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Practice Guidelines for Clinical Treatment of Complex Trauma BLUE KNOT FOUNDATION Dr Cathy Kezelman AM Pam Stavropoulos PhD empowering recovery from complex trauma Practice Guidelines for Clinical Treatment of Complex Trauma Practice Guidelines for Clinical Treatment of Complex Trauma © 2019 Blue Knot Foundation Authors: Kezelman C.A., Stavropoulos P. Dr Cathy Kezelman AM President – Blue Knot Foundation Pam Stavropoulos PhD Head of Research – Blue Knot Foundation Blue Knot Foundation 2019 Practice Guidelines for Clinical Treatment of Complex Trauma: Authors Kezelman C.A & Stavropoulos P.A. www.blueknot.org.au Blue Knot Helpline 1300 657 380 AUDIENCE: These guidelines are intended for clinicians (i.e. counsellors, psychologists, mental health social workers and other mental health professionals) who work in one-to-one therapeutic contexts with clients/patients who experience the impacts of complex trauma. This includes therapists who specialise in this work as well as those who see complex trauma clients as part of their general work. Disclaimer This document is a general guide to appropriate practice. The guidelines are designed to provide information to assist decision-making and are based on the best available evidence at the time of development of this publication. 2 | Blue Knot Foundation www.blueknot.org.au It is a privilege to endorse these guidelines, which are ground-breaking in addressing the major public health problem of childhood/interpersonal abuse and its long-term impact on the health and welfare of the survivors. These guidelines are the foundation of not only trauma-informed care and treatment, but address the vital issue of prevention. These are complex issues, which all of us in mental health, institutions, and societal/political systems need to address. The guidelines show us the way! Joan A. Turkus, M.D. Medical Director, TraumaSci: Complex Trauma Disorders Program Dominion/HCA Hospital, Falls Church, VA, USA Past President and Lifetime Achievement Award International Society for the Study of Trauma and Dissociation The Board of Directors of the International Society for the Study of Trauma and Dissociation is pleased to endorse Blue Knot’s Practice Guidelines for Clinical Treatment of Complex Trauma. Blue Knot has provided the complex trauma field with an invaluable and accessible resource that synthesizes the rapidly expanding evidence base for the efficacious treatment of trauma and dissociation. International Society for the Study of Trauma and Dissociation (ISSTD) Washington, DC www.blueknot.org.au Blue Knot Foundation | 3 Practice Guidelines for Clinical Treatment of Complex Trauma Blue Knot’s Practice Guidelines for the Clinical Treatment of Complex Trauma is a truly remarkable and sorely needed document. In concise, clear language it accurately summarizes the now considerable and empirically supported literature on complex trauma, dissociation, and their treatment. It is a sad and poignant irony that countless people around the world struggle to overcome the impact of complex trauma but are denied effective therapy because so few mental health professionals are familiar with this staggeringly prevalent phenomenon. Hopefully these guidelines will garner sufficient attention to make complex trauma more visible across the helping professions. Steven N. Gold, PhD Director, Trauma Resolution & Integration Program (TRIP) Professor, Center for Psychological Studies Nova Southeastern University Editor, APA Handbook of Trauma Psychology (American Psychological Association) Author, Not Trauma Alone (Routledge) Blue Knot has done a masterful job of presenting treatment approaches for individuals who suffer from the enduring impact of complex trauma. These updated treatment guidelines recognize that randomized controlled trials (RCT) should not be the only source of evidence about treating traumatized individuals. While information gleaned from RCTs is crucial, RCT studies typically exclude the most severely traumatized and symptomatic clients, which means that the mental health field needs additional guidance to successfully treat the most complex trauma reactions. Thankfully, Blue Knot has taken the international lead in providing such guidance. Clinicians, clients, and researchers should read these guidelines! Bethany Brand, Ph.D. Professor of Psychology and Director, Clinical Focus Program Towson University, USA Treatment of Patients with Dissociative Disorders (TOP DD) Studies 4 | Blue Knot Foundation www.blueknot.org.au As evidenced by these revised and updated guidelines, Australia has taken an international leadership role in developing clinical guidance for the treatment of complex trauma. The authors have consolidated a vast amount of research and clinical literature to arrive at