Received 05/01/19

Revised 08/24/19
Accepted 09/01/19
DOI: 10.1002/jaoc.12072

Special Issue:
Trauma-Informed Addiction
and Offender Counseling Issues
Trauma-Informed Supervision:
Clinical Supervision of Substance
Use Disorder Counselors
Connie T. Jones and Susan F. Branco

Substance use disorder counselors are at risk of experiencing burnout, vicarious

trauma, and secondary traumatic stress. These phenomena can lead to counselor
impairment. The authors describe how trauma-informed supervision can mitigate
the risks of impairment for substance use disorder counselors.

Keywords: addictions, substance use, supervision, trauma-informed, secondary

traumatic stress

Counselors have an ethical obligation to maintain self-care and wellness

to ensure that they provide quality services to clients while, at minimum,
avoiding client harm (American Counseling Association [ACA], 2014). This
principle applies to counselors working with all clients; however, counselor
wellness is particularly needed when working with clients diagnosed with
substance use disorder (SUD) to avoid counselor impairment, including
vicarious traumatization (Branson, Weigand, & Keller, 2014) and secondary
traumatic stress (STS; Figley, 1995). One known protective factor against such
impairment is the practice of participating in clinical supervision (Knudsen,
Ducharme, & Roman, 2008). We propose trauma-informed supervision (TIS)
as a helpful model for supervisors working with SUD counselors. We first
describe how SUD counselors are vulnerable to impairment as a result of
burnout, vicarious trauma, and STS. Next, we provide a description of
TIS and how it can be used in clinical supervision with SUD counselors.

SUD Counselors
Researchers have suggested that many clients seeking substance use counsel-
ing and treatment also experience traumatic events and may demonstrate

Connie T. Jones, Department of Counseling and Educational Development, The University of North
Carolina at Greensboro; Susan F. Branco, The Family Institute, Northwestern University. Corre-
spondence concerning this article should be addressed to Connie T. Jones, Department of Counseling
and Educational Development, The University of North Carolina at Greensboro, PO Box 26170, 229
Curry Building, Greensboro, NC 27402 (email: ctjones4@uncg.edu).
© 2020 by the American Counseling Association. All rights reserved.

2 Journal of Addictions & Offender Counseling • April 2020 • Volume 41

symptoms of trauma. For example, Giordano et al. (2016) found that 85% of
clients seeking SUD treatment reported experiencing at least one traumatic
event in their lifetime. Researchers (e.g., Back et al., 2000; K. T. Brady, Killeen,
Saladin, Dansky, & Becker, 1994; Bride, Hatcher, & Humble, 2009; Brown,
Stout, & Mueller, 1996) have stated that there are high rates of comorbid
SUD and posttraumatic stress disorder (PTSD) found in clients diagnosed
with SUD and seeking treatment. A study conducted by the Epidemiologic
Catchment Area found that those who use substances are twice as likely
as those who do not use substances to experience a traumatic event (Back
et al., 2000; Cottler, Compton, Mager, Spitznagel, & Janca, 1992). Cottler
et al. (1992) found that substance users are three times more likely than
those who do not use substances to develop PTSD (Back et al., 2000). The
relationship between substance users and trauma is not new and has been
studied for years (Back et al., 2000; K. T. Brady et al., 1994; Bride et al., 2009;
Brown et al., 1996; Cottler et al., 1992).
Several researchers believe that PTSD has often been underassessed,
underdiagnosed, and undertreated in SUD treatment programs (Bride et
al., 2009; Coffey, Dansky, & Brady, 2003; Dansky, Roitzsch, Brady, & Saladin,
1997; Ouimette, Moos, & Brown, 2003). Given the prevalence of trauma
symptomatology in clients seeking SUD treatment and counseling, it is
not surprising that SUD counselors face a high propensity for experiencing
burnout (Baldwin-White, 2016; Young, 2015), vicarious trauma (Branson et
al., 2014), and STS (Baird & Kracen, 2006; Bride et al., 2009; Figley, 1995). In
the following sections, we briefly review the literature on the prevalence
of these phenomena on SUD counselors.
Burnout
Burnout is a well-researched subject (Maslach, Schaufeli, & Leiter, 2001) and
“is conceptualized as a psychological syndrome in response to chronic emo-
tional and interpersonal stress on the job and is most widely defined by the
dimensions of exhaustion, depersonalization, and inefficacy” (Wallace, Lee,
& Lee, 2010, p. 111). In the helping professions, burnout is often the emotional
response of working with clients who have extensive treatment needs (Everall
& Paulson, 2004; Wallace et al., 2010). Young (2015) suggested that burnout
leading to high turnover among SUD counselors is one of the biggest threats
facing the substance use treatment field. Baldwin-White (2016) found that emo-
tional exhaustion, depersonalization, low confidence in counseling efficacy, and
negative perception of clients seeking substance use counseling led to increased
burnout among SUD counselors. Furthermore, Oser, Biebel, Pullen, and Harp
(2013) emphasized that the impact of burnout among SUD counselors results
in overall poorer quality of client care. Counselors who work with the SUD
population are at high risk of developing burnout because clients with SUD
require a higher level of treatment for multiple reasons (Baldwin-White, 2016;
Lovejoy et al., 1995; Maslin et al., 2001; Stark, 1992). Clinical supervision plays
a significant role in preventing and diminishing counselor burnout (Wallace
et al., 2010; Yu, Lee, & Nesbit, 2008).

