Commonalities among Therapies

Wilson et al. (2001) identify the following characteristics that PTSD and trauma therapies and treatments have in common. On a broad scale, they all focus on reducing symptoms, improving functioning, improving relationships, promoting positive appraisal for the self and the world, listening, empathy, structure, well-timed and dosed intervention, caring and respect, ethical guidance, and the encouragement of self-empowerment and mastery.

Specifically for PTSD, these same authors state that all the various therapies have at least two other things in common, their engagement in or operation along three metaphases of treatment and the extent to which they vary along a continuum of suppression or expression of the trauma. Here are the metaphases:

Phase 1: establishing safety, building the alliance, establishing trust, and relaxation training

Phase 2: disclosure, trauma narrative, trauma script, and imaginal exposures

Phase 3: reconnection, self-continuity and meaning, integration, and synthesis

Regarding the suppression or expression of trauma, Wilson et al. (2001) propose that some treatments are suppressive toward trauma and its sequelae, seeking to reduce or diminish symptom expression (e.g., medication), while others are more expressive (e.g., group therapy). Maintaining a balance between these two poles is a delicate act and is seen as critical to therapeutic change and movement.

Finally, Wilson et al. (2001) summarize quite nicely the mechanisms or modes of therapeutic action operative within some (but not all) of the major treatment approaches. These aspects make these treatments work.

Cognitive-behavioral therapies focus on intrusive phenomena with the goal to extinguish reactivity through reframing and desensitization, overcoming avoidance, and achieving physiological mastery.

Group therapy addresses alienation through peer acceptance, empathy, support, and adaptive suggestions. There is also an educational component and feedback about the interpersonal consequences of trauma and subsequent behavior. There is a focus on normalizing, and true empathy is facilitated because other group members have truly been there.

Constructivist self-development theories focus on boundaries as central to traumatic experience and the creation of new interpersonal and self-narratives.

Psychodynamic and analytic therapies focus on the internalization of the therapist's voice as transference, countertransference, and reenactments unfold and are played out, building toward mastery and a sense of healing. Interpretation, reflection, and empathy are critical tools that allow corrective experiences to develop.

Family and couples therapies are useful modes for discussing disruptions in intimacy and make use of existing alliances, empathy, and trust to facilitate processing and bypassing of defenses.

Psychopharmacological therapies focus on deactivation of physiological mechanisms involved in arousal and reactivity along with the development of mastery and the freeing up of resources in order to devote more energy to other problem areas and symptoms.

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