International Society for Traumatic Stress Studies

1998-01

TREATMENT

A Wall of Silence

By Páll Ásgeirsson
Department of Psychiatry
The University Hospital at Reykjavík Reykjavik, Iceland

In 1995 two snow avalanches took over 30 homes in two villages on the west coast of Iceland. In contrast to other disasters that have previously taken place in Iceland, these two villages received considerable psychiatric assistance and the Icelandic public became quite conscious of the benefit of such help. After the second incident, an outcry for help came from a small town on the east coast that had been struck by an avalanche 21 years previously, resulting in a toll of 12 dead and a nearly total destruction of its industry. True to their professional opinion that it is never too late to work through a traumatic experience, a team of two experienced professionals from the University Hospital in Reykjavik (a psychiatrist and a psychologist) reacted and started work with those people who wanted help.

The work consisted of eight visits to the community that previously has never had any organized psychiatric service. On every visit there were group sessions and individual sessions. Several meetings were arranged with local health authorities and other organizing bodies. A community session was open to everybody. In addition we held other individual and family sessions at our home base in Reykjavik. This organized approach was terminated after 15 months, but several of the clients still have contact for some infrequent assistance.

The village where this took place is an isolated, prosperous community with 1,700 inhabitants that build their economy mainly on fishing and fish processing. It is located in an area under a mountain slope and practically the whole area is now considered to be very dangerous because of possible avalanches. Before a recent danger evaluation of many such villages, locals and the Icelandic community have been remarkably unaware of the life threat that has persisted through the ages, which has in this century lead to a great deal of questionable town planning.

One of the conclusions of our local treatment group has been that a "wall of silence" was built around everything concerning the avalanche, a wall that they felt had been a serious barrier against the rehabilitation of individuals, as well as the community as a whole. The very situation in 1974 where the existence of the whole village was threatened put all attention on the rebuilding of its industry and left no space for work around emotional issues.

In the course of this therapeutic progress, we had contact with about 100 people, who got very different services ranging from one large group session to short-term individual psychotherapy. Several of our clients gave indication that our participation initiated remarkable progress in their personal lives and others had their chronicity acknowledged, which gave them different opportunities to organize their lives. They also expressed the opinion that the afterwaves of our participation influenced the community as a whole by making the 1974 disaster a part of reality for everybody. It might be a realistic evaluation that the fact that this work took place made development possible on other levels of the community as well.

Before our work started, there were some doubts whether this initiative would only reawaken sorrow that we would not have a chance to address adequately. The sorrow and pain was certainly reawakened, but it seems that this initiated considerable constructive rebuilding and mobilization of dormant possibilities.


UNITED NATIONS

A Step Toward Meeting the Rights of Victims

By Yael Danieli, PhD
ISTSS Representative to the United Nations

In most criminal justice systems throughout the world, victims of crime are rightfully called the "forgotten persons." Considerable attention has deservedly been paid to ensuring due process for defendants. Because the state was assumed to represent the best interests of society (including victims), there did not seem to be a need for special provisions for victims, despite the enormous physical, financial and emotional toll crime takes on them.

A fundamental reformulation of the role of the victim came with the adoption by consensus of the United Nations Declaration of Basic Principles for Victims of Crime and Abuse of Power (GA/Res/40/34) by the General Assembly in November 1985. This decision reflected the collective will of the international community to restore the balance between the fundamental rights of suspects and offenders, and the rights and interests of victims.

This "magna carta" for victims recognizes that victims should be treated with compassion and respect. It recommends measures to improve their access to justice and prompt redress (restitution, compensation and necessary assistance, including specialized assistance for healing from trauma) for the harm they have suffered.

The adoption of an international instrument, however important, is only a first step toward improvements in practice. It must be implemented on the international, regional, national and local levels. Initiatives aimed at implementing the principles of the Declaration occurred during the following decade, led by both governments (adopting appropriate legislation and programs) and nongovernmental organizations (developing training and advisory capacities and model practices) (for details, see Danieli et al., 1996).

