Trauma Informed Skills for Supervisors | Counselor Exam Preparation

This episode was pre-recorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through allCEUs. Register at allCEUs.com/counselor-toolbox.

I'd like to welcome everybody to today's presentation on trauma-informed skills for supervision. I am your host, Dr. Dawn Elise Snipes. Normally, when we talk about trauma-informed anything, we're talking about trauma-informed care for clients. It's important to remember, though, that we as humans have probably experienced trauma, and our environment can trigger trauma in us as clinicians, as just people. And we want to look at how that trauma actually affects not only our clients but also our staff, and what that might do to the dynamic in our organization or in our home, for that matter.

We're going to define trauma real briefly, explore the effects of trauma on HPA axis dysregulation. For those of you who haven't heard it before, I'm going to zip through it real fast. Identify problematic employee behaviors and explore how they might relate to prior traumas. Discuss sources of trauma or trauma reenactment in the workplace. Explain briefly what a trauma-organized system is and how trauma contributes to employees' stress, behavioral issues, and turnover. Finally, we're going to identify at least ten common workplace stressors and bad habits and how trauma-informed processes are at work and need to be addressed not only in clients but also in staff. So, we've got a lot to cover.

Trauma is not just your PTSD criteria stuff that goes on. Trauma results when someone is exposed to an event, a series of events, or set of circumstances which is experienced as physically or emotionally harmful and has lasting adverse effects on the individual's functioning mentally, physically, socially, emotionally, or spiritually. Not all traumas are going to have long-lasting negative adverse effects. Additionally, even if they do have lasting adverse effects on somebody, it doesn't mean that they are not addressable. It means that those adverse effects are happening, and that's a clue that we may need to do something a little bit different or give this person some new tools. It's not hopeless, is my point here.

61% of men and 51% of women report exposure to at least one trauma. That statistic surprised me. I expected it to be the opposite way. But 90% of clients in a public behavioral healthcare setting have experienced trauma, and that's according to the Substance Abuse and Mental Health Services Administration. Unresolved trauma or triggered traumatic events will impact the way a person reacts and responds to situations. For example, if you were attacked in the parking lot going to your car one night, and you know that was a traumatic event, then going to your car at night in a parking garage or wherever it was that is similar to that event will be often more stressful for you than it is for somebody who hadn't had that prior experience. It shapes who you are. It shapes trauma, and our experiences shape what things, what situations, what events we perceive as potentially dangerous. It doesn't again mean that we can't function in them, but it does mean that we may react differently to situations like loud noises than other people might.

Triggers of the basic fears, you know, when we are exposed to trauma, we are generally experiencing something that could mean death or harm to us, rejection, isolation, or failure, or loss of control, and the unknown. Most traumatic events involve some level of loss of control, which most humans really don't like. It could also mean death or harm, not necessarily, you know, physical death or or physical harm, but it could mean significant emotional trauma to that person. And we do want to recognize that what is traumatic to one person is different than what's traumatic to another person, partially based on their physiology, but also partially based on their their age, their experiences, how they process things. So we don't want to assume that any one thing is necessarily going to be traumatic for people, but we do need to be aware that any one thing could be traumatic to people.

When there's a threat, the HPA axis is triggered. And I told you I was going to run through this real fast. There are other videos on allCEUs.education that talk about the HPA axis, but for the purposes of this class, corticotropin-releasing hormone, corticotropin-releasing hormone, and ACTH are released when there's a threat. Then that causes the release of cortisol, norepinephrine, glutamate, and adrenaline. All of those are ramped up, turn up the fight-or-flight kind of chemicals that tell your body there's a threat, we need to fight or flee. Fight means we need energy. Blood glucose is released. Estrogen and testosterone levels are altered, not necessarily suppressed, but they are altered because now is not the time to procreate, now is the time to stay focused and survive. And serotonin levels are reduced. Serotonin is one of our modulating neurochemicals that that helps us calm down, that helps us feel a little less anxious in the right amounts. But during a threat, that's not the time to chill out. So serotonin is reduced.

When the brain perceives the threat is gone, the HPA axis returns to baseline, and all is clear, no problem. Unfortunately, for people who have experienced trauma, sometimes they never perceive the threat to be gone. They remain in that state of hypervigilance and feeling unsafe. Continued activation of the HPA axis, yeah, so when they're in that persistent state of feeling unsafe, can lead to poor sleep, and that can lead to people being more stressed, less alert, difficulty concentrating due to adenosine buildup. When we don't get good sleep, then we have more difficulty concentrating, we're more tired, and we're more likely to make mistakes. The use of stimulants to compensate for fatigue. Stimulants themselves are yet another stressor on the body, and it's going to potentially exacerbate the other symptoms and make people even more prone to make mistakes and have more difficulty concentrating. There's increased inflammation, muscle tension, and pain. Again, those things in and of themselves are stressors that are going to activate the HPA axis, but they also inhibit good sleep, which we've already identified as a problem, and may contribute to eventually the development of depressive symptoms.