an updated and state-of-the art treatment formulation. Significantly, this document does not stop with those treatments that carry the evidence- based designation but extends beyond them to consider other approaches and strategies for the myriad of developmental aftereffects that make up complex traumatic stress disorders. It places particular emphasis on dissociation as a process by which repeatedly traumatized children and adults protect themselves, a process that needs recognition and attention. Other recommended approaches include an emphasis on the body-mind and the use of treatments long considered complimentary (and alternative) to mainstream talk therapy. In line with recent research findings from the neurosciences and attachment studies, the case is made here to offer treatment that is holistic and oriented towards the client’s identity development, self-management, relationship ability, and other life skills, and an emphasis on life quality rather than only on the trauma. This model emphasizes the necessity for individualized assessment and treatment formulation, with interventions offered sequentially across three main phases. I repeat what I wrote in my endorsement of the earlier guideline: “This document is a singular and pioneering achievement in its depth and scope…Bravo to all involved in its development! Christine A. Courtois, PhD, ABPP Licensed Psychologist, Private Practice, Washington, DC (retired) Consultant and Trainer, Trauma Psychology and Treatment, Bethany Beach, DE Chair, American Psychological Association Clinical Practice Guidelines for the Treatment of PTSD in Adults. Co-Chair, International Society for Traumatic Stress Studies Complex Trauma Task Force. Chair, Joint Complex Trauma Treatment Guidelines Committee, Division 56 (Psychological Trauma), American Psychological Association and the International Society for the Study of Trauma and Dissociation Author: Healing the Incest Wound: Adult survivors in therapy (revised edition) Recollections of Sexual Abuse: Treatment Principles and Guidelines Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide (co-edited with Julian Ford, PhD; revised and updated version forthcoming) The Treatment of Complex Trauma: A Sequenced, Relationship–based Approach (co-authored with Julian Ford) Treating Complex Traumatic Stress Disorder in Children and Adolescents (co-edited with Julian Ford) www.blueknot.org.au Blue Knot Foundation | 5 Practice Guidelines for Clinical Treatment of Complex Trauma My deepest congratulations and thanks to Blue Knot for your inspirational guidelines. They are an Esperanto that brings honour to Australia and hope to survivors and clinicians all over the world. Dr Valerie Sinason PhD MACP MInstPsychoanal Consultant Child Psychotherapist Psychoanalyst Founder and former Director, Clinic for Dissociative Studies UK I am delighted to endorse these practice guidelines, which will be a milestone in readable and usable heuristics for those clinicians discovering these helpful Blue Knot recommendations. They are balanced with traditional wisdom and leading edge findings. They draw on the collective creations of many contributors in the field, recent and past. Importantly, they avoid the usual stodgy feeling of academic texts in favor of something approachable, engaging and digestible. Sandra Paulsen, Ph.D. Paulsen Integrative Psychology, Bainbridge Island WA, USA Fellow, International Society for Study of Trauma and Dissociation Co-Author Neurobiology and Treatment of Traumatic Dissociation: Toward an Embodied Self Author, Looking Through the Eyes of Trauma & Dissociation: An Illustrated Guide for EMDR Therapists and Clients Author, When There Are No Words: Repairing Early Trauma and Neglect from the Attachment Period with EMDR Therapy 6 | Blue Knot Foundation www.blueknot.org.au These updated practice guidelines are an extraordinary integrative feat melding clinical wisdom with cutting edge neuroscience inside a thoughtful and well-crafted psychotherapeutic frame. It’s actually a pleasure to read and soak in. Unusual in its breadth and depth it will provide a lovely guide for doing quality work informed by the best standards of practice we have to offer our patients. Bravo! Richard A. Chefetz, M.D., Private Practice Institute of Contemporary Psychotherapy & Psychoanalysis Washington, D.C. I am honored and privileged to endorse the 2019 ‘Practice Guidelines for the Treatment of Complex Trauma.’ Distinctly different from the quasi-manualization found in many Guidelines, these address the therapist’s existence in a complex human relationship in which the patient’s traumatization began in early childhood, as well as addressing the specifics ofwhat to do as a therapist that characterizes both the humanity and the unique complexity
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