To improve upon these efforts and foster coordinated implementation, an Expert Group Meeting on Victims of Crime and Abuse of Power in the International Setting was held in Vienna in December 1995. It considered the main elements to be included in a draft manual on the use and application of the Declaration and elaborated an integrated approach, as well as a concerted plan of action. Drawing on the recommendations of the Expert Group that were adopted by the Commission on Crime Prevention and Criminal Justice in its Fifth Session, the UN Economic and Social Council adopted resolution 1996/14, which recognized the desirability of preparing draft manual(s) on the use and application of the Declaration. While acknowledging that the Basic Principles of Justice for Victims of Crime and Abuse of Power contained in the UN Declaration are inclusive enough to transcend national and cultural specificities, the Council called for the manual(s) to take into account the different legal systems and practices of each State.

Accordingly, the Office of Victims of Crime of the U.S. Department of Justice hosted an Expert Group Meeting in Tulsa, Oklahoma in August 1996 to develop the first draft "International Victim Assistance Training [Manual] on the Use and Application of the Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power." It outlines main elements of assistance to victims: (1) development of effective victim service programs focusing on the impact of victimization, crisis response and intervention, counseling and advocacy, participation in the justice system, victim compensation and restitution; (2) responsibilities of professionals and volunteers to victims, e.g., police officers, prosecutors and medical personnel; (3) integration of victim needs in national law, policy and planning and the formulation of the technical assistance requirements and projects; and (4) international cooperation to reduce victimization and assist victims.

Portions of The Initial Report of the Presidential Task Force on Curriculum, Education and Training of the Society for Traumatic Stress Studies (J. Krystal, chair; Y. Danieli, 1989 ISTSS president) were incorporated into the handbook. The U.S. National Center for PTSD and 1996 ISTSS President Matthew Friedman assisted.

A briefer manual, primarily for use by policy makers, was prepared in 1997. But as Eduardo Vetere, head of the UN CPCJ Programme, observed, despite progress in a number of countries, there are still situations where the Declaration is very little applied. This is true of victims of crime, and even moreso of victims of abuse of power.

Reference

Danieli Y., Rodley N.S., and Weisaeth L. (Eds.) (1996). International Responses to Traumatic Stress... Published for and on behalf of the United Nations by Baywood Publishing, Amityville, New York.

In memory of Morton Bard, a fellow 
pioneer victim advocate and a friend.


Editorial

PRESIDENT'S COLUMN

ISTSS Eyes Ambitious Agenda for '98

By Sandra Bloom, MD

Greetings for 1998. Thanks go to Past President Terry Keane, the Sherwood Group and the board for turning over to me a society that is financially stable and thriving. The first item of news for 1998 is the acceptance of the Kuwait Society for Traumatic Stress Studies as part of the ISTSS. Interest in traumatic stress studies has grown steadily in Kuwait since the Gulf War, and a group of professionals have garnered sufficient interest to petition the board of directors for membership.

There is a much to do in the coming year. The pamphlet on traumatic memories, brainchild of Matt Friedman and Susan Roth, with the contributions of many experts in the area of trauma and memory, has been approved by the board and is in the design stage. We hope to distribute the pamphlet widely as a major effort in combating the one-sided reporting that has characterized much of the discussion around this issue. The memory pamphlet will be an excellent beginning for an ISTSS-sponsored public education campaign about issues related to trauma.

We also hope to begin addressing another contentious issue: managed care and the impact the current health-care environment has had on our ability to treat victims of trauma. Robert Dobyns and Richard Epstein have agreed to chair this effort. You will be receiving a survey asking you to document your experiences in the next few months. Please take the time to fill it out. Andrew Stone has agreed to chair an initiative aimed at the development of a Latin American Society for Traumatic Stress Studies. Frank Putnam and Beverly James are looking at the issue of child trauma and what the ISTSS should be doing to promote more interest in this area. We also need to look at forensic issues from several viewpoints: the interface between the forensic system and treatment, as well as the issues of treatment of trauma victims in prisons and learning from those who work with perpetrators. John Fairbank has agreed to chair efforts in this domain. Another area that needs attention is urban violence, and Bessel van der Kolk will begin to explore how we can develop a wide circle of clinicians and researchers dealing with urban problems.

The board also has an ongoing concern about membership, namely widening the circle of leadership and increasing diversity. Matt Friedman has agreed to continue to work on the development of affiliations with other groups that have goals consistent with our own.