I want you to think about people that you work with. You know, we're talking about supervision here, and how the environment in which you work, because we hear a lot of bad stuff sometimes in our sessions and we're exposed to a lot of secondary trauma, how do those things build up or affect the staff, people that you work with, and start creating some of these symptoms that we're talking about? Exacerbation of autoimmune issues. And this is a stressor. When we have increased inflammation, then the body's going to try to fight that, and it can lead to autoimmune issues, which can also lead to increased absenteeism. Seeing this in our workforce, we see people as they get progressively distressed by secondary trauma, making more mistakes, becoming more depressed or irritable, being absent more often. If not absent physically, absent psychologically. They have difficulty connecting, forming rapport, and really being at work when they're at work. We also see hippocampal shrinkage, and that's not one of those things that you're necessarily going to, you know, obviously see because that's on the inside of their head. But the hippocampus plays important roles in the consolidation of information from short-term memory to long-term memory. What is that going to look like on the outside? That's going to look like an employee who is having difficulty remembering things, having difficulty remembering what clients said. They get out of session, they're getting ready to write their notes, they're like, I have no idea what we just talked about. That's not a good thing.

We do need to make sure that we are addressing trauma in our staff. Behavioral symptoms of HPA axis dysfunction: irritability, impaired sleep, hypervigilance, difficulty problem-solving resulting in either inflexibility – this is the way it's supposed to be, this is, you know, we're supposed to do group right now, and this is the way it's got to be – or helplessness, and just kind of being resigned like, senior management doesn't care, nothing I do matters, why should I even bother writing my notes? Those are the types of behaviors we might start seeing. Difficulty concentrating, poor memory, and increased absenteeism. So, we already talked about most of those.

How do these behaviors in an employee impact clients, though? If you've got an employee, and maybe maybe the trauma's not even from your workplace, it's not secondary trauma, it's trauma from their past that's being re-triggered. They were raped when, you know, years ago, and they are working with people who have been raped now. You know, maybe that's re-triggering some stuff for them and creating these, this HPA axis activation and these symptoms. So, how does that impact their work with clients? How does that impact their ability to connect, but also their ability to set emotional boundaries and not get caught up in other people's trauma? And how does it impact how they interact with other staff? Supervising for, for many years, you know, obviously, and being a team member for many years before that, when one member of your staff or more are irritable and sleep-deprived and not concentrating and not getting done what they need to get done, it has a negative impact on the rest of the staff. It's important to recognize that because then when the staff starts to get irritable and frustrated and, you know, all that other stuff, then that is reflected to the clients, and then the clients start feeling unsafe, and it creates this negative downward spiral.

Compared to adults, people who experience trauma before the age of 24 tend to demonstrate greater alterations in brain structure and HPA axis reactivity because that prefrontal cortex is not fully developed yet. Unresolved trauma from the past can contribute to persistent hypervigilance. It's not uncommon for people, especially people in the helping professions, but just not uncommon for people to have experienced trauma in their past which has, you know, they've dealt with it to a certain extent, but there's a certain part of them that is still a little bit hypervigilant, and they don't recognize that that's still an issue. But you may start to see it in the organizational environment. Exposure to trauma triggers can activate the HPA axis: sights, smells, sounds, situations. You know, maybe they thought they were doing fine and everything was hunky-dory, and then they had to accompany a client to court, and it just brought back all that stuff from their past, and they're like, whoa, I didn't expect that. It's important for them to be aware and know what their resources are. As supervisors, we are not their counselors, but it is important for us to make sure they understand how their past is impacting them in the present and their work with the clients, and empowering them to get help if needed in order to make sure that everybody stays healthy and happy.

Exposure to threats from the organization, staff, clients, or secondary trauma in the workplace can lead to gradual onset PTSD. When I worked at the crisis center, and many, many years ago, you know, that was a very stressful position to have, you know, phone, phone crisis counseling. And initially, it wasn't so bad, but over time, you know, not knowing when that call was going to come in, and at this particular crisis center, sometimes you'd have three calls going at once, and you were there all by yourself. It could get very overwhelming and feel very threatening because you felt responsible in some ways for what was going on. And, you know, if you were juggling different calls, you could feel like you weren't giving the clients what they deserved, and, you know, in general, you weren't, but you were doing the best you could. And it caused a lot of stress. And I got to the point where just the sound of the phone ringing, that that particular ring sound that those phones had, when I would hear them, I would tense up. And, you know, was that at that point I knew that, you know, what, I probably need to back off from this for a while.

