A couple of weeks ago, the American Psychological Association (APA) released clinical practice guidelines for the treatment of people diagnosed with post-traumatic stress disorder (PTSD). “Developed over four years using a rigorous process,” according to an article in the APA Monitor, these are the first of many additional recommendations of specific treatment methods for particular psychiatric diagnoses to be published by the organization.
Almost immediately, controversy broke out. On the Psychology Today blog, Clinical Associate Professor Jonathon Shedler, advised practitioners and patients to ignore the new guidelines, labeling them “bad therapy.” Within a week, Professors Dean McKay and Scott Lilienfeld responded, lauding the guidelines a “significant advance for psychotherapy practice,” while repeatedly accusing Shedler of committing logical fallacies and misrepresenting the evidence.
One thing I know for sure, coming in at just over 700 pages, few if any practitioners will ever read the complete guideline and supportive appendices. Beyond length, the way the information is presented–especially the lack of hypertext for cross referencing of the studies cited–seriously compromises any strainghtforward effort to review and verify evidentiary claims.
If, as the old saying goes, “the devil is in the details,” the level of mind-numbing minutae contained in the offical documents ensures he’ll remain well-hidden, tempting all but the most compulsive to accept the headlines on faith.
Consider the question of whether certain treatment approaches are more effective than others? Page 1 of the Executive Summary identifies differential efficacy as a “key question” to be addressed by the Guideline. Ultimately, four specific approaches are strongly recommended, being deemed more effective than…wait for it… 
“relaxation.”
My first thought is, “OK, curious comparison.” Nevertheless, I read on.
Only by digging deep into the report, tracing the claim to the specific citations, and then using PsychNET, and another subscription service, to access the actual studies, is it possible to discover that in the vast majority of published trials reviewed, the four “strongly recommended” approaches were actually compared to nothing. That’s right, nothing.
In the few studies that did include relaxation, the structure of that particular “treatment” precluded sufferers from talking directly about their traumatic experiences. At this point, my curiosity gave way to chagrin. Is it any wonder the four other approaches proved more helpful? What real-world practitioner would limit their work with someone suffering from PTSD to recording “a relaxation script” and telling their client to “listen to it for an hour each day?”
(By the way, it took me several hours to distill the information noted above from the official documentation–and I’m someone with a background in research, access to several online databases, a certain facility with search engines, and connections with a community of fellow researchers with whom I can consult)
On the subject of what research shows works best in the treatment of PTSD, meta-analyses of studies in which two or more approaches intended to be therapeutic are directly compared, consistently find no difference in outcome between methods–importantly, whether the treatments are designated “trauma-focused” or not. Meanwhile, another highly specialized type of research–known as dismantling studies–fails to provide any evidence for the belief that specialized treatments c
ontain ingredients specifically remedial to the diagnosis! And yes, that includes the ingredient most believe essential to therapeutic success in the treatment of PTSD: exposure (1, 2).
So, if the data I cite above is accurate–and freely available–how could the committee that created the Guideline come to such dramatically different conclusions? In particular, going to great lengths to recommend particular approaches to the exclusion of others?
Be forewarned, you may find my next statement confusing. The summary of studies contained in the Guideline and supportive appendices is absolutely accurate. It is the interpretation of that body of research, however, that is in question.
More than anything else, the difference between the recommendations contained in the Guideline and the evidence I cite above, is attributable to a deep and longstanding rift in the body politic of the APA. How otherwise is one able to reconcile advocating the use of particular approaches with APA’s official policy on psychotherapy recognizing, “different forms . . . typically produce relatively similar outcomes”?
Seeking to place the profession “on a comparable plane” with medicine, some within the organization–in particular, the leaders and membership of Division 12 (Clinical Psychology) have long sought to create a psychological formulary. In part, their argument goes, “Since medicine creates lists of recommended treatments and procedures, why not psychology?”
Here, the answer is simple and straightforward: because psychotherapy does not work like medicine. As Jerome Frank observed long before the weight of evidence supported his view, effective psychological care is comprised of:
- An emotionally-charged, confiding relationship with a helping person (e.g., a therapist);
- A healing context or setting (e.g., clinic);
- A rational, conceptual scheme, or myth that is congruent with the sufferer’s worldview and provides a plausible explanation for their difficulties (e.g., psychotherapy theories); and
- Rituals and/or procedures consistent with the explanation (e.g., techniques).
