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Julian D. Ford, Christine A. Coutois (Hrsg.): Treating Complex Traumatic Stress Disorders in Children and Adolescents

Cover Julian D. Ford, Christine A. Coutois (Hrsg.): Treating Complex Traumatic Stress Disorders in Children and Adolescents. Guilford Press (New York, NY 10012) 2013. 368 Seiten. ISBN 978-1-4625-0949-2. 39,95 EUR.
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Subject

This pragmatic book describes remarkable recent advances in understanding, identifying, and intervening in complex traumatic stress disorders in children and adolescents.

Authors/Editors

The Editors Julian D. Ford and Christine A. Courtois are both leading experts in the field of trauma in practice and science:

Julian D. Ford is a clinical psychologist and professor of psychiatry at the University of Connecticut School of Medicine, where he is also director of the Child Trauma Clinic and the Center for Trauma Recovery and Juvenile Justice. He contributes in editorial (Journal of Trauma and Dissociation) and experts boards (International Society for Traumatic Stress Studies, ISSTD). One of his research focuses is trauma affect regulation, where he developed a guide for education and therapy (TARGET). He has published several books on trauma-related topics. The book „Treating Complex Traumatic Stress Disorders in Adults“ edited together with Christine A. Courtois got a Print Media Award from the ISSTD.

Christine A. Courtois is a counseling psychologist in private practice in Washington, DC. She is a past president of Division 56 (Psychological Trauma) of the American Psychological Association (APA) and recently chair of the Clinical Treatment Guideline Development Panel for Posttraumatic Stress Disorder for the APA. Among other honors, Dr. Courtois is recipient of several awards, i. a. of the Outstanding Contributions to Professional Practice Award from APA Division 56, the Lifetime Achievement Award from the ISSTD, and the Sarah Haley Award for Clinical Excellence from the ISTSS. She has published numerous books, book chapters, and articles on trauma-related topics.

The editors could win prominent experts in the field of trauma research and practice to contribute to this book.

Background

Treating children and adolescents with complex trauma histories is a sophisticated challenge for therapeutic professionals. These children/adolescents come into therapy with multiple diagnoses, medications, and often unsuccessful past treatment attempts for their seemingly intractable emotional and behavioral problems. A range of new promising evidence-based treatment approaches have been developed. This gave rise to illustrate the state-of-the-art in treating trauma-related conditions in young people, and to ask experts for specific modalities related to trauma.

Structure and Content

This book comprises state-of-the-art knowledge on the psychobiology with neurobiological mechanisms involved, as well as evidence-based individual treatment approaches complemented by treatment approaches within the daily-life systems of the traumatised children/adolescents. In particular, clinical challenges related to self-regulation, dissociation, impaired caregiver attachment, intergenerational trauma, and engaging families in treatments are addressed.

Numerous experts experienced in research and practice wrote chapters, in which they comprehensibly depict assessment and diagnosis and individual and systemic treatment approaches of trauma-related disorders in children and adolescents. In the following the content of the chapters is summarised:

Essence of chapters 1 and 2 is, that interpersonal stressors, especially in early life, can substantially affect the structure and functioning of brain areas essential for the development of nonverbal and emotional intelligence, an integrated sense of the self, and understanding of the past and the future. Stress disorders should be understood as neuropsychiatric disorders influenced by and influencing a child´s development.

Besides development of intelligence and the sense of the self, the capacity to trust and engage in healthy relationships are often profoundly impaired. Relational trauma sets up expanding consequences, e. g. betrayal of primary responsibilities and roles. Children are especially vulnerable because of their immaturity and being in physical and psychical development (chapters 3 and 4).

Subject of chapter 5 is a subgroup of children/adolescents, that can be found in every community (health care, school, welfare system) experiencing multiple traumatisations, e. g. abuse, neglect, family or peer violence from early age. This cumulative trauma exposure results in complex problems in physical, emotional, cognitive, and behavioral development and health.

The need for an evolving evidence-base with respect to assessment, treatment models, and clinical practice combined with creative clinical practice and wise clinical judgments for complex traumatised children/adolescents is then emphasised in chapter 6. Prerequisite for developing treatment plans is a deep understanding of the problems, needs, and strengths of these children/adolescents. The interrelated domains self-regulation and identity provide a conceptual framework and a link to validated assessment tools for clinicians (chapter7).

Many scientific and clinical innovations have occurred in the traumatic stress field and there is a plethora of interventions and practices, that are evidently effective in helping these children/adolescents recover. A core set of advantageous innovative treatment practices and principles, that can be taught and systematically utilised, is presented in chapter 8.

