Therapists on the front lines: constructing continuous traumatic stress as a dynamic axis of exposure

The study explored how frontline therapists living and working under ongoing security threats constructed Continuous Traumatic Stress (CTS) and how this experience differed from classical trauma responses. Using a qualitative design, the research drew on 12 semi-structured interviews and a focus group with eight additional mental health professionals in southern Israel, including psychologists, social workers, psychotherapists, and educational counselors exposed directly or indirectly to the October 7, 2023, attacks and their aftermath. Data were analyzed using reflexive thematic analysis and interpreted within a CTS framework. Five interconnected themes emerged: continuous multi-channel exposure, multisystem responses, moral injury, long-term coping trajectories between burnout and renewal, and therapist-specific experiences of secondary traumatization and professional identity crisis. Participants described life in a perpetual "waiting room" state, marked by unrelenting alarms, client trauma narratives, hypervigilance, exhaustion, emotional numbing, and somatic strain. Moral injury was expressed through guilt over interrupting treatment, perceived betrayal of professional values, and distrust in institutional support. Coping fluctuated between chronic burnout and resilience through meaning-making, rituals, and collegial support. CTS was used as a conceptual lens to examine participants' narratives rather than as a directly measured diagnostic category. The findings suggest a CTS-informed understanding of frontline therapists' experiences under ongoing threat, demonstrating continuous exposure, multisystem responses, moral injury, coping under strain, and professional identity strain. The study advances a conceptual model for understanding and responding to therapists under sustained threat and attests to the need for CTS-informed supervision, organizational support, and profession-specific assessment tools.