1 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

2 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

3 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.

4 Integrative Treatment for Complex Trauma: Core Components (cont’d.) Immediate trauma-related issues (anxiety, 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 individual’s specific trauma(s), current symptoms as determined by regular assessments, strengths, and family/systems issues.

5 ITCT Core Components (cont’d.) 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 Children’s Hospital departments. Titrated exposure and processing is used per the Self Trauma Model (Briere, 2002), especially in the case of traumatized adolescents.

6 Comparison of Pre- Versus Post TSCC Scores for Clients Receiving ITCT at MCAVIC

7 ITCT Pre-Post Data for MCAVIC Clients

8 Recent adaptations for older adolescents Greater focus on principles of Self-Trauma 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.

9 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

10 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-Master’s 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 John Briere, Ph.D., Director, Psychological Trauma Program, Dept. of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA.