Introduction
There are many reported cases of clients with histories of trauma seeking for treatment thus behavioral counselors should have comprehensive knowledge on how to help victims of trauma. Counselors should also have knowledge on trauma-informed prevention, care and objectives of treatment along with practical counseling techniques. Trauma can be defined to result from 'an event, series of events, or a set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual's functioning and physical, social, emotional, or spiritual well-being' (SAMHSA, 2014). This paper will discuss various trauma-specific treatment models for traumatic stress and other trauma-related disorders, providing a brief outline of immediate and post intervention treatments following a crisis. The paper will also cover some interventions and trauma-specific treatments for substance abuse, mental health and other co-occurring symptoms. Finally, a brief overview of all emerging interventions will be provided as a summary of the Treatment Intervention Protocol.
Trauma-Specific Treatment Therapies
According to Najavits (2014), there exists different trauma-specific treatment therapies with varying objectives and approaches. Some approaches focus on the present situation while some focus on the past or a combination of the present and the past. Approaches that focus mainly on the present try to manage symptoms to improve functioning and address such factors as psycho-education and coping skills. On the other hand, past-focused approaches use a told trauma story with totally overwhelming emotions to understand how the memories impact the person's functioning in the present time and to help them effectively cope in their traumatic experiences. This approach emphasizes on understanding the past and its impacts on present behavior, thinking and emotions. These approaches vary on the basis of their primary focus and a counselor may choose either of them depending on the specific needs of a client. For example, present-focused and psycho-educational approaches would be more suitable for early treatment of clients recovering from substance abuse and/or mental illness whereas a past-focused strategy would be most appropriate for clients with a stable recovery and a history of repressed developmental trauma. However, there are cases when both approaches could be helpful to the client and therefore a counselor chooses to use them either sequentially or concurrently.
Trauma-Specific Models and Treatment Techniques
There are various trauma-specific models designed to alleviate symptoms and restore mental health or to improve psychological well-being. Treatment techniques on the other hand are specific approaches used alongside these models. Trauma-specific models can be tailored to suit different groups of clients including adults, children or clients and people with mental and substance use disorders (SAMHSA, 2014). Immediate intervention is an example of a trauma-specific model which can be applied for different instances such as intervention within the first 48 hours, provision of basic needs, psychological first aid and critical incident stress debriefing. The first 48 hours after a trauma is an acute intervention period especially during a disaster. It usually begins with rescue operations by local agencies and organizations who play a key role on the site. A hierarchy of needs is usually established in the order: survival, safety, security, food, shelter, health, survivors' orientation to the surrounding and communication with family and friends (SAMHSA, 2014). No formal intervention is necessary at this point since the most crucial intervention would be to screen the survivors for psychological effects and inform the trauma response team on the survivor's immediate needs.
Psychological First Aid and Critical Incident Stress Debriefing
A psychological first aid kit should be provided to trauma victims within 48 hours of the disaster in order to ensure their safety, provide an emotionally friendly environment as well as determine those with high risk reactions following the crisis. The primary objective of the first aid kit is to provide a calm and supportive atmosphere in order to facilitate psychological recovery. It also important to inform the respondents of trauma (the rescue workers, journalists and medics) on issues concerning traumatic stress in order to ensure that they approach the survivors with genuine concern and respect to help them to recover. They should respect the survivors' individual ways of coping since some may want information about the disaster while others may not want to talk about it. Finally, a critical incident stress debriefing (CISD) model, initially designed to be used by emergency personnel and first responders, can be applied in different settings under different protocols. The primary focus of this approach is to encourage trauma victims to talk about their experience as a way to provide psychological closure. The facilitator then provides a didactic presentation on the expected stress conditions and how to manage them.
Cognitive-Behavioral Therapies, Cognitive Processing Therapy, and Exposure Therapy
Other interventions that go beyond the initial response include cognitive-behavioral therapies, cognitive processing therapy, exposure therapy, narrative therapy, etc. The cognitive-behavioral therapy (CBT) is usually integrated with other behavioral models and used to treat post trauma disorders, personality disorders and substance abuse. It combines both cognitive and behavioral theories by incorporating cognitions (thoughts) with behavioral change influences. Traditionally, CBT was used to emphasize symptoms reduction but it can be presently used to establish a therapeutic relationship. Secondly, cognitive processing therapy (CPT) is a 12-step treatment which can be administered individually or in a group setting. It was initially designed for rape victims and can be combined with other therapies, specifically exposure and cognitive therapy (SAMHSA, 2014). This model encourages the client to write a detailed account of their experience and capture the emotions, sensations and thoughts they experienced during the crisis. Thereafter, they would read the narrative out loud both at home and during session. The counselor then guides the client to identify areas of cognitive distortions such as maladaptive beliefs. In exposure therapy, victims are encouraged to describe their experience and other trauma-related memories in order to evoke intense emotions which subsequently decrease by desensitizing them after several repeated exposure to the traumatic event or object. However, counselors should take measures to prevent retraumatization of the clients. They monitor the process carefully and give enough time for the victims to process their memories. Therefore, facilitators of exposure therapy need comprehensive training to master its techniques (SAMHSA, 2014).
Conclusion
In conclusion, there are a variety of trauma-specific strategies and models that can be used case management pursuant to trauma victims. There are trauma intervention approaches such as present-focused and past-focused techniques which can be chosen depending on the client's needs and other factors such as client's background, history, etc. Trauma-specific models involve specific interventions taken to alleviate symptoms and regain psychological health. These models can be immediate (administered within 48 hours) to include psychological first aid and provision of basic needs, or post trauma interventions such as cognitive-behavioral, exposure and cognitive processing therapies.
References
Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57). Chapter 6, Trauma-Specific Services.
Najavits, L. (2014). Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Tokyo, New Life Publishers.
