Twice in the last 2 weeks I have met trauma victims who have gone down the vortex of arrested information processing, with therapists insisting that they ‘re-live’ their trauma.
The first client, Gwen had debility due to an accident on holiday. She complained to her therapist she couldn’t identify what was making her fearful on a daily basis, the therapist continued to insist that she could if she tried. Gwen felt the therapist was not listening, was overwhelmed by having to re-live the trauma and dropped out of treatment.
The 2nd client Diane suffered minor disfigurement following an incident at work. She attempted suicide as a child, and the records revealed a multiplicity of labels applied to her including emotionally unstable personality disorder, borderline personality disorder, ADHD and OCD. But nowhere was there evidence of the use of a standardised diagnostic interview, to reliably identify a disorder/s. Psychological treatment had been continuous in adulthood, with a focus on repeated re-living of her trauma. Her latest diagnosis of ‘complex PTSD’ served in her mind to underline the necessity of a trauma focus. But she had not been told that this is not an accepted diagnosis in the DSM-5-TR [American Psychiatric Association (2022)]. Her psychological treatment had manifestly failed but her therapists had continued with the trauma focus. Diane was going ’round and round’ in ever decreasing therapeutic circles.
In neither case was their documentary evidence of homework being set and review at a subsequent session. There was therefore no evidence that CBT had ever taken place. Routine practice is a ‘free for all’ – is this what the UK Government should be spending £2billion a year on for adults and children?
It is time therapists critically appraised the arrested information processing treatment rationale. Acknowledging that it doesn’t go down well in routine practice. It is more respectful to personalise psychological treatment ‘Personalising Trauma Treatment: Reframing and Reimagining ‘ Scott (2022). London: Routledge.
Dr Mike Scott