Magazine article Clinical Psychiatry News

Trust Building Sparks Recovery from Posttraumatic Crisis

Magazine article Clinical Psychiatry News

Trust Building Sparks Recovery from Posttraumatic Crisis

Article excerpt

PHILADELPHIA -- An approach to acute, behavioral crisis intervention in which patients are urged to develop trust in one or two life-defining relationships led to significantly improved scores on the Brief Psychiatric Rating Scale within the first day of treatment, compared with control patients in a study with 62 patients.

This intervention, part of a longer-term strategy of helping to build trusting relationships for the patient, is based on the belief that behavioral crises and the dissociation that accompanies them are triggered by repetition compulsion episodes in people who were victims of abuse or betrayal, Dr. Andreas Laddis said at the annual conference of the International Society for the Study of Trauma and Dissociation.

Once dissociation is triggered, a patient starts a reckless activity such as bingeing on food, drugs, or sex or having flashbacks. The core deficit in chronic, posttraumatic disorders is the patient's abuse of the rules of trust building, said Dr. Laddis, a psychiatrist in private practice in Shrewsbury, Mass. Repetition compulsion is the manifestation of that abuse. A patient compounds his uncertainty, over time making himself more afraid of intimacy.

The acute intervention tested by Dr. Laddis was to have clinicians "find cracks" in the patient's "dissociative self-absorption," and elicit the patient's story. "The clinician's interventions are designed to nudge the client's memory ... to elicit the deep story in little bits," he explained. The clinician then presents the story back to the patient, "with the hope added that social reality has more possibilities than the patient can imagine on his own."

The setting for the initial phase of intervention usually is an emergency room, day-treatment program, a residential facility, or a crisis-intervention facility. It requires having staff available throughout the day. …

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