The four attributes not only fit the evidence but explain why virtually all psychological approaches tested over the last 40 years, work–even those labelled pseudoscience (e.g., EMDR) by Lilienfeld, and other advocates of guidelines comprised of “approved therapies.” 
That the profession could benefit from good guidelines goes without saying. Healing the division within APA would be a good place to start. Until then, encouraging practitioners to follow the organization’s own definition of evidence-based practice would suffice. To wit, “Evidence based practice is the integration of the best available research with clinical expertise in the context of patient (sic) characteristics, culture, and preferences.” Note the absence of any mention of specific treatment approaches. Instead, consistent with Frank’s observations, and the preponderance of research findings, emphasis is placed on fitting care to the person.
How to do this? The official statement continues, encouraging the “monitoring of patient (sic) progress . . . that may suggest the need to adjust the treatment.” Over the last decade, multiple systems have been developed for tracking engagement and progress in real time. Our own system, known as Feedback Informed Treatment (FIT), is being applied by thousands of therapists around the world, with literally millions of clients. It is listed on the National Registry of Evidence based Programs and Practices. More, when engagement and progress are tracked together with clients in real time, data to date document improvements in retention and outcome of mental health services regardless of the treatment method being used.
Until next time,
Scott
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
Scott,
The post on PTSD treatment and APA guild lines you clearly show a political interpretation to research rather than simple critical thinking. The citations in the guild lines are solid. You note that many of the research designs were compared to “nothing” not even just silent relaxation. You imply this is problematic without tell us the reasons and how conclusions drawn from such research finding are suspect at best and false otherwise….
Hi Randy, from what I gather, Scott is saying that the models of practice (guidelines) suggested by the APA are based on research in which models tested are compared against waitlist control/nothing. The conclusions drawn from this kind of research can be that these models work better than nothing but it cannot be logically concluded that the models work better than any other models of practice. There would need to be a comparison made for that conclusion to be drawn.
When research is considered that does compare one model to another model (fairly), the models are equal. See the work of Bruce Wampold.
If the APA were to consider the evidence base of comparison studies and comparison meta studies then a guideline like: “Counseling for PTSD is suggested versus no counseling,” would be a logical conclusion and is well supported by the evidence.
Guidelines not guild lines but the latter makes political sense!!!
Randy, I was wondering if that was intentional “guild lines”:-
Scott, I find your closing sentence confusing. Are you referring to your FIT treatments or the universe of treatments?
Gary, thanks for your note. I’ve edited that last sentence. It was vague! Hope the change makes the meaning more clear.
Second question. Shelder encourages the disregarding of the guidelines due to being bad therapy. Other have lauded the guidelines as important and responsible treatment prescriptions. You did neither. You did what most can’t or won’t, investigate the source document. You don’t come down on either party line other than noting that specific ingredient therapies consistently fail to show significant differentiation. How would you address our collective political voice in the APA, their (to my reading) exaggerated conclusion in the guidelines, and the Shelder encouragement to total disregard?
Thanks for the article.
What you said was clear and precise and in my estimation right on.
Thank you for your continued energy and astute insight, Scott. I work ungodly hours as a licensed therapist and do not have time (or training) to pursue studies the way you manage to do, and every time you come up with a critique that inspires critical thinking instead of passive acceptance. I appreciate that. When there exists too much controversy over what is working right and well, I fail to see how the egos of a few who seek notoriety gain momentum… i experience these industry rifts and shifts as wearing down patients more than assistive. So again, I appreciate your attention to detail and ability to articulate an alternative reality to movement such as this PTSD edict.
Thank you Charlene (and Scott). These were exactly my thoughts and feelings.
Since I have not read the APA guidelines, and have only read Shedler’s critique, and heard the critique of a few other respected colleagues, my comments are more in the form of questions:
1. Scott, it is my understanding the research the APA cites is based on patients with PTSD sans any co-morbid conditions. Likewise, it is my sense the trauma studied is more “simple” than “complex”, as in complex relational trauma survivors.
Does that match your read of the APA guidelines?
2. Scott, in my opinion, there is some excellent clinical work being done with complex trauma and dissociation that has been written about but hasn’t been researched (as you know, it is not so easy to do), and some that has been researched (see Bethany Brand, PhD et al’s research into online, adjunct treatments for DID patients). Has any of the non-researched, clinical work been discussed, and if so where do they situate that work in their overall assessment of the trauma therapy field? Also, has Brand et al’s work with DID been referenced, and if so what conclusions were drawn?
