Diagnosing and Treating Complex Trauma 1st Edition by Trudy Mooren, Martijn Stöfsel ISBN 0415821134 978-1317700562

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ISBN 10: 0415821134
ISBN 13: 978-1317700562
Author: Trudy Mooren, Martijn Stöfsel

The term complex trauma refers to a broad range of symptoms resulting from exposure to prolonged or repeated severely traumatizing events. This broad spectrum of psychological symptoms complicates the formulation of an all-encompassing explicit definition, which in turn complicates the creation of specific treatment guidelines. In Diagnosing and Treating Complex Trauma, Trudy Mooren and Martijn Stöfsel explore the concept of complex trauma with reference to severely traumatised people including refugees, asylum seekers, war veterans, people with severe occupational trauma and childhood trauma and others who have dealt with severe violence.

The book introduces a layered model for diagnosing and treating complex trauma in four parts. Part One introduces the concept of complex trauma, its historical development and the various theories about trauma. The authors introduce a layered model that describes the symptoms of complex trauma, and conclude with a discussion on the three-phase model. Part Two describes the diagnostic options available that make use of a layered model of complex trauma. Part Three discusses the treatment of complex trauma using the three-phase model as an umbrella model that encompasses the entire treatment. Chapters cover a multitude of stabilization techniques crucial to the treatment of every client group regardless of the therapeutic expectations. This part also contains an overview of the general and specific trauma processing techniques. The last chapter in this part covers the third phase of the treatment: integration. Part Four addresses the characteristics of different groups of clients who are affected by complex trauma, the components that affect their treatment and the suggested qualities required of a therapist to deal with each group. The book concludes with a chapter discussing the consequences for therapists providing treatment to people afflicted by complex trauma.

Developed from the authors’ own clinical experiences, Diagnosing and Treating Complex Trauma is a key guide and reference for healthcare professionals working with severely traumatised adults, including psychologists, psychotherapists, psychiatrists, social-psychiatric nurses, and case managers.

Diagnosing and Treating Complex Trauma 1st Table of contents:

