Trainee therapist responses to the discussion of trauma in therapy

Responses to disclosures/discussions of trauma can have lasting impacts on survivors who choose to share their experiences and historically have been categorized as positive, negative, and/or neutral responses with corresponding effects on the survivor. Literature recommends the use of tenets and techniques reminiscent of therapeutic common factors (e.g., listening skills, empathy, support, validation, creating a safe environment and strong therapeutic alliance) when responding to trauma. However, existing research focuses on reactions to survivors\u27 disclosures outside of therapy and there is little research focusing on therapists\u27 responses. Specifically, there are no studies that investigate how therapists or trainees are actually responding in psychotherapy sessions (e.g., frequency and rate of such responses). Accordingly, the purpose of the present study was to qualitatively explore the responses of student therapists in psychotherapy sessions with trauma survivors. A sample of 5 therapist-participants from university-based community counseling centers were selected and transcribed videotaped sessions in which client- and trainee therapist-participants discussed trauma were analyzed using a qualitative and deductive content analysis. A coding system was created to categorize responses based on extant literature. Results indicated that trainee therapist-participants responded in all proposed categories (positive: validating, supportive, empathic; negative: invalidating, unsupportive, unempathetic; and neutral: clarifying questions, and reflection/summary statements). Of these, neutral responses tended to occur more frequently than positive or negative responses. Overall, positive responses followed as next most frequent and negative responses as least frequent. Other findings included that in 2 of the 5 individual sessions, negative responses were more frequent than positive responses; empathic responses were the least frequent code across all 10 coding categories; and 2 sessions had 0 recorded empathic responses. Finally, there were numerous missed opportunities for positive responding throughout the sessions. It is hoped that this study will raise awareness around the importance of therapeutic responses to trauma survivors\u27 discussions in psychotherapy sessions and provide insight as to how trainee therapists might apply their existing competencies to respond to clients in positive ways. Findings have implications for both future studies and clinical training practices, for example in graduate programs for trainee therapists, an area of study that is currently under-researched