Have you heard of the “Baader-Meinhof” effect? If not, I’m positive you’ll soon be seeing evidence of it everywhere.
That’s what “it” is, by the way — that curious experience of seeing something you’ve just noticed, been told of, or thought about, cropping up all around you. So …
You buy a car and suddenly it’s everywhere. That outfit you thought was so unique? Boom! Everyone is sporting it. How about the conversation you just had with your friend? You know, the one that was so stimulating and interesting? Now the subject is on everyone’s lips.
Depending on your level of self-esteem or degree of narcissism, Baader-Meinhof either leaves you feeling on the “cutting edge” of cultural trends or constantly lagging behind others. For me, it’s generally the latter. And recently, its a feeling that has been dogging me a fair bit.
The subject? Trauma.
Whether simple or complex, ongoing or one-off, experienced as a child or adult, trauma is the topic de jour — a cause célèbre linked to an
ever-growing list of problems, including depression, anxiety, dissociation, insomnia, headaches, stomachaches, asthma, stroke, diabetes, and most recently, ADHD.
Then, of course, there are the offers for training. Is it just me or is trauma the subject of every other email solicitation, podcast announcement, and printed flyer?
The truth is our field has been here many times before. Over the last 25 years, depression, multiple personality disorder, rapid cycling bipolar disorder II, attention deficit disorder, and borderline personality disorder have all burst on the scene, enjoyed a period of intense professional interest, and then receded into the background.
Available evidence makes clear this pattern — aha, whoa, and hmm what’s next? — is far from benign. While identifying who is suffering and why is an important and noble endeavor, outcomes of mental healthcare have not improved over the last 40 years. What’s more, no evidence exists that training in treatment modalities specific to any particular diagnosis — the popularly-termed, “evidence-based” practices — improves effectiveness. Problematically, studies do show undergoing such training increases practitioner perception of enhanced competence (Neimeyer, Taylor, & Cox, 2012) .
On more than one occasion, I’ve witnessed advocates of particular treatment methods claim it’s unethical for a therapist to work with people who’ve experienced a trauma if they haven’t been trained in a specific “trauma-focused” approach. It’s a curious statement — one which, given the evidence, can only be meant to bully and shame practitioners into going along with the crowd. Data on the subject are clear and date back over a decade (1, 2, 3). In case of any doubt, a brand new review of the research, published in the journal Psychotherapy, concludes, “There are no clinically meaningful differences between … treatment methods for trauma … [including those] designed intentionally to omit components [believed essential to] effective treatments (viz., exposure, cognitive restructuring, and focus on trauma)” (p. 393).
If you find the results reported in the preceding paragraph confusing or unbelievable, recalling the “Baader-Meinhof” effect can be help. It reminds us that despite its current popularity in professional discourse, trauma and its treatment is nothing new. Truth is, therapists have always been helping those who’ve suffered its effects. More, while the field’s outcomes have not improved over time, studies of real world practitioners show they generally achieve results on par with those obtained in studies of so-called evidence-based treatments 1, 2, 3).
Of course, none of the foregoing means nothing can be done to improve our effectiveness. As my Swedish grandmother Stena used to say, “The room for improvement is the biggest one in our house!” 
To get started, or fine tune your professional development efforts, listen in to an interview I did recently with Elizabeth Irias from Clearly Clinical (an approved provider of CEU’s for APA, NBCC, NAADAC, CCAPP, and CAMFT). Available here: What Every Therapist Needs To Know: Lessons From The Research, Ep. 61.
In it, I lay out several, concrete, evidence-based steps, practitioners can take to improve their therapeutic effectiveness. It’s FREE, plus you can earn a FREE hour of CE credit. Additionally, if follow them on Instagram and leave a comment on this post, you’ll be automatically entered into a contest for one year of free, unlimited continuing education — the winner to be announced on October 31st, 2019.
Until next time,
Scott
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
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I guess I’m a narcissist with low self esteem. Great post, I’m far more aware of this trauma malarkey than I was of the CBT nonsense;). And I don’t like it,
Thought-provoking post. Thanks! The idea that it is ” unethical for a therapist to work with people who’ve experienced a trauma if they haven’t been trained in a specific “trauma-focused” approach” bugs the hell out of me. And I think it is hugely counter-productive.
