Clinical Trainee Perspectives on the Implementation of Trauma-Focused Training

OBJECTIVE

Despite the high prevalence of trauma exposure in the United States and calls for the implementation of trauma-focused psychotherapy training, scant opportunities exist for such training in graduate clinical psychology programs. This study aimed to guide the implementation of trauma-focused psychotherapy training in graduate curricula by examining clinical trainees' perspectives on their current training and desired features for trauma-specific learning environments. The absence of research that centers trainee voices is notable; therefore, this study specifically focuses on trainee perspectives on implementation.

METHODS

The New Haven competencies, developed by the American Psychological Association to support efforts to improve trauma-specific training, were used as a framework to guide the development of a mixed-methods survey. Current doctoral students (N=18) in one clinical psychology program completed the survey.

RESULTS

Trainees overwhelmingly perceived the competencies to be relevant to their psychological assessment and therapy training and to their professional goals but noted a general lack of available trauma-specific training. Nearly all trainees believed that trauma-specific training should be required and expressed varied opinions regarding how requirements should be structured. Important features of a safe and supportive learning environment were reported to include coconstructed norms, choice and flexibility for participation, and integrated wellness practices. Further, instructors' trauma awareness, cultural humility, and responsiveness to students' experiences were emphasized by trainees as important.

CONCLUSIONS

Effective implementation of trauma-specific psychotherapy training should be guided by ongoing dialogue between trainees and training stakeholders.

Clinician Responses to Client Traumas: A Chronological Review of Constructs and Terminology

This paper presents a chronologically-organized review of various concepts and constructs in the literature describing professional burnout, compassion fatigue, secondary traumatic stress reactions, as well as other related terms and constructs that have been used to describe these experiences among clinical practitioners and other social service professionals. A timeline will provide a graphic illustration of the historical relationships between the concepts under examination. This paper begins with a review of practitioner-related stress that primarily results from interaction with clients, followed by an examination of professional burnout, which is thought to result largely from environmentally-related issues. Finally, the paper concludes with a discussion of posttraumatic growth and compassion satisfaction.

Systemic trauma

Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

Traumatic stress symptoms and breast cancer: the role of childhood abuse

OBJECTIVE

The present study investigated relations between reported childhood abuse and recent traumatic stress symptoms in women newly diagnosed with breast cancer (n=330).

METHODS

As part of a larger ongoing study, patients from eight public and private hospitals were referred by their physicians and completed the Childhood Trauma Questionnaire (CTQ), and the Impact of Events Scale-breast cancer (IES), which measured breast cancer-related intrusive and avoidant symptoms.

RESULTS

Emotional abuse, physical abuse, and sexual abuse were correlated with intrusive symptoms. Cancer-related avoidant symptoms approached significance in their relation to emotional and sexual abuse. Multivariate analysis, controlling for age and time since diagnosis, revealed that childhood emotional abuse was an independent predictor of breast cancer-related intrusive symptoms, but that childhood physical abuse and sexual abuse were not significant predictors.

CONCLUSIONS

Childhood emotional, physical, and sexual abuse were associated with breast cancer-related intrusive symptoms. Emotional abuse uniquely predicted intrusive symptoms after controlling for other predictors. Results suggest that a cancer diagnosis may trigger cognitive and emotional responses that relate to patients' prior trauma experiences.

PRACTICE IMPLICATIONS

Physicians and psychologists treating women with breast cancer should be aware that a history of childhood abuse may exacerbate patients' cancer-related intrusive symptoms. Interventions for women affected by both childhood abuse and breast cancer may be most effective when they address both stressors and associated emotional responses. Findings highlight the importance of additional research to explore links between prior trauma and distress following a cancer diagnosis stress.

Benefits of a contextual approach to understanding and treating complex trauma

The conceptual framework and treatment rationale of contextual therapy are described. Contextual therapy was specifically fashioned for survivors of prolonged child abuse (PCA). It is grounded in the observation that contexts beyond abuse trauma, especially restrictions in psychological development stemming from growing up in an ineffective family environment, appreciably impact the adjustment of many PCA survivors. Contextual therapy proposes that remediation of developmental gaps commonly manifested by PCA survivors is essential to equip them to (a) benefit from rather than be debilitated by trauma processing and (b) move beyond symptom reduction to the attainment of adequate social and occupational functioning.

Treating complex trauma in women within community mental health

Community mental health clinicians are likely to find their case loads composed of women who have complicated trauma histories. In response to the absence of comprehensive treatment for trauma survivors within the community mental health system, an alternative model, Overcoming Pain and Adversity in Life (OPAL) is offered. As an intensive treatment program, OPAL is structured in a triphase format to accommodate the individual needs of each woman and to promote symptom reduction and/or resolution.

Psychological aspects of traumatic injury in children and adolescents

Each year millions of children are exposed to some form of extreme traumatic stressor. These traumatic events include natural disasters (e.g., tornadoes, floods, hurricanes), motor vehicle accidents, life-threatening illnesses and associated painful medical procedures (e.g., severe burns, cancer, limb amputations), physical abuse, sexual assault, witnessing domestic or community violence, kidnapping, and sudden death of a parent. During times of war, violent and nonviolent trauma (e.g., lack of fuel and food) may have terrible effects on children's adjustment. The events of September 11, 2001 and the unceasing suicidal attacks in the Middle East underscore the importance of understanding how children and adolescents react to disasters and terrorism. The body of literature related to children and their responses to disasters and trauma is growing. Mental health professionals are increasing their understanding about what factors are associated with increased risk (vulnerability) and affect how children cope with traumatic events. Researchers recognize that children's responses to major stress are similar to adults' (reexperiencing the event, avoidance, and arousal) and that these responses are not transient. A review of the literature indicates that PTSD is the most common psychiatric disorder after traumatic experiences, including physical injuries. There is also evidence for other comorbid conditions, including mood, anxiety, sleep, conduct, learning, and attention problems. In terms of providing treatment, CBT emerges as the best validated therapeutic approach for children and adolescents who experienced trauma-related symptoms, particularly symptoms associated with anxiety or mood disorders. The best approach to the injured child requires injury and pain assessment followed by specific interventions, such as pain management, brief consultation, and crisis intervention immediately after the specific traumatic event. Family support also may be necessary to help the family through this difficult period. The main conclusion that arises from the research on resilience in development is that extraordinary resilience and recovery power of children depend on basic human protective systems operating in their favor. This finding has produced a fundamental change in the framework for understanding and helping children at high risk or already in trouble. This shift is evident in a changing conceptualization of the goals of prevention and intervention that currently address competence and problems. Strategies for fostering resilience described in this article should be tested in future controlled psychotherapy trials to verify their efficacy on children's protective factors.