The role of clinical experience, diagnosis, and theoretical orientation in the treatment of posttraumatic and dissociative disorders: A vignette and survey investigation.
Controversy exists regarding the merits of exposure-based treatments for posttraumatic stress disorder (PTSD) versus a phased approach when prominent dissociative symptoms are present. The first aim of this study was to examine the degree to which diagnosing dissociation in two traumatized patients' vignettes influenced clinicians' preference for phase-oriented treatment and whether clinicians' treatment experience contributed to their treatment preference. The second aim was to assess the extent to which participants had observed traumatized patients worsen when treated with exposure therapy or phase-oriented therapy and whether the theoretical orientation and treatment experience of the clinician were related to the observed deterioration. In the tradition of expert and practitioner surveys, 263 clinicians completed a survey of their diagnoses and treatment preferences for two vignettes and their treatment experience, theoretical orientation, and observations of patients' deterioration. When a marked degree of dissociation was noted in the PTSD vignette, respondents favored phased approaches regardless of the diagnosis given. Reports of having observed patient deterioration during both exposure and phased therapy were predicted by years of experience. Psychodynamic therapists reported more observations of worsening during exposure therapy than cognitive behavior therapy therapists. Clinical experience treating PTSD may heighten awareness of negative therapeutic effects, potentially because experienced clinicians have a lower threshold for detecting such effects and because they are referred more challenging cases.
a Department of Psychology , University of Canterbury , Christchurch , New Zealand.
Martin J
MJ
Dorahy
b Department of Psychiatry , Columbia University , New York , New York , USA.|c New York State Psychiatric Institute , Columbia University Medical Center , New York , New York , USA.
Roberto
R
Lewis-Fernández
d Department of Psychiatry , University of Pretoria , Pretoria , South Africa.
Christa
C
Krüger
e Department of Psychology , Towson University , Towson , Maryland , USA.
Bethany L
BL
Brand
f Department of Psychiatry , Koc University School of Medicine , Istanbul , Turkey.
Vedat
V
Şar
g Queensland Neuropsychology , Brisbane , Queensland, Australia.
Jan
J
Ewing
h Department of Psychology , Carlos Albizu University , San Juan , Puerto Rico.
Alfonso
A
Martínez-Taboas
i Blue Knot Foundation (formerly Adults Surviving Child Abuse) , Milsons Point , New South Wales , Australia.
Pam
P
Stavropoulos
j Department of Psychiatry , University of Queensland , Brisbane , Queensland , Australia.
Warwick
W
Middleton
D004213:Dissociative Disorders / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires
Diagnosis; dissociative disorders; posttraumatic stress disorder; treatment