Format

Send to

Choose Destination
Psychotherapy (Chic). 2019 Sep;56(3):391-399. doi: 10.1037/pst0000228. Epub 2019 Apr 22.

Relationships and responsiveness in the psychological treatment of trauma: The tragedy of the APA Clinical Practice Guideline.

Author information

1
Department of Psychology.
2
Department of Counseling Psychology, University of Wisconsin-Madison.

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. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

PMID:
31008625
DOI:
10.1037/pst0000228

Supplemental Content

Full text links

Icon for American Psychological Association
Loading ...
Support Center