In a clinical context, such as psychotherapy with trauma survivors, the importance of training and supervision cannot be overstated. Extensive and regulated training equips clinicians with the necessary skills and competencies to navigate the complexities and potential risks associated with working with trauma. Supervision plays a pivotal role in this process, providing ongoing support, guidance, and a space for reflection and consultation.
Researchers who engage with vulnerable populations where trauma is likely to be present must also recognise the crucial need for support, skills, and competencies. Understanding the potential impact of trauma on participants and the complexities of trauma-informed research is vital. This entails accessing appropriate resources, seeking relevant training and supervision, and cultivating a supportive network of colleagues who can offer guidance and consultation.
While it is not news to most researchers, it is crucial to remember the well-established Dunning-Kruger effect (Kruger and Dunning, 1999). This cognitive bias highlights the tendency of individuals with limited knowledge or experience in a subject to overestimate their competence. In the context of trauma-informed research, it is important for researchers to be aware that they may be susceptible to overestimating their abilities and underestimating the inherent risks involved.
By embracing the principles of training, supervision, and being aware of the Dunning-Kruger effect, researchers can approach trauma-informed research with humility, openness, and a commitment to ongoing learning. This introduction to clinical skills has highlighted the importance of seeking sufficient support and resources when conducting research with vulnerable populations where trauma could be present. It is imperative to acknowledge that effective research requires continuous development of skills and expertise through practice and reflection.
Supervision and Skills Practice
In research where trauma might be present, it is crucial to prioritise the well-being of both participants and researchers. While it may not be common practice in research to have formal supervision, there is a compelling argument for the value and necessity of such support. Access to a supervisor who is a clinical psychologist or psychotherapist, aiding with preparation, risk assessment, and ongoing guidance, can significantly enhance the safety and ethical integrity of the research process.
In situations where formal supervision from a clinical psychologist or psychotherapist is limited, researchers can explore peer supervision as an alternative. Peer supervision involves seeking support from individuals with relevant expertise or experience in the field, and creating a network that offers guidance and support. While peer supervision does not replace the qualifications of a clinical professional, it can provide valuable opportunities for reflection, discussion, and feedback, helping to prevent vicarious trauma and ensuring that researchers feel adequately supported.
In addition to supervision, it is crucial for researchers to develop essential skills in negotiating consent, discussing limitations to confidentiality, recognising trauma responses, and interrupting trauma narratives before they become dysregulating for the participant or the researcher.
Negotiating Consent and Limits to Confidentiality
The importance of consent cannot be overstated, especially in research where trauma responses may arise. Given the imbalanced power dynamics and lack of control often experienced by trauma survivors, establishing an environment that empowers participants and upholds their autonomy is essential. Informed consent goes beyond a mere procedural requirement; it is the foundation of ethical practice.
As part of the consent process, it is crucial to provide participants with a clear explanation of the research and the limits of confidentiality in cases where risks for harm are disclosed. Additionally, seeking consent for the possibility of slowing down or pausing the session if the participant becomes distressed is vital to ensure their well-being.
An example for seeking consent to slow down or pause:
- Researcher: Before we begin, I’d like to go over some processes we have in place to ensure your comfort and well-being during the session. Is it okay if we talk about that briefly?
- Participant: Yes, that’s fine.
- Researcher: Thank you. Sometimes, when we discuss certain topics, it’s possible that it may bring up difficult feelings or memories. In those moments, I would like to slow down our conversation and potentially pause for a moment to ensure you are comfortable. Would that be alright with you?
- Participant: Yes, that’s ok.
- Researcher: Thank you. Please feel free to let me know if there are any specific topics you would prefer not to discuss. It’s always okay to choose not to answer questions if they cause any discomfort or stress.
- Participant: I appreciate that, thank you.
