Expert therapists and practicing clinicians: Reported prototypical treatments of trauma

PTSD is a frequent psychiatric response to a variety of extreme psychological stressors. While several effective treatments for PTSD such as cognitive-behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) have been included on lists of empirically supported treatments, nonresponse rates to these treatments can be high. According to patient report, psychodynamic interventions are more common than CBT for PTSD in the community, yet only one randomized controlled trial has included a psychodynamic treatment for PTSD. This dissertation reviews the treatment dropout and non-response rates in studies of empirically supported treatments for PTSD. Next, a case for the value of psychodynamic treatment of PTSD is made, utilizing empirical research on links between the psychopathology of PTSD and psychodynamic concepts such as defenses and relationship patterns. Then, an empirical study was conducted to find out how psychodynamic and CBT therapists treat patients with PTSD, to discover commonalities and defining characteristics of treatment within each group of respondents, and to delineate the unique contributions of psychodynamic psychotherapy to the treatment of such patients.Therapists who identified themselves primarily with psychodynamic/psychoanalytic or cognitive-behavioral theoretical orientations were recruited online through professional organization listservs. They were randomly presented one of four case studies, describing variations on trauma. Participants then completed a Psychotherapy Process Q-Sort to describe quantitatively their ideal treatment of the given patient. Results indicated many similarities among clinicians of widely different perspectives. Among clinicians who indicated that their primary theoretical orientation was psychodynamic, three prototypical treatments were discovered, and among clinicians who indicated that their primary theoretical orientation was cognitive-behavioral, four prototypical treatments were found. Overall, the prototypes in the current study were correlated with, but not identical to, prototypes of PD, CBT, or interpersonal therapy (IPT) developed in previous studies based on experts' ratings. While the literature has suggested that clinicians who treat patients who have PTSD may make alterations in their techniques to address issues that are specific to PTSD, the current study provides some evidence that therapists are not aware of how their treatment for trauma is different from the theoretical approaches they endorse.

Dissertation/Thesis

English

Michele A. Schottenbauer

Schottenbauer, M. A. (2007). Expert therapists and practicing clinicians: Reported prototypical treatments of trauma. Dissertation Abstracts International: Section B: The Sciences and Engineering, 67(10-B), 6077