APA guidelines for working with individuals who have complex trauma histories

[cara susanna]

https://www.apa.org/practice/guidelines/adults-complex-trauma-histories.pdf

Hoo boy

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[psych.meout]

https://www.apa.org/practice/guidelines/adults-complex-trauma-histories.pdf

Hoo boy

I haven't had a chance to read it yet, but I have a feeling this isn't going to be great.....

Project Contributors

Christine A. Courtois, PhD, ABPP (chair)
Paul Frewen, PhD, C. Psych (co-chair)
Peter M. Barach, PhD
Bethany Brand, PhD
James Chu, MD
Marylene Cloitre, PhD
Constance Dalenberg, PhD
Nel Draijer, PhD
Victoria Follette, PhD
Julian D. Ford, PhD
Judith L. Herman, MD
Philip Kinsler, PhD
Ibrahim Kira, PhD
Andreas Laddis, MD
Ruth Lanius, MD, PhD
Sandra Paivio, PhD, C. Psych
Laurie A. Pearlman, PhD
Nnamdi Pole, PhD
Francine Shapiro, PhD
Joseph Spinazzola, PhD
Kathy Steele, RN, MSN
Joan A. Turkus, MD

 

[cara susanna]

Yup, plus it's like all of the "pro" CPTSD people and none of the "anti."

 

[Fan_of_Meehl]

https://www.apa.org/practice/guidelines/adults-complex-trauma-histories.pdf

Hoo boy

Will have to read it later but I'll bet--as Richard McNally predicted a while back--the watering down of the PTSD construct via ever-widening Criterion A "bracket creep" is just leading to increasingly broad application of the 'trauma' label to every facet of human existence and every squabbling sociopolitical context.

 

[clausewitz2]

The most striking bit of what I have read so far is an assertion that trauma is in fact the primary cause of many mental health issues, which is supported a sentence later by the observation that it is an established risk factor for many disorders. It doesn't attempt to build a bridge across this conceptual chasm so much as take a blind leap of faith and hope for the best.

 

[Fan_of_Meehl]

The most striking bit of what I have read so far is an assertion that trauma is in fact the primary cause of many mental health issues, which is supported a sentence later by the observation that it is an established risk factor for many disorders. It doesn't attempt to build a bridge across this conceptual chasm so much as take a blind leap of faith and hope for the best.

Right. Correlation is not causation. Description is not explanation. Tautological reasoning is bad, mkay? This is why MH professionals should be steeped in critical thinking, research methods, and the philosophy of science.

And any construct/concept that purports to explain EVERYTHING in principle generally ends up explaining NOTHING in practice.

 

[Sanman]

Will have to read it later but I'll bet--as Richard McNally predicted a while back--the watering down of the PTSD construct via ever-widening Criterion A "bracket creep" is just leading to increasingly broad application of the 'trauma' label to every facet of human existence and every squabbling sociopolitical context.

One the one hand I agree with you. On the other, ever increasing criterion A creep means more patients assuming health insurance has to cover a wider array of life circumstances. There is a benefit to that.

 

[R. Matey]

The most striking bit of what I have read so far is an assertion that trauma is in fact the primary cause of many mental health issues, which is supported a sentence later by the observation that it is an established risk factor for many disorders. It doesn't attempt to build a bridge across this conceptual chasm so much as take a blind leap of faith and hope for the best.

Eh, nomological networks are for nerds. /s

 

[Fan_of_Meehl]

A solid point.

I dunno, man, I'm just tired of the push toward imprecise language that I'm seeing everywhere these days.

I am currently sitting in a Live Teams CEU event where the speaker said to the audience, "Click a 'thumbs up' if you agree that 'inclusion into communities should be classified as a "medical necessity"'

Everyone did a thumbs up.

I'm not saying it's not important or shouldn't be pursued and funded as public policy

However, along with classifying 'service animals' as a 'medical necessity,' classifying something like 'community inclusion' as a 'medical necessity' on par with insulin for diabetics and anticonvulsants for epileptics just seems to:

(A) eliminate any boundaries to the term "medical necessity" and
(B) overstretch and over-apply the medical model to complex social problems that lack simple 'prescriptions' to solve

 

[PsyDr]

"Click a 'thumbs up' if you agree that 'inclusion into communities should be classified as a "medical necessity"'

What does "inclusion into communities" mean, in this case?

 

[Sanman]

A solid point.

I dunno, man, I'm just tired of the push toward imprecise language that I'm seeing everywhere these days.

I am currently sitting in a Live Teams CEU event where the speaker said to the audience, "Click a 'thumbs up' if you agree that 'inclusion into communities should be classified as a "medical necessity"'

Everyone did a thumbs up.

I'm not saying it's not important or shouldn't be pursued and funded as public policy

However, along with classifying 'service animals' as a 'medical necessity,' classifying something like 'community inclusion' as a 'medical necessity' on par with insulin for diabetics and anticonvulsants for epileptics just seems to:

(A) eliminate any boundaries to the term "medical necessity" and
(B) overstretch and over-apply the medical model to complex social problems that lack simple 'prescriptions' to solve

That's the thing. It completely overreaches on A. However, we can provide valuable services in terms of B. It is where we thrive in many circumstances. There is no pill that cures "You have terminal cancer" or social isolation/lack of inclusion. This is an end run around the idea that psychotherapy should be covered to help folks deal with a variety of social/societal concerns and not just "medical" concerns. I do think that it can help create resilience and improve both physical and mental health outcomes. Because social isolation often leads to depression which, in turn, leads to things like medication non-compliance and passive death wish.

 

[Fan_of_Meehl]

What does "inclusion into communities" mean, in this case?

Precisely my point

 

[AcronymAllergy]

One the one hand I agree with you. On the other, ever increasing criterion A creep means more patients assuming health insurance has to cover a wider array of life circumstances. There is a benefit to that.

I mean, if everything is trauma, then by extension, we can treat everything.

 

[Ollie123]

I mean, if everything is trauma, then by extension, we can treat everything.

Oooo, I'm totally reinventing myself as a cardiac surgeon.

Repairing your aortic aneurysm is totally within my scope of practice. You only have one because your body was keeping the score.

 

[Fan_of_Meehl]

Oooo, I'm totally reinventing myself as a cardiac surgeon.

Repairing your aortic aneurysm is totally within my scope of practice. You only have one because your body was keeping the score.

I heard that if you tug downward on the appendix rapidly 3 times at a rate of 1hz it functions as a 'hard reset' of the body's trauma scoreboard. It'll reset that trauma odometer all the way back to zero just like a used car salesman would.

 

[Sanman]

Oooo, I'm totally reinventing myself as a cardiac surgeon.

Repairing your aortic aneurysm is totally within my scope of practice. You only have one because your body was keeping the score.

Poor choice, IMO. The overhead is too high. I will be starting a botox clinic to take care of those "worry" lines related to years of anxiety and complex trauma.

 

[albatross_at_crossroads]

Poor choice, IMO. The overhead is too high. I will be starting a botox clinic to take care of those "worry" lines related to years of anxiety and complex trauma.

Why not start now? There's a naturopathic "health center" near me that has a clinical psychologist on the team who works "collaboratively" with the naturopaths (I don't know what that means exactly but they are making a lot of money). There's also a spa in the city that has a master's level therapist on board as well. So I can definitely see this as a worthwhile business venture. Have a nurse do the injections and you can do the post-therapy while the client's face adjusts.