The relevance of trauma to general clinical practice.

Abstract

Research findings on the prevalence in general clinical settings of trauma histories, trauma-related disorders and various other psychological disorders associated with trauma exposure, and physical health problems related to trauma are surveyed. It is argued, on the basis of diverse comorbid conditions associated with trauma exposure, that generalists with varied experience who obtain specialized trauma training are especially well equipped to develop competency in trauma practice. There are many subjects that have the potential to be useful and relevant facets of the psychology practitioner’s repertoire of knowledge and skills. Why should clinicians, who already have such a wide-ranging compendium of material to master in order to maintain competency in general practice, expend the time and effort to master yet another content area? It is this question that the remainder of this article aims to address. Appreciation of the relevance of trauma to understanding psychological difficulties played a central role in the very first pioneering stages of the development of psychotherapeutic practice (Herman, 1992b). The sustained, systematic empirical study of trauma, however, is much more recent. The legitimization of psychological trauma as an issue worthy of study can be traced back roughly a quarter century to the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–III; American Psychiatric Association, 1980). This event marked the official recognition of posttraumatic stress disorder (PTSD) as a diagnostic syndrome. In the intervening period between 1980 and the present, the study of trauma has evolved rapidly, generating a vast body of empirical, clinical, and theoretical literature (Gold & Faust, 2002). The systematic study of the impact of trauma on psychological functioning is so recent that even the most elementary aspects of the identification, assessment, and treatment of psychological trauma have not been incorporated into the standard curriculum for training professional psychologists (Courtois, 2002). The vast majority of psychologists currently practicing, therefore, are not familiar with this knowledge base. The overwhelming majority of contemporary psychological trauma specialists were of necessity self-taught, since their graduate training occurred in an era predating the existence of their field of specialization. They developed their expertise in trauma studies on their own initiative by reading and attending workshops