Journal of Addictions & Offender Counseling • April 2020 • Volume 41 3

 Vicarious Trauma
SUD counselors often work with clients who have experienced traumatic
events and/or exhibit symptoms of trauma. Therefore, researchers have
examined how such counselors are affected, if at all, by vicarious trauma.
Vicarious trauma, the cumulative impact of exposure to traumatic content,
occurs as a result of the counselor engaging with clients who are trauma
survivors or who are experiencing trauma. Vicarious trauma can affect
the counselor’s inner experiences (e.g., worldview, identity, spirituality;
Jenkins & Baird, 2002; Pearlman & Saakvitne, 1995). Wang, Strosky, and
Fletes (2014) found that vicarious trauma over an extended period of time
can negatively affect SUD counselors’ sense of well-being and overall pro-
fessional efficacy. Jordan (2018) described vicarious trauma as the result
of counselor “empathic engagement” (p. 128), thus allowing the counselor
to experience the emotions of the trauma survivor. Knight (2018) stated
that vicarious trauma creates a cognitive shift that affects the counselor’s
worldview. Similarly, Baird and Kracen (2006) noted that vicarious trauma
can significantly shift the way that counselors view themselves, others
(including clients), and the world in general.
STS
Many counselors who work with clients with SUD will experience STS,
also known as compassion fatigue (Figley, 1995; Jenkins & Baird, 2002). STS
can be described as a phenomenon in which counselors who provide treat-
ment to traumatized clients themselves become indirectly traumatized and
experience adverse reactions after witnessing clients battle with the effects
of trauma (Baird & Kracen, 2006; Bride et al., 2009; Figley, 1995; Jenkins &
Baird, 2002). Figley (1999) defined STS as “the natural, consequent behav-
iors and emotions resulting from knowledge about a traumatizing event
experienced by a significant other—it is the stress resulting from helping
or wanting to help a traumatized or suffering person” (p. 10).
Both vicarious trauma and STS are emotional responses to working with
clients who are trauma survivors or who are experiencing trauma (Jenkins
& Baird, 2002). STS differs from vicarious trauma because the psychological
effects and symptoms of STS mimic those of PTSD (Baird & Kracen, 2006).
The difference between PTSD and STS is that the person experiencing the
direct trauma develops PTSD, whereas the person hearing about the trauma
develops STS (Jenkins & Baird, 2002). STS also differs from vicarious trauma
in the “nature of symptoms (observable reactions vs. more covert changes in
thinking)” (Jenkins & Baird, 2002, p. 425). STS has more observable reactions,
whereas vicarious trauma involves changes in thinking and the inner experi-
ence (Jenkins & Baird, 2002). STS has been empirically studied in relation to
other areas of specialty counseling, such as mental health (J. L. Brady, Guy,
Poelstra, & Brokaw, 1999; Cunningham, 2003), child welfare (Bride, Jones, &
MacMaster, 2007; Meyers & Cornille, 2002), and intimate partner violence
and sexual assault violence (Bell, Kulkarni, & Dalton, 2003; Ghahramanlou &
Brodbeck, 2000). Not much empirical research has been conducted concerning