Sources of workplace trauma. I want you to think about your organization. How is your organization like a family? Because a lot of trauma occurs in family situations. So for staff, in what ways is your organization like a family? Maybe there's somebody on your staff who has attachment issues with their with their parents, so they are constantly seeking approval of their supervisor. You know, they, they're transferring that into their work family, so to speak. Maybe they have some transference reactions with other staff members that remind them of their the position of their big brother, their big sister, whomever. Thinking about how the staff represents a family, and, you know, in some cases, the staff does become a family. If you work at a place for long enough, you do feel a certain kinship with your colleagues.

How is your organization like a family for clients? And when clients go there, a lot of our clients have not had wonderful family relations. That's not true with all of them, by any means, but sometimes they come in and they are seeking a place to feel safe. They are seeking a place to get unconditional positive regard. They are seeking a place to learn how to develop healthy attachment, all those things that we do in healthy familial relationships. And among each other, especially if it's group or IOP or residential, clients will almost invariably start developing an analogous family within the treatment unit. You'll see different dynamics come out, and you can draw parallels between their family of origin. Thinking about who is the analogous caregiver at your organization? If you're in that going, going to work, who would you think of as the parental unit? Who would you think of as your your siblings and your equals and your uncles? And, you know, the organization that I worked at many years ago, we had lots of different departments, and the directors and the different departments were kind of like aunts and uncles. And, you know, my staff were kind of like siblings or whatever, if you want to do a familial chart that way. For clients, who is the analogous caregiver? And usually this is going to be the primary clinician. And if the primary clinician is too, for the client, in their own stuff, to be emotionally or physically available, how is that mirroring what may have happened to them with their with their biological caregivers? What does that say to them in terms of their worth and all that kind of stuff?

How can things at the organization trigger prior traumas for staff? Well, and for clients, and this one's kind of both in the same. We've all experienced stuff in our life, some good, some bad. Thinking about, and we're going to talk about those characteristics in a minute, thinking about the things that trigger our sense of unsafeness, and that's not a word, but we're going to use it today. What things at the organization might trigger a sense of unsafeness? One of the frustrations I have in a lot of provider facilities, I'm choosing my words carefully around here in Middle Tennessee, is when you walk into them, the music that they are playing is exclusively Christian. And well, you know, I'm Catholic, I have no problem with it. It can feel triggering for people who may have had a bad experience with the church, or who may be of a different religion, or who may be atheist, or or whatever. That always bothers me from a culturally responsive perspective. We want to recognize, what do clients feel? Do they feel accepted and welcomed the minute they walk into the door? Do they see things around that are representative of their beliefs and their culture? If yes, great. If no, might need to take a look at it, because that's the first impression when they walk into somewhere is, am I going to be acceptable here?

For each of the following, think about examples of that type of trauma in client and staff's personal lives, as well as at your workplace. And we're just going to go through this really quickly, but it's something that you can ponder later to really think about. Sources of trauma that your staff or your colleagues, if you're not a supervisor, might have experienced: emotional, physical, sexual neglect, abuse, or victimization, include domestic violence. You know, that kind of hits most of the adverse childhood experiences right there. But, you know, how has I had those things impacted people on your staff? And most of them are probably not going to come out and say, yeah, I am a survivor of childhood abuse or whatever. They're not going to be sharing that just with their office mate or even with their supervisor. But if we run the numbers, we can hypothesize that probably one out of every two people that you work with, on the low end, has experienced some sort of traumatic event in their life. We're not sure what, what it is, but it's important to be aware. And it's important to be aware in your area what the most prevalent types of trauma are. Is that gun violence? Is it rape? Is it, you know, whatever it is, domestic violence, child abuse? How prevalent is that in your area? The Child Advocacy Center is a great source of data for what's going on with children. Your victim advocates, which are usually at either the sheriff's department or the State Attorney's Office, are also usually good resources to find out about the prevalence of different types of trauma in your area.

Having a caregiver with substance abuse or mental health issues is also traumatic. And we talked about that in the presentation on ACEs because that caregiver is unable to form a healthy attachment, so people's love maps get messed up. And from early on, disappearance or abandonment of a loved one. You know, especially the children, younger children, if one of their caregivers is in jail for eight months, 18 months, five years, whatever, that's a long time. You know, they're 18 months old when their caregiver goes to jail for 18 months, and, you know, their life doubles in the amount of time between when the person goes away and the person gets out. That's that's a long time. When you think proportionally, what does that mean to the child? A lot of children can't understand, you know, why did Mommy have to die? Why did Mommy have to go to jail? You know, why did this happen? Why and why did the divorce happen? And, you know, I'm with this parent, does this parent not like me? What's going on there? There's a lot of trauma that can be involved in those things. Violent events in the community, natural disasters, are fire, war, and combat issues, and medical trauma are also other sources of trauma. Medical trauma is pretty broad, but a lot of times it involves something medical, something physical that's traumatic, and it can include things like, you know, heart attacks, or getting MRSA when you're in the hospital, or a variety of different things. Premature labor is another medical trauma.

