● Clinicians will familiarize themselves with the wide number of theoretical perspectives that can inform and enhance their work in the field of trauma. ● Clinicians will themselves become educated in a number of traditional and complementary multimodal and mind– body–spiritual approaches to healing trauma and create a large enough professional toolbox to be able to offer clients methods to heal and address symptoms that occur at all four levels of being. This chapter will identify some of the adjunct professionals who may comprise a treatment team and then explore the importance of a multimodal and multitheoretical approach to trauma treatment. This exploration will include an overview of some useful theoretical frameworks in which to ground the work and examine some of the most current methods available within those frameworks.
Sometimes, this happens simply because the healing work proceeds only as quickly as the client can tolerate it, and it is not unusual to do a piece of the work at one time, only to return later to complete an additional piece. Sometimes, however, the client re-enters treatment because earlier treatment did not address the totality of aspects of the self that were affected by the trauma. In such a case, it is not surprising that the same symptoms have resurfaced or that new symptoms have emerged. Traditional therapeutic approaches are often excellent at addressing the cognitive and emotional components of the trauma; however, they frequently ignore the body and spiritual realms. An integrative and holistic approach will work to ameliorate this problem in three ways. ● Clinicians will work from a treatment team approach, and part of their role will be to facilitate referrals to other helping professionals and to integrate within the primary therapy the advice, recommendations, and follow-up from other parts of the treatment team. Building a Collaborative Treatment Team Three components of the treatment team have already been discussed: The client, clinician, and group facilitator. In addition, to address the other levels of being that have been affected Psychopharmacology and Trauma The most common adjunct professional employed in a team approach is a psychopharmacologist. Many clients are not able to self-regulate their emotional upset in a way that allows them to adequately function in their daily lives; therefore, the addition of a medical consultant is invaluable. Four selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) have the most support for their use to address PTSD symptoms: Sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac), and venlafaxine (Effexor) (NCPTSD, 2022a). Benzodiazepines are often prescribed to individuals with PTSD but are not recommended for the treatment of PTSD (NCPTSD, 2022b). While benzodiazepines can help provide short-term relief, they are not intended for long-term use and can be relied upon as a means of avoidance of trauma reminders. It is crucial for clinicians to develop a network of referral sources of psychopharmacologists who are knowledgeable and sensitive to trauma treatment and who are willing to work in a collaborative manner with the referring clinician. Clients often have mixed responses to the use of medications, ranging from “I can’t live without them” to “I don’t want to put any chemicals in my body.” Traumatized clients may develop complicated relationships with their medications as well as with their prescribers. This is a treatment issue that will need to be addressed during therapy, and the transference to the physicians and the medications will need to be resolved. For example, the reason that some clients may balk at the idea of putting something into their bodies may be that doing so consciously or unconsciously evokes a trauma trigger of previous intrusions. Other clients with addictive tendencies may risk becoming addicted to their medications or refuse to take needed medications because of their interpretation of the mandates of self-help programs such as Alcoholics Anonymous that insist on sobriety from all substances. A useful stance for the clinician to take is to inform clients that taking or not taking medication is not a moral issue. The clinician can assure clients that they are neither for nor against medication, but want to determine with clients, in a collaborative fashion, what is in each client’s best interest and how it can best be achieved. When clients feel that medications are not something being forced on them, they are more apt to engage in dialogue about the pros and cons of various options, including what the warning signs may be if their current choices (or current combination of medications) are not serving them adequately. As long as a client is not presenting a danger to self or others, the question of using psychotropic medication or consulting with other professionals can remain a personal, information-
by the trauma, it is often useful for the client to have a team of professionals from other disciplines who can enhance and accelerate the identified treatment goals.
based choice. Having a signed release-of-information form from the client, which authorizes regular communication with the prescribing physician, is crucial in order to avoid splitting (the client giving different information to different providers or developing a relational stance that holds one provider as the good one and the other as the bad one, as some clients with personality disorders may do), share observations and impressions with each other, and provide a collaborative holding matrix. Case Example 1 Lisa, who has a history of traumatic neglect and abuse by both of her parents, relates to the team of her therapist and her psychopharmacologist as if they were her surrogate, healthy parents. Lisa religiously reports to her clinician when she has seen her psychopharmacologist and tells the clinician what they talked about and whether any changes in her medication regimen were introduced. She periodically inquires of each of the two professionals if they have met each other, if they have spoken recently, or if they are aware of those aspects of each other’s personal lives that she has become privy to, such as the birth of children or vacation schedules. This collaborative team serves as a holding matrix for her, in lieu of the one that she did not receive as a child. In addition to traditional medical options for depression, anxiety, and other dysregulated moods or thought processes, clinicians should be aware of alternative methods of addressing these states that may align with a client’s interests or desires. Using Internet resources, clinicians are able to search “CAM”— complementary and alternative medicine—to access a large body of professionals who use herbal remedies, vitamin therapies, and homeopathic treatments as well as explore homeopathic medicine. (See the Resources section of this course for websites.) Having a working knowledge of the benefits and risks of these options, in addition to contact with professionals in these fields as referral sources, is recommended. These interventions lack the efficacy research of some of the other treatments described in this course, and some do question their utility (National Center for Complementary and Integrative Health, 2021). As the CAM name suggests, these approaches are often used as supplements and in conjunction with more efficacious trauma interventions or psychotherapies. Case Example 2 Bob, who was dealing with issues related to sexual dysfunction, told his clinician that he had begun taking large amounts of several herbs and vitamins that he had researched on the Internet as possibly being useful to help with his condition.
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