4 Journal of Addictions & Offender Counseling • April 2020 • Volume 41

STS and SUD counselors until recent years (Bride et al., 2009; Bride & Kintzle,
2011; Bride & Walls, 2007; Ewer, Teeson, Sannibale, Roche, & Mills, 2015).
We aim to present information on how clinical supervision, and more specifi-
cally TIS, can support SUD counselors in managing the impact of burnout,
vicarious trauma, and STS. TIS can be used in clinical supervision for licensed
professional counselors (LPCs) who work with clients diagnosed with SUD,
state-licensed addiction/drug counselors, and those working toward becom-
ing independently licensed as an LPC or licensed addiction/drug counselor,
as all of these individuals are vulnerable to experiencing burnout, STS, and
vicarious trauma. This article examines clinical supervision practices, specifi-
cally TIS, with SUD counselors trained as professional counselors. Next, we
review the role of clinical supervision with a focus on TIS.

Overview of Clinical Supervision

Clinical supervision, an intervention in which a senior counselor works

with a more novice counselor to build professional and clinical skills, is
a requirement for all emergent professional counselors (Bernard & Good-
year, 2019). The primary goals of clinical supervision are to “foster the
supervisee’s professional development” and to “ensure client welfare”
(Bernard & Goodyear, 2019, p. 12). Professional counselors receive clinical
supervision from program faculty and/or field site supervisors from the
time they begin their counselor education training program and throughout
their prelicensure residency(ies) postgraduation (Council for Accreditation
of Counseling and Related Educational Programs [CACREP], 2015).
As previously noted, clinical supervision benefits both counselors and
clients by ensuring counseling services use best practices and follow ethical
guidelines. Quality supervision is an important foundation from which
counselors promote their professional growth and pattern their future
counseling services (Borders et al., 2014). Incompetent, inconsistent, or
unqualified supervision not only is a risk to supervisees and their clients but
also creates a precedent for less-than-optimal future professional counseling
care (Culbreth, 1999; Culbreth & Cooper, 2008; Schmidt, Ybañez-Llorente,
& Lamb, 2013). Hence, it is crucial that a closer exploration of the clinical
supervision of SUD counselors be reviewed.
Clinical supervision is different from administrative supervision, although
the supervisor may be providing both types of supervision. Administrative
supervision focuses more on the day-to-day logistics in the supervisee’s
job tasks and duties. Clinical supervision focuses more on the supervisee’s
clinical development and growth as a substance use counselor, ensures the
treatment provided to the clients is effective, and monitors that no harm is
being done. Some states (e.g., Virginia, North Carolina) require that clinical
supervisors with a counselor education background receive some type of
formal training, whether it be a three-credit graduate-level course or 45
clock hours of clinical training (Center for Credentialing and Education,
n.d.). There are different models of supervision to aid in guiding clinical