What are some problematic staff behaviors and how might they relate to prior trauma or learning? So, we're going to go through a couple of them here. Avoidance or quitting instead of addressing issues. I'm seeing it more and more right now, unfortunately, in in staff that instead of figuring out what's wrong and how to fix it, as soon as the going gets tough, they hit the bricks. Could this be because of prior learned learning? Yes. You know, they could think that there's something else better out there, FOMO, whatever. But it also could be that they had adversarial relationships in some way. Maybe they were abused or neglected by authority figures in their past, so they're afraid to engage with current authority figures, and instead of engaging with that threat, they retreat.

Failure to do paperwork or tasks could be due to exhaustion, hypercortisolism, or apathy, lack of knowledge, and fear of judgment for asking for help. When we are persistently hypervigilant, when trauma is being activated, when we feel unsafe, we can get exhausted, which can make it even harder. And, you know, sometimes we call it burnout, but it can make it harder to get our daily work done. Insubordination. We've probably all seen it. In what way could this be caused by trauma? It could be a transference. It could just be poor social skills. You know, I'm not saying that all of these are definitely caused by trauma. I don't want you to think that, but I do want you to consider the possibility that they could be. So, insubordination could be a transference reaction. Maybe they see this authority figure as reflective, or they have that transference reaction from someone who was abusive to them in the past, or hurt them in the past in some way. So now that they're bigger, they're being insubordinate, they're taking their power back. And prior learning, if they learned that being insubordinate gets them their way, then they may do that.

Overly aggressive client monitoring could be due to fear of losing control. They're afraid that if something goes wrong, that they are going to be blamed, be rejected, be fired, you know, whatever. And and that could, think about a child who grew up in a household where a parent had a substance abuse issue or a severe mental health issue, and they had to help take care of their siblings. And then they come to work, you know, they grow up and they start this job, and they are one of the parts of their job is milieu monitoring, and they are again taking care of a group of people. It's a recapitulation of that prior scenario, which could trigger some of those feelings and fears that they had when they were younger.

Let's talk for a minute about trauma-organized systems. In a trauma-organized system, multiple people with diverse histories have come together to create an organization. Hey, okay, doesn't mean it's trauma-organized yet. But in an organization, you've got multiple people. Organizations are live, functioning, interconnected systems. Like people, think about organizations. Every person in an organization is a different body part. You know, some are fingers, some are noses, whatever. Let's look at the similarity. And you can learn more about this in Sandra L. Bloom's book on Restoring Sanctuary. Love that book. Anyhow, in an individual trauma response, an individual experiences trauma, their nervous system identifies a threat, says, "Crap, turn on the HPA axis, we need to fight or flee." They experience hypervigilance and fatigue. You know, they're trying to fight this, this threat, which can, if it goes unchecked, lead to hypercortisolism and emotional dysregulation, depression, apathy, and all those other symptoms that we talked about. All right, so that's the individual. We already went over that.

In an organization, how can we see a similar paradigm? Staff identifies a threat. So we don't have a nervous system, we have the staff who's nervous. That triggers their HPA axis, and they're like, "Crap, you know, things are going bad. I see all of senior management going over to the to the main office too frequently. That means something bad's fixing to happen. I don't know." So their HPA axis goes off. They spread the message to the team. So now they're spreading, you know, they're releasing that cortisol to everybody. The team unites to fight, flee, or freeze. You start seeing people figure out, okay, how are we going to protect our own backs? The team becomes focused on threat elimination, not service provision, and you see reduced productivity and more errors.

I worked in an organization that was a non-profit, largely funded by state and federal dollars. Every year, when it came time for funding, there was a certain amount of anxiety that rose. And that so that was the trigger. And then we would all start watching for how frantically our senior management was running around. And there became a lot of talking and gossiping. You know, this was before Twitter, but we were twittering to each other without Twitter. And a lot of misinformation often got passed. But we were uniting to fight or flee. We were trying to protect each other from getting surprised. We were trying to figure out what was going on because there wasn't a whole lot of transparent communication. And during that time, a lot of people would regularly start looking for other jobs. They'd be at work looking for other jobs instead of doing their notes or paying attention to what they were supposed to be doing.

