A mixed methods approach investigating cognitive changes in vicarious trauma within trainees and qualified therapists

Background: Previous research has explored the impacts of empathically engaging with client trauma accounts on therapists. The majority of this has been quantitative, guided by measures of secondary traumatic stress symptoms or belief-disruptions consistent with Constructivist Self-Development Theory (CSDT). Results have been inconsistent and interpretation is affected by methodological shortcomings. There have also been differences in findings between qualitative and quantitative approaches. Whilst most quantitative measures focus on the negative impacts of trauma work, qualitative studies have revealed the presence of positive impacts; referred to as vicarious posttraumatic growth. A review of previous literature, addressing their methodological limitations, is presented.\ud \ud Aims: This study had four aims. The first was to explore the occurrence of the five belief areas, consistent with CSDT (trust, safety, esteem, control, intimacy), within qualitative evidence. The second was to measure implicit constructions of participants’ belief systems to determine whether they constructed themselves as more similar to a client struggling with trauma. The third was to triangulate qualitative findings with quantitative measures widely used in the vicarious trauma literature to determine whether there is consistency in results. The final aim (presented in the extended paper only) was to use an inductive analysis to explore any areas of importance in participant accounts that were not covered by CSDT.\ud \ud Methodology: Participants were 10 Trainee Clinical Psychologists and 10 Qualified Mental Health Professionals working for the National Health Service (Clinical Psychologists, Social worker, Psychiatrist & Psychiatric Nurse). They were recruited using purposive sampling from three Doctoral courses and two NHS trusts. Repertory grids were followed by semi-structured interviews exploring trauma work experiences. Psychometrics, including a measure of belief disruption, Trauma and Attachment Beliefs Scale (TABS), were completed at the end of the interviews. \ud \ud Principal Findings: Directive content analysis revealed evidence for all CSDT belief-areas, although some were more frequently identified than others. Positive and negative beliefs co-occurred, suggesting vicarious trauma and vicarious posttraumatic growth can occur in parallel, for both trainee and qualified therapists. Some differences between groups are discussed. Repertory grids suggested both groups construed themselves as least similar to clients struggling with trauma and more similar to clients experiencing posttraumatic growth. Data triangulation revealed some inconsistencies between the TABS and qualitative data. This may be due to the TABS using global statements, whereas qualitative data address specific examples and contexts that the beliefs related to. Finally, the inductive thematic analysis revealed two super-themes: impact and active coping. Participants acknowledged the negative impacts of trauma work but often related this to a process of normalisation, accepting that this was part of their role, which helped them deal with this. \ud \ud Conclusions & Clinical Implications: The finding that positive and negative beliefs can co-occur, as well as the inconsistencies between qualitative and quantitative data, has implications for measures like the TABS which focus only on negative impacts of trauma work. This study is exploratory, and the first to compare British trainees and qualified therapists, therefore further research is required to determine the relevance of these findings. A critical reflection of the research process is provided