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David C. Young
- Publié sur Amazon.com
Both 1st & 2nd editions present research evidence and clear treatment guidelines for a wide variety of treatments: Psychological Debriefing, Cognitive-Behavioral Therapy, Psychopharmacology, EMDR, Psychodynamic Therapy, Hypnosis, Couples/Family Therapy, Group Therapy, and "Creative" Therapies. There's even a section on therapeutic interventions based in schools.
But several strong changes clearly distinguish this 2nd edition. Whereas the 1st edition had 12 different effective treatments, the 2nd edition has 18. Most important for those of us who work with children, PTSD therapy for children and teens is given MUCH more prominence in the 2nd edition. One chapter is devoted exclusively to the special issues of assessing children/teens for PTSD. Five chapters are devoted to therapies for children and teens.
There's an important new chapter on treating not only PTSD, but PTSD with co-morbid disorders, with other psychological diagnoses, such as depression, panic, borderline personality disorder, psychosis and substance abuse. This chapter has long been needed. As all clinicians know, most people with PTSD have other problems, other diagnoses. Depression or dysthymia, for example, is found in over almost two-thirds of those with PTSD. And among men, about half also have a substance abuse problem. The section on substance abuse - the longest in this chapter - is certainly most welcome!
Also new in the 2nd edition are three chapters on "early interventions" -- treating trauma right after it happens, hopefully reducing the chances that PTSD will become more long-term or even chronic. And we can certainly rejoice in having, here & ready-to-hand, updated research that's been conducted since the 1st edition was published in 2000.
While a solid improvement from the first edition, however, the 2nd edition has four serious omissions. First, there's no chapter on family therapy devoted for children and teens. Many child/teen clinicians, I suspect, have found that a family therapy component can certainly be important in helping a child heal from trauma. If nothing else, parents often benefit from being part of their child's therapy. Of course they want to do something. And as we all know, when the parents benefit, the children usually benefit, too.
Two serious omissions come from this book's near-exclusive "Treatments" bias. This means that treatments are considered the main avenue for client healing. Research in the past decade has demonstrated that this just isn't true. (See, for example, the recent research on treating PTSD in the 2nd edition, 2010, of The Heart and Soul of Change: Delivering What Works in Therapy.) And most clinicians who work regularly with severe PTSD know that building an effective therapist/client relationship is at least, if not more challenging and important with many clients than the treatments used. "Effective Treatments for PTSD" exclude most "relationship-oriented" therapies, client-centered therapies. The exceptions are psychodynamic and "Emotionally-Focused Therapy". Sadly EFT, here, is restricted to couples therapy. (EFT, by the way, has been proven effective with some traumatized teens.)
The third serious omission, also coming out of this "treatments-only" bias, is that incorporating client strengths, client resources, client feedback and client engagement, while not excluded, isn't emphasized nearly to the extent that its importance demonstrated in research suggests.
The fourth serious omission is no chapter on what's called compassion fatigue & vicarious traumatization. Since the 1980's, we've known that therapists who treat a lot of PTSD are, themselves, highly at-risk for becoming traumatized by proxy, by working with so many traumatized clients. I realize that this isn't an "Effective Treatment". But given how common, and how serious this problem is, given how many good therapists burn out in treating PTSD, I think, frankly, that it's irresponsible not to include a chapter devoted to recognizing and treating this problem. Certainly therapist compassion fatigue makes any treatment much less effective.
But even with these serious omissions, I strongly recommend buying this new, 2nd edition. Given that research shows so many treatments can be effective, and that newer research is showing that, for treatments to be most-effective, they need to closely fit the client's preferences and needs, the diversity presented here, and its research backing, is most welcome. And in the "Introduction", the editors take a refreshingly clinically-reasonable, non-dogmatic position on the need for more treatments and treatment diversity.
"...clinicians following these guidelines should not limit themselves only to these approaches and techniques. All current treatments have limitations; either not all patients respond to them, patients drop out of treatment, or, for various reasons, therapists are not comfortable using a particular intervention. To promote the development of improved treatments, creative integration of new approaches driven by sound theoretical principles is most welcome in the field. Promoting new treatments ultimately enhances and optimizes treatment outcome, thus contributing to optimal public health across national borers."
So buy this book! And maybe, for best results, however, use it in conjunction with the 2nd edition, 2010, of "The Heart and Soul of Change".
Note: for treating what's coming to be called "Complex PTSD", you may want to add the recent, Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide. This hard-to-treat & debilitating reaction to severe and prolonged trauma often needs its own types of interventions, as well as its own special therapeutic relationships.