Treatment issues arising in working with victims of violent crime and other traumatic incidents of adulthood.

This article examines treatment issues in the assessment and treatment of trauma resulting from incidents of adulthood, as exemplified by the experience of victims of violent crime. Issues addressed include resistance, trauma-engineered identifications, roles based on violence-based parataxic distortions, and recommendations for an integrative ongoing listening perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transference issues concerning victims of violent crime and other traumatic incidents of adulthood.

This article examines transference in the assessment and treatment of trauma resulting from incidents of adulthood, with particular focus on the experience of victims of violent crime. In furtherance of treating the individual rather than a diagnosis, such as posttraumatic stress disorder, it proposes the term violence-based parataxic distortion (V-PD) to differentiate between projections and distortions based on traumatic experiences of the crime as distinct from transference reactions that relate to past object relationships, specifically with significant others from early development, self-organization, and characterological formation. The interplay between transference reactions, V-PDs, and the real relationship is examined, with illustrations. It is noted that distortions may arise regarding organizations, institutions, and governmental entities, as well as individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Countertransference in the treatment of PTSD.

Reviews the book, Countertransference in the treatment of PTSD, edited by John P. Wilson and Jacob D. Lindy (see record 1994-98036-000). This book purports to be the first to examine systematically the unique role of countertransference in working with victims of trauma. To help systematize clinical work with trauma victims, the contributors produced a theoretical model that attempts "to identify the core elements and dimensions of countertransference and their relationship to PSTD." The unique status of this book claimed by the editors is predicated on an assumption unexamined by the editors; namely, that the contributors have uncovered a new clinical phenomenon—countertransference to PSTD. This assumption rests on a second important and unquestioned assumption that the victims of PSTD suffer differently and more horribly than do other sufferers of the human condition. Haven't clinicians learned by now that suffering is suffering regardless of the external event that may have precipitated the hurt? If suffering is suffering, regardless of its provocation, then countertransference is countertransference regardless of the external events to which the clinician is responding. While this volume, by carefully delineating and systematizing a host of therapist responses to patient inductions, contributes to a better understanding of countertransference, it hasn't discovered a new clinical phenomenon. The value of this book resides in the thoughtful ways the contributors discuss monitoring one's countertransference and their compassionate and efficacious responses to the suffering of their patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger and posttraumatic stress disorder symptoms in crime victims: A longitudinal analysis.

Among trauma-exposed individuals, severity of posttraumatic stress disorder (PTSD) symptoms is strongly correlated with anger. The authors used 2 longitudinal data sets with 282 and 218 crime victims, respectively, to investigate the temporal sequence of anger and PTSD symptoms following the assault. Cross-lagged regression analyses indicated that PTSD symptoms predicted subsequent level of anger, but that anger did not predict subsequent PTSD symptoms. Testing alternative models (common factor model, unmeasured 3rd variable model) that might account for spuriousness of the relation strengthened confidence in the results of the cross-lagged analyses. Further analyses suggested that rumination mediates the effect of PTSD symptoms on anger. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intrusive memories in perpetrators of violent crime: Emotions and cognitions.

The authors investigated factors that may determine whether perpetrators of violent crime develop intrusive memories of their offense. Of 105 young offenders who were convicted of killing or seriously harming others, 46% reported distressing intrusive memories, and 6% had posttraumatic stress disorder. Intrusions were associated with lower antisocial beliefs before the assault, greater helplessness, fear, dissociation, data-driven processing and lack of self-referent processing during the assault, more disorganized assault narratives, and greater negative view of the self, negative interpretations of intrusive memories, perceived permanent change, and self-blame. In a logistic regression analysis, the cognitive and emotional variables explained substantial variance over and above demographic factors. The results suggest that cognitive factors that predict reexperiencing symptoms in victims of crime generalize to perpetrators. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for posttraumatic stress disorder: An evaluation of two self-report scales among crime victims.

The validity of the Impact of Events Scale (IES) and the Posttraumatic Stress Disorder (PTSD) Symptom Scale, Self-Report version (PSS-SR) was examined among crime victims. Both instruments performed well as screeners for PTSD. For the IES, sensitivity ranged between .93 and 1.00; for the PSS-SR, sensitivity ranged between .80 and .90. Specificity for the IES ranged between .78 and .84 and for the PSS-SR ranged between .84 and .88. Some individual items from the 2 scales performed just as well as the total scales. The authors conclude that either of these short self-report instruments or their individual items are suitable as screeners for PTSD, specifically in settings where mental health professionals are unavailable. Cross-validation of these results is necessary because of the small sample size in this study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintaining the Safe and Effective Therapeutic Relationship in the Context of Distrust and Anger: Countertransference and Complex Trauma.

Prior research has shown that anger is a prominent feature in the psychopathology of trauma survivors. This hostile reactivity can be difficult for clinicians, who must balance instruction or interpretation designed to teach clients appropriate ways to handle anger and judicious withholding of response to maintain the therapeutic alliance for other purposes. Unlike studies that ask therapists to report their own mistakes, this research centers on advice given by 132 interview participants who had completed long-term trauma therapies. Clients generally reported greater satisfaction with trauma clinicians who were emotionally disclosing after angry episodes and who took partial responsibility for disagreements in therapy. Outcomes and satisfaction tended to be poor if therapists were "blank screens" in the face of anger. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological interventions for terroristic trauma: Symptoms, syndromes, and treatment strategies.