Journal of Addictions & Offender Counseling • April 2020 • Volume 41 5

supervisors, including cognitive behavior models (Haynes, Corey, & Moulton,
2003), developmental models such as the integrated developmental model
(Stoltenberg & McNeill, 2010), person-centered models (Haynes et al., 2003),
and social role models. This article will focus on the TIS model.
Clinical Supervision for SUD Counselors
The addictions field places great importance on clinical supervision because
it aids in counselor competence and helps ensure client welfare (Borders
& Brown, 2005; Culbreth, 1999; Culbreth & Borders, 1998; Durham, 2003;
Knudsen et al., 2008; Powell & Brodsky, 2004; Remley & Herlihy, 2010;
Schmidt et al., 2013; Vallance, 2004). The importance is demonstrated by
the fact that most supervisees in the addictions field must complete more
supervised hours than their peers in other specialty areas such as mental
health (Kerwin, Walker-Smith, & Kirby, 2006; Schmidt et al., 2013). Despite
the intense focus on clinical supervision in the field, many clinical supervi-
sors are ill prepared, undertrained, and overworked and receive minimal
training in clinical supervision (Culbreth, 1999; Culbreth & Cooper, 2008;
Schmidt et al., 2013). Oftentimes, clinical supervisors for SUD counseling
are promoted to the clinical supervisor position because of seniority rather
than clinical supervision training, education, skill, or knowledge (Culbreth
& Cooper, 2008; Schmidt et al., 2013). This is problematic because clinical
supervision is a complex phenomenon that includes skills, supervision
models, and techniques (Bernard & Goodyear, 2019) and is vital to devel-
oping ethical, competent counselors (Bernard & Goodyear, 2019; Borders
& Brown, 2005; Schmidt et al., 2013).
There are concerns about how the lack of preparedness for SUD clini-
cal supervisors affects the preparation and growth of their supervisees,
as SUD counselors receive more ethical violations than any other type of
counselor (Gallagher 2009, 2010; Schmidt et al., 2013; St. Germain, 1997).
The empirical finding that SUD counselors commit more ethical violations
than other counselors suggests a dire need for more qualified SUD clinical
supervisors (Gallagher 2009, 2010; Schmidt et al., 2013; St. Germain, 1997).
Despite all the benefits of proper clinical supervision and the concerns
facing SUD counselors, empirical research on the SUD field and clinical
supervision is scarce (Culbreth, 1999; Juhnke & Culbreth, 1994). There has
not been any focused attention on SUD counselors and clinical supervision
since Juhnke and Culbreth (1994) and Culbreth (1999). This is alarming
and calls for future research because clinical supervision in the SUD field
is vital to the development of SUD counselors due to the unique nature of
substance use counseling (Culbreth, 1999).
Supervision as a Protective Factor
According to the ACA Code of Ethics (ACA, 2014), one important function
of clinical supervision is to monitor for supervisee impairment (Standard
F.5.b.). In a meta-analysis of over 41 studies examining human service
professionals who work with trauma survivors, including counselors and

6 Journal of Addictions & Offender Counseling • April 2020 • Volume 41

mental health professionals, Cieslak et al. (2014) found that these profes-
sionals are indirectly exposed to trauma by way of their clients and practice
experiences. Cieslak et al. found a strong relationship between symptoms
of secondary trauma, vicarious trauma, and burnout. Knudsen et al. (2008)
determined that clinical supervision served as a protective factor against
emotional exhaustion, a measure related to burnout (Cieslak et al., 2014),
and turnover among SUD counselors. Hence, clinical supervision can serve
as an effective buffer against job burnout, vicarious trauma, and STS for
SUD counselor supervisees. One model of clinical supervision in particu-
lar, trauma-informed supervision (TIS), is uniquely situated to enhance
the innate protective factors of clinical supervision. In fact, Jordan (2018)
described TIS as a “buffer” (p. 128) against vicarious trauma. Next, we
explore TIS and how it can serve SUD counselors.

TIS

In response to the identified needs of SUD counselors, particularly those

related to managing client co-occurring trauma-related symptoms and the
supervisee’s reaction to client-based trauma, including burnout, vicarious
trauma, and STS, clinical supervisors may consider TIS as an effective
model of clinical supervision. TIS is gaining traction within the clinical
supervision literature and was recently the main focus of a special issue
of The Clinical Supervisor journal (Knight & Borders, 2018), although infor-
mation on TIS with SUD counselors was not included in the special issue
content. Despite the rise of TIS in clinical literature, the National Child
Traumatic Stress Network (NCTSN; 2018) acknowledged that a definition
of what constitutes quality TIS or a defined TIS model has not yet been
determined and agreed upon. However, TIS is predicated on the tenets of
trauma-informed practice (TIP).
TIS mirrors the tenets of TIP (see Figure 1), a model of practice that addresses
trauma-related symptoms with all clients to promote best practices for client
care (Berger & Quiros, 2014; Knight, 2018; Substance Abuse and Mental
Health Services Administration [SAMHSA], 2014a, 2014b). Therefore, clinical
supervisors who provide TIS, in addition to basic competency in conducting
clinical supervision, must also possess foundational knowledge of the impact
of trauma on clients, awareness of the effects of indirect trauma, and the core
tenets of TIP (Knight, 2018). TIS is frequently used as a supplement to other
clinical supervision models. To address the lack of a unified TIS model, we
first provide information related to SAMHSA’s (2014a) trauma-informed
approach, followed by NCTSN-recommended competencies for TIS. Last, we
provide information on how researchers and clinicians have used TIP in TIS.
Although many representations of TIP delineate five core tenets (Berger
& Quiros, 2016; Conover, Sharp, & Salerno, 2015; Goodman et al., 2016),
SAMHSA’s (2014a) trauma-informed approach adds an additional sixth
tenet—cultural, historical, and gender issues—whereby issues relevant
to culture, gender, race, ethnicity, and historical trauma are included in

