Specific Therapies for Specific Traumas and Adjunctive Treatments

Much of the treatment discussed in previous chapters has been rather generic and relevant to the treatment of PTSD in general. But are all traumas and traumatic stressors created equal? To answer this question, one needs only to ask yet another question, "Are all patient's the same?" Certainly not. The development and use of specific treatments for specific types of trauma (e.g., sexual assault, disasters, or combat-PTSD) is the product of at least two phenomena, basic pragmatics of clinical theory and research and the expanding sophistication of clinical science in the mental health field. In order to develop a sound study to test the effectiveness of a particular treatment, the more specific and targeted the population and sample, the better a study will be on methodological and statistical grounds. It is easier to develop a model and a treatment protocol for a small, more circumscribed treatment sample than for an entire population. Further, once such a study is developed and (hopefully) validated, the issue of generalizability comes into play. For example, if I want to develop and test a treatment for test taking anxiety, I might begin by focusing on just prospective college students taking the SAT. If the intervention is effective, I must test the protocol with different samples before I can claim it is relevant to the entire test-taker population. So specific therapies for specific trauma groups are a matter of methodological pragmatics.

Another reason that specific therapies for specific traumas are utilized is the growing scientific sophistication of both clinical research and clinical practice. Many professionals advocate the use of empirically supported treatments as the only way to practice ethically and effectively. As was just discussed, this is going to result in clinicians' having to use more circumscribed treatments for more specific populations, and clinical phenomena as these are the treatments being

Student Alert

Looking back on my training as a psychologist, I realize that one area that was sorely lacking was specific training in clinical method. Sure, we all got training in how to conduct a clinical intake, how to do a history, how to administer and interpret psychological testing, how to diagnose, and even how to treat. "What more is there?," you might ask. Clinical method refers to your specific approach to clinical problem solving and the management of clinical issues beyond the disorder you are treating. Clinical problem solving is sometimes referred to as clinical cognition or expert cognition. Management of clinical issues includes managing such things as informed consent, how to write a child custody report, when to intervene in an emergency, when not to treat, and so on. These nuances of clinical practice get learned over the years through experience. I only mention these here because as students, we often seek this kind of guidance only to find we have to learn it on our own. Don't lose faith, though. An important remedy to this problem is to find a good professional mentor or two and study their every move. Don't be afraid to ask stupid questions. Eventually, you'll develop a clinical method and approach that works best for you.

put to the empirical test. I also believe, however, that as our clinical science evolves, our ability to utilize prescriptive treatments will grow. I see the one-size-fits-all approach to psychotherapy, for example, as clinical science in a less-developed and earlier stage of professional and paradigmatic development. Theoretically, at least, as we become more sophisticated diagnostically, in research, and in application, we can't help but be more specific in our treatment approaches. This is not to say that there is not a place for more broad and generic approaches to treatment. In fact, I believe it is possible that treatment research will show these one-size-fits-all treatments to be as effective or more so than more prescriptive treatments. However, in the words of one of my favorite professors, "That is an empirical question," and only time will tell.

As far as adjunct treatments are concerned, most clinicians know from experience that client difficulties are often so multifaceted and layered that the use of adjunctive treatments is an absolute necessity. It is just good clinical practice.

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