Terrorist attacks combine features of criminal assaults, disasters, and acts of war. Accordingly, much of the clinical knowledge in treating this relatively new kind of traumatic event is adapted from experiences in treating victims of criminal assault, homicidal bereavement, natural and manmade disasters, war and political violence, workplace homicide, and school shootings. This article reviews the pertinent literature on these types of trauma and combines this information with the author's own experience in treating direct and indirect victims and survivors of recent terrorist attacks. The article describes the psychological syndromes resulting from terrorism and discusses crisis intervention, individual therapy, and family therapy modalities for treating victims of terror. Last, the role of mental health clinicians in the larger national and international response to terroristic trauma is highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The place of psychodynamic psychotherapy in the integrated treatment of posttraumatic stress disorder and trauma recovery.

Psychodynamic psychotherapists treating posttraumatic stress disorder (PTSD) sufferers can draw on an accumulated body of trauma studies from their own field to guide their work. However, these reports, often based on case studies or conceptual reviews, do not have the same empirical conclusiveness as more recent evidence-based research demonstrating the efficacy of cognitive–behavioral and body-oriented therapies. In this article, a psychodynamic psychotherapist reflects on his treatment of an Israeli man who developed PTSD after enduring 4 terrorist attacks. The author shows how assimilative integration offered him a theory- and research-based model that helped him comfortably combine separate treatment interventions. He also shows how this model helped him locate with some precision the specific contribution of psychodynamic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Process and treatment adherence factors in group cognitive-behavioral therapy for partner violent men.

This study used multilevel modeling to examine process and treatment adherence factors as predictors of collateral partner reports of abuse following participation in a cognitive-behavioral group treatment program for partner violent men (N = 107). Therapist working alliance ratings predicted lower levels of physical and psychological abuse at the 6-month follow-up and were the strongest predictors of outcome. Homework compliance partially mediated associations between early alliance ratings and psychological abuse at follow-up. Greater group cohesion during treatment, assessed by client report, also predicted lower physical and psychological abuse at follow-up. The findings support the promotion of a collaborative therapeutic environment to induce change among partner violent men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing cognitive behavioral therapy and integrated cognitive behavioral therapy/psychodynamic therapy in group treatment for partner violent men.

This was a pilot study comparing the effectiveness of cognitive–behavioral therapy (CBT; n = 18) with integrated CBT and psychodynamic therapy (CBT/PT; n = 27) in reducing partner violence. The study examined differences between the two treatment groups at posttreatment with regard to attachment dimensions, interpersonal problems, psychological/behavioral functioning, and general symptom and relationship distress. Results indicated that the CBT/PT groups showed significantly more improvement than the CBT groups on measures of partner violence, attachment, and interpersonal problems at posttreatment. Conversely, the CBT groups showed significantly more improvement than the CBT/PT groups on measures of psychological/behavioral functioning and general symptom and relationship distress. Finally, there was a significant difference between the treatment groups on recidivism rate, with the CBT/PT groups having the lowest rate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Impact of the Sibling in Clinical Practice: Transference and Countertransference Dynamics.

For many years, the impact of sibling relationships on psychological development has been neglected in the literature, overshadowed by the role of the parent-child relationship. As a result, attention to sibling dynamics and sibling transference as valuable information for case formulation and treatment interventions has not been used to its maximum potential. The authors demonstrate how deliberate consideration of sibling dynamics as well as the transferences and countertransferences associated with those dynamics can facilitate treatment. Several important sibling dynamics are discussed, including siblings' influences on identity development; sibling rivalry, jealousy, envy, guilt, and resentment; and sibling attachment. The impact of sibling dynamics on adult love relationships is discussed, as are potential effects of sibling abuse and sibling bereavement. Examples of how these dynamics can manifest themselves in transference and countertransference reactions and suggestions for working with those dynamics are illustrated with clinical examples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Noninterpretative measures in the analysis of trauma.

Psychoanalysis has a long and distinguished history in the use of non-interpretative measures, first introduced by Freud in the case of the Rat Man and, then, formalized in the case of the Wolf Man. Freud passed the mantle to Ferenczi when he declared the future development in psychoanalysis would center around Ferenczi’s introduction of the role of activity in psychoanalytic technique. Over the course of his clinical career Ferenczi described a theory of trauma, the Confusion of Tongues paradigm and experimented with Relaxation Therapy which included a wide array of non-interpretative measures in order to successfully treat trauma. Three clinical cases are presented by the authors to illustrate the use of non-interpretative measures in the contemporary analysis of trauma. Trauma creates a developmental freeze which interferes with the individual’s capacity to mentalize, i.e. create representations which can be stored in language and thus, symbolize concepts for meaning formation. Arrested development of cognition and verbal interaction is stored in the body as a somatic memory. Non-interpretative measures are an effort to reach the split-off precognitive and somatic aspects of the trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Legal issues in the assessment and treatment of individuals with dual diagnoses.

