Relationships and Responsiveness in the Psychological Treatment of Trauma: The Tragedy of the APA Clinical Practice Guideline

Abstract
The therapeutic relationship and responsiveness/treatment adaptations rightfully occupy a prominent, evidence-based place in any guidelines for the psychological treatment of trauma. In this light, we critique the misguided efforts of the American Psychological Association’s (APA, 2017) Clinical Practice Guideline on Posttraumatic Stress Disorder in Adults to advance a biomedical model for psychotherapy and thus focus almost exclusively on treatment methods for particular disorders. Instead, the research evidence, clinical expertise, and patient preferences and culture (the necessary triumvirate of evidence-based practice) should converge on distinctive psychological guidelines that emphasize the therapy relationship, treatment adaptations, and individual therapist effects, all of which independently account for patient improvement more than the particular treatment method. Meta-analytic findings and several trauma-specific studies illustrate the thesis. Efforts to promulgate guidelines without including the relationship and responsiveness are seriously incomplete and potentially misleading. The net result is an APA Guideline that proves empirically dubious, clinically suspect, and marginally useful; moreover, it squanders a vital opportunity to identify what actually heals the scourge of trauma. We conclude with recommendations for moving forward with future APA practice guidelines. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Impact Statement
Clinical Impact Statement—Question: How useful is the American Psychological Association’s (APA) Clinical Practice Guideline for treating traumatized clients and what are the consequences of ignoring the therapy relationship and responsiveness in this guideline? Findings: The APA Guideline for trauma adheres to a biomedical model that focuses on identifying particular treatment methods that work, but ignores the research evidence that most treatments for posttraumatic stress disorder produce similar outcomes and that relationship and responsiveness/adaptation factors contribute strongly to treatment success. Meaning: APA Guidelines are too narrowly focused on identifying treatments for particular disorders and should be expanded to include evidence-based relationships and adaptations. As written, the guidelines will not produce more effective treatment. Next Steps: Psychologists should advocate for practice guidelines that will result in more effective services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
CopyrightHolder: American Psychological Association
Year: 2019