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

机译：创伤心理治疗的关系与响应性：APA临床实践指南的悲剧

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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.
机译：治疗关系和响应性/治疗适应理所当然地占据创伤心理治疗的任何指导方针所突出的循证地位。在这种光明中，我们赞许美国心理协会（APA，2017）临床实践指南对成年人的临床实践指南的误导，以推进心理治疗的生物医学模型，从而专注于特定疾病的治疗方法。相反，研究证据，临床专业知识和患者偏好和文化（基于证据的必要的实践）应融合在强调治疗关系，治疗适应和个体治疗师的独特性心理指导方面，所有这些都是独立占据的患者改进比特定的治疗方法更多。荟萃分析结果和几项创伤特异性研究说明了论文。在没有关系和响应的情况下颁布指导方针的努力严重不完整，潜在的误导。网络结果是APA指南，证明经验可疑，临床嫌疑人，略微有用;此外，它阐明了一个重要的机会，以确定实际愈合创伤的祸害。我们结束了推荐，以便向未来的APA实践指南提出前进。

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