Abstract
Complex trauma (CT) results from exposure to severe stressors that occur within the caregiver system, are chronic, and largely begin in childhood or adolescence. This article describes the evidence-informed treatment of a 9-year-old female with chronic CT symptoms, resulting from long-term sexual, physical, and psychological abuse within her family. Treatment lasted 17 months and followed an assessment-driven, phase-based process. This process was flexibly implemented based on the unique circumstances of the case, while remaining consistent with the intent of the treatment models. Pre- to post-treatment data indicated significant reductions in trauma-related symptoms. Verbatim clinical vignettes illustrate specific interactions between family members and therapists, as well as interventions related to the treatment.
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References
Achenbach, T. M. (1991). Manual for the child behavior checklist and revised child behavior profile. Burlington: University of Vermont.
Amaya-Jackson, L., & DeRosa, R. (2007). Treatment considerations for clinicians in applying evidence based practice to complex presentations of child trauma. Journal of Traumatic Stress, 20, 379–390.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.
Arvidson, J., Kinniburgh, K. M., Howard, K., Spinazzola, J., Strothers, H., Evans, M., … Blaustein, M. E. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the ARC intervention model. Journal of Child & Adolescent Trauma, 4, 34–51.
Blaustein, M. E., & Kinniburgh, K. M. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. New York: Guilford.
Briere, J. (1996). Trauma symptom checklist for children. Odessa: Psychological Assessment Resources.
Briere, J. (2001). Detailed assessment of posttraumatic stress. Odessa: Psychological Assessment Resources.
Briere, J., & Lanktree, C. B. (2012). Treating complex trauma in adolescents and young adults. Thousand Oaks: Sage.
Briere, J., & Scott, C. (2013). Principles of trauma therapy (2nd ed.). Los Angeles: Sage.
Cloitre, M., Stolbach, B. C., Herman, J. L., van der Kolk, B., Pynoos, R., Wang, J., & Petkova, E. (2009). A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22, 399–408.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford.
Cohen, J. A., Mannarino, A. P., Kliethermes, M., & Murray, L. A. (2012). Trauma focused CBT for youth with complex trauma. Child Abuse & Neglect, 36, 528–541.
Collins, S., Griffiths, S., & Kumalo, M. (2005). Patterns of disclosure in child sexual abuse. South Africa Journal Psychology, 35, 270–285.
Cook, A., Blaustein, M., Soinazzola, J., & van der Kolk, B. A. (Eds.). (2003). Complex trauma in children and adolescents. Retrieved from www.nctsn.org.
Cook, A., Spinazzola, J., Ford, J. D., Lanktree, C., Blaustein, M., Cloitre, M., & van der Kolk, B. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.
Eyberg, S. M., & Pincus, D. (1999). Eyberg child behavior inventory Sutter student behavior inventory revised professional manual. Odessa: Psychological Assessment Resources.
Ford, J. D. (2009). Neurobiological and developmental research: clinical implications. In C. A. Courtois & J. D. Ford (Eds.), Treating complex traumatic stress disorders: an evidence-based guide (pp. 31–58). New York: Guilford.
Ford, J. D., & Cloitre, M. (2009). Best practices in psychotherapy for children and adolescents. In C. A. Courtois & J. D. Ford (Eds.), Treating complex traumatic stress disorders: an evidence-based guide (pp. 59–81). New York: Guilford.
Ford, J. D., & Courtois, C. A. (2009). Defining and understanding complex trauma and complex trauma disorders. In C. A. Courtois & J. D. Ford (Eds.), Treating complex traumatic stress disorders: an evidence- based guide (pp. 13–30). New York: Guilford.
Grasso, D., Greene, C., & Ford, J. D. (2013). Cumulative trauma in childhood. In J. D. Ford & C. A. Courtois (Eds.), Treating complex traumatic stress disorders in children and adolescents (pp. 79–99). New York: Guilford.
Hodgdon, H. B., Kinniburgh, K., Gabowitz, D., Blaustein, M. E., & Spinazzola, J. (2013). Development and implementation of trauma-informed programming in youth residential treatment centers using the ARC framework. Journal of Family Violence, 28, 679–692.
Kisiel, C., Fehrenbach, T., Small, L., & Lyons, J. S. (2009). Assessment of complex trauma exposure, responses, and service needs among children and adolescents in child welfare. Journal of Child & Adolescent Trauma, 2, 143–160.
Kisiel, C., Lyons, J. S., Blaustein, M., Fehrenbach, T., Griffin, G., Germain, J., Saxe, G., Ellis, H., & Praed Foundation & National Child Traumatic Stress Network. (2010). Child and adolescent needs and strengths (CANS) manual: The NCTSN CANS Comprehensive Trauma Version: A comprehensive information integration tool for children and adolescents exposed to traumatic events. Chicago: Praed Foundation/Los Angeles, CA & Durham, NC: NCTSN.