Parallel processes exist when individuals, groups, or organizations have significant relationships and tend to mirror each other, like clients and staff, or team members, different departments, like case management and counseling, or courts and social service workers. Defenses like scapegoating, denial, coercion, and conflict avoidance begin to dominate the environment and use energy which we could use for treating clients. We're so worried about who's in power and watching our own back, we're forgetting to focus forward on the client that's in front of us. This leads to a state of chronic hyperarousal and lack of a sense of safety, causing hypervigilance and the perception of a threat instead of opportunity, the perception of pathology rather than strength, and risk rather than reward.

We want to help staff members see their daily activities. You know, maybe their department gets 86'd because funding got cut. That is problematic. That's, you know, that stinks. But they get transferred. So instead of seeing it as a threat, it's an opportunity to learn how to run a different program. Instead of seeing it as a problem, see it as a strength that they get to develop new skills. And instead of seeing it as a risk, see it as a reward that the organization as a whole or their supervisor was determined to, you know, have their backs. It showed was some support there. And I greatly respect my old supervisor for always doing the best he could to do that. He would juggle and shuffle. You know, he called his widgets, but he would move his widgets around in order to do his best to ensure that everybody maintained their job, even when there were significant state or federal level funding cuts. And that helped our organization have less chronic hyperarousal, at least around job security.

Think of a time when these systems have mirrored each other and used offenses like scapegoating, denial, coercion, conflict avoidance, causing a state of chronic hyperarousal and threat. Clients and staff. And one example would be is if the unit is short-staffed, staff is irritable, they get irritable with clients for not doing exactly what they're supposed to do or whatever. Then the clients generally respond in kind and get irritable right back. We can see these things mirror each other. If staff is stressed out, clients are generally stressed. If staff is emotionally disengaged, a lot of times clients are going to have more difficulty emotionally engaging. Even, you know, think about the therapy room. If you're having a day where you're having difficulty with rapport and connecting, or maybe with a particular client, you know, your difficulty connecting is probably mirrored by that client's difficulty connecting with you. Team members. If staff is overworked and begin bad, begin to blame each other for a client leaving against medical advice. Obviously, I spent most of my time in residential settings, so these are more residential type examples. But we do see a lot of the blame game going on and scapegoating. If you would have been more alert to this, that, or the other, we could have intervened, yada, yada. Departments. I gave the example of case management and counseling before, and that was those were two of the departments. If they lack communication, they may not get tasks done. Counseling thinks they're overwhelmed, and case management, and case management isn't doing anything. Case management thinks that counseling is not doing anything, and they're overwhelmed. They're parallel processes. Instead of being able to step be empathetic, they are mirroring each other. And courts and social service workers. Clients in dependency drug court were was a group that I worked with a lot. But the courts would often get frustrated with the clients, and the social service workers, sort of who represented the clients, basically, would often get frustrated with the courts. And that frustration would go back and forth, feeling like each other was trying to sabotage the other one.

Fear conditioning is another issue that causes trauma in the workplace. When people are exposed to a threat and directly or indirectly experience negative consequences, the takeaway message is the same thing that you get in addicted families: don't talk, don't trust, don't feel. And if you say or do anything, it'll probably be worse for you in the long run, so just shut up and keep your head down. The communicated message, more nicely said, is, "It's not safe here. You are just a number, and you can be replaced." When somebody's directly exposed to something that had negative consequences, it can cause this. Such as they got fired for not maintaining their billable hours. So now they fudge the time on their notes to make sure they're making billables. Not okay. But it could be the result of prior experiences. Now, was it traumatic to get fired? Yes. Are there other ways to approach it? Maybe. But this is where fear conditioning comes in. And I'm not necessarily saying this is trauma, but I do want to have you recognize how people in your organization may behave in response to fear of repercussions. They filed a restraining order and trusted the system to protect them, and it failed to work. So now they're afraid to trust the system. And as clinicians, in many cases, we are part of the system, especially if you're in community mental health. They confided in an authority figure and had confidence broken. That can lead them to not want to confide in you again.

Indirect conditioning. If you see a peer get demoted for insubordination because they went to City Council, so now staff won't stand up for what they believe to be right. Okay, in that particular instance, you can dissect that and go, "What's going to City Council and running your mouth the best way to handle that situation? How else would have been a better way to stand up for what you believe to be right in in this situation?" So there are lessons to be learned from things that happen. If something had a negative consequence, you know, obviously it probably shouldn't happen again. What else could you do differently to try to achieve the same goal? Somebody got fired for something petty by an unquote unreasonable boss. Now everyone hides when the boss is around. We've probably all worked in those situations. A staff member got put on administrative leave after a client complained. Now staff is afraid to enforce the rules. I know, oh my gosh, I can't tell you how many of those I had to deal with over the years, and it was frustrating, and I felt bad for having to put the staff on administrative leave if I didn't know, if I didn't believe that the the complaint was true, but I had to do it. And the fear conditioning was there for all for all to see that if you don't comply with certain clients, they know how to work the system to get you put on leave. And it was important too, encourage staff to still do what they needed to do, document it, but do it in a way that was safe for everybody involved. For example, if you have to initiate consequences with a client, bring another staff member so you have, you know, a witness to what's going on. Or, you know, there are ways to protect yourself if there are unpleasantries that have to be done.

