Trauma Practice — Tools for Stabilization and Recovery (Second and Expanded Edition)

In our clinical practices, most of our patients / clients experience numerous traumatic events in their lives. These include interpersonal, physical, sexual, and emotional violence, as well as accidents and disasters. The impact of trauma can be disabling and trauma-related disorders are not rare. Concerning the treatment of post-traumatic stress and similar disorders, cognitive behavioural therapy (CBT) is one of the most well-researched and effective interventions. This book emphasises much on the cognitive behavioural approach and applies the principles of reciprocal inhibition, pairing of exposures to traumatic memories, and relaxation. It contains a structured manual with many tools and protocols readily usable in clinical settings, and provides therapists and clinicians with excellent resources and guidance for working with subjects with trauma-related disorders.

The book is well structured. It begins with an introduction to the theories of CBT and psychophysiology of trauma, and its contents is arranged in 3 sections according to Judith Herman’s (1992) Tri-phasic Model for the treatment of trauma. The 3 sections are: Safety and Stabilisation, Remembrance and Mourning, and Reconnection. Each section is further divided into interventions related to (i) ‘body’; (ii) ‘cognition’; and (iii) ‘behavioural’ and ‘emotion / relation’.

The first section, Safety and Stabilisation, mainly focuses on helping subjects to develop skills to self-sooth and self-rescue, to establish a ‘safe’ environment for further trauma work. It describes in detail various techniques to achieve safety and stabilisation. These include: progressive muscle relaxation, autogenic relaxation, sensory grounding and containment, uses of imagery of a safe place, and utilisation of emotional support systems.

The second section, termed ‘trauma memory processing’, corresponds to Remembrance and Mourning in Herman’s Model. It aims to create a space to allow subjects to safely process and work through unresolved traumatic memories, and then begin to make sense of the devastating experience. These techniques mainly involve cognitive restructuring and various exposure interventions (systemic desensitisation and narrative interventions). Although newer approaches, like eye movement desensitisation and reprocessing (EMDR), are not covered in the book, the authors believed that the latter approaches certainly fit the CBT trauma framework, as both EMDR and CBT aim to help individuals process the trauma.

The third section, Reconnection, focuses on ‘redefining oneself in the context of meaningful relationships and engagement in life activities’. Interventions include centering oneself, addressing the victim mythology of the subjects, and using memorials and letters to self to reconnect the horrific past to a hopeful future.

Overall, this is a user-friendly guidebook for trauma therapy. Templates and worksheets are handy and lend themselves to reproduction for clinical use. Moreover, they can be used in a highly individualised way to fit into the scenarios of different patients. This book teaches us practically about ‘how to’ implement cognitive behavioural treatments for subjects with traumatic experiences.

Another aspect that impressed me the most was ‘compassion fatigue’ discussed in the last part of this book. ‘Burnout’, ‘vicarious traumatisation’, ‘secondary traumatic stress’, and ‘compassion fatigue’ described the deleterious effects that helpers and care providers endure when working with trauma victims. This highlights the importance of the well-being of clinicians and therapists. Mental health care providers themselves need to pay more attention to their own psychological well-being while helping others. Strategies for developing resilience towards and prevention of compassion fatigue are needed. This area of study is still in its infancy and deserves further attention.

This book is well thought-out and helpful. However, the authors want us to apply their work with caution. For example, indirect retraumatisation can be an issue during the trauma therapy. Sometimes it is possible for the well-intended but untrained therapist to engage in treatment with survivors that can actually retraumatise their clients, thus resulting in failed treatment and rendering future treatment more difficult and painful for the survivors. Other difficulties, such as how to determine a subject’s readiness for the next phase of trauma care, how to deal with co-morbidities (particularly personality problems), can also be anticipated. Progress of the treatment may be hindered if the therapist fails to tackle these difficulties. Thus, this book serves as a guide and does not substitute training and supervision.

Angel Tsang, MBChB (email: tsang330@gmail.com)
Department of Psychiatry
Tai Po Hospital
New Territories, Hong Kong SAR
China

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