&ns, "d/ice, "nd6&r c&nsult"ti&ns fr&' their $r&fessi&n"l te"'. 4&rking in is&l"ti&n tends t& incre"se the risks &f such sy'$t&'s "nd is c&ntr"indic"ted 1hen 1&rking 1ith this $&$ul"ti&n. Pr&fessi&n"ls sh&uld "ls& set re"listic g&"ls "nd %&und"ries in their 1&rk. Additi&n"l tr"ining "nd educ"ti&n c"n %e &%t"ined t& re'"in current &n the e/&l/ing liter"ture rel"ted t& underst"nding "nd tre"ting tr"u'". Such $r&fessi&n"l de/el&$'ent c"n "ls& sti'ul"te ne1 ide"s "nd interests in their $r&fessi&n"l gr&1th.