The benefits of being a part of the ISTSS are still too closely held a secret. With the help of the Media Committee, chaired by Jessica Wolfe, we hope to bring attention to the Washington, D.C. conference, as well as hold a public education seminar at the meeting. The theme for the Annual Meeting is "Ending Cycles of Violence: Integrating Research, Practice and Social Policy." Elizabeth Kuh and her co-chair Christine Courtois will organize the meeting. Our intent is to demonstrate through the meeting itself that the sources of human trauma are interrelated and that only integrated approaches 
will yield effective change. Rachel Yehuda has again agreed to spearhead the 1998 fundraising efforts, following her successes with the 1997 meeting.

As you can see, this is an ambitious agenda, and there is so little time. If you are interested in any of these or other areas, please contact the appropriate chair or me and get involved.


ISTSS News

ISTSS Chooses New President-Elect, Directors

Ann Jennings arranged the exhibit of her daughter Anna's artwork and writings at the ISTSS Annual Meeting in Montreal. A white three-ring looseleaf binder, containing a report of evidence of abuse at Philadelphia State Hospital, along with some letters, writings and a newsletter, may have been mistakenly picked up from her exhibit table. Some of the contents are the only existing originals. If you know of the binders' location, please contact Ann Jennings at (work) 207/287-4207; (home) 207/395-2492; or via e-mail, afj@mint.net.

Lost Item at ISTSS Annual Meeting

In fall balloting, ISTSS members voted on a new president-elect and filled five other board positions. The president-elect is Alexander (Sandy) McFarlane, University of Adelaide, Australia, who will serve on the board for three more years as president-elect (1998), president (1999) and past president (2000). Newly elected board members are Patricia Resick of the University of Missouri at St. Louis and Heidi Resnick of the Medical University of the Medical University of South Carolina.

Re-elected to the board are Bessel van der Kolk of the Boston University School of Medicine, Susan Roth of Duke University and Tom Lundin of Uppsala University Hospital in Sweden.

Many thanks to all candidates who participated in the 1997­1998 elections. The nominating committee is chaired by the immediate past president. This year's chair was Matthew Friedman of the National Center for PTSD. Terence Keane will chair the next committee, which will be responsible for nominating candidates for the 1998-1999 elections. For more information on ISTSS elections, see http://www.istss.org.


Student Committee Update

By Karestan Chase Koenen, M.A.
Chair, ISTSS Student Committee

Since 1994, the ISTSS Student Committee has been an active force in promoting the interests of students in the organization. As chair of the Student Committee for 1997­98, I intend to continue this tradition. To keep student members informed of the Student Committees activities, members of the committee and I will present regular reports in StressPoints.

Outgoing Chair Carol Goguen and I attended the board of directors meeting at the ISTSS annual meeting in Montreal. At the meeting, the board members recommitted themselves to increasing student membership and participation in the organization. As a concrete step in this direction, the board voted to decrease the cost of membership in ISTSS from $70 to $60.

Patricia Resick was nominated to be board liaison to the Student Committee. In this role, Resick will facilitate communication between the Student Committee and the board and will work with the Student Committee to help us reach our goals for the year. The board also decided to offer student poster awards to student members who submit their research to be presented at the 1998 Annual Meeting. The monetary value of the award is still to be decided.

The Student Committee met at the Annual Meeting to establish its goals for the year. Our main goal for the year will be to develop a directory of graduate programs, internships and post-docs that provide training related to trauma and PTSD. This project will be headed by committee member David Lilly, and the final product will be presented at the Annual Meeting in Washington, D.C. We expect that this directory will be an invaluable resource to students interested in receiving training in trauma and PTSD.

Other goals outlined for this year include developing avenues for fundraising and developing programs specifically oriented toward students for the Annual Meeting. Topics for student programs might include developing a research program or ethical issues around training students to treat traumatized clients. Following the success of the student pizza party at the Annual Meeting 
in Montreal, we also intend to continue to offer students opportunities to meet informally with board members.

If you are a student member of ISTSS and have any questions about the Student Committee or would like to get more involved, please feel free to contact me by phone at 617-232-9500, ext. 5917, or by e-mail at koenen.karestan_c@boston.va.gov. I am looking forward to an exciting and productive year!


