The authors of this article describe the rewards and challenges for clinicians treating veterans who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Issues of vicarious trauma, secondary traumatic stress, compassion fatigue, and burnout are defined and reviewed, as are compassion satisfaction and posttraumatic growth. Patient, clinician, and organizational characteristics that are likely to affect clinicians working with this clinical population are discussed. Patient factors that may increase strain on clinicians are discussed such as age, likelihood of redeployment, comorbid conditions, attendance issues, and elevated risk for suicide and aggression. Clinician factors, such as theoretical orientation, training, supervision, military affiliation, personal trauma history, spirituality, social support, and self-care, are also discussed as possible risk and protective factors for vicarious trauma and burnout. Organizational influences, such as caseload size and diversity, clinician control and autonomy, use of evidence-based practices, availability of resources, rural isolation, and the philosophy of the clinic, are further discussed. Recommendations for ameliorating risks are discussed relative to each area and include allowing clinicians to plan their own appointments so as to balance their caseload of OEF/OIF veterans, attending to self-care practices, and having a supportive team with thorough training in evidence-based practices. Future empirical research is needed on risk and resiliency factors for clinicians working with traumatized OEF/OIF veterans given that this population is likely to grow.

This investigation utilized path analyses to examine the direct and indirect effects of experiences of potentially traumatic events in childhood, trauma-related guilt, and the use of avoidant coping strategies on level of PTSD symptomatology among a sample of female survivors of domestic violence. The results of this investigation indicated that individuals with more extensive histories of potentially traumatic events in childhood were more likely to report the experience of trauma-related guilt after exposure to domestic violence victimization in adulthood. Further, the path model indicated that experiencing trauma-related guilt was associated with greater use of avoidant coping strategies. Trauma-related guilt was related to increased PTSD symptomatology both directly and indirectly through the use of avoidant coping strategies. These findings highlight the importance of attending to guilt-based affective and cognitive reactions, maladaptive coping strategies, and the association between these constructs when treating survivors of relationship violence with multiple exposures to potentially traumatic events.