Even so, I am still open to the possibility that some of the new strategies based on polyvagal theory, somatic experiencing, etc. may have – MAY have – taken us into undiscovered realms of effectiveness in treating folks who have been traumatized.
Peace!
Great post, as always!
I often have to “check myself” and step back from the finely tuned marketing powerhouses of some of these approaches. Great reminder of what’s at play psychologically for us as practitioners. Similar to you Scott, I tend to be more susceptible to the “lagger” mentality!
I’m a Clinical Psychologist and I’ve beed trained in Psychotraumatology, I can say that I observed this “trend” to “see” or to “dig” for trauma. I know that not specifically the method / approach matters, but the therapeutic alliance and the personality of the therapist. And as you said, of course, trauma was there long before any “psychotraumatologist” ever.
*I forgot to mention that this “trend” was through the majority of my colleagues. Like there was nothing but trauma. And we can easily understand the link between this attitude and the confirmation bias.
If more clinicians were trained early in their clinical education to become proficient in the use of routine outcome measurement as well as all the other stuff, maybe we would get more interested in providing personalized clinical care to those in need. We wouldn’t invest so heavily in labeling and fads and using methods and modalities as secret serums and we wouldn’t get so easily sucked into “the business” of therapy. Maybe we would free ourselves up to focus on what makes sense to the people who come to us for help and maybe we would push the needle and become more effective as helping professionals. 40 years is a long time to be okay with just good enough.
Thanks, Scott, for another great article and reminder that there are many “right” ways to work with any given client. S
BTW – I keep forgetting to mention that your website and this blog along with your books and trainings continue to be invaluable to those of us in the field who are teaching, training, and mentoring other clinicians.
Yours is one of the places I often refer new clinicians to when they are confused about best practices and evidence-based work in our field.
Thank you for continuing your work and sharing it so generously with us!
Always good to read your posts, and they are always creative. Very pleased.
I’m so relieved to hear (read) Scott Miller say that he believes he tends to be on the
back end of the latest fad. I was really feeling left out, hearing all of my colleagues gushing about their training regarding trauma therapy, while I missed all of the workshops that were presented in my part of the country.
Thanks, Scott, for some evidenced based insight into what is actually productive in the journey of learning how to be a helpful therapist!
I have a pair of palladium limited edition rainbow boots. In a town of 28000 I am pretty sure I am the only one. Next year I think I will still be the only one. Do I care ? But if people did start buying them? Would I care ? No but I hope they like them as much as I do. They are a comfortable fit and better than leather for the planet.
What I really appreciate about your posts and your work with others over many years. That it feels like the equivalent of rainbow boats.
Working in one of those highly specified UK iAPT services I have to navigate that line between NICE approved and what works for people.
Trauma really challenges us on this distinction. It defies the foundations on which much of what EB is constructed upon. Diagnosis or neat problem descriptors. Having worked with And known friends and loved ones deal with “trauma “ and often the shadow it can cast. One in which what that shadow touches also appears to define the laws of physics. The sun does not always rise in the same place. We don’t always find it in the west or east. We can move that tree in the garden to open up the light. Equally sometimes the shadows can be comfortable.
Thanks for the post. Keep them coming.
Scott,
I’m usually a great fan of all you write and pass it in to others. However, I’m disturbed by your treatment of trauma here.
Certainly there is a great influx of trauma information, some with grandiose claims. Being both a clinician and a survivor of complex trauma I feel I can speak to this from a number of perspectives.
Firstly, the therapeutic relationship is paramount. Without this, no technique or method is useful. Your SRS are also beneficial. It is important to ask clients as they are the experts on what is working for them. That being said, it’s so important that people treating trauma have an understanding of what they are doing.
There is a lot of evidence that ‘the body keeps score’. I can attest to this personally and also from conversations with countless survivors. Many of whom have become knowledgeable about treatment methods and ways to ‘heal’ so that their own pain and terror can be alleviated. Other ‘fads’ such as BPD have an incredibly high correlation with developmental complex trauma. I’ve seen the explanation of processes occurring in the brain due to trauma to be revelationary for survivors in understanding their own fight, flight, freeze, faun and fragment responses. In the case of complex trauma, clients traumatic experiences are interwoven with attachment issues.