The difficult legal, ethical, and professional issues confronting psychologists who work with people with dual diagnoses are discussed here. Applicable constitutional principles are outlined in the context of discussing the right to institutional services and to refuse treatment, statutes that go beyond constitutional protections are described, issues that people with dual diagnoses face in the criminal and civil justice systems are highlighted, and some recommendations that psychologists should consider when providing services to this population are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countertransference temptation and the use of self of self-disclosure by psychotherapists in training: A discussion for beginning psychotherapists and their supervisors.

Most recent articles on self-disclosure have addressed advanced questions of theory and technique related to self-disclosure in psychoanalysis. This article, however, takes up issues related to the use of self-disclosure by psychotherapists in training. Rather than arguing categorically that beginning psychotherapists should or should not use self-disclosure, the focus here is on the factors influencing the decision of whether or not to make a self-disclosure. Illustrated by 2 case examples, it is argued that because of their relative lack of experience in working with transference and countertransference, beginning therapists are especially susceptible to the temptation to use self-disclosure and nondisclosure to close off--rather than to analyze--a patient's intense transference feelings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims.

The purpose of this study was to compare cognitive-processing therapy (CPT) with prolonged exposure and a minimal attention condition (MA) for the treatment of posttraumatic stress disorder (PTSD) and depression. One hundred seventy-one female rape victims were randomized into 1 of the 3 conditions, and 121 completed treatment. Participants were assessed with the Clinician-Administered PTSD Scale, the PTSD Symptom Scale, the Structured Clinical Interview for DSM-IV, the Beck Depression Inventory, and the Trauma-Related Guilt Inventory. Independent assessments were made at pretreatment, posttreatment, and 3 and 9 months posttreatment. Analyses indicated that both treatments were highly efficacious and superior to MA. The 2 therapies had similar results except that CPT produced better scores on 2 of 4 guilt subscales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting recidivism with the Personality Assessment Inventory in a sample of sex offenders screened for civil commitment as sexually violent predators.

We examined the ability of scores from the Personality Assessment Inventory (PAI; Morey, 1991) to predict postrelease (M = 4.90 years follow-up) arrests in a sample of 1,412 sex offenders. We focused on scores from 4 PAI measures conceptually relevant to offending, including the Antisocial Features (ANT), Aggression (AGG), and Dominance (DOM) scales, as well as the Violence Potential Index (VPI). Scores from several PAI measures demonstrated small- to medium-sized effects in predicting violent nonsexual recidivism, nonviolent recidivism, and sex offender registry violations, with the AGG scale being the strongest (d = 0.50 for violent nonsexual recidivism, d = 0.55 for sex offender registry violations) and most consistent predictor of recidivism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The detection of feigned uncoached and coached posttraumatic stress disorder with the MMPI-2 in a sample of workplace accident victims.

In this study research participants completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) under standard instructions and then were asked to fake posttraumatic stress disorder (PTSD) when completing the MMPI-2 for a 2nd time in 1 of 4 conditions with different instructions on how to fake PTSD: (a) uncoached, (b) coached about PTSD symptom information, (c) coached about MMPI-2 validity scales, or (d) coached about both symptoms and validity scales. These MMPI-2 protocols were then compared with protocols of claimants with workplace accident-related PTSD. Participants given information about the validity scales were the most successful in avoiding detection as faking. The family of F scales (i.e., F, FB, Fp), particularly Fp, produced consistently high rates of positive and negative predictive power. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding adverse experiences in the psychiatric institution: The importance of child abuse histories in iatrogenic trauma.

Psychiatric institutions are intended to be places of treatment and sanctuary. However, iatrogenic events in the hospital may interfere with treatment delivery and adherence (Shaw, McFarlane, & Bookless, 1997); additionally, a history of childhood abuse may increase vulnerability to negative emotional reactions to later adverse or threatening events (Chisholm, Freeman, & Cooke, 2006). The present study extends previous research on the frequency and impact of negative hospital events using the Psychiatric Experiences Questionnaire (Cusack et al., 2003), specifically considering the rate of negative events and consumers' perceptions of their treatment experiences. Questionnaires were administered to 43 participants with a history of at least one inpatient psychiatric hospitalization. Results indicated that 98% of participants had experienced at least one negative event in the psychiatric hospital. Child abuse history was significantly related to number of reported negative hospital events, so that those with a history of child abuse reported experiencing a greater number of negative hospital events and a higher level of subjective distress. Implications for research, clinical practice, and policy to improve trauma-sensitive assessments and treatments are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evolution of psychotherapy and the concept of manualization: An integrative perspective.

In this article, the author examines some historical perspectives that may help psychologists who have recently been reading more about manualized treatments decide how to incorporate such information into contemporary practice. Even before the age of manualization, each of the major schools of psychotherapy—psychodynamic, cognitive-behavioral, and family systems therapy—suffered from their own respective limitations in being unable to be exhaustive or definitive about the complexities that routinely take place in clinical practice. Perspectives on the role of manualized psychotherapy, the role of nonspecific factors and the therapeutic alliance, and the respective roles of professionalism and behavioral technology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)