The centrality of common factors to therapy’s effectiveness has become ever more widely recognized and embraced, as evidenced by the republication of the best-selling Heart & Soul of Change (Duncan, Miller, Wampold, & Hubble, 2010). This recent synthesis of the common factors research emphasized the integration and inextricability of the various factors. That is, you can’t just add more empathy or therapeutic alliance to an otherwise non-viable treatment approach and suddenly have a viable treatment. Rather, the common factors are necessarily grounded in a coherent and credible treatment model – itself a common factor – that is embraced by therapist and client. Such a treatment model serves as the foundation for the explanation of the problem, the plans for rectifying the problem, and the hope for successful change. These constitute much of the basis for the therapeutic alliance, the most important predictor of treatment success (Norcross, 2010). Our phase model of trauma-informed treatment is highly credible for addressing a wide range of presenting problems, and is readily embraced by therapists as well as clients, so it provides an excellent foundation for the therapeutic alliance.
Guiding the client to face, process, and resolve a trauma memory is arguably the most profound and impactful example of such a treatment activity. Furthermore, transformative trauma resolution procedures, such those taught in our programs, can effect memory reconsolidation at the source of the associated symptom-generating mental model.
Motivational interviewing (MI) is a directive counseling approach – involving both style and specific procedures – designed to elicit motivation and action for positive behavioral change (Miller & Rollnick, 2002). It explicitly avoids the authoritarian, confrontive approach which has been shown to increase client resistance (Patterson & Forgatch, 1985). Intervention components include: (1) individual assessment and feedback focusing on the discrepancy between behaviors and goals; (2) emphasizing the individual’s free choice and responsibility for his or her own behavior; (3) providing advice to make a positive change; (4) offering a menu of ways to accomplish the change; (5) attitude of empathy and acceptance of the client’s perspective; and (6) interventions to enhance self-efficacy, reinforcing self-confidence and optimism regarding goal achievement (Miller & Rollnick). MI has an impressive track record of leading to improved treatment compliance as well as positive behavioral changes (Hettema, Steele,& Miller, 2005). However, as a stand-alone intervention, treatment effects do not endure (Miller, 2005); therefore it is essential to capitalize on the client’s motivation with further interventions to effect lasting change.
The focus on attachment-related issues has become more mainstream in the psychotherapy field, especially among those therapists working within a trauma orientation. The goal is to assist certain clients in achieving secure attachment status, which occurs naturally during early childhood for much of the population. People with secure attachment status tend to be more resilient in the face of potentially traumatic stressors (Muller, Sicoli, & Lemieux, 2000), which is not surprising because secure attachment comes with a repertoire of coping skills, as well as a likelihood of having healthier relationships and thus better social support. Furthermore, those with less than secure attachment status tend to be less responsive to trauma treatment (Muller & Rosenkranz, 2009; Stalker, Gebotys, & Harper, 2005). Brief interventions directly targeting the client’s attachment status, such as the one we teach, have not yet been formally tested.
Abstract: This study examined MASTR/EMDR, a trauma-focused treatment for traumatized youth taken in charge by youth protective services. Participants were 40 adolescents who were exhibiting conduct problems and internalizing and externalizing behaviors and who had been exposed to maltreatment. Participants were randomly assigned to MASTR/EMDR treatment or to a routine care condition. Self-report questionnaires and semistructured interviews were administered to participants and one of their parents/caregivers at three points in time: pretreatment, post treatment (12 weeks), and follow-up (12 weeks). Repeated measures analyses of covariance showed that participants in the experimental group had significant improvements in their trauma symptoms and behavioral problems compared with the control group at the posttreatment evaluation. These effects were maintained at a 3-month follow-up. Results support the effectiveness of MASTR/EMDR.
Greenwald, R. (2003, Spring). The power of a trauma-informed treatment approach. Children’s Group Therapy Association Newsletter, 24(1), 1, 8-9.