Thanks so much for your offering us your impressions and critical reflections, here.
Dr. Benau,
I realize your questions were addressed Scott, not me, but I thought I could offer some references.
In answer to #1: Complex (developmental or relational) trauma is not recognized by the American Psychiatric Association. In fact the developmental trauma proposal put together by a number of prominent trauma research scholars was flatly rejected by the American Psychiatric Association even though it has since been recognized in the ICD-10. Hence, the problem of the American Psychological Association appealing to the ‘scientific’ or ‘medical’ community for PTSD guidelines. How do you provide guidelines for PTSD treatment with any sense of legitimacy if you don’t fully recognize the entire population of those who experience PTSD symptomotology? These guidelines do not apply to most people who experience PTSD. There are an estimated five to ten times more people who suffer from complex PTSD than single instance trauma or combat trauma. Treating development trauma is much different, difficult and time consuming than treating a single instance trauma such as an automobile accident. With complex trauma, you are not only about healing the trauma, it also often involves working with affect dysregulation, working with dissociated parts, working with transference or relational repair because the primary attachment is ruptured during the early developmental years. Those with developmental trauma do not have healthy attachment or a model or often the experience of healthy relationships. Although, borderline personality disorder is often seen as the equivalent diagnosis, it’s not the only disorder implicated. Childhood abuse and neglect has long lasting impact on the subsequent brain development of children which Dr. Martin Teicher theorizes leads to acquisition of most adult psychopathologies or disorders that are currently identified within the DSM. Dr. Dan Siegel makes a similar kind of argument that puts diagnostic categories into question because the DSM lacks any internal inconsistency if you account for the effects of developmental trauma and attachment failure. The symptoms for ADHD, bipolar disorder, borderline personality disorder, major depression, psychotic disorders and anxiety disorder begin to overlap and look strikingly similar when you look at the impact of childhood trauma on the brain. Dr. Bruce Perry and Dr. Laurence Heller who look at mental health through a trauma informed lens refer to this impact as ‘environmental failure’ which is a very different way of looking at ‘disordered’ patients than most psychiatrists who prefer to attribute disorders to genetic origins. So what was once conceptualized as distinct ‘disorders’ or brain ‘diseases’ with distinct genetic origins starts looking more like a house of fallen cards. See evidence: “Impact of Childhood Maltreatment on Brain Development” powerpoint presentation by Dr. Martin Teicher on https://drteicher.files.wordpress.com/2017/11/isnr_2017_keynote_teicher.pdf
In answer to #2: In terms of complex trauma empirical research, there is actually quite a bit of research about how chronic child abuse, neglect and sexual abuse effects the developing brain. However, it’s a relatively new field of study. It’s difficult to get research funding for treatment because of the push to promote the use of psychiatric medication in research institutions. However you can find complex trauma evidence based research at: http://www.traumacenter.org (Bessel van der Kolk, Joseph Spinazolla) and Dr. Martin Teicher’s work on childhood abuse and neglect at Harvard: https://drteicher.wordpress.com/. Their work is also readily accessible on researchgate.com and academia.com
In terms of actual clinical work, I’d suggest looking up Janina Fisher PhD: licensed clinical psychologist and instructor at the Trauma Center, founded by Bessel van der Kolk, MD. A faculty member of the Sensorimotor Psychotherapy Institute, an EMDR International Association consultant, past president of the New England Society for the Treatment of Trauma and Dissociation, and former instructor, Harvard Medical School, Dr. Fisher lectures nationally and internationally on the integration of the neurobiological research and new trauma treatment paradigms into traditional psychotherapies. (www.janinafisher.com)
Also: Suzette Boon and Kathy Steele who co-wrote: “Coping with Trauma-Related Dissociation: Skill Training for Patients and Therapists” Boon is founder of the European Society for Trauma and Dissociation and Steele is past president of the International Society for Trauma and Dissociation.
Onno van der Hart Ph.D.: past president of the International Society for Trauma and Dissociation is author of “The Haunted Self: Structural Dissociation and the Treatment of Chronic Dissociation”. His research publications which includes the efficacy of EMDR with dissociative patients can be found on Research Gate.
Dr. Vedat Şar has also published research on dissociation.
