Abstract

A Professional Practice Guideline for Adults with Complex Trauma Histories recently has been published jointly by the American Psychological Association (APA, Division 56, Trauma Psychology) and the International Society for the Study of Trauma and Dissociation (ISSTD) (APA, 2024). The guideline involved input from an international panel of identified experts in complex trauma. The presenters chaired this effort and will describe the guideline’s development and content.

Professional practice guidelines are developed based on a review of available research evidence, clinical consensus, and population descriptions to establish recommendations for clinicians and others regarding treatment approaches, but do not make specific treatment recommendations. This guideline recommended the following 7 principles of treatment using the acronym HISTORY as a mnemonic: 1) Humanistic, attending to and respecting the uniqueness of each individual and their history and context; 2) Integrative, applying a variety of treatment strategies according to the unique goals and needs of the individual; 3) Sequential, attending to issues of personal safety, stabilization, and skill building prior to direct exposure to trauma processing; 4) Timeline, giving attention to the lifespan chronology of the individual’s traumatic exposure; 5) Outcomes, establishing and working towards mutually established and defined goals that are strength-based and individualized; 6) Relational, providing a trustworthy and responsive relationship, a “safe haven” and “learning laboratory”; and, 7) WhY, addressing spiritual and existential questions about the trauma and its impact and role in the individual’s life.

Several additional issues are also included:  the lack of attention to trauma in the training curricula of most service professions, including psychology, and the need for specialized training and consultation/supervision to supplement generic clinical training when providing care to complexly traumatized individuals. Clinicians are encouraged to keep abreast of current research and treatment literature and to engage in continuing education efforts. Attention to the provider’s overall emotional well-being is warranted due to the strain and intensity that can accompany working with a highly traumatized population. Clinicians and others should be knowledgeable about vicarious traumatization and treatment traps that are common in order to work against burnout and support sustainability and satisfaction in doing this work. Attention to issues of diversity, equity, and inclusion is needed because contextual issues and intersectionality can impact the occurrence of traumatization, its understanding by the victim and its impact, and the need for specialized considerations in the treatment. Finally, the parallel development of posttraumatic growth in the therapist and the client is discussed.

Potential to Distress: No