Integrative Treatment of Complex
Trauma (ITCT) and Self Trauma Model
for Traumatized Adolescents
Cheryl Lanktree, Ph.D. and John
Briere, Ph.D.
MCAVIC-USC Child and Adolescent
Trauma Program
Types of Trauma and Clients Treated
with Integrative Treatment of
Complex Trauma (ITCT)
Age range: 2 yr. to 21 yr.
Cultural diversity and economic
disadvantage particularly addressed with
ITCT
Physical and sexual abuse
Emotional abuse and neglect
Community violence and domestic violence
Parental substance abuse
Traumatic loss of family member
Severe medical condition or injury
Multiple types of trauma with attachment
disturbance
Integrative Treatment of Complex
Trauma (ITCT): Core Components
Assessment-driven treatment, with standardized
measures administered at 3 month intervals.
Integration of directive play, cognitive-behavioral,
(exposure, cognitive interventions), art, and
relational therapy. Primary caretakers participate
in collateral sessions and in family therapy.
Relationship with therapist is crucial to success of
therapy.
Gradual exposure and exploration of trauma in
developmentally-appropriate and safe context,
balanced with attention to increasing affect
regulation capacities, enhanced self-esteem, and a
greater sense of self-efficacy.
Integrative Treatment for Complex
Trauma:
Immediate trauma-related
issues (anxiety,
Core Components
(contd.)
depression, suicidality, posttraumatic) addressed
early in treatment when possible -- in order to
increase the capacity of client to explore more
chronic and complex trauma issues.
Complex trauma issues are addressed as they
arise, including attachment disturbance,
behavioral and affect dysregulation, interpersonal
difficulties, and identity-related issues.
Interventions are designed to address individuals
specific trauma(s), current symptoms as
determined by regular assessments, strengths,
and family/systems issues.
ITCT Core Components (contd.)
Treatment interventions incorporate aspects
of TF-CBT, attachment theory, family
-focused interventions, and manualized
traumatic grief treatment. Multiple
modalities (individual, group, and family
therapy) are used in multiple settings:
clinic, schools, and Childrens Hospital
departments.
Titrated exposure and processing is used
per the Self Trauma Model (Briere, 2002),
especially in the case of traumatized
adolescents.
Comparison of Pre- Versus Post
TSCC Scores for Clients Receiving
ITCT at MCAVIC
ITCT Pre-Post Data for MCAVIC
Clients
Recent adaptations for older
adolescents
Greater focus on principles of SelfTrauma Model (STM) as they have been
developed for adolescents and adults
(Briere, 2002; Briere & Scott, 2006).
More traditional psychotherapy approach,
involving serial verbal interactions between
client and therapist (reduced focus on
art/play therapy).
Therapeutic relationship and discussion of
trauma experiences trigger (a) trauma
memories, (b) distorted cognitions, and (c)
relational schema, which are then processed
per the STM.
Recent adaptations for older
adolescents (continued)
Steps of trauma processing, per STM
Exposure to memories, and triggering aspects of the
treatment relationship, within the therapeutic
window
Activation (evoked emotions, cognitions, additional
implicit memories)
Disparity (safety of session, nonreinforcement of
fear and expectations of danger)
Counterconditioning (upsetting material and
responses occur in the context of support,
validation, positive attachment feelings/experiences)
Extinction/resolution (trauma material eventually
loses its capacity to produce distress)
Sequential and simultaneous iterations processing
memories of multiple traumas, abusive relationships
Training and Contact
Information For ITCT and STM
Clinical Staff requesting training should have completed a
Masters or Doctoral degree in Social Work, Counseling or
Clinical Psychology, or Marriage and Family Therapy and have
some knowledge/experience regarding trauma-focused therapy.
Interns/Trainees who are pre-Masters or pre-Doctoral should
have completed relevant course work and have some therapy
experience.
Training and consultation provided by MCAVIC-USC
Psychological Trauma Program at site, other NCTSN sites, and
national trainings.
CONTACT INFORMATION:
Cheryl Lanktree, Ph.D., Executive Director, MCAVIC, Long Beach,
CA.
[email protected] ; 562-933-0590
John Briere, Ph.D., Director, Psychological Trauma Program, Dept.
of Psychiatry and Behavioral Sciences, University of Southern
California, Los Angeles, CA.
[email protected];
www.johnbriere.com
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