Supervising trauma treatment: The contextual trauma treatment model applied to supervision.

Abstract

The recent publication of the American Psychological Association's "Clinical Practice Guideline for the Treatment of PTSD in Adults" resulted in debates concerning multiple issues, among them, an overreliance on randomized controlled trials (RCT) to the exclusion of other research methods, the application of the guideline recommendations to clinical practice, generalizability, and whether cognitive-behavioral approaches are superior to other modalities for the treatment of posttraumatic stress disorder (PTSD) symptoms. The guideline not only has far-reaching implications for practice and research, but for training and education as well. Training is often quite limited regarding when and how to apply trauma-responsive intervention, whether evidence-based or evidence-informed, particularly when the presenting problems are more complex than are typically addressed by an RCT design. The Trauma Resolution and Integration Program, a training program specifically for the treatment of trauma based on the contextual trauma therapy (CTT) model, was developed at a university-based training clinic staffed entirely by doctoral psychology students. Central to this treatment approach is the observation that clients with PTSD and those with complex trauma histories suffer not only from trauma symptoms, but also from gaps and warps in their personal development that interfere with their ability to function effectively. We begin by delineating the principles undergirding the CTT model and their application to supervision. We also discuss how foundational training in trauma psychology and treatment modalities for PTSD, along with supervision, are essential, but often unavailable, components of the implementation of evidence-based and evidence-informed recommendations made in the available PTSD treatment guidelines. Clinical Impact StatementThis article focuses on the principles guiding a supervisory approach to providing supervision and mentoring to students working with survivors of complex trauma. We delineate the principles guiding our supervisory approach that can be beneficial to clinicians in private practice, group practice, or in academic/medical institutions.

Graduate training and certification in trauma treatment for clinical practitioners.

“…One example, the Trauma Resolution and Integration Program (TRIP) in the psychology department of NOVA Southeastern University, offers training on trauma and trauma treatment for doctoral students. It has been well received by students due to its emphasis on handson experience through the direct provision of specialized trauma services to students under close clinical supervision in its universitybased clinic (Ellis et al, 2019). This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

“…Recently, a special issue of the journal The Clinical Supervisor was devoted to the topic of trauma-informed supervision and assembled papers on a variety of topics written by those with requisite experience and expertise. Knight (2018) described a model that directly incorporates the elements of trauma-informed practice (safety, trust, collaboration, choice, and empowerment) into supervision that paralleled the coursework description in the Black (2006), Ellis et al (2019), and Newman (2011) training articles and Pearlman and Saakvitne’s model. Supervisee safety is paramount and is maintained by clear supervisory boundaries and encouragement to be actively involved in a relationally based learning process.…”

Therapeutic Alliance in Cognitive Behavioural Therapy in Child and Adolescent Mental Health-Current Trends and Future Challenges

“…In trauma work, the ability of a young child to verbalise how they feel and the trust they need to build with a therapist is critical to effective therapy ( Scheeringa, 2011 ). Working with traumatised children would require acute awareness on the part of the therapist to be aware of the transference phenomenon and therefore the therapy would benefit from the supervision of the therapist ( Ellis et al, 2019 ). Alliance ratings were found to get progressively more positive especially when trauma work was introduced in the intervention and this is a significant finding especially when trauma could adversely affect the trust of the child in a caregiver or therapist ( Zorzella et al, 2017 ).…”

Trauma-informed supervision of trainees: Practices of supervisors trained in both trauma and clinical supervision.

“…This emotion-cognition-action sequence not only served as a conceptual map for the supervision session but also modeled how novices could structure their next counseling sessions. Such deliberate use of parallel process (and metamodeling), apparent throughout our supervisors' reports, has been encouraged by some TIS authors (Berger & Quiros, 2016;Ellis et al, 2019) and seems to reflect another integration of supervisors' trauma-informed practice knowledge through supervisioninformed application.…”