Practitioners’ experiences of assessing traumatic events

Kerr, J., Lorenz, H., Sadler, S., Roberts, V., Steel, C., & Thew, G. R. (2025). ‘You never know who you’re gonna speak to’: exploring Psychological Wellbeing Practitioners’ experiences of assessing traumatic events. the Cognitive Behaviour Therapist, 18, e29.

Key Takeaways

Psychological Wellbeing Practitioners (PWPs) experience significant ambiguity when distinguishing between traumatic events and PTSD during assessments .
PWPs report feeling underprepared due to limited formal training on trauma assessment and PTSD differentiation .
Conducting trauma assessments is emotionally overwhelming, often leading to lingering distress, suppression of emotions, and eventual desensitisation .
Time pressure and service targets exacerbate assessment challenges, sometimes compromising thoroughness and self-care .
Peer support, effective supervision, and on-call duty supervision emerge as critical buffers against stress when assessing traumatic events

Rationale

Although NHS-Talking Therapies (NHS-TT) routinely encounter service users with traumatic histories (Hepgul et al., 2016; Sandford, 2023), psychological wellbeing practitioners (PWPs) receive minimal formal training in PTSD assessment (Murray, 2017).

Existing research highlights high rates of clinician stress and burnout when working with trauma (Owen et al., 2021; Voss Horrell et al., 2011), but little is known about how junior practitioners experience the assessment of traumatic events.

By foregrounding PWPs’ perspectives, this study addresses gaps in understanding diagnostic decision-making, emotional impact, and support needs, posing the guiding question:

How do PWPs experience and manage the process of assessing traumatic events within NHS-TT services?

Method

Sample: 11 PWPs (9 women, 2 men; age M=28.5 years, SD=5.3; ethnicity: 54.5% White British, others varied; PWP experience 5–36 months) .
Setting: One UK NHS-TT primary care service; participants recruited via internal invitation.
Data Collection: Semi-structured interviews (≈50 min each), conducted Aug–Sep 2023 via Microsoft Teams (10) and face-to-face (1); audio-video recorded and transcribed verbatim.
Analysis: Reflexive thematic analysis (Braun & Clarke, 2021):
1. Familiarisation: Multiple readings of transcripts.
2. Coding: Inductive semantic coding by first author, reflexively noting biases.
3. Theme Generation: Grouping codes into initial themes via thematic mapping.
4. Review & Reflexivity: Supervisory discussions to refine theme definitions and explore researcher influence.
5. Theme Definition: Finalising six themes and 13 subthemes; constructing thematic map (Fig 1).
6. Triangulation: Two external PWPs reviewed themes and quotes for credibility.
Software: NVivo-style manual coding; no dedicated qualitative software specified .

Results

Theme 1: Navigating Diagnostic Ambiguity

Subthemes & Details

Boundary Uncertainty: PWPs struggle to decide when a disclosed event qualifies as a “traumatic event” versus meeting full PTSD criteria. “Sometimes someone tells me about a childhood argument—that doesn’t feel like trauma to me—but I worry I’m minimizing their distress.” [P4]
Descriptor Complexity: The Patient Case Management Information System (PCMIS) taxonomy feels rigid and ill‐fitting, forcing PWPs to “shoehorn” cases into inappropriate labels. “I end up choosing ‘Other’ far too often because none of the descriptors really match.” [P7]
Deference to Senior Clinicians: Lacking clear guidelines, PWPs often defer the final decision on trauma descriptors to Step 3 therapists or supervisors. “If I’m not sure, I’ll leave it blank and let the Step 3 clinician decide—they know better.” [P2]

Theme 2: Perceived Lack of Training

Subthemes & Details

Scarcity of Formal Education: Many PWPs report zero or one brief workshop on PTSD across their entire training. “In my two years, the only ‘trauma training’ was a two-hour slot squeezed into a CPD day.” [P9]
Learning by Fire: New practitioners learn mostly through observing senior colleagues or self‐directed reading, which feels haphazard. “I watched a Step 3 get one case, then another, then suddenly I’m doing it and thinking, ‘What have I missed?’” [P5]
Unclear Exploration Limits: Without concrete training, PWPs worry about pushing too far—or too little—when exploring traumatic memories. “Am I allowed to ask for details, or am I risking retraumatizing them? There’s no manual.” [P11]

