Treating Complex Trauma
Combined Theories and Methods
This forward-thinking volume outlines several approaches to therapeutic treatment for individuals who have experienced complex childhood and adult trauma, providing a framework for helping challenging patients and emphasizing the importance of maintaining good therapeutic relationships. Responding to the intense disagreement and competition among clinicians championing their own approaches, the book identifies the strengths and limitations of multiple theories of treatment, addressing the need for qualified clinicians to be versed in multiple theories and techniques in order to best benefit their patients. Among the topics discussed: Difficulties in diagnosing cPTSD among other similarly presenting disorders Cultural and ethnic considerations in trauma treatment Addressing avoidance when talking to patients Maintaining the therapeutic relationship with aggressive patientsTreating Complex Trauma: Combined Theories and Methods serves as a practical guide for therapists looking to applying multiple approaches in their practice, with the aim of providing the most effective treatment strategy possible for each individual. 04 02Chapter One The Need for Utilizing Multiple Approaches for Complex PTSD: No Theory Has It All Introduction: Complex Clients Need Multiple Approaches What is Trauma and Who Gets to Define It? Difficulties in the Study of Complex Trauma PTSD vs. cPTSD: Important Distinctions Therapeutic Efficacy and the Therapeutic Alliance Multiple Treatments, Equal Efficacy Commonalities Among All Approaches The Therapy Relationship and Clinical Hypothesis Testing Negotiating the Beginning of Therapy Conclusion ReferencesChapter Two: How Trauma Stokes Fear: Considerations in Beginning of Therapy The Neurobiology of Trauma Evidence for Intergenerational Trauma Effects Fear: Known, Unknown, and Acted Out Clinical Hypothesis Testing and Introducing the Concept of Fear The Unhelpful Link between cPTSD and Personality Disorders How Trauma Can Lead to Incorrect Diagnoses Assessing Character Style Managing Fear in the Beginning of Therapy Conclusion Initial Goals in the Beginning of Therapy for People with cPTSD ReferencesChapter Three: Nurturing the Therapeutic Alliance: Mentalizing and Emotional Safety Characteristics of Therapists Who Have Good Outcomes -The Effective Therapist Has Sophisticated Interpersonal Skills -The Effective Therapist Has an Ability to Explain A Client’s Distress and Takes the Client’s Unique Experience into Account - The Effective Therapist Is Persuasive About Treatment Ideas And Monitors Progress in An Authentic Way - The Effective Therapist Can Deal with Difficult Material While Communicating Hope and Optimism - The Effective Therapist Is Keenly Aware of Their Own Psychology - The Effective Therapist Stays Aware of Relevant Research and Strives to Continually Improve Trust and the Mentalizing Therapist Normalizing and Managing Shame Creating Safety Though Respecting Avoidance How Much Should We Encourage the Processing of Memories? Conclusion Interventions for Mentalizing and Maintaining Emotional Safety ReferencesChapter Four: The Therapeutic Alliance and Maintaining Physical Safety Trauma, Suicidal Ideation and Deaths of Despair The Alarming Epidemic of Suicide Avoidance and Therapist Feelings About Suicidal Clients Risk Factors for Suicide The Trauma of a Suicidal Crisis Clinical Management of Suicidality Crisis Response Plans Conclusion Interventions for Managing Suicidality ReferencesChapter Five: Dissociation : Controversies and Clinical Strategies Normal vs. Trauma Related Dissociation Assessing Excessive Dissociation Controversies Regarding Dissociation: TM vs. SCM A Combined Model of Dissociation? Dissociation of Trauma in the Mental Health Field Treating Dissociative Disorders Conclusion Interventions for Working with Dissociative Clients ReferencesChapter Six: The Need to Numb: Substance Abuse and Therapeutic Management Substance Use Problems: Evolving Social Perceptions and Reality The Increase in Problematic Substance Use Links Between Trauma and Substance Use Combined Vulnerability: Psychological and Biological Models Assessing Substance Use Treatment Approaches for cPTSD and Substance Use Treatment Approaches Specifically for Substance Use Conclusion Interventions for Helping People with Excessive Substance Use ReferencesChapter Seven: When Trauma is in the Body: Managing Physical Concerns Effects of Trauma on the Body Links Between Childhood Adversity and Physical Illness Proposed Mechanisms Explaining the Trauma Illness Connection Relationships and the Buffer Against Illness Research on the Decrease of Physical Symptoms in Therapy Treating People Who are Somatically Focused Conclusion Interventions for Helping People who Are Physically Focused ReferencesChapter Eight: When Fight Impulses Dominate: Managing Anger Anger and Clinical Avoidance Links Between