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An aside: I also think it’s interesting that Dr. Bessel van der Kolk once commented in a lecture about survivors of 9-11 and how they often chose to treat their own PTSD. A majority of the New Yorkers surveyed had chosen to ignore the experts and found their own solutions more effective traditional psychotherapy. Many sought out alternative healing such as yoga, Reiki, acupuncture, meditation, and some other things that had nothing to do with conventional wisdom. So, I think the lesson for the APA is: just because you make a pronouncement about what people should do to treat PTSD, doesn’t mean people will follow your lead. Or, rather ‘should’ follow their lead.
Tired of advocacy research! The key to your article is this quote, should start with that!
Here, the answer is simple and straightforward: because psychotherapy does not work like medicine. As Jerome Frank observed long before the weight of evidence supported his view, effective psychological care is comprised of:
An emotionally-charged, confiding relationship with a helping person (e.g., a therapist);
A healing context or setting (e.g., clinic);
A rational, conceptual scheme, or myth that is congruent with the sufferer’s worldview and provides a plausible explanation for their difficulties (e.g., psychotherapy theories); and
Rituals and/or procedures consistent with the explanation (e.g., techniques).
The four attributes not only fit the evidence but explain why virtually all psychological approaches tested over the last 40 years, work–even those labelled pseudoscience (e.g., EMDR) by Lilienfeld, and other advocates of guidelines comprised of “approved therapies.”
Scott,
Thanks for your comments. Unfortunately, this is what I feared when I learned a few years back that APA planned to develop “treatment guidelines.” Several of us in Division 32 had a meeting with the APA guidelines committee at that time. They promised to “follow the data” but appear not to have done so. For more than a century, our profession has searched for “treatments,” meaning specific techniques, that are effective. Apparently, we just cannot believe that common factors, and particularly human factors, are the primary agents of change. This committee, unfortunately, has apparently fallen under the spell of techniques and have failed to follow where the data lead in terms of the power of those factors. Thanks for your thoughtful analysis, Scott. It’s amazing to see the weak research that is used to recommend these treatments.
Scott – Thank you for your time and patience in providing a critique of these Guidelines and I am in full agreement with you. I have neither the time nor the will to fully research the supporting evidence and am deeply sceptical of any research that seeks to promulgate manualised treatment models.
As you know, I am a pragmatist and you may remember that I am a psychological trauma specialist practitioner. At risk of stating the obvious, everyone is an individual and, clearly, should be treated as such. Most people require a tailored approach, based upon a strong foundation – an understanding of the impact of trauma and the myriad of presenting difficulties. What works? Everything helps some of the people some of the time and, sadly, nothing helps all of the people all of the time, whether manualised or randomised.
The essence of the APA Guidelines mirrors the age old problem of governments, institutions, health authorities all and any statutory or specialist services……..which are obliged to promote a solution based upon its population conforming to a predetermined size & shape. Most education systems are designed to force the significant minority of round pegs into square holes. I had hoped that in the 21st centre psychological therapy would cease promoting this malpractice. It seems we still have a long way to go.
In the profound words of Aaron Beck – “Each person is a unique individual hence psychotherapy should be formulated to meet the uniqueness of the individual’s needs, rather than tailoring the person to fit the procrustean bed of a hypothetical theory of human behaviour.” And so say all of us.
The best approach we have is to engage the patient in providing feedback on their experience in order to better inform our approach, thus to modify what we do and how……and when, we do it.
Bad APA Advice about PTSD:
The new APA guidelines for treating PTSD are so poor. I don’t even know where to begin. I felt it was quite telling that the International Society for Traumatic Stress Studies (on Twitter), Dr. Bruce Perry (on Twitter) and Dr. Bessel van der Kolk (Body Keeps the Score account on Facebook) — premiere leaders in the trauma field — supported Shelder’s claims by posing a link to the Psychology Today to their respective social media feeds.
APA – Time for Paradigm Shift:
Advising practitioners to ignore the crappy guidelines that continue promoting CBT for PTSD is sound advice. For once, Psychology Today has got it right. I’m quite pleased that the Amercan Psychological Association was called out on that major blunder. Similarly, the American Psychiatric Association and the Veteran’s Administration has been duly criticized for ignoring sound neuroscientific evidence and simply becoming the ‘talking head’ or ‘parrot’ for the institutionalized status quo. This needs to happen for the benefit of trauma survivors who have limited access to treatment and services.