Journal of Addictions & Offender Counseling • April 2020 • Volume 41 7

 Safety

Culture, Historical, and Trustworthiness

Gender Issues

TIP

Empowerment Choice

Collaboration

FIGURE 1
Tenets of Trauma-Informed Practice (TIP)

overall TIP (see Figure 1). Specifically, policies and processes that are
inclusive of these factors are taken into consideration when developing
treatment protocols (SAMHSA, 2014a). Ignoring the sixth tenet could result
in inadvertent harm or poor quality care for intended populations, hence
its necessary inclusion for TIS.
In the absence of a unified TIS model, NCTSN (2018) recommended 10
core competencies for supervisors providing TIS. The competencies are
meant to serve as a guidepost for agencies, supervisors, and organizations
when considering training needs and include an emphasis on identifying,
assessing, and managing STS in supervisees and supervisors. Many of the
competencies parallel TIS literature (reviewed next), such as the supervisor
possessing knowledge related to identifying the signs and symptoms of
STS and facilitating supervisees’ management of their reactions to clients’
trauma. Unique to the NCTSN competencies is the emphasis on clinical
supervisors’ capacity to monitor their own symptoms of STS and ability to
appropriately use self-disclosure in supervision. Each competency is clearly
defined and includes supporting references and resources (NCTSN, 2018).
Jordan (2018) used an ecological foundation when providing TIS.
Specifically, Jordan described an ecosystemic developmental trauma model
in which the trauma-informed counselor considers all facets of a client’s
experience, including social values, health, economics, friendships, education,
stress buffers, and resiliency factors, to better comprehend the overall
client development within the context of a traumatic event (or events).
Additionally, Jordan considered the impact of transgenerational trauma
and developmental trajectory disruptions as they pertain to the client. A
clinical supervisor operating within Jordan’s ecosystemic developmental

8 Journal of Addictions & Offender Counseling • April 2020 • Volume 41

trauma model conducts supervision that supplies the supervisee with
a supervision contract to establish safety, provides the supervisee with
psychoeducation on the model to inform clinical practice, and frequently
assesses the supervisee for vicarious trauma.
Knight (2018) detailed how TIS can be seamlessly incorporated into Bernard
and Goodyear’s (2019) discrimination model in which the supervisor assumes
teacher, consultant, and counselor roles at various times throughout the
clinical supervision relationship. Within this context, Knight (2018) proposed
a TIS supervisor would provide education and training on TIP to a new
supervisee. The TIS supervisor would assume a consultancy role after a
supervisee has gained some competence in providing TIP, and the TIS
supervisor would encourage the supervisee to critically analyze his or her
TIP work. Finally, Knight (2018) suggested that the TIS supervisor would
continuously assume a counselor role in the supervisory relationship to
promote supervisees’ self-reflection and awareness of their own reactions
and feelings to the trauma experienced by their clients.
Berger and Quiros (2014) delineated how TIS incorporates the TIP tenets
of safety, trustworthiness, choice, collaboration, and empowerment into the
supervisory relationship. For example, safety in supervision is established
via a thorough assessment of the office space where supervision is conducted
for privacy and how it is set up, as well as to ensure that supervision times
are reliable and consistent. Next, Berger and Quiros (2014) described trust-
worthiness as developed through well-defined supervisory boundaries and
clear expectations of both supervisor and supervisee within the relationship.
They highlighted choice and collaboration in the supervisory relationship
as a mutual arrangement whereby both parties’ contributions are equally
encouraged and considered when determining an appropriate interven-
tion with clients. Last, they described empowerment in the supervisory
relationship to consist of acknowledging and validating successes as well
as challenges while encouraging supervisees’ growth via skills practice of
their choice under supportive supervision. Berger and Quiros (2014) refined
their model with research described next.
Berger and Quiros (2016) qualitatively explored the perceptions and prac-
tice of TIS clinical supervisors. Twelve participants shared their ideas and
experiences about qualities of TIS, challenges to providing TIS, and effective
TIS interventions. TIS qualities included supervisor training, practice, and
overall knowledge related to trauma; consistent supervision schedules; and
separation of clinical and administration supervision to delineate boundaries
between both roles. Other noted characteristics of TIS were the integration
of an interpersonal relationship model into supervision, a strongly attuned
and empathic supervisor, and supervisor acknowledgment of sociocultural
and oppressive factors faced by clients. The challenges to TIS that partici-
pants identified included the complexity of the client’s clinical portraits,
collaboration with institutions that do not adhere to trauma-informed care,
and scarcity of resources. Finally, participants described multiple strategies
to facilitate effective TIS, including empowering supervisees, especially as

