Trauma Practice (eBook)

|9|Phase 0: Foundations of the Trauma Practice Model

For fast-acting relief from stress, try slowing down.

Lily Tomlin

|10|Phase 0: Foundations of the Traum Practice Model

We have added a Phase 0 to Herman’s (1992) Tri-phasic Model in this edition of Trauma Practice. This addition reflects an attempt to identify and promulgate the knowledge and skills necessary for a trauma clinician to meet their clients with competence from the first session throughout the course of treatment and all the way to discharge. We hope this information supports clinicians working with trauma survivors to become increasingly intentional with the ways in which they manage themselves and engage their clients. Recent research is replete with data that suggests the value of what the therapist brings to the process of treatment is much greater than the technical elements of the treatments themselves.

Benish, Imel, and Wampold (2007, p. 746) state:

Given the evidence that treatments are about equally effective, that treatments delivered in a clinical setting are effective (and as effective as those in clinical trials), that the manner in which treatments are provided are much more important than which treatment is provided…

Recent outcome research (Miller et al., 2013, 2020; Llewelyn et al., 2016) has begun to discover what makes psychotherapy optimally effective. It is much less about the treatment method utilized and much more about the relational and technical expertise of the therapist. This process of developing expertise and maximizing outcomes by psychotherapists with all their clients has given birth to a burgeoning field of clinical training and research called deliberate practice. Deliberate practice was first discussed by Ericsson (2006) after conducting a study with musicians who were enrolled in an elite training academy in Germany. Through surveys and interviews, Ericsson was able to distill what was common among these students that produced excellence in their playing. These activities were:

1. Observing their own work

2. Getting expert feedback

3. Setting small incremental learning goals just beyond the performer’s ability

4. Engaging in repetitive behavioral rehearsal of specific skills

5. Continuously assessing performance

These activities have been utilized in training and supervision programs with psychotherapists and yielded significantly improved outcomes among their clients. Evidence-based psychotherapeutic treatments are effective less because of the technical aspects of the treatment (0–1% of variance) and much more a result of clinician expertise with both the treatment model and maintaining a positive therapeutic experience for the client (5–9% of variance) (Chadwell et al., 2018; Duncan et al., 2010; Lutz et al., 2007; Wampold, 2005). The more deliberate the clinician is in refining technical and relational skills the more effective implementation of evidence-based treatments will become. In addition to relational and technical competence is the requirement for the consistent attuning to our clients, the actual experts of their own struggles. This constant attunement allows us to continually bolster our relationships with them as well as repair any unintentional relational damage done in previous sessions. We strongly advocate integrating feedback-informed practice (Miller et al., 2013, 2015) with all clients in each session.

In addition to developing technical expertise with the clinician’s treatment(s) of choice, continual augmentation of relational skills, and the utilization of feedback-informed treatment is highly recommended. This capacity enhances effectiveness with clients across the diagnostic continuum. With this as a starting point, we also wish to add some skills and preparatory activities to evolve a clinician’s expertise specifically with trauma survivor clients.

Preparation for the Therapist

In the 21st Century, therapists who treat trauma and have interest in pursuing excellence in this endeavor must dedicate a significant amount of time and resources toward their preparation. This preparation includes two components: preparation in their professional development and preparation for each and every individual client. Many of these professional preparatory capacities may already be a part of the professional’s knowledge and skill set, but if they are not, then some preliminary work will be required to set the work on the right foot before even having contact with their first client. Below is a list of knowledge and capacities that serve as a foundation for the practice of trauma-informed care and the pathway to excellence as a trauma therapist:

• Becoming proficient in the principles and practices of trauma-informed care. Trauma-informed care is:

  • Understanding the prevalence of trauma and adversity and their impacts on health and behavior

  • Recognizing the effects of trauma and adversity on health and behavior

  • |11|Training leadership, providers, and staff on responding to patients with best practices in trauma-informed care

  • Integrating knowledge about trauma and adversity into policies, procedures, practices, and treatment planning

  • Resisting re-traumatization by approaching patients who have experienced adverse childhood experiences and/or other adversities with nonjudgmental support

• The principles of trauma informed care are:

  • Establish the physical and emotional safety of patients and staff

  • Build trust between providers and patients

  • Recognize the signs and symptoms of trauma exposure on physical and mental health

  • Promote patient-centered, evidence-based care

  • Ensure provider and patient collaboration by bringing patients into the treatment process and discussing mutually agreed upon goals for treatment

  • Provide care that is sensitive to the patient’s racial, ethnic, and cultural background, and gender identity

In addition to making the principles and practices of trauma-informed...