Review of Treatment of Complex Trauma: A Sequenced, Relationship Based Approach.

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Courtois, C.A. & Ford, J.D., with foreword by John Briere (2015). Treatment of Complex Trauma: A Sequenced, Relationship Based Approach. New York: Guilford Press, 378 pages. ISBN-13: 978-1462524600 ISBN-10: 1462524605

By: Kimberly Kalupa, Ph.D.

As a scientist-practitioner who is trained in exposure-based treatments for Posttraumatic Stress Disorder, Dialectical Behavior Therapy, and Interpersonal Therapy, I can unequivocally state that this book combines the best of these approaches to comprehensively address the many nuances of complex trauma and its effects.

This book is 378 pages in length and is divided into three well-organized sections: 1) The overview of complex traumatic stressors and sequelae; 2) treatment of complex traumatic stress reactions and disorders; and 3) advanced treatment considerations and relational issues. The first section (Chapters 1 & 2) highlights the complexity of various forms of trauma and equally complex stress-related symptoms and disorders. These chapters offer insight into diagnostic issues, as well as key information about the breadth of questions and considerations one should have when assessing for trauma and its impact. These chapters provide unique insight by placing factors within a developmental context throughout the client’s lifespan.

Moving into the second section (Chapters 3–7), Chapters 3 and 4 offer practical advice for preparing oneself to work with complex posttraumatic conditions and the clients that present with these conditions. These chapters build on empirically supported work by providing some clearly articulated guidelines and practice tools. The authors do an excellent job of drawing on years of experience working with complex trauma, and offer a great deal of wisdom and practical advice for preparing oneself to best serve the needs of these clients. Chapter 5 discusses the three-stage model of trauma treatment and the importance of Stage I, which involves client safety, education, and engagement. This lays a crucial foundation for continued work by providing clients with several key skills to manage distress and conflict. Chapter 6 builds on this discussion by moving into Stage II: the art of trauma processing within these populations; and Stage III: applying therapy gains to daily life. Chapter 7 highlights how three systems-based approaches can further address varying interpersonal difficulties found in clients with complex trauma. It discusses how group, couples, and family therapy can build on gains achieved in individual work.

The final section of the book (Chapters 8–10), offers more tailored advice for working with trauma-exposed clients, with special consideration being given to relationship issues. Chapter 8 articulates the challenges involved in treating intrapersonal issues that are common in trauma-exposed clients. This chapter offers insight for addressing various manifestations of severe affective dysregulation and dissociation. These factors, when not addressed, can be the very factors that lead to early termination from therapy or suboptimal engagement, which are essential considerations when treating complex trauma. The final chapter approaches the often-neglected topic of therapist “self-care” in a respectful and informed way. This section highlights complicated issues of transference and countertransference associated with working with traumatized populations. It further extends practical advice for establishing healthy therapeutic boundaries as well as attending to personal emotion regulation. It validates the toll that working with trauma-exposed clients can take on providers and offers practical tips to allow practitioners to be their most available, helpful selves.

This book masterfully bridges the gap between cognitive and behaviorally-based approaches and interpersonal or relational factors. This provides a much-needed expansion of more narrowly-focused, seemingly disparate treatments. It provides fundamental insight into how one might relate to trauma survivors and address key intrapersonal and interpersonal factors that are frequently disrupted in response to exposure to trauma. These are the very factors that can so negatively impact quality of life and are frequently ignored in evidenced-based PTSD treatment models. This volume would be an excellent resource for clinicians of all levels who work with traumatized clients. It clearly articulates common pitfalls that might arise when working with these populations and offers clear, practical and evidence-based advice to prevent, identify, and address these pitfalls as they arise. There are thoughtful case examples and vignettes woven into the fabric of this book that bring to life the complex issues that are presented.

Reading this book is akin to taking a master class in the nuances of trauma-informed therapy. While it is written for clinicians who work with complex trauma and those that train others to treat these conditions, the solid research base of this book is a virtual gold mine for researchers in the area of complex trauma and its treatment. Given the high rates at which traumatized clients appear for treatment, and the complex intrapersonal and interpersonal impacts of trauma, more comprehensive approaches are needed. This book provides essential suggestions for optimizing treatment for these clients by addressing the complex problem of trauma through the sound application of multi-theoretical approaches.

Kimberly Kalupa, Ph.D. is a licensed clinical psychologist with strong interests in health psychology and trauma. She is currently working with medical inpatients on a consultation liaison service through the University of New Mexico Hospital. She also provides donor evaluations for kidney transplant services. After earning a Ph.D. in Medical/Clinical Psychology from the Uniformed Services University of Health Sciences, she completed an internship in clinical health psychology at the University of Florida and a post-doctoral fellowship in clinical Health Psychology (Minneapolis VA Medical Center). She later developed and coordinated an integrated primary care based mental health program at the Pensacola VA, and has taught as an adjunct for several universities. She has consulted on clinically relevant health psychology research in the area of eating behavior, obesity, and community-based intervention.