Crisis Intervention and Trauma: New Approaches to Evidence-Based Practice
Cohen, Jonathan, American Journal of Psychotherapy
JENNIFER L. HILLMAN: Crisis Intervention and Trauma: New Approaches to Evidence-Based Practice. Kluwer Academic/Plenum Publishers, New York, 2002, ix + 310 pp., $65.00, ISBN 0-306-47341-0.
"Evidence-based practice" is the guiding metaphor of this book, the latest of a series by Kluwer/Plenum on "Issues in the Practice of Psychology." Its main subject is, broadly speaking, psychological conditions that may be thought of as more or less "traumatic," and their treatment through crisis intervention and psychotherapy.
The initial chapters provide an historical overview of crisis intervention, suggested procedures for its application, and a social-psychological overview of trauma. Thoughtfully presented, these provide a useful introduction to this field. In later chapters, evidence of the sort that can be easily evaluated is put to good use. Writing with a sensitivity to the challenges beginning therapists face in working with difficult patients, Hillman provides information and practical advice about violent patients, suicide, older patients in care facilities, and underserved populations.
Conversely, the sections dealing with issues of classification, explanation, and psychotherapeutic treatment-that strike me as the book's intellectual heartshow the real weakness of too-heavy reliance on the metaphor. Without being able to critically evaluate evidence-that is, to assess its function of testing theory-it is not worth very much. In these sections evidence is so disconnected from any serious exercise of this function that the book's arguments and treatment recommendations (e.g., for Posttraumatic Stress Disorder and Dissociative Disorder) are very difficult to take seriously.
To give an example: The discussion of dissociative conditions and borderline personality, clustered together in a chapter entitled "Long-Term Sequela (sic) of Trauma," is prefaced by an account of a "powerful paradigm shift" (p. 83) that has been brought about by a small group of theorists who have noted common traumatic features. According to this revolutionary theory, "trauma represents the causal factor in virtually all cases of borderline personality disorder" (p. 86). This justifies her cursory dismissal of the work of "traditional" theorists (Kernberg, Adler, and Masterson), who "minimize the impact of trauma" (p. 85). Obviously, she has read neither Beyond the Pleasure Principle nor The Traumatic Neuroses of War.
Lacking historical and conceptual perspective, Hillman is fascinated by charismatic practitioners and new, problematic treatments that are riding the wave of "evidence-based" popularity-such as Eye Movement Desensitization and Reprocessing (EMDR) and Dialectical Behavior Therapy. Her prominent accounts of these treatments read more like advertising than analysis, and her tendency to bridge conceptual chasms with verbal formulas results in trains of thought that are all but incoherent, such as the following:
DID [Dissociative Identity Disorder] shows a relative degree of variation and uncertainty regarding its validity. . . . The diagnosis of DID remains highly controversial. . . . Assuming that DID does exist as a true clinical phenomenon, one promising aspect of this tragic disorder is that individuals with DID are believed to have a good prognosis if they receive appropriate treatment, (pp. 95-101)
Hillman does not appear to have much usable understanding of the problematics of contemporary diagnosis. …