Treating Complex Traumatic Stress Disorders (Adults): Scientific Foundations and Therapeutic Models Hardcover – 12 Mar 2009
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"Treatments based on a traditional conceptualization of PTSD are frequently insufficient to address the diverse, long-lasting, and pervasive effects of complex trauma. This book offers a comprehensive review of treatment considerations, assessment measures, best practices, and evidence-based treatment approaches specifically tailored for psychotherapy with people who have experienced prolonged abuse and neglect by caregivers. An indispensable guide for any mental health professional who works with trauma survivors." - Pamela C. Alexander, Senior Research Scientist, Wellesley Centers for Women, USA
"This is the single best source for clinical expertise in complex traumatic stress disorders. Leading clinicians and researchers share a rich array of individual, couple, family, and group therapy models that illustrate basic treatment principles and best practices. Informed by recent research, the contributors cover the developmental and neurobiological background against which to frame essential assessment and treatment issues. Chapters on such pragmatic topics as vicarious traumatization and risk management offer advice on reducing stress for therapists working with these challenging cases." - Frank W. Putnam, Departments of Pediatrics and Psychiatry, Cincinnati Children's Hospital Medical Center, USA
"Courtois and Ford present an essential, comprehensive work for clinicians and researchers. Evidence-based practice recommendations for psychotherapeutic and pharmacologic treatment are presented - carefully adapted for those suffering from complex traumatic stress disorders - and a range of treatment models are clearly described. Rich clinical material, and attention to management of the therapeutic alliance, therapist self-care, and other key challenges in working with these clients, make this a most useful and innovative resource." - Josef I. Ruzek, Acting Director, Dissemination and Training Division, National Center for PTSD, USA
About the Author
Christine A. Courtois, PhD, ABPP, a counseling psychologist in private practice in Washington, DC, is National Clinical Training Director of Elements Behavioral Health; cofounder and past Clinical and Training Director of The CENTER: Posttraumatic Disorders Program, in Washington, DC; chair of the Guideline Development Panel for Posttraumatic Stress Disorder of the American Psychological Association (APA); past president of APA Division 56 (Trauma Psychology); and past founding Associate Editor of the Division's journal, Psychological Trauma: Theory, Research, Practice, and Policy. She is a recipient of the Outstanding Contributions to Professional Practice Award from APA Division 56, the APA Award for Distinguished Professional Contributions to Applied Psychology as a Professional Practice, the Lifetime Achievement Award from the International Society for the Study of Trauma and Dissociation (ISSTD), and the Sarah Haley Award for Clinical Excellence from the International Society for Traumatic Stress Studies (ISTSS), among other honors. She is coauthor (with Julian D. Ford) of Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach, and has also published several other books and numerous chapters and articles on trauma-related topics.
Julian D. Ford, PhD, a clinical psychologist, is Professor of Psychiatry, Psychology, and Law at the University of Connecticut, where he is also Director of the Center for Trauma Recovery and Juvenile Justice. He has served on the Steering Committee of the National Child Traumatic Stress Network, as Associate Editor of the Journal of Trauma and Dissociation and the European Journal of Psychotraumatology, as Co-Chair of the Presidential Task Force on Child Trauma for APA Division 56, and as a board member and Vice President of ISTSS, and has published several other books on trauma-related topics. Dr. Ford developed and conducts research on the Trauma Affect Regulation: Guide for Education and Therapy (TARGET) psychosocial intervention for adolescents, adults, and families. Dr. Ford and Dr. Courtois were awarded the Print Media Award from ISSTD for this volume.
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This recent collection of 20 articles from over 30 leading scholars, researchers and clinicians in the field will doubtless be the standard reference for Complex PTSD for many years. If you want to know more about how to understand, diagnose and treat Complex PTSD, START HERE! The articles are divided into three sections: overview, individual treatment approaches and strategies and - what a relief! - systemic treatment approaches and strategies. I say, "What a relief!", as often in reviews of treatment approaches, systemic approaches are given short shrift. And in my experience, systemic approaches are often VERY much needed, in some cases indispensible, for healing Complex PTSD, especially with children & teens, and especially with major problems with attachment - one sadly common hallmark of Complex PTSD. Each article has an extensive bibliography for those who want to know more.