Journal of Addictions & Offender Counseling • April 2020 • Volume 41 9

related to promoting professional growth and development; attending to
the supervisor-supervisee relationship; establishing an emotionally safe
environment in supervision; addressing a parallel process; remaining
knowledgeable and up to date on TIP; and frequently advocating both
supervisee and supervisor self-care.

Case Study

Recognizing the lack of one definitive TIS model, we present the following
case study to demonstrate the use of TIS using the core TIP tenets with a
counselor working in the SUD field. The case study begins with the back-
ground context and then is guided by the six TIP tenets (SAMHSA, 2014a).
Best practice recommendations from Berger and Quiros’s (2016) research
on TIS and SAMHSA’s (2014a) TIP are woven within each tenet.
Background
Cin is an SUD counselor seeking clinical supervision as required to obtain
full licensure as an LPC. Cin has received clinical supervision as a gradu-
ate student and has recently started working in a substance use treatment
facility serving marginalized and low-income populations. In her new posi-
tion, she has been assigned a supervisor. She is hoping for a developmental
supervision process that promotes her growth as a counselor and ensures
her clients’ welfare. Cin hopes to work on strengthening the counseling
relationship, effective treatment planning, culturally appropriate assess-
ment and interventions, and counselor self-care.
Maria, the new clinical supervisor assigned to work with Cin, has a clinical
background in trauma work and SUD. Maria completed a course on clini-
cal supervision practice and has since registered with her state’s board to
provide clinical supervision to Cin. TIP is infused in Maria’s clinical work
and has led her to be interested in using TIS within her clinical supervi-
sion practice as a way to promote supervisees’ development and safeguard
against potential burnout, vicarious trauma, and STS.
Safety
Maria established a physically safe space for supervision by ensuring that
supervision was conducted in a secure and private office with sound-
proofing devices. Furthermore, she kept the office space neat and orderly
while providing comfortable seating and water and maintaining a mutually
agreed-upon room temperature. In the first supervisory meeting, Maria and
Cin developed a supervision contract in which both parties identified a
consistent supervision time and “backup plans” for supervision to account
for illnesses, delays, or unforeseen events. Maria established emotional
safety by adhering to the supervision contract to promote consistency and
through the initial supervision session intervention of broaching (Jones,
Welfare, Melchior, & Cash, 2019). To begin the broaching process, Maria
used a genogram in which both she and Cin could share their family

