V. Krishna Kumar, PhD
A Review of Serlin, I. A., Krippner, S., & Rockefeller, K. (Eds. 2019). Integrated care for the traumatized. A whole-person approach. Rowman & Littlefield: Lanham, MD. Paperback $40.00
In a world rife with conflicts and wars, suffering from trauma has become a common occurrence. Trauma is not restricted to military personnel who have suffered physical casualties; it also affects those who come home safe deprived of their fellow combatants. Injured physically and/or psychologically are scores of civilian men, women, and children as a result of having lost family members, their entire community, or destruction of their way of life. Trauma can also occur in everyday life as a result of natural tragedies, oppression, harassment and bullying from insensitive individuals—the effects of which can last life-long. In view of this, this edited book on trauma treatment approaches is welcome, especially because the approaches discussed differ from the traditional single-theory-based approaches inasmuch as they focus on integrated growth-promoting approaches to treat the whole person.
This edited book is unusual in its scope and content. The scope is international—the cadre of selected authors share their approaches and experiences in treating trauma in several countries resulting from wars and natural disasters (disease, hurricane, and tsunami). The book also includes a Foreword by Charles Figley and is divided into four sections: Foundations, Whole-Person Group Therapy Models, Intervention for Communities, and Future of Integrative Care for the Traumatized.
Treating trauma in one’s own culture is a challenging task but treating traumatized individuals from other cultures (e.g., refugees), and in cultures different from one’s own poses exceptional challenges. The book describes approaches that are essentially experiential in nature where therapists involve individuals from local communities and train them to work with traumatized people. In this book, you do not see applications of such therapeutic approaches as CBT, Dialectical Behavior Therapy, or Psychodynamic. Rather you see an exposition of phenomenological approaches to diagnosis and experiential approaches to treatment using art and play therapy, dance-movement therapy, psychodrama, animal-assisted intervention, meditation, and discovery of meaning. A remarkable feature of such experiential approaches is that they can be applied cross-culturally with perhaps greater creativity and spontaneity than some of the traditional approaches. To the credit of the authors, they not only explicate the theoretical underpinnings of the psychotherapeutic approaches they use but also provide examples of how they apply them to the traumatized people from around the world (Europe, Asia, Middle-east, Africa, the Caribbean island countries, & South and North America). Several authors indicate how they gather data to assess the effectiveness of their programs and make improvements. The authors emphasize taking a context-based evolving approach to adjust their treatment strategies as they implement their approaches in different cultures.
The hegemony of the symptom-reduction medical model and the intuitive appeal of evidence-based research may have marginalized some of the alternative approaches (experiential and phenomenological) from mainstream psychology. Can this book help correct this situation? This question remains to be answered. A more important question is: Should we continue to emphasize the use of Western “quantitative” (with Likert scales and randomized control trials) approaches in evaluating treatment outcomes around the world? Myron Eshowsky (Chapter 10) notes “A number of indigenous researchers are quite critical of Western-style evidence-based research . . . Western researchers often overlook the knowledge that indigenous people have of their own challenges and needs” (p. 152). Also, demanding evidence-based effectiveness research for treating traumatized individuals from wars and natural disasters may be a stretch given that people in dire suffering require immediate attention and help. Asking them to complete assessment instruments may be asking for too much in the face of their immediate needs. Another problem with evidence-based research is that treating the traumatized requires to be long-term and that conducting long-term assessments of effectiveness requires plenty of resources and availability of the treated individuals who may have moved on to other locations.
What this book can do is inform psychologists that alternative approaches to diagnosis and treatment are currently being used to treat trauma around the world with some success. Without their availability, traumatized people would receive no help at all. The book serves an important purpose—it brings to people in the field a variety of person-centered psychotherapeutic modalities that people will not ordinarily know about or have heard of in treating trauma arising from wars and natural catastrophes. More importantly, the authors talk from the authority of experience gained from working in many parts of the world where they have ventured to implement their programs. Some readers are likely to ask about research-based evidence which supports the continued use of these programs. Conducting field research with control groups is not the easiest thing to do. Several authors do address the issue of evidence, but they also acknowledge that such evidence is limited. It should be noted that without these courageous individuals who have ventured to put themselves in dangerous situations to help others, there will be no help for thousands of people scarred and damaged due to trauma. Can research replace the informed observations of experienced therapists?