The "Overview" section covers a satisfyingly large number of topics, including current approaches to understanding & defining Complex PTSD, overviews on best Practices with children & teens and with adults, cultural issues, risk management/treatment alliance and compassion fatigue/vicarious traumatizing. I want to compliment the editors for this last article. Few areas of psychotherapy are more prone to therapist burnout via PTSD by association than Complex PTSD. I strongly recommend that all clinicians who work significantly in this area become competent in assessing their own risks to compassion fatigue and take regular steps to manage this.
The "Individual Treatment Approaches and Strategies" section is refreshingly clear of biases toward one school. In addition to the standard Cognitive/Behavioral models, they also include articles on Experiential and Emotion-Focused Models, Sensorimotor Psychotherapy and - useful for clinicians to know --Pharmacotherapy. Each article presents an initial summary, the model's basic assumptions/theory, reviews the research, discusses specific clinical applications and presents a case example and/or transcript. While not lengthy, they provide enough information for clinicians to decide whether to pursue an approach further.
The "Systemic Treatment Approaches and Strategies" section includes Richard Schwartz's "Internal Family Systems" as well as traditional multi-person "systems" treatments - Couple Therapy, Family Systems Therapy and Group Therapy. As with the individual treatment section, each section includes overview, basic assumptions, review of research, clinical applications and case example/transcript. Both the "Internal Family Systems" and the "Couple Therapy" articles are written by the field's giants - Schwartz and Susan Johnson & Christine Courtois. These two articles are gems for a moderate introduction. I found the family section more disappointing - particularly since so little has been "overviewed" in this field. But then this could be because my giants - Daniel Hughes (see Attachment-Focused Family Therapy and Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children) and Heather Forbes & B. Bryan Post (See Beyond Consequences, Logic, and Control: A Love-Based Approach to Helping Attachment-Challenged Children With Severe Behaviors) - weren't even referenced. Nor did they reference the Grand Dame of RAD family approaches, albeit less therapy than parenting -- Nancy Thomas. (Her 2nd ed. of "When Love Is Not Enough: A Guide to Parenting Children with RAD" is a strong improvement, correcting parts in the 1st ed. which could be misinterpreted and lead families to become punishing.)
I have three complaints, which are serious, but which don't take away the true importance of this collection. First is that by emphasizing treatments ONLY, they mention, but do not emphasize as much as, in my experience, as is desperately needed, the difficult relationship-building aspects. In my experience, building specific Complex-PTSD relationships is more important than particular treatment approaches. For information about building relationships, and about more on accessing client strengths & feedback, I recommend Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients and The Heart and Soul of Change: Delivering What Works in Therapy (Be sure to get the 2nd ed., 2010!).
Second is that large areas of Complex PTSD are neglected or even completely ignored. For example, as someone who treats Combat PTSD with soldiers (and their families) who've experienced three and four deployments of a year or more, I'm finding that the worse the deployment, and more deployments appear to be creating symptom clusters highly typical of Complex PTSD. Another area: as someone who treats individuals with Asperger's/High Functioning Autism, I find that many AS/HFA teens, especially, because of problems they face - socially, educationally, vocationally, in managing feelings, cognitively - also appear to develop symptoms quite similar to the Complex PTSD cluster.
Third is that I strongly wish that issues of addiction & various forms of self-medicating were more integrated into the Complex PTSD concept and into the treatment approaches. I find addictions/self-medicating distressingly common in Complex PTSD. And when present, addictions/self-medicating greatly complicates building treatment alliances and other relationships, the resources available to clients and finding approaches which integrate this into general Complex PTSD treatment.
Again, though, I want to emphasize: if you work in this field, I'd recommend buying this book. Its rampant pluralism of approaches is just what Complex PTSD needs. Here, like nowhere else in my clinical experience, one size does NOT fit all. Not only are different treatment approaches needed, commonly different modalities, such as family & group, are also needed. Therefore, knowing several approaches helps the vital process of individualizing treatments.
We can never know enough treatments for helping these people & their families. And "Treating Complex Traumatic Stress Disorders" can help us all find more approaches that can help us help more clients.
The first half gives in depth trauma theory, including the neurological components, multicultural treatment, and trauma theory development. This will either present you with new and necessary ideas, or a solid reminder of the foundation of trauma work. The second half consists of several chapters that outline specific types of trauma treatments, including transcripts from real therapy sessions. As a student, I appreciated reading about the variety of treatment methods that I can later pursue in post-grad training. I also think it would be good to know what other people are doing, even if I opt not to.
One warning, this book is specifically catered to complex traumatic stress disorder, not PTSD. Although, it does point out the connections and similarities.
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