Scott and Stradling: Counselling for Post-traumatic Stress Disorder

This book is important reading, as it competently deals with the treatment of a major health issue which is both prevalent and chronic, with strong co-morbidity. While the tone didn’t particularly engage me, I did finish the book with some insights and solid understanding.

Rating: 3.5

Counselling for Post-traumatic Stress Disorder, 3rd Edition

By , 2006. ISBN 1412921007. Sage. 158 pages.

Counselling for Post-traumatic Stress Disorder is important reading, as it competently deals with the treatment of a major health issue, which is both prevalent (“5 per cent of men and 10-12 per cent of women will suffer PTSD at some point in their life”, p. 115) and chronic, with strong co-morbidity — i.e., a relationship with other disorders, particularly substance abuse, giving rise to the likelihood that people who have received other diagnoses may also be suffering from a previous trauma.

The book might more accurately be entitled “Cognitive Behavioural Counselling for Post-traumatic Stress Disorder”, as it is a comprehensive, detailed guide to that specific approach, an essential text for cognitive behavioural therapists and of some interest to those with other orientations. This is particularly true in its country of origin, Britain, where CBT, as an “evidence based” therapy seems to have acquired almost total dominance over the field of counselling as supplied by the National Health Service.

The book begins with an examination of diagnostic criteria, assessment and the development and course of PTSD, before moving into the territory of neuroscience with a conceptualisation of PTSD as “the maladaptive interplay of two levels of memory” (the title of Chapter 5), and a clear explanation for non-experts of how the hippocampus and amygdala work together as part of a “threat evaluation system” (p. 32). The authors explain how the amygdala can register and react to a sense of threat which is inaccessible to rational thought, and can be triggered by some kind of trip switch that can be set off by, say, seeing a colour which reminds the person of the traumatic event, before they have a chance to realise consciously what has happened. These repeated experiences, and the way the person reacts to them (e.g., hyper-arousal) and tries to prevent their happening, form the basis of PTSD.

From neurobiology we move into cognitive profiling of the various cognitive biases suffered by traumatised clients, which do not in themselves seem to differ very much from those of most clients/people — although they can be complicated by survivors’ guilt, and differ in content, with the most relevant example of dichotomous thinking being “I am safe/unsafe”.┬áThe “cognitive-contextual approach” (the title of Chapter 7) is introduced, an interesting refinement of traditional CBT, giving emotions a more prominent place in the conceptualisation of distress and treatment.

A twelve-session plan is presented in some detail, before Part Two, which is entirely made up of case examples. The transcripts give the reader an idea of how the therapist accompanies and educates the client, using theory and relevant metaphors. Part Three presents recent research findings, relatively short considerations of pain management and work with children and adolescents, an even shorter and fairly dismissive consideration of the Eye Movement Desensitisation Reprocessing (EMDR) approach to trauma, and a very brief consideration of the complex situation in which traumatised refugees find themselves. The Penn Inventory, a new PTSD screening inventory, is included, as well as a scale for assessment of counsellor competence.

While the tone didn’t particularly engage me, and I was not converted to the approach, I did finish the book with both some insights into the range of experiences of PTSD and what felt like a solid understanding of the principles and practice used by cognitive behavioural therapists to “defuse” it.

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