Trauma Survivors Deserve Access to Effective PTSD Treatment:
Most United States healthcare insurance plans do does not cover neurofeedback, yoga, EMDR or somatic experiencing even though these modalities have been proven to work with PTSD. Ironically, CBT which does NOT work to process or integrate trauma, in most cases, is covered by insurance because it’s ‘Evidenced Based.’ But the truth is if you look at the research, CBT is NOT an effective treatment modality for PTSD (with the exception of single instance trauma) in terms of efficacy when one looks at long term outcome studies. ‘EVIDENCE BASED’ means COST EFFECTIVE for the purposes of insurance companies. PTSD is not ‘suppose’ to last more than thirty days or six months because it doesn’t follow the RULE of managed care. But, in reality, this means little to nothing for most trauma survivors who are desperately seeking help for their ongoing emotional pain and suffering.
As Bessel van der Kolk says, with PTSD, The Body Keeps the Score:
As Shelder’s article mentions, CBT is a top-down, not a bottom up therapy which is not particularly useful since it involves engaging the prefrontal cortex and verbal language centers of the brain that are hijacked in the experience of trauma. Literally, “there are no words” to describe trauma. Talk therapy doesn’t really work meaning psychotherapists need to seriously rethink what they do in their offices with the client if CBT is their primary treatment modality.
Instead, effective trauma therapy means engaging bodily sensations and actively working with memories to process and integrate trauma in a manner that means a person is no longer triggered. Effective trauma therapy also faciliates the calming of the central nervous system as Sebern Fisher has written in the “Healng the Fear Driven Brain”. When you calm down the amydala, when you re-engage the pre-frontal cortex, even DBT becomes a little less relevant except for the psycho educational element, I suppose. This is why neurofeedback is proving to be such a successful treatment for affect dysregulation.
EMDR is more effective than CBT for trauma:
EMDR is also extremely effective, even though it is essentially a form of ‘exposure therapy’ — but it has a different and long pasting positive effect on the traumatized brain, unlike CBT, because trauma memories are integrated via the process of bilateral stimulation. Most every trauma informed therapist today, including EMDR therapists incorporate some form of somatic therapy based on the latest understandings in the neuroscience field.
Consider Dr. Bessel van der Kolk’s comment in a Psychotherapy Networker article:
“The VA seems to be surprised by how many veterans drop out of prolonged exposure therapy. It would be helpful for them to find out why, but the likely answer is that it is re-traumatizing them. Cognitive Behavioral Therapy (and “Trauma Focused CBT”), talk therapies, and prolonged exposure therapies CAN make some changes in people’s distress, BUT traumatic stress has little to do with cognition—it emanates from the EMOTIONAL PART OF THE BRAIN that is rewired to constantly send out messages of DANGERS and DISTRESS, with the result that it becomes difficult to feel fully ALIVE and IN THE PRESENT. Blasting people with the memories of the trauma may lead to desensitization and numbing, but it does not lead to INTEGRATION: an organic awareness that the event is over, and that you are fully alive in the present. The VA seems to be surprised by how many veterans drop out of prolonged exposure therapy. It would be helpful for them to find out why, but the likely answer is that it is RE-TRAUMATIZING them.” [capitalizations mine.]
As a trauma survivor, I could not agree more.
Somatic Experiencing enables survivor to integrate trauma:
Somatic Experiencing is far more effective in terms of processing and integrating trauma memories. In fact, I would go so far as to say to anyone engaged in CBT for PTSD that you are wasting yout time and money. I know because I used to have PTSD and I have since healed. If you want to see an inspirational accounting of trauma healing see Peter Levine’s video, https://m.youtube.com/watch?v=bjeJC86RBgE Ray’s Story – Somatic Experiencing. This is a remarkable demonstration of how Somatic Experiencing changed the life of a soldier with PTSD. Psychiatric medications and CBT would never have successfully enabled this soldier to heal his trauma in this way.
Psychotherapists need to become trauma informed and retool:
Any legitimate neuroscientific/trauma informed therapist or researchers knows that CBT is not the treatment of first choice for those with PTSD especially those with childhood histories of trauma (or relational trauma). Most trauma also involves working with dissociation or dissociative parts. The idea that you are going to do dissociative work with CBT is simply nuts! The fact that the APA tried to pass their PTSD Guidelines off as some legitimate thing is pretty laughable and embarrassing. It goes to show you how deeply the intransigent ones still hold power within academic research circles and how much psychotherapists who are trained in nothing other than CBT will cling desperately to the notion that CBT is the GOLD STANDARD, that it’s effective PTSD, despite reality, despite the truth.
