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Relationships and Responsiveness in the Psychological Treatment of Trauma
The Tragedy of the APA Clinical Practice Guideline
Abstract
The therapeutic relationship and responsiveness/treatment adaptations rightfully occupy a prominent, evidence-based place in any guidelines for the psychological treatment of trauma. In this light, we critique the misguided efforts of the American Psychological Association’s (APA, 2017) Clinical Practice Guideline on Posttraumatic Stress Disorder in Adults to advance a biomedical model for psychotherapy and thus focus almost exclusively on treatment methods for particular disorders. Instead, the research evidence, clinical expertise, and patient preferences and culture (the necessary triumvirate of evidence-based practice) should converge on distinctive psychological guidelines that emphasize the therapy relationship, treatment adaptations, and individual therapist effects, all of which independently account for patient improvement more than the particular treatment method. Meta-analytic findings and several trauma- specific studies illustrate the thesis. Efforts to promulgate guidelines without including the relationship and responsiveness are seriously incomplete and potentially misleading. The net result is an APA Guideline that proves empirically dubious, clinically suspect, and marginally useful; moreover, it squanders a vital opportunity to identify what actually heals the scourge of trauma. We conclude with recommendations for moving forward with future APA practice guidelines.
Keywords: trauma, posttraumatic stress disorder, psychotherapy relationship, responsiveness, treatment adaptations, guidelines
Cite This Article
Norcross, J. C., & Wampold, B. E. (2019). Relationships and responsiveness in the psychological treatment of trauma: The tragedy of the APA Clinical Practice Guideline. Psychotherapy, 56(3), 391-399. doi: 10.1037/pst0000228
The missing ingredient is a lack of understanding of the subject matter of psychotherapy. It’s the client’s experiencing, understood as follows: The typical presenting problem has a psychogenic/ interpersonal origin; it is understood in an atheoretical way as all human experience is unique; and a conscious act cannot significantly alter the symptomatology.
Recommended method of treatment: My concept of therapeutic catharsis. It offers what has been lacking in the history of psychotherapy: A criterion that differentiates between a therapeutic and a non-therapeutic emotional release: i.e.. the unforced (therapeutic) and forced (non therapeutic) activation of the client’s emotional experiencing. See my Operationalizing the Actualizing Tendency, on ResearchGate and PsycINFO.