East Asian Arch Psychiatry 2011;21:170 Book Review

Trauma Practice — Tools for Stabilization and

Recovery (Second and Expanded Edition)
Authors: Anna B Baranowsky, J. Eric Gentry, D. Franklin Schultz
Hogrefe Publishing
USD49.00; pp188; 978-0-88937-380-8

In our clinical practices, most of our patients / clients The third section, Reconnection, focuses on ‘redefining
experience numerous traumatic events in their lives. These oneself in the context of meaningful relationships and
include interpersonal, physical, sexual, and emotional engagement in life activities’. Interventions include
violence, as well as accidents and disasters. The impact of centering oneself, addressing the victim mythology of the
trauma can be disabling and trauma-related disorders are not subjects, and using memorials and letters to self to reconnect
rare. Concerning the treatment of post-traumatic stress and the horrific past to a hopeful future.
similar disorders, cognitive behavioural therapy (CBT) is Overall, this is a user-friendly guidebook for trauma
one of the most well-researched and effective interventions. therapy. Templates and worksheets are handy and lend
This book emphasises much on the cognitive behavioural themselves to reproduction for clinical use. Moreover,
approach and applies the principles of reciprocal inhibition, they can be used in a highly individualised way to fit into
pairing of exposures to traumatic memories, and relaxation. the scenarios of different patients. This book teaches us
It contains a structured manual with many tools and protocols practically about ‘how to’ implement cognitive behavioural
readily usable in clinical settings, and provides therapists treatments for subjects with traumatic experiences.
and clinicians with excellent resources and guidance for Another aspect that impressed me the most was
working with subjects with trauma-related disorders. ‘compassion fatigue’ discussed in the last part of this book.
The book is well structured. It begins with an ‘Burnout’, ‘vicarious traumatisation’, ‘secondary traumatic
introduction to the theories of CBT and psychophysiology of stress’, and ‘compassion fatigue’ described the deleterious
trauma, and its contents is arranged in 3 sections according to effects that helpers and care providers endure when working
Judith Herman’s (1992) Tri-phasic Model for the treatment with trauma victims. This highlights the importance of
of trauma. The 3 sections are: Safety and Stabilisation, the well-being of clinicians and therapists. Mental health
Remembrance and Mourning, and Reconnection. Each care providers themselves need to pay more attention to
section is further divided into interventions related to (i) their own psychological well-being while helping others.
‘body’; (ii) ‘cognition’; and (iii) ‘behavioural’ and ‘emotion / Strategies for developing resilience towards and prevention
relation’. of compassion fatigue are needed. This area of study is still
The first section, Safety and Stabilisation, mainly in its infancy and deserves further attention.
focuses on helping subjects to develop skills to self-sooth This book is well thought-out and helpful. However,
and self-rescue, to establish a ‘safe’ environment for further the authors want us to apply their work with caution. For
trauma work. It describes in detail various techniques to example, indirect retraumatisation can be an issue during the
achieve safety and stabilisation. These include: progressive trauma therapy. Sometimes it is possible for the well-intended
muscle relaxation, autogenic relaxation, sensory grounding but untrained therapist to engage in treatment with survivors
and containment, uses of imagery of a safe place, and that can actually retraumatise their clients, thus resulting
utilisation of emotional support systems. in failed treatment and rendering future treatment more
The second section, termed ‘trauma memory difficult and painful for the survivors. Other difficulties, such
processing’, corresponds to Remembrance and Mourning in as how to determine a subject’s readiness for the next phase
Herman’s Model. It aims to create a space to allow subjects of trauma care, how to deal with co-morbidities (particularly
to safely process and work through unresolved traumatic personality problems), can also be anticipated. Progress of
memories, and then begin to make sense of the devastating the treatment may be hindered if the therapist fails to tackle
experience. These techniques mainly involve cognitive these difficulties. Thus, this book serves as a guide and does
restructuring and various exposure interventions (systemic not substitute training and supervision.
desensitisation and narrative interventions). Although
newer approaches, like eye movement desensitisation and Angel Tsang, MBChB (email: [email protected])
reprocessing (EMDR), are not covered in the book, the Department of Psychiatry
authors believed that the latter approaches certainly fit the Tai Po Hospital
CBT trauma framework, as both EMDR and CBT aim to New Territories, Hong Kong SAR
help individuals process the trauma. China

170 © 2011 Hong Kong College of Psychiatrists