Abstract
Treating Complex Trauma is the product of nearly 30 years of clinical experience and wisdom gained by the authors since Barrett and Trepper (1986; Trepper & Barrett, 1989) first wrote about what was then called the multiple systems approach. The book is intended to be a practical guide for clinicians working with survivors or perpetrators of complex trauma. The book is divided into seven chapters within two parts. The first part covers complex trauma, the engaged mindstate, treatment guidelines, and ethical attunement. The second part covers the three stages of treatment within the collaborative change model (CCM). The book leaves the reader with a sense that clients who receive treatment from the authors at the Center for Contextual Change are deeply transformed by the experience.
Unfortunately, Treating Complex Trauma does not equip the reader to effectively apply the authors’ clinical wisdom for three reasons. First, the CCM does not adequately incorporate existing theories of complex trauma. Second, the book does not provide enough clear, concrete information for the clinician reader to know how to apply the model. Third, the use of sexist language limits the value of the book.
The authors began developing the CCM shortly before the publication of Trauma and Recovery (Herman, 1992) and Betrayal Trauma (Freyd, 1996). Unfortunately, as the CCM has evolved, neither Herman’s complex trauma theory nor Freyd’s betrayal trauma theory has been cogently incorporated into the model. Betrayal trauma is mentioned in the terminology section of the introduction to Treating Complex Trauma and then never again addressed. There is only one sentence in the book directly acknowledging Herman’s work.
In addition to the model’s lack of integration with existing trauma theory, the book is limited by unclear language. Barrett and Stone Fish present five essential ingredients for therapy, five foundational elements of effective treatment, and three stages for change. They explain that the primary aim of these ingredients, elements, and stages is to facilitate client movement from a survival mindstate to an engaged mindstate. Unfortunately, the amount of unclear terminology and mixed metaphors in the book make it difficult for the reader to understand the concepts well enough to apply them. For example, when describing the three stages of change, the authors use the metaphor of constructing a building and refer to Stage 1 as “pouring the foundation” (p. 71), then in the same paragraph refer to Stage 2 as “pouring the foundation” (p. 71).
Finally, readers of Psychology of Women Quarterly may find Treating Complex Trauma to be limited by the use of sexist language in the authors’ description of the model. They refer to the three stages of change as “a man-made rendition” (p. 70) of the natural cycle of change. This was an unfortunate choice of words to describe a model of relational healing that was actually made by women. This is not a consistent issue, but a poor choice in this case.
Although Treating Complex Trauma is limited in several respects, it is not without value, particularly to clinicians. First, the book has something compelling to offer the clinician reader in its case examples that give the flavor of what the CCM approach is like, that is, it is depathologizing, keenly attentive to safety, and simultaneously honors acceptance and change. Second, the chapter on ethical attunement stands on its own. This chapter details how to work with practitioners’ energy in order to be as present as possible for survivors of complex trauma. The authors divide this energy into the domains of emotional, physical, spiritual, intellectual, and sensual, and they encourage attention to attending to and replenishing each domain.
On the whole, Treating Complex Trauma is generally not useful for the nonclinician reader and somewhat useful for clinicians. The case examples indicate that the CCM can be quite effective and has transformed many lives. Perhaps the clinical wisdom presented in this book would be clarified in trainings and workshops offered by the Center for Contextual Change.