Thinking about how prior experiences influence future experiences. Jane is a survivor of domestic violence, and she works for you. How might that impact the way that she interacts with authority figures at your organization, especially authority figures of the same, you know, gender and age-ish as the person who was abusive to her or is abusive to her? How will she interact or how would that affect how she interacts to clients similar to her? Will it increase her level of empathy? Will it increase her level of judgmentalism? How does it? It depends on the person, but we do want to look at her behavior from a trauma-informed lens. How is her experience impacting her interaction with this particular client? How does being a survivor of domestic violence affect how she interacts on a daily basis? Sight, smell, sound, situation with people in your organization? Maybe they're her abuser, or a particular type of cologne, and when she's, if she smells that, how does that impact how she acts and reacts, not only in that moment, but for the rest of the day?

Tom is a 16-year-old runaway whose parents were neglectful and both addicted to substances. Now he works in a substance abuse treatment facility. You know, he was drawn to that career. How does that impact his the way he interacts with authority figures? With anyone who might be a transference for his parents? And anybody who might remind him, maybe he's working with people who are addicted to drugs and alcohol, and also parents. How does that impact what is his attitude towards them? And how does that impact how he works with them as opposed to somebody else?

Staff and groups are all impacted by individual and collective exposure to trauma. Sally experienced trauma as a child when she was put into foster care. She now works in a counseling center and identifies greatly with the children who are in or at risk for foster care and feels very angry towards the case caregivers involved. How does Sally's past impact her relationships with her colleagues? And you thought I was going to say with her clients. Let's talk about her colleagues first. Some of her colleagues may have a lot of compassion for the parents who were neglectful and struggling and couldn't seem to make ends meet. How, how do you think that her past impacts her relationship with them? How does it impact her relationship with DCF workers? If she resents being put into foster care, how does she feel towards Department of Children and Families now? How does it impact how she interacts with adult clients who are in the system now? You know, the the parents who are now, you know, in the system seeking counseling, required to get counseling because their children have been taken away. How is the whole system impacted by Sally? You know, what impact does she have on the organization, on the clients, on the sense of welcomingness, acceptance that people experience when they come into your organization? And how does the whole system, DCF, the organization, the foster care system, all that, how does that impact Sally today?

Bad habits that contribute to trauma. Gossiping. Is it something that's going to necessarily cause trauma? Not necessarily, but gossiping talks about things that are bad and makes people feel unsafe. You don't know when people are going to be talking behind your back. It also can cause recapitulation of other trauma. If somebody keeps talking about, you know, what happened to Jane, then it can contribute to trauma and a sense of a lack of acceptance and safety. Playing favorites. When a supervisor plays favorites, that can be a recapitulation of childhood trauma for people, but it also can just create a bad sense of organization and cohesion in that team. Openly disciplining staff or clients, causing them humiliation. There is a time and a place for correction, and openly disciplining them in the middle of a staff meeting is probably not it, or in the hallway, probably not it. And it's important to remember that part of creating a trauma-informed supervision is making sure that people feel safe and they're not afraid to see you because they're afraid you're going to humiliate them.

Poor communication contributes to stress. If we don't know what's going to happen, then that's the unknown. And if we have a history of trauma, then the unknown can be very scary to us. Or too much communication and catastrophizing. When there's hypothesizing six months out that budgets are going to get cut and jobs are going to get lost and threats are being made, you know, if you guys don't get your billables up, there's, you know, yada, yada, yada, we've all heard it. That can also cause a lot of people to feel unsafe in their environment. And if they worry that they're going to lose their job, then it's hard to be invested in their job. And if they're not invested in their job, then they're not invested in their clients, and clients are getting poor quality care. It also means they're probably invested in trying to find another job, so they're often not effectively using organizational resources.