Kliethermes, M., Nanney, R. W., Cohen, J. A., & Mannarino, A. P. (2013). Trauma-focused cognitive-behavioral therapy. In J. D. Ford & C. A. Courtois (Eds.), Treating complex traumatic stress disorders in children and adolescents: scientific foundations and therapeutic models (pp. 184–202). New York: Guilford.
Kluft, R. P. (2011). Ramifications of incest. Psychiatric Times, 27 (12).
Lambert, M. J., Lunnen, K., Umphress, V., Hansen, N., & Burlingame, G. M. (1996). Administration and scoring manual for the outcome questionnaire (OQ-45.1). Salt Lake City: IHC Center for Behavioral Healthcare Efficacy.
Lanktree, C.B., & Briere, J. (2008). Integrative Treatment of Complex Trauma for Children (ITCT- C): A Guide for the Treatment of Multiply-Traumatized Youth. Unpublished treatment manual. Long Beach, CA: MCAVIC-USC, NCTSN (http://www.johnbriere.com)
Lanktree, C., Briere, J., Godbout, N., Hodges, M., Chen, K., Trimm, L., & Freed, W. (2012). Treating multi-traumatized, socially-marginalized children: results of a naturalistic treatment outcome study. Journal of Aggression, Maltreatment & Trauma, 21, 813–828.
Lawson, D. M., & Quinn, J. (2013). Complex trauma in children and adolescents: evidence based practice in clinical settings. Clinical Journal of Psychology: In session, 69(5), 497–509.
Maker, A. H., Kemmelmeir, M., & Peterson, C. (2001). Child sexual abuse, peer sexual abuse, and sexual assault in adulthood: a multi-risk model of revictimization. Journal of Traumatic Stress, 14, 351–368.
McCloskey, L., & Bailey, J. (2000). The intergenerational transmission risk for child sexual abuse. Journal of Interpersonal Violence, 15, 1019–1035.
McDonald, R., Jouriles, E. N., Ramisetty-Mikler, S., Caetano, R., & Green, C. E. (2006). Estimating the number of American children living in partner-violent families. Journal of Family Psychology, 20, 137–142.
McLeod, B. D. (2001). The therapy process observational coding system for child psychotherapy. Los Angeles: University of California, Los Angeles.
Newman, L., & Stevenson, C. (2008). Issues in infant-parent psychotherapy for mothers with borderline personality disorder. Clinical Child Psychology and Psychiatry, 13, 505–514.
Pinsof, W. M. (2005). Integrative psychotherapy alliance scales revised-short form: individual. Evanston: The Family Institute at Northwestern University.
Russell, D. E. H. (1986). The secret trauma: incest in the lives of girls and women. New York: Basic.
Sedlak, A. J., Mettenberg, J., Basena, M., Petta, I., McPherson, K., Greene, A., et al. (2010). Fourth national incidence study of child abuse and neglect (NIS-4): report to congress, executive summary. Washington: U.S. Department of Health & Human Services.
Silverman, W. K., Ortiz, C. D., Viswesvaran, C., Burns, B. J., Kolko, D. J., Putnam, F. W., & Lisa Amaya-Jackson, L. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology, 37, 156–183.
Steinberg, A. M., Brymer, M., Decker, K., & Pynoos, R. S. (2004). University of California Los Angeles posttraumatic stress disorder reaction index: DSM-IV. Psychiatric Assessment, 6, 96–100.
Stroebel, S. S., O’Keefe, S. L., Beard, K. W., Kuo, S. Y., Swindell, S. V., & Kommor, M. J. (2012). Father–daughter incest: data from an anonymous computerized survey. Journal of Child Sexual Abuse, 21(2), 176–199.
Turner, H. A., Finkelhor, D., & Ormrod, R. (2010). Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine, 38, 323–330.
Weiner, D., Schneider, A., & Lyons, J. A. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: treatment retention and outcomes. Child and Youth Services Review, 31, 1199–12.
Wells, M. G., Burlingame, G. M., & Rose, P. M. (1999). Administration and Scoring Manual for the Youth Outcome Questionnaire-Self-Report, 2.0.Orem, UT: American Professional Credentialling.
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Lawson, D.M., Hight, S.M. Treating Complex Trauma: An Evidence-Based Case Example of Severe Childhood Abuse. Journ Child Adol Trauma 8, 211–225 (2015). https://doi.org/10.1007/s40653-015-0054-z
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DOI: https://doi.org/10.1007/s40653-015-0054-z