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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
John C. Norcross, Ph.D.
An internationally recognized authority on behavior change and psychotherapy, John C. Norcross is Distinguished Professor of Psychology at the University of Scranton, Adjunct Professor of Psychiatry at SUNY Upstate Medical University, and a board-certified clinical psychologist. Author of more than 400 publications, Dr. Norcross has co-written or edited 22 books, including "Psychotherapy Relationships that Work," "Handbook of Psychotherapy Integration," "Leaving It at the Office: Psychotherapist Self-Care," "Insider’s Guide to Graduate Programs in Clinical & Counseling Psychology," and "Systems of Psychotherapy: A Transtheoretical Analysis," now in its 9th edition. Dr. Norcross has been elected president of several APA divisions, the International Society of Clinical Psychology, and the Society for the Exploration of Psychotherapy Integration. He has served on the Board of Directors of the National Register of Health Service Psychologists as well as on APA’s governing Council of Representatives. Dr. Norcross edited the Journal of Clinical Psychology: In Session for a decade and has been on the editorial boards of a dozen journals. An engaging teacher and clinician, John has conducted workshops and lectures in 30 countries. He lives in the northeast Pennsylvania with his wife, two grown children, and their two grand-kids.
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.