This dissertation presents two qualitative studies investigating expert trauma counselors’ experiences of clinical decision-making and countertransference. Chapter 2, Acutely Alert: A Grounded Theory of Clinical Decision-Making Processes of Expert Trauma Counselors addresses the research question, what are the clinical decision-making experiences and processes of expert trauma counselors? Chapter 3, Exploring Self: A Grounded Theory of Expert Trauma Counselors Encountering Countertransference examines, how do expert trauma counselors perceive, experience, and use countertransference? A purposeful sample of ten expert counselors participated in three rounds of semi-structured interviews. Data collected during interviews were transcribed, analyzed and used to develop subsequent interview questions, continuing until conceptual saturation occurred. Data analysis procedures included open, axial, and selective coding (Corbin & Strauss, 2014). The study utilized measures to promote trustworthiness delineated by Lincoln & Guba (1985) and Morrow (2005). Chapter 2 findings included three categories with a central category, evaluating reactivity. They comprise a theory representing how participants’ trauma-specific heightened awareness and accumulated knowledge inform clinical decision-making. Chapter 3 findings revealed four categories with a central category, experiential analysis, which details participants’ analysis of their reactivity. The resulting theory illustrates a process of self-inquiry as participants encounter client dysregulation. Implications for practitioners, supervisors, and counselor educators include examination of one’s own reactivity and heightened awareness and the impact on treatment and the working alliance, establishing one’s own definition and understanding of countertransference and clinical intuition, and developing a clinical routine of reflective practice and countertransference management strategies.