Healing Trauma: a Professional Guide

People feel overwhelmed, frightened, and beyond control in traumatic experiences. Apart from physical, interpersonal and sexual violence, these also include accidents, natural and man-made disasters. Traumatic experiences can fundamentally change not only the way of life of the victims, but also their psychological outlook. It is not uncommon in our clinical practice to encounter cases related to trauma. Healing Trauma offers a systematic examination in the interpretation of trauma psychology and management of trauma cases in Hong Kong. Not only does it emphasise empirical evidence from international and local research, it also captures the experience of local experts in dealing with a range of trauma under a unique cultural context.

This book is divided into 7 parts. It begins with an introduction, assessment and intervention of trauma. It is followed by examining interpersonal trauma, medical trauma, mass trauma and disaster. In conclusion, the prospect of professional training and reflections of psychological trauma are discussed.

The first section is about research and practice in trauma assessment, as well as the psychological and psychopharmacological management of trauma. It summarises the psychometric properties and previous findings of assessment tools for traumatic stress that have been translated into Chinese, and their limitations. Current influential theories about traumatic stress and salient risk factors in post-traumatic stress disorder (PTSD) are examined. The controversy and evidence behind the effectiveness of critical incident stress debriefing is discussed. There is an overview on the cognitive model of persistent PTSD, and its therapeutic implications on cognitive behaviour therapy. I found one of the most interesting parts was about the concept of resilience and post-traumatic growth. While some individuals may suffer chronic psychopathology after trauma, others recover and show a lack of negative reactions, and some will even report beneficiary effects. The latter 2 post-trauma outcomes are usually referred to as resilience and post-traumatic growth, respectively. Positive explanatory style, such as meaning- making and optimism towards positive events, is used to explain the underlying cognitive mechanisms of post- traumatic growth. Interestingly, this concept is consistent with Chinese philosophies, which in turn arouse research interests in Chinese societies.

The second section focuses on various types on trauma, including interpersonal trauma, medical trauma, mass trauma and disaster. For example, in reviewing existing child sexual abuse prevention worldwide and locally, it is essential to understand the 4 preconditions in Finkelhor’s model. These are the targets for primary, secondary, and tertiary prevention in the public health mode of child sexual abuse, and entail (1) the abuser’s motivation; (2) the abuser’s inhibitions; (3) external impediments; and (4) the child’s resistance. This brings about awareness for a multi- level prevention model, which may need more direction in the local setting. From the local experience of severe acute respiratory syndrome (SARS), increasing interest has been noted about post-traumatic experiences due to a severe physical illness. Despite having a relatively high recovery chance, recovered individuals from SARS remained psychologically distressed and faced social prejudice. In turn, this implied the need for further developments in the psychological support system. Taking into account of the 911 disaster in 2001 and Sichuan earthquake in 2008, psychological support for the community after disasters in Hong Kong was also reviewed.

This book takes us through a journey pertaining to the development of trauma psychology in Hong Kong in terms of identification, treatment, and prevention. On reflection, it reminds us of the importance to rationally strike a balance between the goodwill to intervene and the duty to do no harm. Hence, it is important to develop a rational, stepwise, systematic, and sustainable model of intervention. At the same time, we should not overlook the capacity for resilient coping and self-healing in trauma victims. We should also be aware of the danger of over- generalising and over-pathologising, especially with respect to relatively minor trauma incidents. At the end of the day, the greatest challenge to eradicate trauma is to work on the events causing it, such as abuse, violence, wars, and man-made disasters. This book gives a comprehensive yet concise view about trauma, and offers thorough insights on the issues.

Clara Siu, MBBS (smw732@ha.org.hk)

Department of Psychiatry

Queen Mary Hospital

Hong Kong SAR, China

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