Failing to debrief. This is a big one that contributes to trauma. A lot of times as clinicians, we kind of lock it down. We have a session with somebody, and you know, it was an intense, heavy session, okay, you know, and we take it, we pack it up, maybe we write our note and, you know, put it away. That doesn't necessarily mean that we have dealt with its impact on us. It's important that we debrief. Not necessarily, and I'm not necessarily talking about a huge organizational crisis. I'm just talking about a heavy session, or if a client acts out, or, you know, worse, a client tries to commit suicide or leaves AMA. It's important for everybody on the team, if the team is involved, for everybody to have an opportunity to debrief. Debriefing allows people the opportunity to look at retrospectively what happened, what we missed, what we could have done differently, and how we can prevent it in the future. So it takes the person from a place or the team from a place of feeling powerless to a position of feeling empowered to prevent it from happening again. We want to focus on the strengths. We can look at, you know, what mistakes were made, and they happen, and how can we improve in the future? That's one of the greatest challenges that risk management departments have is communicating that message. Assuming they believe it, that it's more important to tell us what you did and be honest about it so we can prevent problems in the future instead of worrying about demotion. And that's a big thing with sentinel, in sentinel incidents, if people are afraid that they are going to be reprimanded or worse for making mistakes, they're often going to hide them. If people know that the organization is aware that we're all human and we all screw up sometimes, they're more likely to be honest about what happened so it can be intervened early.

A focus on the negative and ignoring the positive is, you know, that's a bad habit that sometimes we do in our personal lives, but it can also be problematic in the office. If you're having a team meeting and the team meeting focuses on the lack of completion of billable hours, the lack of completion of paperwork, the problems that for the grievances that got filed, for the dis, for the bat, for the other thing, and that's the whole staff meeting, people walk out of there and they just feel battered. It's important that we make people, we create an environment that focuses on strengths. If we're getting a lot of grievances, you know, sometimes it happens, we need to look at what's going on that's creating those grievances instead of saying these need to disappear. We need to say, "What can we do differently to support you so whatever's causing these grievances doesn't need to happen? How can we help you? What can we do?" Instead of, "How can I punish you?" But we also want to focus on the positive. Who completed treatment successfully? Who has, you know, made their billable hours? Who had the most awesome notes in progress note that you read that week? Whatever it is. We used to do chart audits, and there was a rubric we used, and whoever got the highest scoring chart audit would, you know, get to choose what kind of snack food we had during our during our team meeting. Little things like that.

Insufficient training, which throwing people into the deep end is what my my boss used to say, you know, "Just go in and do it, and you'll figure out how to swim." I'm like, "Really?" That can be stressful and it can contribute to staff wanting to leave because they're not sure what to do, they feel powerless, they feel out of control, they feel a lack of guidance, and they're afraid that if they don't do it right, they're gonna get fired. When people are trying to figure out how to swim, to use that analogy, they're using all their energy trying to figure out how to get their head above water. They're not worried about the client, they're not worried about those other things, which contributes to staff exhaustion and turnover, like I said, but it also contributes to poor client services. We want to make sure that staff feel comfortable doing what they're doing. I'm a huge fan of manuals. I love standard operating procedures. It makes me feel safe. Not everybody is like I am, but even if you just have a skeleton guide, go by guide for each position in your organization, that can help people feel a little less uneasy.

Insufficient supervision is another bad habit. A lot of things come up, and we have questions, and it could be administrative, it could be clinical, and it's not just for people who haven't gotten licensed yet. We need to make sure that there is open communication. It doesn't necessarily even need to be supervisor-supervision. You can have peer supervision where staff gets together once a week or once a month, and they talk about the cases and the challenges and the frustrations that they may be experiencing. And then one person from each group brings it to the team supervisor, and then we try to figure out how to brainstorm and and address those issues.

And scapegoating or blaming also contributes to trauma. One place that I worked, there was one particular staff person who just loved to throw every other department under the bus, and it was almost a game at a certain point during our monthly staff meeting, which department she was going to throw under the bus because we knew it was going to happen. It wasn't even shocking anymore. And instead of, you know, trying to focus on, "All right, what went wrong? What do we need to do to make this go right?" It was, "You know, these people screwed up, these people screwed up, these people screwed up. I don't know what to do about it." And that wasn't helpful in the organization because it left a lot of people feeling unsupported.

Thinking about clients, are not clients, but staff members, and five problematic behaviors and what they might be communicating. If they fail to do their paperwork or run groups, this was a common problem in residential. What might that be saying to me as a supervisor? What are they trying to communicate to me? "I'm overwhelmed. I don't have good time management skills. My caseload is too heavy. I don't know how to run these groups or do this paperwork." You'd be surprised how many clinicians I worked with that just could not wrap their head around writing a treatment plan, so they didn't do it. And I'm like, "Well, that's not an option." What is the person trying to say? Or maybe it's just passive resistance. Maybe they're not happy with the the shift that they're on or the caseload that they have, so they decided, "Well, whatever, you know, I will just half-ass everything."

