The Trauma Treatment Handbook: Protocols Across the Spectrum

When a person experiences a problem integrating one or more disturbing or life-threatening events, clinicians have a wide range of tools with which to assist their recovery. The phenomena, which is called a trauma, is the topic covered by a new book by psychologist Robin Shapiro, PhD. In The Trauma Treatment Handbook: Protocols Across the Spectrum, she addresses practically all protocols currently available – to include pharmacology. I tend to agree with the charge made in the preface by trauma authority Daniel Siegel, MD as to the lack of scientific research regarding many of the presented modalities. However, I also concur that due to the complexity of traumas the various approaches warrant significant discussion. In this volume Shapiro has done so brilliantly.

Shapiro takes what could be a mind-numbing collection of acronyms and various methods, which have been coined with catchy names – many of which have even been trademarked – and in a very effective conversational style clearly explains each. She does so in a manner, which can be appreciated both the experienced clinician as well as members of the general public. She comes across as a knowledgeable, experienced, and compassionate psychotherapist. While she is not hesitant to give her candid opinion, she does so in a way that is factual and respectful.

I particularly appreciated how she started off with the neurological basis of trauma. She shows us how the various responses to a traumatic event can affect people differently based upon differences as to how their brain functions. From there she discusses multiple ways to handle traumas caused by a single event such as a car accident. Then she covers more complex traumas, which result from prolonged neglect, abuse, or exposure to life-threatening situations such as experienced by military personnel during combat deployments. Additionally, she gives the reader a plausible theory as to why many people can more easily integrate these occurrences, while others often find themselves developing debilitating mental difficulties.

One thing that is extremely clear in this book is the depth of Shapiro's expertise with and preference for Eye Movement Desensitization and Reprocessing (EMDR). However, this did not stop her from providing relatively unbiased and open-minded discussions of the various modalities. For instance, she unabashedly stated while medications do not provide lasting resolution, they do have considerable value when it comes to symptom reduction.

Two chapters that I particularly value in this book are the ones on clinician self-care and hypnotherapy. The former was the topic of the final chapter. Although it was a clear and concise addition to the book, it was way too brief – leading me to believe that this topic needs to be expanded upon. Indeed, the issue of a care provider becoming traumatized by constant exposure to the problems of others is one that warrants more than a brief closing remark at the end of such an otherwise profound book.

I was thrilled when I noticed in the table of contents that Shapiro had included a chapter on the efficacy of hypnotherapy in the treatment of trauma. But when I saw the too few pages, which were dedicated to the subject, I was extremely disheartened. Yes, her brief comments were favorable. Yet, she failed to justify her opinions. What I was looking for was an understanding of hypnosis and specifically why it could be a factor in the treatment of trauma. Instead, I found her well-written comments to be just another adulation of Ericksonian "Hypnotherapy", which is essentially an intriguing school of psychotherapy -- yet johnny-come-lately aberration – which produces various hypnotic effects. Clearly, Ericksonian methods have proven to be effective with trauma patients. Nevertheless, any discussion regarding the use of hypnotherapy for the treatment of trauma would require knowledge and respect for the full breadth of the field, which is most often lacking among members of the psychology community, who normally have little more than lay hypnotherapist-level training.

While reading Shapiro's excellent handbook, I could not help but be reminded of the Buddhist Sutra in which seven blind men were asked to describe an elephant. As the story goes, each of them approaches a different part of the beast with the intent of providing a conclusive description. They confidently form opinions based upon their limited experience. In many ways the various approaches presented are doing just this. That is dogmatically viewing trauma through limited perspectives. Regardless, Shapiro's refreshing approach synoptically views the various techniques as valid contributions. She clearly weaves a thread between them as she discusses neurology, integration theory, and attachment theory. Indeed, she most definitely sees the elephant – not just the parts.

Despite the insistence by a few clinicians that their technique is the complete answer to the trauma treatment problem, I welcome Shapiro's eclectic approach. As Siegel states in the preface, much of the treatment of trauma is still an art. Although psychologists tend to cloak their profession with the mantle of scientific legitimacy, the comprehensive – largely non-scientifically supported – comments in this book are backed by almost a century of psychotherapists successfully helping help people overcome their suffering. Therefore, I welcome Shapiro's book and highly recommend it to anyone concerned about helping others or themselves surmount this affliction.