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This article explores the potential neurobiological alterations in clinicians who are exposed to the traumatic experiences of their clients. The authors speculate on the role of mirror neurons, the autonomic nervous system, the sympathetic and parasympathetic systems, the amygdala, the hypothalamus-pituitary-adrenal axis, memory, and the left and right hemispheres. A view of these neurobiological processes is integrated with psychodynamic psychotherapy processes, and current conceptions of vicarious or secondary trauma. Implications for understanding the differential effects of trauma treatment on the therapist are explored.