10 Journal of Addictions & Offender Counseling • April 2020 • Volume 41

constellation and identify racial, ethnic, and sociocultural backgrounds to
facilitate discussion on how these factors might influence client work and
their supervision alliance.
Trustworthiness
The supervision contract also set expectations for both supervisor and super-
visee and included stipulations that clinical supervision would be separate
from administrative supervision to maintain boundaries. This meant that
Cin would receive the majority of her administrative supervision during
weekly group meetings for all agency clinicians. Separating the types of
supervision also protected the supervisory alliance by allowing Maria to
focus solely on the clinical aspects of supervision.
Trust was further promoted in the relationship as Maria continued to use
Cin’s genogram as a tool whereby Cin could share her own trauma history.
Cin’s sharing of her own trauma history allowed Maria to be attuned to any
potential countertransference in Cin’s clinical work. Maria encouraged Cin
to explore her own reactions to her clients’ trauma histories to validate and
normalize them (Knight, 2013). This became especially important as Cin’s
caseload increased and she began cofacilitating groups. On occasion, Cin
shared that she sometimes felt her work was not making a difference in
the seemingly insurmountable problems that her clients faced. She began
spending longer hours at the office to ensure she could complete her prog-
ress notes and treatment plans in a timely manner and she ate lunch at her
desk while working, if she ate lunch at all. Maria observed these behaviors
and remained attuned to Cin’s increased detachment when describing her
clients in supervision. Maria used her observations and knowledge about
Cin’s history to gently address the possibility that Cin could be experienc-
ing symptoms of burnout, vicarious trauma, and possibly STS. To further
assist Cin, Maria administered the Professional Quality of Life Scale (Stamm,
2009) to measure compassion satisfaction and fatigue to better determine
how Cin experienced symptoms and to establish a baseline by which they
could monitor Cin’s progress. Maria and Cin worked to establish self-care
protocols, such as ensuring they were both taking lunch breaks away
from their desks, building in time for brief walks between sessions, and
determining that Cin would reengage with her own personal professional
counselor to address aspects of her personal history of trauma.
Choice
Agency work leaves little opportunity for counselors’ input in regard to the
number of clients on their caseload or the types of clients seen. Trauma, in
particular, was so pervasive among Cin’s SUD clients that it would be very
challenging to limit the number of clients who experienced trauma. However,
Maria was able to support Cin in her choice of how and when to schedule
clients. For example, Cin was able to reorganize her work schedule to allow
time for self-care and appointments with her personal counselor while still
accommodating her clients’ appointment needs. Maria worked with the

Journal of Addictions & Offender Counseling • April 2020 • Volume 41 11

agency administration to promote the option of several telework days a
month to allow Cin to be up to date on her client paperwork, attend profes-
sional development opportunities, or use as mental health wellness days.
Collaboration
As Cin’s skills and experience as an SUD counselor grew, Maria took on the
“consultant” role as supervisor (Bernard & Goodyear, 2019) by learning more
about Cin’s preferred theoretical models to use with clients. Additionally,
Maria considered Cin’s recommendation to utilize different assessment
measures with clients that took into account their racial, cultural, and
socioeconomic background, rather than using outdated instruments normed
on groups that did not reflect the backgrounds of the clients served. Maria
and Cin shared ideas on interventions and techniques that were deemed
most appropriate with clients. In turn, Maria encouraged Cin to enact a
similar collaborative stance with her clients to allow them a voice in their
treatment plans. Furthermore, Maria attended to the parallel process of Cin’s
work to assist clients in developing healthy coping strategies to manage
their responses to trauma by also supporting Cin to act similarly around
her own reactions to her clients’ trauma (Knight, 2013).
Empowerment
Throughout the supervision relationship, Maria supported and encouraged
Cin’s professional development by providing education on trauma-informed
care, burnout, vicarious trauma, and STS. Cin chose to use her agency-
sponsored professional development funds to seek further training and
certification in trauma-informed interventions supported by evidence-based
research. Because supervision sessions often addressed the sociocultural
and oppressive factors that clients faced, Maria also encouraged Cin to seek
membership with their state counseling association to gain knowledge of
additional resources. Cin’s membership allowed her to network with other
SUD counselors to advocate at the state and federal level for increased fund-
ing for additional services and qualified SUD counselors for clients in need
of SUD treatment.
Cultural, Historical, and Gender Issues
Maria opened the initial supervisory session with Cin by broaching the
topics of race, ethnicity, and sociocultural factors and used a genogram to
further flesh out how their backgrounds influenced their clinical work and
supervisory alliance. Throughout supervision, Maria frequently used the
genogram as a checkpoint to gauge how Cin’s worldview shaped her case
conceptualization and treatment planning. Through this lens, they were
able to broaden the genogram to consider the impact of gender disparity,
particularly as it related to stressors Cin experienced in her personal life
(i.e., childcare) that affected her professional life.
This case study depicted potential avenues by which a clinical supervisor may
infuse the tenets of TIP into TIS with a supervisee. One will note that because

12 Journal of Addictions & Offender Counseling • April 2020 • Volume 41

there is currently no sanctioned TIS model, TIS as represented in the case study
utilized the TIP tenets to supplement clinical supervision. The emphasis on the
tenets ensures that a TIS supervisor maintains the focus of supervision on sup-
porting, guiding, and navigating trauma-related concerns with a supervisee.

