Clinicians are paying increasing attention to people suffering from the direct impact of traumas, usually diagnosed as having Posttraumatic Stress Disorder (PTSD). When facing these sufferers, clinicians have to make relevant decisions: What do I do in order to alleviate these symptoms that are so intense and distressing?
Some may search for an answer in the recently released clinical practice guidelines, but these may prove ineffective for a given client. Actually, it appears that all specialized treatments for PTSD have similar effectiveness and, in parallel, many clients show only partial response or no response at all.
In that context, it seems more favorable for clinicians to have a rich set of techniques and procedures, and then be able to select what would work with whom, in order to tailor treatment to the needs of the unique individual experiencing post-traumatic symptoms.
For example, exposure, both in imagery or in-vivo, may be particularly beneficial to some and detrimental to others. Conversely, not exposing patients to traumatic memories may be protective to some but deprive others of a faster, and possibly more effective, route to change.
Some may benefit from the exposure to traumatic memories until suffering reaches extinction, while others may benefit from elaboration of the memory in the form of rewriting. For other persons, the problem is not just the trauma itself, but the impact it has on underlying views of self and others; that is, their interpersonal schemas.
For example, as a consequence of traumas such as rape, assault, or witnessing severe accidents, pre-existing schemas such as "self as vulnerable" and "other as threatening or unreliable" may be reinforced and crystallized to the point that the person is unable to exit the state of alarm underlying PTSD symptoms.
For these persons, changing maladaptive schemas is an avenue to soothing symptoms. So, what should a clinician do?
In a special issue of Journal of Psychotherapy Integration, guest editor Dr. Giancarlo Dimaggio tried to provide the practicing clinician with a view on some of the most widespread and validated, or clinically relevant, treatments for PTSD
- prolonged exposure
- EMDR
- interpersonal therapy
- narrative-emotion focused
- memory specificity training
- schema-therapy
All authors were asked to describe the core features of their approach, the hypothesized mechanisms of change and, most of all, to provide detailed examples of how their approach works. The goal was to allow the readers to enter the therapist's room, with the different rooms to observe, to inform their own larger perspective and see what they could import into their everyday practice.
Such an effort needed a wrap-up piece, providing an integrative and comprehensive reading of the different approaches. The piece was written by Bruce Wampold, one of the most brilliant scholars in the field of psychotherapy, unable to remain confined within the boundaries of a specific approach. In his words: "Psychological problems are too complex to think that there is an identifiable psychological deficit that can be addressed by a particular therapeutic ingredient. We should think that we are working with people rather than with deficits."
Note: This article is in the Clinical Psychology topic area. View more articles in the Clinical Psychology topic area.