Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment, 2nd Edition
by John Briere and Catherine Scott provides a comprehensive, research-informed approach to understanding and treating trauma. This updated edition incorporates recent advances in trauma research and clinical practice, offering therapists practical and empathetic methods for working with trauma survivors. The text emphasizes the importance of a client-centered, flexible approach that addresses both the immediate symptoms of trauma and the underlying factors contributing to trauma’s long-term effects.
Part I: Understanding Trauma and Its Impact
The opening section lays the groundwork for understanding trauma, defining it as an experience that overwhelms an individual’s capacity to cope, often resulting in long-term psychological effects. The
authors outline the major types of trauma, such as physical abuse, sexual assault, combat trauma, and natural disasters, explaining how each can lead to distinct responses.
Key Concepts:
• Types of Trauma: Includes single-event trauma (acute), chronic trauma (repeated events), and complex trauma (severe, prolonged abuse often occurring in childhood).
• Immediate and Delayed Responses: Describes the range of immediate reactions (e.g., shock, denial) and how symptoms can evolve over time into more enduring conditions like PTSD, complex PTSD, or other dissociative disorders.
• Neurobiological Impact: Explores how trauma affects brain structures like the amygdala, hippocampus, and prefrontal cortex, impacting emotional regulation, memory, and executive functioning.
This section establishes a framework for understanding trauma as both a psychological and
physiological phenomenon, recognizing that symptoms can manifest as emotional, cognitive, and physical disruptions.
Part II: Clinical Presentation and Diagnosis
The second section examines the clinical manifestations of trauma-related disorders, including PTSD, acute stress disorder, and other comorbid conditions such as depression and anxiety. The authors emphasize accurate diagnosis, highlighting that trauma-related symptoms can vary widely among individuals.
PTSD and Trauma-Related Disorders
• DSM-5 Criteria for PTSD: Discusses the diagnostic criteria, including the key symptoms of re-experiencing, avoidance, negative changes in cognition and mood, and hyperarousal.
• Complex PTSD: Addresses cases where individuals experience pervasive, ongoing trauma (often in childhood), leading to more complicated symptom profiles that include emotional
dysregulation, identity disturbances, and interpersonal difficulties.
Comorbid Conditions
• Depression and Anxiety: Recognizes the high comorbidity rates of these disorders with trauma, explaining that trauma survivors may experience overlapping symptoms that complicate diagnosis.
• Dissociative Disorders: The text covers dissociative symptoms like depersonalization and derealization, which can arise as coping mechanisms to manage overwhelming trauma.
Part III: Evaluation and Assessment
In this section, Briere and Scott offer guidance on assessing trauma, covering both formal diagnostic tools and therapeutic assessments. They advocate for an empathic, client-centered approach to evaluation, acknowledging that many survivors may be hesitant to discuss their experiences.
Key Approaches:
• Clinical Interviewing: Offers practical techniques for interviewing trauma survivors, including how to ask sensitive questions and create a safe environment to facilitate open discussion.
• Psychometric Assessments: Discusses the use of standardized assessments like the ClinicianAdministered PTSD Scale (CAPS), PTSD Checklist for DSM-5 (PCL-5), and other trauma inventories.
• Functional Assessment: Examines the impact of trauma on daily functioning, helping clinicians understand how trauma affects the survivor’s ability to work, maintain relationships, and perform other life tasks.
The authors also underscore the importance of recognizing the client’s strengths and coping mechanisms, which can be harnessed as resources in treatment.
Part IV: Treatment Models and Therapeutic Approaches
The core of the book delves into various treatment approaches for trauma, with each chapter offering a structured guide to a specific modality. The authors advocate for an integrative approach, combining evidence-based practices tailored to the individual needs of each client.
Evidence-Based Therapies for Trauma
• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): Explains how cognitive restructuring, exposure techniques, and relaxation skills help clients process trauma memories and reduce PTSD symptoms.
• Eye Movement Desensitization and Reprocessing (EMDR): Details the procedure of EMDR, which helps clients reprocess trauma memories through guided eye movements or other forms of bilateral stimulation.