Implications

As the case study demonstrates, there are many benefits to using TIS in clinical
supervision with supervisees working with SUD clients. SUD counselors are at
increased risk of experiencing myriad concerns related to working with clients
exposed to trauma (Baird & Kracen, 2006; Baldwin-White, 2016; Branson et al.,
2014; Bride et al., 2009; Figley, 1995; Young, 2015). Clinical supervision has been
demonstrated to be an important component to preventing counselors from
the aforementioned risks of practice (Knudsen et al., 2008). TIS is uniquely po-
sitioned to extend the protective factors of clinical supervision because it offers
a mode that aids supervisees in processing factors that contribute to burnout,
vicarious trauma, and STS. TIS not only supports counselor development and
well-being but also ensures client well-being. Clinical supervisors working with
counselors in the SUD field should not only become knowledgeable about the
risk factors, signs, symptoms, and effects of burnout, vicarious trauma, and
STS but also be able to differentiate between them (NCTSN, 2018).

Recommendations

Despite limited research on TIS in general, and more specifically on TIS with
SUD counselors, some recommendations can be made for practicing clinical
supervisors in the field of SUD. Given the previously noted challenges related
to the clinical supervisor preparation of SUD counselors, it behooves agencies
and other stakeholder organizations to offer clinical supervision training as
continuing education opportunities to strengthen the skills of current clinical
supervisors (Branco, 2018). In addition, more focused training on TIS, perhaps
guided by recommendations described throughout the article, can be sponsored
by agencies and continuing education providers to better inform both clinical
supervisors and supervisees on how TIS can benefit their clinical practice.
Knight (2013) noted that SUD students should be exposed to a broad range of
trauma-related information early in their graduate education, including informa-
tion on burnout, vicarious trauma, and STS. Counselor educators and field and
university supervisors should incorporate TIS in their lectures and supervision
practices to promote wellness for counselors-in-training and monitor for impair-
ment risks. This recommendation remains relevant and aligns with CACREP’s
(2015) wellness requirements for all accredited counselor education programs.

Future Research

As noted previously, there is a great need for future research in the area of
how trauma-focused supervision can be used with SUD counselors. As we

Journal of Addictions & Offender Counseling • April 2020 • Volume 41 13

explained, TIS can be an effective mode of supervision to buffer against the
potential effects of burnout, vicarious trauma, and STS. Previous researchers
on TIS did not focus on the substance use field but rather examined TIS in
mental health, child welfare, intimate partner violence, and sexual assault.
Given what is known about SUD counselors’ risk of experiencing indirect
trauma, research that focuses on TIS with SUD counselors is necessary to
ensure that their needs are being met and they are not at risk for impair-
ment in order to provide effective client treatment.
Also, there is an additional need for research that looks at clinical supervision
for SUD counselors in general. There is a tremendous gap in knowledge
surrounding the SUD field and clinical supervision. This gap must be addressed
because SUD counselors have historically committed ethical violations at a
higher rate than their peers in other counseling specialties despite the fact that
the field places a high importance on clinical supervision (Gallagher, 2009,
2010; Schmidt et al., 2013; St. Germain, 1997). Without additional empirical
research on clinical supervision within this specific context, the SUD field is
at a loss for guidance (Culbreth, 1999; Juhnke & Culbreth, 1994).
Finally, the current status of TIS in clinical literature reflects how researchers
and practitioners currently provide TIS via application of the TIP tenets
within clinical supervision modalities. NCTSN (2018) acknowledged that
no definitive model of TIS yet exists; therefore, research could expand on
Berger and Quiros’s (2014) qualitative survey of TIS supervisors to develop a
coherent and universally accepted TIS model. Until such a model is proposed
and agreed upon, TIS supervisors will continue to apply TIP to inform TIS.

Conclusion

Counselors who work with clients with SUD are at risk of experiencing
burnout, vicarious trauma, and STS (Baird & Kracen, 2006; Baldwin-
White, 2016; Branson et al., 2014; Bride et al., 2009; Figley, 1995; Young,
2015). The effects of experiencing these phenomena can have negative
outcomes for both the client and the counselor. Clinical supervision has
been identified as one of the ways to prevent and combat the phenom-
ena and the negative outcomes (Knudsen et al., 2008). TIS can be used
as a model of supervision or can be combined with another supervision
model to buffer and alleviate the effects of burnout, vicarious trauma,
and STS. TIS is based on TIP and can address the indirect trauma that
SUD counselors may experience.

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