If psychotherapists are beginning to wonder why their ‘consumers’ are leaving their professional practices in droves and moving towards ‘alternative healing’ providers or New Age cult leaders such as Teal Swan and the quasi ones such as Deepa Chopra, Marianne Williamson and Oprah Winfrey or obsessively reading books such as the law of attraction and the ‘Alchemist’, it’s because psychotherapy has become irrelevant and ineffective in healing core wounds that often resulted from traumatic events. CBT is not effective! It is not even ‘relational’ as in ‘relational repair’ or transference work (see: David Richo’s videos on transference). Another concept some clinical psychologists could chew on for a while: there are no ‘quick fixes’ in life. Your client will not be miraculously ‘fixed’ or better or transformed in ten or twenty sessions – CBT or no CBT. This would be a fine definition for hubris. We need a world of healers, not ‘quick fix’ operators and charlatans. We need people that are committed to working with people through the long haul. If you want to offer a ‘quick fix’, I think they might be hiring or offering service at Jiffy Lube.
The denial of trauma and its societal effects neecs to end:
Even though many healthcare experts (including Dan Siegel, Gabor Mate, Vincent Feletti, Bruce Perry and Bessel van der Kolk) have identified TRAUMA as the SINGLE MOST healthcare problem facing problem facing our country — even mental health professionals are failing to educate themselves about how to treat it as it relates to their own clients. The denial is HUGE. Even though it’s vital that today’s psychologists and psychiatrists retool re-educating themselves regarding trauma informed treatment modalities, there’s still those who refuse to open their eyes to the all pervasive effects of trauma in our world. If you are a psychotherapist and you can’t see that what you are treating each and every day when you sit across from your client is the result of some form of attachment trauma or sexual abuse, then you are clearly in the wrong field.
Most every client in therapy has been effected by trauma:
I have no doubt that many people enter the mental health profession with the best of intentions. As a psychologist, you are probably a ‘Nice Guy’ or a compassionate soul. You are probably a ‘nice’ person to talk to for a session or two. However, if you cannot offer your clients a solid and proven method for resolving or integrating their childhood trauma or attachment issues (by essentially re-wiring my brain to create new neuropathways) you are relatively useless to those clients with suicidal thoughts, those with eating disorders, those with substance abuse issues, those with sexual abuse histories or childhood physical or emotional abuse histories.
The trauma field has become a revolutionary paradigm for mental health:
Incidentally, I’m a trauma survivor who feels indebted to people like Richard Schwartz (Internal Family Systems), Dr. Peter Levine (Somatic Experiencing), Dr. Stephen Porges (Polyvagal Therapy), Francine Shapiro & Laura Parnell (EMDR), Dr. van der Hart & Janina Fisher (Dissociation), Calming the Fear Driven Brain, Dr. Bessel van der Kolk (The Body Keep the Score). These people transformed my life for the better. They are all true pioneers in the field of trauma therapy and research.
CBT is losing ground. It’s being challenged and discredited:
The APA Guidelines for PTSD are not legitimate insofar as they simply do not account for the latest research in neuroscience therefore they will not be widely accepted nor adopted, the APA will lose credence and I predict they will be forced to revise their guidelines in the near future. Additionally those who continue to uncritically and unabashedly promote Aaron Beck, one of the founding fathers of the False Memory Foundation, lose more in terms of credibility in the eyes of the trauma informed therapy profession every day.
Psychotherapists need to stop promoting CBT as a solution to depression, as a solution to distress, as a solution to anxiety and start recognizing that in the mnd of their clients the ‘past is [often] the present’ as David Richo says:
Psychotherapists re-traumatize their patients when they pretend that trauma does not exist, that their clients must simply focus on the ‘here and now’ and simply ‘move on from the past’ by developing a sense of ‘resiliency’, a ‘positive attitude’ and adopting healthy cognitions to replace those ‘faulty’ ones. I’d argue that there’s a little more to the therapeutic exchange. But since most psychotherapists haven’t dealt with their own skeltetons, maybe it’s best they stick to CBT. We need more people dedicated to dealing with the realities of a traumatized society.
Trauma survivors know what works. Honor the trauma survivor. Just because you possess a PhD, doesn’t mean you know everything. Listen, learn, evolve:
Of course, what would I know about my own experience of incest, rape and near death as a child? Who am I to suggest what works for PTSD, for relational trauma or dissociation? I apologize if I sound aggressive, and I am also tired of the mental health lies that continue to be promoted in the name of evidence based care. If you want to help your clients, I’d suggest educating yourself in the latest treatment modalities. Stop promoting nonsense.