A Qualitative Exploration of Secondary Traumatic Stress Among Behavioral Health Providers

Background: While many behavioral health providers experience compassion satisfaction and other positive benefits from their work, the associated challenges place providers at increased risk for secondary traumatic stress (STS; Sprang et al., 2021). STS describes the phenomenon of helping professionals experiencing posttraumatic stress symptoms in response to the indirect traumatic content they experience via work with clients (Bride et al., 2023). Recent data indicates that nearly half of providers report elevated symptoms, with over 25% meeting full PTSD criteria (Holmes et al., 2021). STS is associated with functional impairment, poorer physical and mental health (Armes et al., 2020), and reduced quality and effectiveness of client services (Sprang et al., 2021). Current interventions largely prioritize individual factors like self-care (Molnar et al., 2017), yet frequently overlook the critical role of organizational influences (Bride et al., 2023). Given these high rates of distress, there is an urgent need for interventions that address both the root causes and practical management of STS. Our study explores the nuances of STS to provide evidence-based strategies for providers and leadership alike.

Methods: The qualitative portion of this study was part of a larger mixed-methods project that initially surveyed N=926 behavioral/mental health therapists. Individuals interested in participating in focus groups were invited to participate in the qualitative portion of the study as we sought to further explore their experiences related to STS and burnout. In total, K=8 focus groups were held, involving N=41 participants. Participants who were employed as a behavioral/mental health therapist and held an active provisional or independent license to practice psychotherapy met the eligibility criteria. The majority of the sample identified as cisgender women (53.8%), while 34.7% were cisgender men, and 11.5% were non-binary or transgender. Participants ranged in age from 23-62, with a mean of 36 years (SD=11.45). The sample was racially diverse: 53.8% were Black, 34.6% were White, 24.3% were bi- or multiracial, and 7.7% were American Indian or Alaska Native. Among participants, the mean age of experience, from the attainment of their provisional license onward, was 12.54 years (SD=10.73). Participants worked in a range of settings; the majority were master’s level therapists (86.7%), while 13.4% held a doctorate. All focus groups lasted approximately 90 minutes, were conducted via Zoom and co-facilitated by at least two researchers using a semi-structured interview guide. Zoom-generated transcripts were analyzed using thematic analysis (Braun & Clark, 2006).

Results: The qualitative analysis yielded four themes and two subthemes: (1) Impact of What We Hold; (2) “It’s Just Too Much” Realities of Mental Health Profession; (2a) Grind Culture in Mental Health Profession; (3) Organizations as Barriers to or Facilitators of Provider Wellbeing, and (3a) Leadership Walking the Talk; and (4) Surviving and Thriving Strategies.

Implications: As a whole, findings suggest that organizational factors impact experiences of STS among clinicians and may help differentiate those with and without clinically elevated STS. Efforts to improve organizational safety, equity, and transparency may be particularly successful in addressing STS. We offer policy and practice strategies and considerations for providers and organizations.