Part I Definition and treatment models

1 Complex trauma defined

1.1. Disruptive experiences

1.1.1. Chronic and multiple exposure

1.1.2. Interpersonal violence

1.1.3. Limited (or no) support

1.1.4. Differing impact depending on life stage

1.1.5. Childhood exposure

1.1.6. Adult exposure

1.1.7. Childhood and adult exposure

1.2. History of complex trauma

1.2.1. A brief history of PTSD

1.2.2. PTSD

1.2.3. Prevalence

1.2.4. The legitimacy of PTSD

1.2.5. Criticism

1.2.6. PTSD comorbidity with other psychological disorders

1.2.7. PTSD comorbidity with personality disorders

1.2.8. PTSD comorbidity with other problems

1.3. Trauma models

1.3.1. Complex trauma, complex PTSD, or DESNOS

1.3.2. Developmental trauma disorder

1.3.3. Enduring personality change after catastrophic experiences

1.4. A working definition of complex trauma

2 Treatment models

2.1. General treatment theories

2.1.1. Learning theory

2.1.2. Cognitive theory

2.1.3. Theories of memory

2.1.4. Cognitive theories integrated with learning theory

2.1.5. Existential theory

2.1.6. Object relations theory

2.1.7. System theory

2.1.8. Narrative school of thought

2.1.9. Dissociation

2.1.10. Resilience, resistance, and posttraumatic stress growth

2.1.11. Neurophysiological stress responses

2.2. Treatment methodologies4

2.2.1. Cognitive behavioural therapy

2.2.2. Schema therapy

2.2.3. Dialectical behavioural therapy

2.2.4. Mentalization-based therapy

2.2.5. Other methods

2.3. Treatment planning principles

2.3.1. Multidisciplinary guidelines for complex trauma

2.3.2. The three-phase model

Part II Diagnostics and indication assessment

3 Psychodiagnostics

3.1. Instrument selection

3.1.1. General symptom inventories

3.1.2. Social relationships and interactions

3.1.3. Depression

3.1.4. PTSD

3.1.5. Dissociation

3.1.6. Core cognitions

3.1.7. Personality structure

3.1.8. Complex trauma

3.2. Psychodiagnostic assessment of immigrants

4 Treatment design

4.1. Intake

4.1.1. Medical history

4.1.2. Collaboration

4.1.3. Presenting problem

4.2. Case conceptualization

4.3. Treatment indication

4.3.1. Treatment options

4.4. Treatment plan

4.5. Treatment context

4.5.1. Different disciplines

4.5.2. Treatment setting

4.5.3. Social network

Part III Treatments

5 Phase 1 – the stabilization phase

5.1. Phase 1 goals

5.2. The three-phase model and the layered complex trauma model

5.3. Window of tolerance

5.4. Comorbid problems

5.5. Therapeutic relationship

5.5.1. Reliability and clarity

5.5.2. Availability of the therapist between sessions

5.5.3. Realistic goals

5.5.4. Stop sign

5.5.5. Professional conduct

5.6. Overview of stabilization techniques

5.6.1. Stabilization techniques

5.7. Where to begin

5.8. Combinations of stabilization techniques

5.9. Medication

5.10. From stabilization to therapeutic processing

5.10.1. The transition to phase 2

5.10.2. Treatment does not always mean resolution

5.10.3. Tethering between phase 1 and phase 3

6 Phase 1 – psychoeducation

6.1. Aspects of traumatization

6.1.1. Vulnerability

6.1.2. Then and now

6.1.3. Control

6.1.4. Altered cognitions

6.2. Metaphors

6.2.1. The wedding as a metaphor for trauma processing

6.2.2. A car crash pile-up as a metaphor to explain delayed trauma reactions

6.3. The retraumatization triangle

6.3.1. Analytical model of trauma-associated reactions

6.3.2. Point of intervention

7 Phase 1 – control techniques

7.1. Improving self-care

7.1.1. Regular circadian rhythm

7.1.2. Structuring current problems

7.2. Crisis plan

7.3. Sleep hygiene

7.4. Dealing with substance use

7.5. Dissociation and grounding

7.5.1. Waiting

7.5.2. Sitting and watching

7.5.3. Colours

7.5.4. Stand or sit

7.5.5. Sensory perception

7.5.6. Request specific information

7.5.7. Physical activity

7.6. Awareness of the present: mindfulness techniques

7.7. Rational rehabilitation for PTSD

8 Phase 1 – relaxation techniques

8.1. Relaxation exercises

8.2. Breathing exercises

8.2.1. Sinus line breathing

8.2.2. Abdominal breathing

8.3. Generalizing the relaxation effect

8.4. Relaxing activities

9 Phase 1 – regulating trauma symptoms

9.1. Inventorying triggers

9.2. Stop mechanism

9.3. Safe objects

9.3.1. Defence objects

9.3.2. Objects symbolizing safety

9.3.3. Imaginary helpers

9.4. Regulating stress and aggression

9.5. Controlling reexperiences

9.5.1. A safe place

9.5.2. The chest

9.5.3. The hand as a projection screen

9.5.4. Trauma as film

9.5.5. Trauma as TV film

9.6. Nightmares

9.6.1. Nightmare rescripting

9.7. A worry place

9.8. Natural processes: promoting health

9.8.1. Thought box

9.8.2. Resource Development and Installation

9.8.3. Anchor exercise

9.9. Therapeutically processing cognitions

10 Phase 2 – general aspects of therapeutic processing

10.1. Freedom to stop

10.2. When to start therapeutic processing: the risks

10.2.1. Transition dilemma

10.2.2. Encapsulated traumatic experiences

10.3. Decision tree for therapeutically processing traumatic events

10.4. Dysregulation in phase 2: linking with phase 1

10.5. Closure

11 Phase 2 – general trauma processing techniques

11.1. Testimony therapy

11.1.1. Testimony therapy is not applicable to all trauma problems

11.1.2. Literal transcription

11.2. Other narrative techniques

11.3. Narrative Exposure Therapy

12 Phase 2 – specific trauma processing techniques

12.1. Exposure

12.1.1. Exposure and complex trauma

12.1.2. Complications

12.1.3. Structured writing

12.2. Eye Movement Desensitization and Reprocessing

12.2.1. Indication

12.2.2. EMDR and complex trauma

12.2.3. Trauma lists

12.2.4. The EMDR module

12.2.5. Complications

12.2.6. Realistic expectations

12.3. Brief Eclectic Psychotherapy for Psychotrauma

12.4. Imaginary confrontation: rescripting

12.5. Expressive therapies

12.6. Cognitive interventions

12.6.1. Cognitive therapy

12.6.2. Alterations of meaning and purpose

12.6.3. EMDR for use in changing core cognitions

12.6.4. Survivor guilt

12.6.5. The function of guilt

12.6.6. Pie-chart technique

13 Phase 3 – integration

13.1. Chronological phase completion

13.2. Jumping directly from phase 1 to phase 3

13.3. Meaningfulness

13.4. Scheduling activities

13.4.1. Education, work, and volunteerism

13.4.2. Social contacts

13.4.3. Interests and hobbies

13.5. Posttraumatic growth

13.6. Posttraumatic relapse

13.7. Chronic problems: shuttling between phase 1 and phase 3

13.8. Aftercare

13.8.1. Voucher system

13.8.2. Three-month follow-up

13.8.3. Relapse prevention

13.8.4. Long-term aftercare for chronic problems

13.9. Treatment termination

Part IV Client and therapist

14 Client groups with complex trauma

14.1. People affected by the Second World War

14.1.1. Main presenting problems

14.1.2. Factors affecting treatment

14.1.3. Typical cognitions

14.1.4. Therapist profile

14.1.5. Treatment recommendations

14.2. Refugees

14.2.1. Main presenting problems

14.2.2. Factors affecting treatment

14.2.3. Typical cognitions

14.2.4. Therapist profile

14.2.5. Treatment recommendations

14.3. War veterans

14.3.1. Main presenting problems

14.3.2. Factors affecting treatment

14.3.3. Typical cognitions

14.3.4. Therapist profile

14.3.5. Treatment recommendations

14.4. Occupational-related traumatization

14.4.1. Main presenting problems

14.4.2. Factors affecting treatment

14.4.3. Typical cognitions

14.4.4. Therapist profile

14.4.5. Treatment recommendations

14.5. Traumatized people from the post-war generation

14.5.1. Main presenting problems

14.5.2. Factors affecting treatment

14.5.3. Typical cognitions

14.5.4. Therapist profile

14.5.5. Treatment recommendations

14.6. People traumatized in early childhood

14.6.1. Main presenting problems

14.6.2. Factors affecting treatment

14.6.3. Typical cognitions

14.6.4. Therapist profile

14.6.5. Treatment recommendations

15 Therapist boundaries

15.1. Transference and countertransference

15.2. Audience to shocking stories

15.2.1. Adaptation

15.2.2. Professional distance

15.2.3. Stability

15.2.4. Balanced caseload

15.3. The impact of clients’ problems

15.3.1. Realistic treatment goals

15.4. Therapist guilt

15.5. Sharing feelings

15.6. The challenges posed by traumatized clients

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Tags: Trudy Mooren, Martijn Stöfsel, Treating Complex