Academic journal article Journal of Counseling and Development : JCD

Trauma Competency: An Active Ingredients Approach to Treating Posttraumatic Stress Disorder

Academic journal article Journal of Counseling and Development : JCD

Trauma Competency: An Active Ingredients Approach to Treating Posttraumatic Stress Disorder

Article excerpt

In the 37 years since posttraumatic stress disorder (PTSD) was conceptualized as a diagnosis (American Psychiatric Association, 1980), researchers and counselors have labored to develop and refine treatments for survivors of trauma. In 2010, a significant milestone was passed with the publication of the Department of Veterans Affairs (VA) and Department of Defense (DoD) treatment guideline for PTSD (Management of Post-Traumatic Stress Working Group, 2010), which presented clear evidence that trauma-focused treatment works best for clients with trauma-related symptoms. If a competent professional follows these guidelines, clients with PTSD can reasonably expect relief from their acute trauma symptoms and, with continued engagement, their more chronic symptoms as well (Baranowsky & Gentry, 2014; Briere & Scott, 2014; Cahill, Rothbaum, Resick, & Follette, 2009).

Since then, empirical meta-analytic research has produced additional sets of best practices and treatment guidelines to help counselors manage trajectories of treatment with trauma survivors and their families (Baranowsky & Gentry, 2014; Cahill et al., 2009; Cloitre et al., 2011, 2012; Forbes et al., 2007; Ursano et al., 2004). The discipline of trauma counseling has matured beyond determining whether treatment is effective and toward integrating the most effective methods of treatment. Now, the field is approaching another evolutionary leap in the understanding and prescription of treatment for posttraumatic conditions. Four active ingredients have been identified as common to all effective treatments for survivors of trauma and hypothesized to be primary mechanisms for the effects demonstrated by evidence-based treatments. We have identified these active ingredients, and in this article we present a generic clinical structure for treating posttraumatic conditions that infuses these active ingredients into a phasic model. By using the phasic structure of the model, counselors will be able to efficiently complete these four therapeutic tasks while still using the evidence-based trauma resolution methods of their choice. The ability to complete these four tasks should represent minimal competency for traumafocused counselors.

Identifying Effective Treatments for Trauma Survivors

In 2010, the VA and DoD, using 56 professional reviewers, created a comprehensive clinical practice guideline for the management of posttraumatic stress (Management of Post-Traumatic Stress Working Group, 2010). This guideline may be the most comprehensive documentation to date for understanding effective treatment of posttraumatic conditions. Its authors conducted a thorough literature review regarding psychotherapeutic and psychopharmacological treatments that had demonstrated effectiveness in studies from 2002 to 2009, evaluated the evidence for each method, and assigned them to categories based on the strength of evidence (Management of Post-Traumatic Stress Working Group, 2010). Their categorization of psychotherapeutic treatments is summarized in Table 1. The methods most strongly recommended were "evidence-based trauma-focused psychotherapeutic interventions that include components of exposure and/or cognitive restructuring; or stress inoculation training" (Management of Post-Traumatic Stress Working Group, 2010, p. 117).

The authors of the VA/DoD guideline established the cornerstone of trauma recovery as the use of evidence-based trauma-focused interventions, which are more effective with clients and are strenuously indicated over nonspecific treatment (Alvarez et al., 2011), up to 86% better than no treatment (Powers, Halpern, Ferenschak, Gillihan, & Foa, 2010). However, in a published analysis of seven existing guidelines for treating PTSD (Forbes et al., 2010), a panel of expert authors indicated that current evidence was insufficient to drive most of the recommendations in the guideline. While Forbes et al. (2010) supported use of the recommended first-line treatments for posttraumatic stress, they concluded that these treatments cannot resolve traumatic stress by themselves; they remain "embedded in broader clinical care that includes . …

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