Aggression and Trauma Anger as a Result of Feeling Over-Responsible Mind, Body and Brain: The Neuropsychology of Anger Anger And Problems Regarding Ideas of Transference When the Therapist is the Focus of Anger Treating Anger and Aggression Conclusion Interventions for Treating Angry and Aggressive Clients ReferencesChapter Nine: Sociocultural Consideration in Trauma Treatment Culture and the Culture of Avoidance: Thinking about Differences Between Therapist and Client Trauma, Microaggressions and Race and Class Trauma, Microaggressions and LGBT Persons Stereotypes and Stereotype Threats Talking about Differences Conclusion ReferencesChapter Ten: Vicarious Trauma and Self Care for the Trauma Therapist Compassion Fatigue and the Impact of Vicarious Trauma Too Much Empathy? The Risk of Burnout and Potential Consequences Therapist Vulnerabilities Countertransference and the Importance of Therapist’s Emotions Over-Responsibility and the Trappings of the Super Therapist Therapist Self-Care Conclusion Self-Care Interventions References 13 02Tamara McClintock Greenberg, Psy.D., M.S. , is a clinical psychologist in private practice in San Francisco, CA, where she specializes in treating adults with depression, anxiety, relationship issues, trauma, and those who are coping with medical illness, either as a patient or affected family member. She has been practicing psychology in San Francisco since 1997. As an Associate Clinical Professor of Psychiatry at the University of California, San Francisco, Tamara spent over 12 years seeing medical patients and their families in the UCSF hospitals and clinics and has spent the last 20 years supervising psychiatry residents, psychology interns and students in a number of different training centers. Tamara received a post-doctorate master’s degree in Clinical Psychopharmacology from Alliant University/California School of Professional Psychology in 2004, her Doctorate Degree in Clinical Psychology (secondary emphasis in Clinical Health Psychology) from Argosy University/Minnesota School of Professional Psychology, Minneapolis, MN in 1997. She received the Jacob Markovitz Memorial Scholarship toward her graduate school studies. Her APA-approved predoctoral internship was at the Veterans Affairs Medical Center in North Chicago, IL from 1996-1997. She has been licensed as a clinical psychologist in the state of California since 1999 (PSY 16206). Her publishing has focused on care taking, health psychology, and psychoanalytic psychology, women’s issues and trauma, with the aim of helping people navigate complex physical and/or psychological issues. Her most recent book is the Second Edition of Psychodynamic Perspectives on Aging and Illness (Springer, 2016). Her 2012 book, When Someone You Love Has a Chronic Illness (Cedar Fort, 2012) continues to be a helpful resource for patients and caretakers alike. This latter title has sold around 5,000 copies and sales continue to be strong, with recent Amazon.com ratings below 100,000. Tamara has written for multiple publications, including The Huffington Post, Psych Central, Psychology Today, The Good Men Project, Maria Shriver’s website, The San Francisco Chronicle, and has been quoted as an expert in Forbes, USA Today, Newsweek, Next Avenue (PBS), and more. She has been interviewed by numerous radio stations, including several NPR stations and affiliates. Tamara is a member of The American Psychological Association, Division 38 (Health Psychology) of the APA, California Psychological Association, and Northern California Society for Psychoanalytic Psychology. 18 02 This forward-thinking volume outlines several approaches to therapeutic treatment for individuals who have experienced complex childhood and adult trauma, providing a framework for helping challenging patients and emphasizing the importance of maintaining good therapeutic relationships. Responding to the intense disagreement and competition among clinicians championing their own approaches, the book identifies the strengths and limitations of multiple theories of treatment, addressing the need for qualified clinicians to be versed in multiple theories and techniques in order to best benefit their patients. Among the topics discussed: Difficulties in diagnosing cPTSD among other similarly presenting disorders Cultural and ethnic considerations in trauma treatment Addressing avoidance when talking to patients Maintaining the therapeutic relationship with aggressive patientsTreating Complex Trauma: Combined Theories and Methods serves as a practical guide for therapists looking to applying multiple approaches in their practice, with the aim of providing the most effective treatment strategy possible for each individual. 19 02 Evaluates a range of clinical approaches and techniques for treating complex trauma Outlines common symptoms of complex childhood and adulthood trauma
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