Yes, certainly an attuned therapist who focuses initially and throughout on the therapeutic alliance is crucial. But more is needed here. For example, I am not a fan at all of CBT and its prevalence as an easy way to train people and conduct research. Some CBT techniques are likely used by most therapists. However, in the case of trauma survivors, to deliver a purely cognitive approach to people dysregulated due to trauma I believe verges on abuse.
It is important to understand what is going on for someone with trauma symptoms so as not to retraumatise them or project that a method such as CBT should work for them.
Therefore, as you say, the SRS and alliance are primarily important. But, I think to callously disregard some of the very good growing work in trauma treatment is dismissive and possibly dangerous.
Scott,
I saw you in San Francisco in December. Thank you for sharing your knowledge and insights. So helpful!
As usual, I appreciate the wit and flair of your writing while you elucidate the actual research and facts of our field. I wish more colleagues and my college would take this seriously. After many years of clinical work and using the outcome measures, I am a believer and also tired of having to get more CEU’s to keep “proving efficacy”. Thank you for continuing to bring forth the data in creative, accessible and timely ways!
This is in the least dismissive, at the worst dangerous. Certainly the prevalence of trauma information is overdone and flimsy in many instances such as short competency courses. However, trauma and particularly complex trauma create changes that are useful to understand, even if merely to attune to your client with positive regard. In an industry saturated with cognitive solutions, it’s so important to know in the case of trauma the body does indeed ‘keep score’. For a trauma survivor, a bottom up approach, rather than the top down industry standard, can be the greatest saving grace. This I know both personally and professionally.
Thank you. I am forwarding to my colleagues the link to your conversation with Ms. Irias. I regularly engage in peer supervision and supervision with a mentor. An EAP I work with collects outcome data and that has been helpful in my work. You have inspired to collect outcome data with my other clients.
Dear Scott:
Thank you for your consistent sane voice in all the psychobabble so easily swallowed in our field of psychotherapy. Having been in the field 50 years now I have watched so many fads come and go with all kinds of trainings and certifications and egotistical claims that my type of therapy is better than yours because I have learned this recent technique and have been certified to deploy it.
The belief in magic is alive and well in our psychotherapeutic field among practitioners who have forgotten what Helen Harris Pearlman taught us back in the 50s that good “casework” as it was called by Social Workers way back then is all about the “helping relationship.”
At your suggestion I bought Stephen Bacon’s book about Psychotherapy as a contructed reality in which he suggests that the therapeutic variable might be the therapist’s “charisma.” Using Bacon’s idea, I suppose that if a therapist thinks his or her certification in the lastest therapeutic fad gives him/her more confidence and “charisma” and it fits for the client, then maybe the certification is an advantage, but I suspect that this misfounded belief in a magical technique just as often or even more often undermines a therapeutic connection especially if the technique is not perceived by the client as all that relevant.
I had a client tell me last week that she left her therapist because all the therapist wanted to do to her was EMDR and she didn’t see the point. The therapist, she said, didn’t seem to want to listen to her so she sought help elsewhere.
I got a PESI brochure last week for a workshop leading to certification in “tapping”. Wow! I guess if EMDR doesn’t work, there is always “tapping.” It seems odd that professionals with at least a Master’s degree and sometimes a Doctorate are enamored with this snake oil.
Thank you for your sanity and your reasonable presence in the psychobabble hurricane which surrounds us.
I believe we are all enamored with these fads, to greater or lesser extents, because providing psychotherapy is a tough job! A significant probability of failure haunts every therapeutic exchange, so it makes sense the we, like out clients, grasp for a semblance of control as these fads claim to offer us just that. They can be damaging as they can negatively color and distort, for the clinician and the client alike, what is really the most therapeutic and potentially powerful in the exchange, the alliance.
As someone who has experienced complex trauma and the aftermath, I acknowledge that a clinician fixated on a particular technique at the expense of a good and trusting therapeutic relationship is unhelpful and even harmful.
However, it is clear when clinicians have an understanding of trauma, when they know to go slowly, when they realise that intense emotions are part of the dysregulation involved in feeling unsafe and traumatic memories being triggered.
As a survivor I cannot describe the relief when as part of a trusting relationship, a variety of techniques have been used which have helped alleviate the charge and trauma surrounding traumatic memories. Or the relief when through this trusting relationship my attachment processes have been in part rewired. These are important parts of trauma work, all held with the crucial therapeutic alliance.