Theme 3: Emotional Overwhelm

Subthemes & Details

Immediate Arousal: Listening to graphic or painful stories triggers strong visceral reactions—tears, tension, nausea—that must be suppressed. “I’ve had to learn to clamp down tears mid-session… clients shouldn’t have to ‘parent’ my reaction.” [P10]
Cumulative Distress: Repeated exposure to trauma narratives erodes emotional reserves over days, leading to pervasive fatigue. “By Wednesday, I’m spent—every story feels heavier than the last.” [P3]
Adaptive Desensitisation: Over time, some PWPs notice they become emotionally blunted—a double‐edged sword that protects but also risks detachment. “I noticed I no longer jump at the words ‘rape’ or ‘murder.’ I’m calmer, but I wonder if I’m losing empathy.” [P1]

Theme 4: Interplay of Personal Distress and Professional Role

Subthemes & Details

Trigger Spillover: PWPs with personal histories of trauma find certain topics in sessions highly triggering, blurring personal–professional boundaries. “When a client describes childhood abuse, I flash back to my own—it’s hard to keep that out.” [P8]
Empathic Overidentification: Imagining themselves in clients’ shoes can intensify emotional load and lead to overinvolvement. “I find myself thinking, ‘What would I do if that were me?’ and then it’s hard to stay neutral.” [P6]
Off-Duty Ruminations: Traumatic stories replay in PWPs’ minds outside work hours, affecting sleep and relationships. “I lie awake running through the details—my partner hears me sighing at 3 a.m.” [P4]

Theme 5: Pressurising Service Context

Subthemes & Details

Target‐Driven Constraints: Strict session counts and completion metrics push PWPs to rush or truncate trauma discussions. “I have to hit six sessions; I can’t afford to spend three on just one traumatic event.” [P1]
Risk vs. Rapport: Balancing the need to assess risk factors (e.g., self-harm) with building a trusting space feels like walking a tightrope. “I’ve got to ask about suicidal thoughts, but I also need them to open up—sometimes it feels like sabotage.” [P2]
Administrative Burden: Completing detailed PCMIS entries and risk assessments after emotionally draining sessions adds to workload stress. “I finish the trauma assessment and face another hour of typing up notes—my head’s spinning.” [P7]

Theme 6: Value of In-Service Support

Subthemes & Details

Peer Debrief & Camaraderie: Informal chats with fellow PWPs offer a safe outlet to vent and normalize reactions. “Grab a coffee with a colleague and it’s like, ‘Thank God someone else heard that too.’” [P11]
On-Call Duty Supervision: Immediate access to a senior clinician by phone during or after tough assessments is invaluable. “Just knowing I can ring the duty supervisor at 6 p.m. if I’m floundering is a lifesaver.” [P3]
Variable Clinical Supervision: While some supervisors model empathy and validation, others treat trauma talk as routine checklist items. “One week I get real emotional support; the next it’s, ‘Right, next case,’ and I feel dismissed.” [P5]

Insight

The study reveals that diagnostic uncertainty and emotional burden are central challenges for PWPs in trauma assessments—challenges that stem more from role design and service pressures than individual shortcomings.

By mapping how ambiguity, training deficits, and systemic targets intersect to shape PWPs’ experiences, this research deepens understanding of the lived realities behind seemingly technical clinical tasks.

It extends prior work on clinician stress (Owen et al., 2021) by pinpointing the assessment phase as a critical juncture for burnout risk and highlights peer and supervisory support as protective factors worthy of formalization.

Future research could evaluate trauma-focused training interventions, implement real-time emotional support mechanisms, and examine whether similar patterns emerge in other stepped-care models .

Clinical Implications

Comprehensive, Tiered Trauma Training

Foundational Workshops: Incorporate mandatory, stand-alone modules on PTSD diagnostic criteria, ICD/TDSM-V thresholds, and safe enquiry techniques into the PWP core curriculum.
Advanced Skill Clinics: Offer quarterly “deep dive” sessions—role-plays, case studies, video-stimulated recall—led by trauma specialists to build confidence in differentiating trauma vs. PTSD and in using structured problem-descriptor frameworks .
E-Learning Refreshers: Develop on-demand microlearning (5–10 minute) videos and quizzes to reinforce concepts and serve as quick prompts before assessments.

Structured, Emotionally-Safe Supervision

Reflective Trauma Supervision: Create designated supervision slots explicitly for trauma case review, emphasizing emotional processing for the practitioner as well as clinical decision-making. Supervisors should be trained in “trauma-informed supervision” techniques (e.g., modelling self-care, normalizing stress reactions) .
Peer-Supported Triads: Form small, mixed-experience groups of three PWPs who meet monthly to discuss challenging cases, share coping strategies, and practice giving/receiving real-time feedback. Rotate membership to broaden perspectives.
On-Call Debrief Protocols: Standardize the use of “rapid response calls” post-assessment, ensuring every PWP has access to a designated trauma-informed supervisor within two hours of any particularly distressing session.

