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Trauma-Specific Treatment Models

trauma-6.pngWhile awareness of trauma has grown considerably in both the mental health and substance abuse fields, access to mental health or substance abuse services of any kind is often limited, much less services that are gender responsive, culturally relevant, trauma-informed, and trauma specific. Additional barriers to services exist for survivors who do not speak English or are undocumented, or for whom accessing behavioral health services carries a high level of stigma.

There are currently a handful of trauma treatment models that have been developed specifically for survivors of domestic violence. Most have adapted some form of Cognitive Behavioral Therapy (CBT), one of the common evidence-based treatments for posttraumatic stress disorder (PTSD), by including issues of particular concern to DV survivors and/or by modifying the length of treatment to increase accessibility. Several of these models have shown promise for improving the mental health and well-being of DV survivors, depending on their circumstances. To learn more about these models, see A Systematic Review of Trauma-Focused Interventions for Domestic Violence Survivorsby Carole Warshaw MD, Cris Sullivan, PhD, and Echo Rivera.

OTHER PROMISING APPROACHES: COMPLEX TRAUMA TREATMENT MODELS
While evidence-based trauma treatment designed specifically survivors of DV is currently limited, there are a number of other trauma treatments that may prove helpful for DV survivors if they are adapted to incorporate DV-specific concerns and studied to assess their safety and efficacy for DV survivors. The most promising of these are complex trauma treatment models.

Based originally on the work of Judith Herman, MD, in her 1992 book, Trauma and Recovery, complex trauma models offer a more comprehensive framework for understanding and responding to the various effects of chronic abuse as well as a more flexible multi-modal treatment approach. To date, none have been specifically tailored to or studied for survivors of domestic violence. In the long run, however, these models may ultimately prove to be especially useful to DV survivors, particularly those whose experiences of abuse have been more prolonged and severe. Complex trauma treatment models also tend to be consistent with many elements of trauma-informed practice, including addressing safety as a priority, recognizing that symptoms may be coping strategies, and stressing the importance of respectful, collaborative relationships in supporting healing and recovery (Harris, 1998; Saakvitne, Gamble, Pearlman, & Lev, 2000, Courtois and Ford, 2012). Treating Complex Traumatic Stress Disorders (Adults) An Evidence-Based Guide Edited by Christine A. Courtoisand Julian D. Ford. Guilford Press, New York 2009.

SAMHSA’S NATIONAL REGISTRY OF EVIDENCE-BASED PROGRAMS AND PRACTICES
While it is beyond the scope of this Special Collection to provide a comprehensive review of trauma-specific treatments, this supplementary resource references a handful of trauma treatment approaches that are available in published form and take a broader approach, are relevant to women, and could potentially be adapted for survivors of domestic violence.

In addition, the National Registry of Evidence Based Programs and Practices, maintained by the Substance Abuse and Mental Health Services Administration (SAMSHA), currently lists 27 trauma-specific treatment techniques that have met stringent criteria for research evidence, and new techniques are being added on a regular basis. However, the treatments listed have not been designed specifically for DV survivors.

Trauma Treatment in the Context of Domestic Violence 
For an in-depth review of mental health treatment in the context of DV, see the forthcoming eBook based on Warshaw, C., Brashler P. Mental Health Treatment for Survivors of Domestic Violence. In C. Mitchell and D. Anglin (Eds. ), Intimate partner violence: A health based perspective. New York: Oxford University Press (2009) (chapter is available on request from info@ncdvtmh.org).