Main description:

This forward-thinking volume outlines several approaches to therapeutic treatment for individuals who have experienced complex childhood and adult trauma, providing a novel framework for helping patients with a number of challenging symptoms, with clinical hypothesis testing and solid therapeutic relationships as a vital foundation. Responding to the intense disagreement and competition among clinicians championing their own approaches, the book identifies the strengths and limitations of multiple therapeutic approaches, addressing the need for qualified clinicians to be versed in multiple theories and techniques in order to alleviate suffering in their clients.

Among the topics discussed:

How to choose specific therapeutic methods and when to shift techniques
The neurobiology of trauma and management of fear
Cultural and ethnic considerations in trauma treatment
Addressing avoidance and creating a safe therapeutic environment
Management of dissociation, substance abuse, and anger

Treating Complex Trauma: Combined Theories and Methods serves as a practical guide for clinicians looking to expand their knowledge of approaches for treating complex trauma. It aims to provide clinicians with options for different therapeutic methods, along with the necessary context for them to select the most effective approach in their treatments.

"For the first time in the professional literature we are finally afforded a clear, cogent, and detailed explication of complex trauma and the multifaceted parameters of treatment. Dr. Tamara McClintock Greenberg provides perspicacious insight and clinical wisdom only a seasoned career therapist can yield. Offering sophisticated and nuanced distinctions between complex trauma and PTSD, she shows how treatment is necessarily contextual and tailored to the unique clinical and personality dynamics of the sufferer that is thoroughly client specific within the therapeutic dyad. She dispenses with simplistic and supercilious attitudes that embarrassingly boast a uniform or manualized treatment to trauma, instead carefully taking into consideration polysymptomatic, neurobiological, and socialcultural differences that inform the interpersonal, emotional, and safety milieu from the beginning of treatment to stabilization, the working-through process, and then onto successful recovery. This is a must-read book for those in training and senior clinicians alike."
--Jon Mills, PsyD, PhD, ABPP, Faculty, Postgraduate Programs in Psychoanalysis & Psychotherapy, Adelphi University, NY; author of Treating Attachment Pathology

"Dr. Greenberg has written an invaluable book on treating complex trauma. She delves into multiple approaches, assessing what techniques the client can tolerate at a given therapeutic stage. She covers how to maintain consistency and connection through a flexible approach and avoid pitfalls. This is a must read for clinicians wishing to treat clients with complex PTSD."

--Louann Brizendine, MD, Clinical Professor UCSF; author of The Female Brain

Contents:

Chapter 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

References

Chapter 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

References

Chapter 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

References

Chapter 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

References

Chapter 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

References

Chapter 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

References

Chapter 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

References

Chapter 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

References

Chapter 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

References

Chapter 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