Abstract
Robin Shapiro, The Trauma Treatment Handbook: Protocols Across the Spectrum. New York: Norton, 2010. 256 pp. US$32.95 (pb), ISBN 978393706185.
The Trauma Treatment Handbook: Protocols Across the Spectrum by Robin Shapiro is exactly what the title of the book suggests – an extensive description of nearly every available treatment for Posttraumatic Stress Disorder (PTSD). The book is divided into six sections. The first presents a brief description of PTSD, including chapters on diagnostic criteria, as well as a detailed description of dissociation and related states. The second section describes the assessment and preparation of clients for treatment of PTSD and related problems. The third and main section of the book is a compendium of different treatments for PTSD. Coverage ranges from the mainstream treatments such as exposure therapy and eye movement desensitization and reprocessing (EMDR) to more obscure interventions such as energy psychology and re-enactment protocol. Many of these chapters provide useful case examples that help clarify the nature of each treatment. The fourth and fifth sections review treatments that Shapiro recommends when working with complex PTSD and related problems and special populations, such as the military, victims of rape, and complicated grief. The final section provides a brief chapter on methods of self care for clinicians working with these populations.
This book will likely appeal to some readers and much less to others. The strengths of the volume reflect the author’s wealth of experience in working with traumatized clients. This expertise is immediately apparent in the chapters on assessment and preparation for trauma work. She spends little time describing tools for assessing PTSD symptoms but provides recommendations on how to assess temperament, attachment and emotional regulation, as well as culture. She stresses the importance of capturing the unique characteristic of each client. In the third section of the book, she shares her experience with each treatment modality and provides readers with detailed recommendations on which treatment to use for various symptoms (e.g., cognitive versus emotional symptoms). The emphasis on experience, however, is also the major weakness of the book because it goes along with a lack of reliance on empirical research concerning the efficacy and effectiveness of various treatments. For example, in her description of exposure therapy, a well established gold-standard treatment (e.g., Bisson & Andrew, 2007; Roth & Fonagy, 2005), she is very cautious in recommending its use, stating “Exposure therapy on its own may retraumatize trauma survivors. It can lead clients to drop out of therapy, self-medicate with alcohol or drugs, or become deeply hopeless, depressed, and suicidal” (p. 81). In contrast, she is very enthusiastic about less well established treatments, such as energy therapies despite the fact that current reviews of treatment for PTSD suggest that they lack the necessary body of research to support their use (Cukor, Spitalnick, Difede, Rizzo, & Rothbaum, 2009). In her introduction she states that:
there are battles between proponents of some of the major therapies, using research studies to win their arguments. They tend to look at the research that proves that their modality is best and ignore the valid research that doesn’t. I am staying out of the fray. I use phenomenological research. (p. 4)
It becomes clear that by phenomenological research she is referring to her own clinical experience. Unfortunately, though Shapiro claims to be staying out of the fray, based on her biased description of exposure therapy she clearly is not. In contrast to her very cautionary stance on exposure therapy, she says of EMDR that “when it works, and it most often does, it makes trauma symptoms disappear” (p. 98). This is a very bold statement about the efficacy of EMDR – one that is not backed by current research findings that suggest the efficacy of EMDR is equivalent to exposure and cognitive behavioral therapies (CBT) (e.g., Bisson & Andrew, 2007, Seidler & Wagner, 2006).
Given Shapiro’s emphasis on presenting her own experience in working with traumatized individuals this book is unlikely to appeal to researchers studying the treatment of PTSD or more empirically-oriented clinicians. I would not recommend this book for students, but rather experts already familiar with PTSD who are interested in developing a broad overview of available treatments for survivors of trauma. Shapiro’s emphasis on the process of therapy and the importance of incorporating individuals’ differences into treatment is a welcome addition to the array of PTSD treatment handbooks; however the lack of empirical backing behind many of her statements ultimately weakens the message she is conveying.