Service Design and Workflow Adjustments

Built-In Recovery Time: Allocate “buffer sessions” or short breaks after any appointment involving trauma assessment, allowing PWPs 10–15 minutes to journal, practice grounding exercises, or make debrief calls before moving on.
Flexible Target Frameworks: Revise completion metrics to incorporate “complex case allowances”—for clients with trauma presentations, allow extra sessions without penalty to ensure depth of exploration without rushing.
Integrated Digital Tools: Implement quick digital checklists (e.g., within PCMIS) that guide PWPs through trauma enquiry steps, symptom screening (e.g., PCL-5), and risk protocols, reducing cognitive load and documentation time .

Well-Being and Resilience Supports

Regular Well-Being Audits: Include self-report well-being scales (e.g., Professional Quality of Life Scale) in quarterly staff surveys to detect early signs of compassion fatigue or burnout.
Mindfulness and Stress-Reduction Groups: Offer weekly, on-site or virtual guided mindfulness, yoga, or peer-led resilience workshops tailored to trauma workers.
Managerial Coaching: Train team leads to recognize signs of secondary traumatic stress, encourage vacation use, and proactively redistribute high-intensity caseloads.

Policy and Accreditation

Trauma Competency Standards: Advocate for inclusion of “trauma-competent assessment” as a requirement in national Talking Therapies accreditation, tying workforce funding to demonstrated training and supervision adherence.
Data-Driven Quality Improvement: Track both process metrics (e.g., proportion of trauma assessments using standardized tools) and practitioner outcomes (e.g., well-being audits, supervision attendance) to drive continuous service refinement.

Potential Benefits and Challenges

Benefits: Enhanced diagnostic accuracy; stronger practitioner confidence; reduced emotional toll; improved client outcomes and retention; minimized risk of practitioner burnout.
Challenges: Securing funding and protected time for additional training and supervision; shifting organizational culture away from purely productivity-driven metrics; ensuring equitable access to resources across large or remote services.

By embedding these recommendations into both the PWP training pathway and the operational fabric of NHS-Talking Therapies, services can create a trauma-competent workforce that is both clinically effective and sustainably supported.

Strengths

Collaborative Design: Partnership with service leadership ensured practical relevance.
Rigorous Reflexivity: Triangulation with external PWPs and supervisory sessions bolstered credibility.
Gold-Standard Analysis: Reflexive thematic approach captured both semantic content and researcher positionality.

Limitations

Sampling Bias: Volunteers may have stronger views—either positive or negative—potentially skewing data.
Single-Service Scope: Findings may not generalize across diverse NHS-TT contexts or international settings.
Lack of Service-User Perspective: Excludes how assessment experiences affect or are perceived by clients.

Socratic Questions

Diagnostic Ambiguity: How might clearly defined problem-descriptor guidelines change PWPs’ assessment experiences?
Training vs. Experience: Can extensive practical experience compensate for limited formal trauma training, or is structured education essential?
Emotional Management: What are the ethical and practical implications of normalizing “desensitisation” as resilience in mental health work?
Systemic Pressures: How can services reconcile the need for efficiency (targets) with the emotional demands of trauma assessment?
Support Structures: In what ways could digital peer-support platforms enhance real-time emotional support for remote practitioners?

References

Kerr, J., Lorenz, H., Sadler, S., Roberts, V., Steel, C., & Thew, G. R. (2025). ‘You never know who you’re gonna speak to’: exploring Psychological Wellbeing Practitioners’ experiences of assessing traumatic events. the Cognitive Behaviour Therapist, 18, e29.

Hepgul, N., King, S., Amarasinghe, M., Breen, G., Grant, N., Grey, N., Hotopf, M., Moran, P., Pariante, C. M., Tylee, A., Wingrove, J., Young, A. H., & Cleare, A. J. (2016). Clinical characteristics of patients assessed within an Improving Access to Psychological Therapies (IAPT) service: results from a naturalistic cohort study (Predicting Outcome Following Psychological Therapy; PROMPT). BMC Psychiatry, 16, 52. https://doi.org/10.1186/s12888-016-0736-6

Sandford, D. M. (2023). Understanding the factors associated with mental health practitioners’ engagement in effective suicide prevention activities within an Improving Access to Psychological Therapies (IAPT) service. University of Glasgow.

Murray, H. (2017). Evaluation of a trauma-focused CBT training programme for IAPT services. Behavioural and Cognitive Psychotherapy, 45, 467–482.