Tardiness could be avoidance of stress. They, they don't want to get there. They know as soon as they get there, you know, it's going to hit the fan. And so they get there at the last possible minute, which often ends up making them tardy. It could be again, passive resistance. They don't like what's going on, so they figure, "Well, I'll get there when when I get there, and the organization will be grateful, thank you very much." Or it could just be poor time management. And this is up to supervisors to again, examine the function and the communication of the behavior. If the staff person is yelling a lot or irritable a lot with each other, with clients, what's going on? Maybe they have inadequate communication skills. I had one supervisee who was amazing, absolutely amazing with her clients, and they loved her. She did great work there, you know, fabulous work. But with her peers, it was a much different story, and she had a lot of frustration with pretty much every single one of her peers and at the organization. Trying to figure out what that behavior was about. Sometimes clients or staff members, I'm sorry, will get irritable with other staff members or with clients because they don't understand the clients' presenting issues and the meaning of their behavior. We had clients who would sometimes just barge into our offices and start talking. It's like, "Okay, where did that come from? That's kind of disrespectful. What does that mean?" And for a lot of these clients, we started understanding that for some of them, they were starting on a manic episode, some ADHD, some just had no social skills because they'd never been taught. It was individualized based on the client, but it was important to start recognizing that clients are generally not trying to be disrespectful. So what else might they be communicating by their lack of respect of your boundaries? People can yell and be irritable when they get overwhelmed, or they could be trying to regain power as a traumatic reenactment. Something is going wonky, and it reminds them of a time when they were powerless in the past, and they, you know, start taking that fight stance in order to get things back under control.

Failing to maintain professional boundaries could be due to transference, reenactment, or transference of a family of origin, or needing approval of clients and fear of negative feedback. Sometimes clinicians, and I've seen it, will not maintain those boundaries. They will get a little too chummy with clients, especially in residential, because they don't want to get negative feedback, they don't want to get complaints piled on them. And clients know this. And when the environment, when the administrative environment is not supportive or not.

Communicating that they're supportive of you know toeing the line and setting boundaries, then people can start to feel a little bit uneasy because they're afraid that if they get a grievance filed on them, they will get it'll go into their file and yada yada yada.

Mitigating trauma. How can we help staff prepare for trauma and mitigate it? Well, educate them about trauma. You would think that we all got plenty of trauma education in graduate school. We didn't. At least most people didn't. It's important to educate staff, and this includes not line staff, milieu monitoring staff, PRN staff, desk front desk staff, administrative staff about trauma, how prior trauma can impact people in the present, and what might trigger what's going on with them. Because a lot of times, especially reception staff, may be on the receiving end of a very agitated client because something triggered their prior trauma, and we want to help staff understand what's going on. Likewise, if a client gets irritable, maybe the doctors run in 30 minutes late and starts to get loud, it could trigger a trauma response in the reception staff, and we want them to understand those dynamics and be able to be mindful and present focused and prepared for how to deal with it.

We want to educate them about sources of potential threat or trauma in social services. You know, be aware this may happen. It probably won't happen a lot, but it could happen. So let's talk about it. Let's plan for it so it's not scary when it happens and move on. Strategies to cope with threat or trauma. When you feel traumatized, you know, when you feel threatened, you know, what is your plan? How do you handle these different situations? And if you feel traumatized afterwards, you know, there's lasting effects. You keep thinking about it. Can't get it out of your head. What do you do? What are the processes? The impact of stressed-out staff on the milieu, so they understand why it's important to take care of themselves. We want to help staff increase mindful awareness, develop resiliency and hardiness skills, use collaborative creative problem-solving skills. We want to mitigate and effectively manage caseloads so one person doesn't get all the quote hard cases and use regular debriefings for clients who leave against medical advice, clients who just simply act out, and/or even if a staff member leaves suddenly. You know, if we see our organization as sort of a second family, then that can feel very traumatizing. It can feel very much like abandonment or if a staff member dies. Had that happened to.

Trauma is always stressful. Exposure to repeated trauma can contribute to compassion fatigue and burnout. Hearing about people's trauma can cause secondary traumatization and trigger personal trauma memories. Prior trauma impacts reactions to current events because a lot of times we react, we react in the present the way we reacted to protect ourself back then. Many people recreate a family of origin or in their workplace, which may perpetuate a trauma-organized system. When people are chronically exhausted, they tend to respond with emotional numbing and dysregulation, which impact rapport with clients and staff, their ability to be empathetic, and their motivation to get any work done. In a trauma-organized system, staff and off staff often blames the organization for causing their distress with a litany of if onlys. If only I had a little smaller caseload, if only this, if only I had this resource. When a system is trauma-organized, all of the staff act like the sympathetic nervous system and direct energy toward fighting or fleeing from the threat instead of focusing on clients.

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