Predictors of Secondary Traumatic Stress among Social Workers: Supervision, Income, and Caseload Size (Quinn, Ji, & Nackerud, 2019)

The findings reported in this study suggest a number of recommendations for social work practice. At an administrative/policy level, the results suggest that providing clinical social workers poor-quality clinical supervision, providing low salaries, and assigning them large client caseloads may increase the risk of social workers developing secondary trauma symptoms.

Given the high costs of providing health insurance to employees, as well as increased employee turnover and lost productivity due to STS and subsequent burnout, administrators may be able to reduce financial losses in the long run by providing skilled clinical supervision to clinical social workers, awarding larger salaries, and encouraging reasonable client caseloads, particularly to those social workers that primarily work with traumatized clients.

At an individual level, the results suggest that social workers experiencing anxiety may possess an increased vulnerability to developing STS. Personal self-care to reduce daily anxiety levels may be important to protect clinical social workers from developing STS symptoms. Likewise, administrators can also play a role by providing free or reduced-cost stress-relief activities for their employees, including an Employee Assistance Program (EAP).

A Person-Centered Approach to Multicultural Counseling Competence (Quinn, 2013)

If a therapist can be a person that possesses a genuine and accepting way of being, then he or she will likely move toward providing these person-centered, culturally adapted facilitative mechanisms of change for the client or family. If the MC client or family perceives these mechanisms to be a genuine aspect of the therapist’s way of being, then trust and familiarity will likely occur, resulting in a process of change to occur, which is hypothesized to resemble the process mechanisms.

Though these mechanisms are not a magic bullet, they are sufficient for this process of change to occur both during and beyond therapy. The client or family may return to therapy someday, or these therapy experiences may have been sufficient to continue a process of “becoming” for the rest of their lives. Ultimately, in the process of becoming one’s own person, or in becoming “their own family,” so to speak, the client may choose the family, and the family may choose its members, but this valuing process lies beyond the scope of the therapist’s personal and clinical judgments. Rather, this process emerges from within the client and family.

A Person-Centered Approach to the Treatment of Borderline Personality Disorder (Quinn, 2011)

Frequently, but not the rule, the more the client has been traumatized in life, the more difficult his or her process of developing an internal evaluation of experience. For some borderline clients, the process mechanisms will occur sufficiently that the self-actualizing tendency will move the client toward further becoming, and the therapist will no longer be needed in the client’s life. Other clients may have their tendency toward self-actualization so disrupted that they will seek longer term work in therapy to remove the blocks of trauma and abuse.

The mechanisms are not presented as a “magic bullet,” but as a lifelong movement toward health; a movement that helps the client see that “happiness is choice.” And so, if a therapist can facilitate for the client a reliance on an internal locus of evaluation of experience, then the client has stepped into the process of becoming one’s own person.

A Person-Centered Approach to the Treatment of Combat Veterans with Posttraumatic Stress Disorder (Quinn, 2008)

Veterans who see combat and subsequently develop PTSD report that a transformation occurs between the time of entering the military and the time of their discharge. The stages that I have heard commonly described in this transformation consist of the following:

Civilian self, old self: Before military training.

Breakdown of old self: Combat training and breakdown of the civilian self, which following training becomes the old self.

Military self, new self: Integration of the new self into a unit of soldiers (an army of one, if you will).

New self finds new purpose: The feelings of purpose arise as the new self and the soldier’s unit are trained to accomplish a common goal—win in combat.

New self shattered: Combat happens, during which the new self’s combat training more or less overrides the old self’s civilian-based fight, flight, and freeze instincts as they would naturally occur.

Shattered self survives: The combat training may save the soldier’s life, and the soldier consequently comes to regard combat mode as a necessary and continuous way to stay alive.

Shattered self returns home: The soldier survives combat and returns home but cannot turn combat mode off.

Combat mode at home: The veteran acts in ways consistent with combat training— that is, maintaining a safe perimeter around the house, sleeping sporadically, being on guard at all times, being unable to leave the perceived safety of home, constantly looking over the shoulder, and so on.

New self and old life: The veteran is unable to integrate the new self into his or her old life and thus becomes at odds with the naïve, civilian way of life.

PTSD: PTSD sets in. The veteran exhibits behaviors deemed appropriate for the preservation of life on the battlefield but considered eccentric, inappropriate, and threatening to family and civilians in the civilian environment. The veteran is diagnosed with PTSD and begins treatment.

Quinn, A. (2008). A person-centered approach to the treatment of combat veterans with posttraumatic stress disorder. Journal of Humanistic Psychology, 48(4), 458-476.

Quinn, A. (2011). A person-centered approach to the treatment of borderline personality disorder. Journal of Humanistic Psychology, 51(4), 465-491.

Quinn, A. (2013). A person-centered approach to multicultural counseling competence. Journal of Humanistic Psychology, 53(2), 202-251.

Quinn, A., Ji, P., & Nackerud, L. (2019). Predictors of secondary traumatic stress among social workers: Supervision, income, and caseload size. Journal of Social Work, 19(4), 504-528.