Treating Multitraumatized,Socially Marginalized Children: Results of a Naturalistic Treatment Outcome Study

Although early-onset, repeated trauma is relatively common in socially marginalized populations and related to numerous negative outcomes, most empirically validated interventions are not especially well tailored to meet the complex and individualized needs of child and adolescent trauma survivors in such contexts. Integrative treatment of complex trauma (ITCT) was developed as a specialized treatment that is empirically informed, culturally sensitive, extendable beyond the short term, and customized to the specific social and psychological issues of each child. This article examines the potential effectiveness of ITCT in assisting 151 traumatized children living in an economically deprived environment. Results indicate significant reductions in anxiety, depression, posttraumatic stress, anger, dissociation, and sexual concerns as a function of time in treatment.     

An Ecological Community-Based Approach for Dealing with Traumatic Stress

Abstract

This article presents our ecological approach toward building community resilience in the aftermath of a traumatic event and its application in the case of a terror attack on a Kibbutz. It delineates the various principles guiding our framework, outlines the phases of our community intervention, describes the intervention processes, and addresses some dilemmas relevant for such interventions.     

Evaluation of a Trauma-Informed School Intervention with Girls in a Residential Facility School: Student Perceptions of School Environment

In response to the high nationwide prevalence of psychological trauma among court-involved youth who have been exposed to abuse and neglect and the associated far-reaching adverse consequences, there are calls to develop a trauma-informed workforce across the various systems (child welfare, juvenile justice, mental health, and education) designed to serve this population. We describe a pilot test of a modified version of the Heart of Teaching and Learning (HTL) curriculum, an intervention designed to increase trauma-informed practices in education settings. This program was implemented in a public charter school that exclusively serves court-involved youth placed in residential treatment. The intervention was associated with decreases in trauma symptoms experienced by youth. Because student perceptions of teachers were high both before and after implementation of the curriculum, no statistically significant changes were observed. The article concludes with a discussion of the ways in which the curriculum can be used to help prepare a national education workforce capable of implementing trauma-informed evidence-based practices in school settings.     

Applications of Trauma Treatment for Schizophrenia

Because of the high rates of trauma and posttraumatic stress disorder in individuals with psychotic disorders, there has been increasing emphasis on incorporating trauma treatment into comprehensive care for schizophrenia. Yet, despite heightened awareness of the need, limited information has been provided specifying an effective approach tailored to this population. Significant advances in trauma treatment have been made in recent years that can provide a general framework for guiding such interventions for individuals with schizophrenia. This article provides a brief review of the relationship between trauma and schizophrenia and offers a heuristic view of applications of current trauma treatment to psychotherapy for schizophrenia.     

Therapist Awareness of Appropriate Intervention in Treatment of Domestic Violence

SUMMARY

Given the widespread nature of relationship violence, psychotherapists must recognize the probability that at some point they will treat a violent couple or someone involved in a violent relationship, even if they do not specialize in the treatment of family violence. Two analogue studies reported in this chapter were designed to investigate how therapists conceptualize cases involving domestic violence families and the types of interventions they indicate they would make. The first study surveyed 362 members of the American Association for Marriage and Family Therapy (AAMFT). Respondents were asked to conceptualize and provide interventions for one of two actual cases that involved family violence. The second study surveyed 402 members of the American Psychological Association (APA). Respondents were asked to give a diagnosis based on a case presentation. After being informed the case resulted in a homicide, respondents were asked what interventions they would have made prior to the outcome, had they been given the opportunity to provide counseling. Results from both analogue studies indicate that a large number of respondents were unable to properly assess the danger inherent in cases of domestic violence, and many more would not have intervened in a timely and appropriate manner.     

Chaos and Trauma in the Lives of Adolescent Females with Antisocial Behavior and Delinquency

Summary

Female adolescents entering the juvenile justice system have complex and serious problems in multiple areas of adjustment. Literature is reviewed on the prevalence and form of antisocial behavior in girls and on the long-term implications of such problems in adolescence. Risk factor characteristics, including family fragmentation, physical and sexual trauma, mental health problems, official arrest and self-report offending histories of a population of girls referred for out-of-home placement because of repeated and chronic juvenile offending are presented. In addition, with the exception of sexual trauma histories, these sample characteristics are compared to a similar sample of chronically offending boys. A treatment approach is described and pilot data are presented on its feasibility. Implications for designing empirically-based, gender-related treatment models are discussed.     

The Lazarus Project: a longitudinal study of spiritual transformation among substance abusers

This is a longitudinal study of spiritual transformation at the Lazarus Project (LP), a 12-month Pentecostal-Charismatic residency program for substance abuse. In 2006, we began administering to residents an assessment protocol consisting of psychological (depression, self-esteem, psychopathology, Big 5 personality markers) and religiosity (fundamentalism, religious orientation, spiritual well-being, mysticism) measures. Assessments were at: (T1) induction; (T2) six months; (T3) graduation; and (T4) one-year post-graduation. We also assessed a membership group from the sponsoring church using the same protocol. Analyses found that general change in graduate scores occurred from T1 to T2 and persisted to T3 and T4. Comparative analyses found that LP graduate score patterns generally agreed with those of LP dropouts at T1, but diverged at T2, becoming more similar to score patterns of church members. Using all measures, a regression analysis found that the personality marker of (less) openness was the most powerful predictor of resident dropout. The preliminary findings suggest that, among chronic substance abusers, the LP helps to facilitate conversion as a form of spiritual transformation that persists at least one-year post-graduation.     

Community-Based Collaboration in Support of Older Persons

This study describes the processes for community-based collaboration in support of the older person living in the world of HIV/AIDS in South Africa. Secondary data from study from 333 older persons (> 60 years) and 28 leaders of community agencies of and for health and wellbeing were thematically analyzed. Findings suggest that older persons are resources in community partnership for ameliorating the impact of HIV and AIDS. This would be the case even as the older people may be living with HIV or AIDS.     

The predictive capacity of self-reported motivation vs. early observed motivational language in cognitive behavioural therapy for generalized anxiety disorder

ABSTRACT

Client motivation to change is often considered a key factor in psychotherapy. To date, research on this client construct has largely relied on self-report, which is prone to response bias and ceiling effects. Moreover, self-reported motivation has been inconsistently related to treatment outcome. Early observed client in-session language may be a more valid measure of initial motivation and thus a promising predictor of outcome. The predictive ability of motivational factors has been examined in addiction treatment but has been limited in other populations. Addressing this lack, the present study investigated 85 clients undergoing cognitive behavioural therapy (CBT) alone and CBT infused with motivational interviewing (MI-CBT) for severe generalized anxiety disorder. There were two aims: (1) to compare the predictive capacity of motivational language vs. two self-report measures of motivation on worry reduction and (2) to examine the influence of treatment condition on motivational language. Findings indicated that motivational language explained up to 35% of outcome variance, event 1-year post-treatment. Self-reported motivation did not predict treatment outcome. Moreover, MI-CBT was associated with a significant decrease in the most detrimental type of motivational language compared to CBT alone. These findings support the importance of attending to in-session motivational language in CBT and learning to respond to these markers using motivational interviewing.