A particularly challenging manifestation of impaired self-regulation is dissociation causing attentional, physical, information-processing, identity, behavioral, and relational problems. For therapists it is crucial to recognize these dissociation related symptoms. Chapter 9 summarises the target of all therapeutic approaches: reconnection to dissociated feelings, sensations, cognitions, experiences, and self-states resulting in an (re-)integrated self.

For polytrauma the two most widely used approaches helping process trauma memories and create coherent personal narratives are trauma-focused cognitive behavior therapy (TF-CBT) and eye moment desensitisation and reprocessing (EMDR), which are presented in chapters 10 and 11.

Chapter 12 and 13 then depict additional valuable tools in the treatment of complex traumatic disorders, i. e. dialectic behavior therapy (DBT), which was originally developed for other severe psychiatric disorders and dangerous behaviors, and an innovative biopsychosocial neurosequential model.

Translational research endeavours resulted in several evidence-informed and clinically savvy intervention models for complex traumatisation disorders (chapter 6). Several complementary complex trauma-focused therapies have explicitly designed to enhance trauma-impaired self-regulation and relational capacities (chapter 14).

Models of organisational change based on creating environments providing a sanctuary from trauma (chapter 15) and systems of care, that intentionally provide resources to restore self-regulation in the traumatised children/adolescents, their families, and communities (chapter 18) can expand therapists therapeutic resources.

Families with intergenerational cycles of complex trauma including historical trauma and severe strain of prolonged conflicts and maltreatment have to deal with both, dysregulation in the children and the impairments in adult caregivers with their own complex trauma histories. In such cases simultaneous help for traumatised children and caregivers is needed. This special issue is focus of chapters 16, 17, and 18 on child-parent psychotherapy, parent-child interaction psychotherapy, and trauma systems therapy. It is emphasised that a helpful therapy for clients with a complex trauma history needs to be individually tailored considering all interdependent personal, ethnocultural, and contextual aspects leading to symptoms of dysregulation and impairment caused by traumatisation. In conclusion, understanding the unique unhappiness of a polytraumatised child and its family is the core challenge for a therapist.

In summary, thematic issues running through this book and pointing to the future of this field are:

  • Psychotherapists should be well educated and specifically trained and practicing good self-care.
  • Psychotherapy practice should be evidence-based, involve families and social environments, and consider ethnocultural issues.
  • Therapy models should be empirically supported and informed by the professional observations of the therapists and the lived experience of the clients and their families; their application should be flexible and responsive to the individual case.
  • Diagnostics should be trauma-specific, i. e. multimodal guiding the choice and the process of interventions.
  • Clinicians and people should be aware, that bio-psycho-social dysfunctions are often due to trauma; this should be considered in diagnostics and therapeutic decisions.

Discussion and Conclusion

In line with the policy of national health systems for guaranteeing best quality by the means of financial resources to the interests of the clients evidence-based care for trauma-related disorders is proclaimed. To consider the interests of clients, patient-centred outcomes should be the target, both in practice and research. This fundamental approach was not explicitly addressed – an aspect I was missing with respect to its great relevance for evaluating effectiveness of therapies from different viewpoints of the parties.

The book provides a selection of commonly helpful and complementing techniques in trauma diagnostics and therapeutic possibilities useful in the clinical practice in the US. The tools and instruments are not necessarily available as a validated German version, and they are oriented on the DSM classification system.

To me a very important message of this book is, that trauma can lead to a variety of psychological, psychiatric, or psychosomatic disorders (i. e. depression, bipolar, anxiety, eating, reactive attachment, intermittent explosive, attention-deficit/hyperactivity, oppositional defiant, substance use disorder(s), etc…), and that the frequent PTSD symptoms are often not recognised as PTSD leading to unhelpful treatments and further consequent problems. This may raise awareness in clinicians for a comprehensive mulitmodal and intervention-guiding diagnostic, and understanding in people, that a trauma might be the underlying cause for the symptoms and social problems of their children.

All together, this book provides a comprehensive overview of the „state of the art“ knowledge in the field of trauma-related disorders in young age in a bio-psycho-social manner. It aims at integrating scientific research and clinical practice in a reflexive, fertilising, vivid circle intending to provide the best possible instant and sustainable help for the clients. Researchers and students as well as professionals in the psycho-social field may value this book as a supplemental, comprehensible source of information.


Rezension von
Dr. Christiane Barbara Pierl
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Zitiervorschlag
Christiane Barbara Pierl. Rezension vom 06.10.2014 zu: Julian D. Ford, Christine A. Coutois (Hrsg.): Treating Complex Traumatic Stress Disorders in Children and Adolescents. Guilford Press (New York, NY 10012) 2013. ISBN 978-1-4625-0949-2. In: socialnet Rezensionen, ISSN 2190-9245, https://www.socialnet.de/rezensionen/16387.php, Datum des Zugriffs 27.11.2020.


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