• Prolonged Exposure Therapy (PE): Covers PE’s systematic approach to reducing avoidance
behaviors and desensitizing clients to traumarelated stimuli.
Relational and Process-Oriented Approaches
• Psychodynamic Therapy: Describes how psychodynamic techniques can uncover unconscious trauma-related material, helping clients gain insight into deep-rooted emotional responses.
• Attachment-Based Therapy: This approach is particularly beneficial for clients with early childhood trauma, aiming to repair disrupted attachment styles and establish secure therapeutic relationships.
Integrative and Experiential Therapies
• Mindfulness and Acceptance-Based Approaches: Outlines how techniques from Mindfulness-Based Stress Reduction (MBSR) and Acceptance and Commitment Therapy (ACT) can help clients develop acceptance of their traumarelated thoughts and feelings.
• Somatic Experiencing: Focuses on the physical body as a key area of trauma recovery, recognizing that trauma is often “stored” in the body. The authors provide practical techniques for helping clients release stored tension and restore a sense of physical safety.
Part V: Special Topics in Trauma Therapy
This section addresses complex cases and specific issues that trauma therapists often encounter.
Working with Complex Trauma and Dissociation
The authors describe strategies for working with clients who have complex trauma histories, including those with dissociative symptoms. They emphasize the importance of stabilization before trauma processing and provide guidelines for establishing a strong therapeutic alliance to manage dissociative responses.
Trauma and Substance Use
Acknowledging the high rates of substance use among trauma survivors, the authors discuss the intersection between trauma and addiction. They outline how substance use may serve as a coping mechanism for trauma survivors and provide integrative treatment strategies that address both trauma symptoms and substance use.
Trauma in Diverse Populations
• Cultural Sensitivity: Emphasizes the importance of understanding cultural factors that influence trauma responses, including experiences related to race, ethnicity, and socioeconomic background.
• Gender and Sexuality: Addresses the unique trauma experiences and needs of LGBTQ+ clients and discusses the influence of gender on trauma responses and symptom presentation.
Trauma Across the Lifespan
Explores how trauma affects individuals at different developmental stages, from childhood through older
adulthood. For example, childhood trauma can disrupt normal development and create challenges that persist into adulthood, while older adults may experience unique traumas related to aging, loss, or health issues.
Part VI: Integrating Trauma Therapy with Self-Care and Professional Development
Recognizing that working with trauma survivors can lead to secondary traumatic stress, compassion fatigue, and burnout, the authors dedicate a section to therapist self-care. They provide strategies for maintaining personal well-being, including mindfulness practices, peer support, supervision, and setting healthy boundaries with clients. This section also encourages therapists to continually pursue professional development, attend workshops, and engage in reflective practices to avoid burnout.
Conclusion: A Flexible, Client-Centered Approach
The book concludes by reinforcing the importance of flexibility, empathy, and client-centeredness in trauma therapy. The authors stress that trauma therapy is not a one-size-fits-all process and that each client’s needs and pace will vary. By integrating a range of therapeutic techniques and adapting them to the client’s unique circumstances, therapists can create a safe space for healing and growth. Key Takeaways and Strengths of the Book
• Comprehensive Overview: Covers a wide array of trauma-related disorders, assessment methods, and therapeutic approaches.
• Focus on Empathy and Flexibility: Prioritizes a client-centered approach that respects each individual’s trauma experience and unique needs.
• Incorporation of Evidence-Based and Integrative Approaches: Combines established therapies like CBT and EMDR with emerging
approaches such as somatic and mindfulnessbased therapies.
• Attention to Therapist Well-Being: Recognizes the challenges of trauma work and the importance of self-care for therapists.
Principles of Trauma Therapy, 2nd Edition is an invaluable resource for both new and experienced clinicians seeking to understand and effectively treat trauma. Its balanced approach, thorough research, and practical guidelines equip therapists to support clients through their healing journey, addressing trauma’s complex psychological, physiological, and social dimensions.