As a clinician I cringe at the influx of short ‘fad’ training about trauma. Here in Australia it’s all the rage with ‘trauma informed’ sadly being a tick box exercise. This is very sad as I believe that trauma underpins a great deal of the severe mental health and substance use issues we see. But luckily there are some very good groups here in Australia, such as the Blueknot Foundation which was started by a medical doctor with her own lived experience of complex trauma. I have found this and a number of the emerging clinicians and services with a rep understanding of trauma extremely useful.
Sadly, with any ‘fad’ it becomes a popularised way of making quick money at the expense of real, genuine work and connection. I’m sure all fads have some basis of benefit, but it should not be at the expense of the client’s perceptions of the benefit, or overshadow the therapeutic relationship.
There is certainly great benefit with many of the techniques to work with trauma, and these should be used to fit the client if appropriate. This is especially true of somatic or body based methods. We often ignore the body as clinicians, but the body can hold so much trauma which is difficult or impossible to process through traditional talk therapy. I would hope that we could see a beneficial synergy of a strong alliance, a willingness to use other methods even the magik, and clinicians aware of the role trauma plays in mental health issues without the need to attend expensive short training. I hope we can combine the best of it all for those desperately desiring to heal.
Research has consistently shown that it is the therapist-client relationship (or the alliance or just the therapist) that is associated with the most effective change. Yet, those who are firmly convinced of this have yet to explain how that happens.
The best that Norcross and Wampold (2019) (referred to by Scott) could do was to conclude that “the (therapist-client) relationship serves as the curative foundation of effective psychotherapy for trauma,” and “the relationship is the heart of healing trauma [as] relational damage is the core of trauma.” (p. 393). If one includes “little ts” and “big Ts,” that covers most of the problems presented for therapy.
While the Norcross-Wampold summary of therapy for trauma was described in quite a captivating way, their discussion may have the effect of moving the Baader-Meinhof Effect to the Baader-Meinhof Syndrome. The great unanswered question(s) remain unanswered. That is, what makes the most effective therapists so effective; or, why outcomes have remained stagnant for the last forty years.
Thanks to a client of mine who asked for multiple-hour sessions for several days a week in hopes of a breakthrough (which happened at the end of the second week), and during which I had the unheard of luxury of not having to worry about time, I was able to resist all urges that I “had to do something.” Instead, I just supported that person’s experiencing as best I could.
In doing so, I repeatedly observed the following: SUFFICIENT SUPPORT FOR THE CLIENT’S EXPERIENCING; i.e., the explicit and implicit dimensions, with the latter as by far the most important as that is where not-yet-verbalized hurtful experiences have been held in “cold storage” start to unfreeze, is my offering of the key to the great unanswered question(s).
I also discovered that this kind of support is profound in its simplicity as it requires the most exacting attention and patience. The essential element here, which took me some years to formulate, is that the therapist should not distract clients from their sense of their own experiencing. We know what that’s like in ordinary conversation. For clients, its really quite upsetting (See fascinating research bv David Rennie).
When the client’s nervous system has “decided” it has received enough support, the client will get “emotional.” That is fine. It has occurred in an unforced/unprovoked way. It is NOT retraumatizing. It’s what I’ve termed therapeutic catharsis. If interested, check out PsycINFO, or ResearchGate, two of my articles on their website.
Sufficient support for the client’s experiencing may be why FIT is so effective. It invites the client to “speak” to the therapist.
Well written and I want to win the competition
I bought into the trauma training need story. Took training in CPT, PE & EMDR to improve my practice.
Trauma is complex by nature. I think most people want to see a clinician who understands trauma on a deep level and it could be more of a focus during grad school. Sometimes I wonder if it is more of a “you can trust me” badge? I have received therapy from a therapist who thought they were trauma informed but they really weren’t. It did harm. I view it similarly to the understanding that we all know and understand methods to deal with OCD and eating disorders but we recognize the need to be more specifically trained in those areas.
Thanks for your comment Jillian.
Interesting comparison- I enjoy your posts. These fad treatments have their limitations. Also, I started following Clearly Clinical on Instagram. I liked the CEU podcast.