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Book Reviews   |    
Treating Psychological Trauma and PTSD
Reviewed by Victor McGregor, Ph.D., R.N.C.S.
Psychiatric Services 2002; doi: 10.1176/appi.ps.53.7.905-a
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edited by John P. Wilson, Matthew J. Friedman, and Jacob D. Lindy; New York, Guilford Press, 2001, 467 pages, $45

This is an authoritative volume that should be on the required reading list for any serious course on trauma, stress, posttraumatic stress disorder (PTSD), victimology, or abnormal psychology or clinical psychology practicum. It provides a solid foundation for beginning and experienced clinicians who are interested in treating traumatized patients. The book covers treatment of children, adults, couples, families, and persons with dual diagnoses, severe mental illness, and "other trauma-related disruptions of the self."

Treating Psychological Trauma and PTSD thoroughly examines the complex nature and aftereffects of trauma and its implications. It broadens the reader's perceptions of psychopathology and provides a much-needed lens for understanding both catastrophic trauma and the inevitable, pervasive, smaller—but common—trauma that goes unrecognized in everyday life. The broad spectrum and variability of symptoms are well addressed. The chapters in this book are informed by the latest theory and clinical research and describe a broad array of effective interventions and fine-tuned treatment goals.

The contributors articulate how traumatic victimization inevitably challenges one's belief system, eroding the deeper meaning of life until depression and anxiety take over. The book emphasizes that the goal of treatment is to enable the patient to maintain a sense of integrity of self that should not fragment. The self it proposes is holistic in that identity is stabilized by compensating for the assaults on its integrity. For example, the healed self is responsible in continuing commitments in interpersonal functioning, intimacy, and attachments.

The innovative authors and editors use the term "allostasis" to describe this "organismic model" of trauma. The concept involves a more dynamic view of human stress response. McEwen (1) described allostasis as the response to the "wear and tear" produced by stressors of all kinds. In Treating Psychological Trauma and PTSD, the authors' underlying philosophy shows respect for the patient as an individual capable of repairing deep damage. "Understanding the purpose of maladaptive response," they note, "helps the clinician effect good outcomes."

The contributors include coverage of the biological medical model but far exceed its limits. The slow evolution of the diagnosis of PTSD does not prevent them from anticipating that the next edition of DSM will delineate many of the complex facets of trauma that have not been recognized in mainstream psychiatry. The book offers excellent reformulations of diagnostic criteria and treatment goals for PTSD. Further elaboration on how trauma can be an opportunity for deepening one's spirituality is needed, but that would probably be the subject of another volume.

The contributors' clinical backgrounds in psychology, psychiatry, pharmacology, cognitive-behavioral approaches, and psychoanalysis provide a good basis for clarifying the nature of trauma so that sound guidelines for treatment can be articulated. Their collective effort in this volume provides a solid knowledge base for further syntheses of the material and greater consensus on guidelines for treating trauma-related conditions.

I highly recommend this book. It is a vital contribution to the field of mental health in general and is on the cutting edge of expanding the practice guidelines for mainstream therapy of traumatized patients.

Dr. McGregor is a nurse practitioner in psychiatry at Hudson Valley Psychiatric Associates and at Ulster County Mental Health Center in Kingston, New York.

McEwen BS: Protective and damaging effects of stress mediators. New England Journal of Medicine 338:171-179,  1998


McEwen BS: Protective and damaging effects of stress mediators. New England Journal of Medicine 338:171-179,  1998

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