Critical Skill: Interrupting the Trauma Narrative
A common impulse among trauma survivors is the pursuit of justice through the sharing of their experiences, an innate drive towards restoring balance and gaining recognition. The act of retelling traumatic events can inadvertently lead to a re-experiencing of the trauma, significantly heightening distress for the participant and potentially posing a risk of vicarious trauma for the researcher.
Contrary to social norms and expectations around empathetic listening, one of the most critical clinical skills in trauma work is the ability to interrupt the trauma narrative. It’s a sensitive task that must be done with utmost respect and understanding, acknowledging the participant’s need to share while prioritising their psychological safety. It’s about delicately steering the dialogue away from the graphic or detailed recounting of the traumatic event. Hence consent to interrupt is an important step.
Given that trauma is an embodied experience, questions asking survivors to directly articulate their feelings can be unhelpful, potentially reinforcing the cycle of re-experiencing. Instead, the interruption needs to slow things down, helping the participant to re-anchor themselves in the present moment and reconnect with their surroundings.
An example of halting the trauma narrative:
- Participant: “It was just a regular day, you know, I was on my way to work. I remember I had just stopped at a red light and then… I heard this loud crash, and everything just… just…”
- Researcher: “May I pause you for a moment?”
- Participant: “Uh… sure, yeah.”
- Researcher: “I want to acknowledge the significance of this experience and express my gratitude for your willingness to share it. It’s important to keep in mind that recounting difficult events can be distressing. May I suggest taking a moment to focus on something else?”
Interrupting a participant too late in the process increases the risk of intensifying distress and eliciting a 5F response or dissociation. Despite the discomfort associated with interrupting someone, it is important to recognise that in the presence of a trauma history, it is better to intervene sooner rather than later.
Anchoring in the Present
Regrettably, it is an unfortunate reality in trauma therapy that clients find themselves unexpectedly outside their window of tolerance during sessions. Particularly in the initial stages of therapy, when rapport is still being established, attending sessions can be overwhelming for individuals with a trauma history. In these moments, it becomes crucial for the practitioner to steadfastly ground themselves in the present moment and assist the client in reconnecting with the here and now.
The most effective way to achieve this is through sensory input that activates the prefrontal cortex, the part of our brain responsible for information processing. Touch, sound, and smell can help to ground the participant in the present moment. It is essential to always prioritise obtaining consent before engaging in any sensory activities.
An example of anchoring in the present:
- Researcher: [continuing from the previous vignette] May I suggest taking a moment to focus on something else?
- Participant: Yes, please.
- Researcher: What is your favourite colour?
- Participant: Blue.
- Researcher: Could you find three blue objects in the room that you like and describe them to me?
In this vignette, the visual senses are engaged by surveying the room, aiding individuals in reorienting themselves to the present moment. Describing the objects activates the cognitive aspect of the brain, facilitating the participant’s return to their window of tolerance. This technique can be extended to other sensory phenomena, such as touch, smell, and taste, offering additional opportunities to ground individuals in the present and promote a sense of safety.
Post-Session Support for Participant and Researcher
Effective post-session support is crucial to ensure the well-being of both participants and researchers. Just as preparation with supervision is essential before engaging in the research process, planning for post-session support is equally vital.
For participants, it is important to establish a comprehensive plan that addresses their specific needs and circumstances. This may involve providing contact details of additional support resources, such as social workers or psychologists if they are available within the context of the study. By having access to appropriate support systems, participants can seek assistance and process any difficulties after a session, should they need it.
Similarly, researchers must also have a support system in place to process their encounters in a safe and regulated manner. Supervision plays a crucial role in this regard, providing a space for researchers to reflect, debrief, and address any personal reactions or potential vicarious trauma that may arise from engaging with traumatic data. Seeking guidance from a supervisor or participating in peer support sessions can help mitigate the risk of unintended consequences and ensure the well-being of the researcher.
By prioritising post-session support for participants and researchers, the research process can be conducted with greater sensitivity and care, acknowledging the potential impact of exposure to trauma and promoting the long-term well-being of all involved.