ANNUAL MEETING

ISTSS Honors Award Winners 
at Annual Meeting

During the 1997 Annual Meeting in Montreal, ISTSS held its annual awards banquet to recognize achievements in the field of traumatic stress studies. The Society congratulates the following award winners:

Lifetime Achievement Award
Edna Foa, PhD

Chaim Danieli Young Professional Award
Lisa Najavits, PhD
Caron Zlotnick, PhD

Robert S. Laufer, PhD, Memorial Award for Outstanding Scientific Achievement
Zahava Solomon, PhD

Sarah Haley Memorial Award for Clinical Excellence
Laura Brown, PhD


ESTSS

Fifth ESTSS Conference: 
Traumatic Stress, Health and Narrative Communities -- A Transgenerational Perspective from Maastricht

By Roderick Orner
President, ESTSS

The legacy of European Conferences on Traumatic Stress (ECOTS) spans almost 10 years, with venus spanning Norway, England, The Netherlands and France. This most recent Maastricht congress of nearly 400 delegates may prove to be the one that saw European trauma conferences come of age.

Coincidentally, the same may be the case for the European Society for Traumatic Stress Studies. On the strength of achievements linked to presidential terms of Wolter de Loos and Stuart Turner, the ESTSS has evolved into a viable professional society. Its growing membership, efficient secretariat and active board of directors are well placed to promote psychotraumatology in Europe.

So, the question arises -- what are the distinctive conference ingredients that helped effect these transformations? Probably not the conventional scientific program structure comprising conference plenary sessions (controversies and dilemmas in psychotraumatology, traumatic expectations and family dynamics, gender and the process of coping with traumatic stress, amnesia and discovery in the study of trauma) presented by internationally recognized experts. Nor the well trodden path of specialist symposia (UN peacekeeping, trauma in the etiology of anxiety disorders, outcome studies, child sexual abuse, torture, aging, psychosocial interventions in war stricken areas, debriefing, counteracting cycles of inter ethnic violence, neurobiological correlates of stress on memory, treatment of refugees and asylum seekers, traffic accidents and EMDR). Not even parallel paper sessions on such broad themes as occupational trauma, family and culture, diagnostic concepts, trauma in somatic medicine, healing, psychobiology and public health.

Workshops were not markedly different from those held at previous European conferences with respect to issues addressed, namely traumatic stress reactions after fatal accidents in the workplace, poetic communication with torture victims, language as a change indicator in narratives of trauma, applying breaks in therapy, hypnosis in PTSD, the impact of trauma on content and group processes in Balint groups, guilt, biodynamic analysis, play and drawings with traumatized children and preventative group work with war veterans.

But conference arrangements were at all levels informed by a concerted resolve to approach learning and sharing from the distinctive perspective of "narrative communities" ("Erzahlgemeinschaften"). Narrative communities are project-focused groups that effect change through problem-oriented learning. Members typically start by sharing personal experiences and impressions of subjects or issues under consideration. This in contrast to taking lecture notes and rote memorizing of textbook summaries. It is learning through personal experience referenced by evidence. Daily plenary sessions were used to good effect to mold the conference into a narrative community. Here particular prominence was given to salutogenic reactions to trauma; the hitherto largely unexplored potential of traumatic stress to engender health, personal growth and constructive social or political action.

Thematic poster sessions provided further daily opportunity for narratives to develop. Each had a designated moderator, and rather than rely on a sequence of formally delivered lectures, the stimulus for discussion was invited poster presentations on themes such as coping with torture, theories about traumatic stress and their relationship to prediction and outcome, the sense of varied therapy modalities, psychobiology, working with traumatized children and their families in cases of child abuse, support within the family and resources in clients and therapists.

Around these themes, narratives developed recognizing the capacity of trauma to disrupt and cause suffering -- especially so when denial and refusal to acknowledge the evidence available to our senses is a feature of the recovery and readjustment environment. Set against this grim scenario stands the spectre of salutogenic factors that may be introduced to engender healthy functioning and awareness raising.

As the scientific program unfolded, issues of pathogenesis and salutogenesis made their distinct impressions on the ethos of the Fifth European Conference. Opportunities arose to confront and share the potentially inhibiting ramifications of denial (e.g., with respect to the human capacity for sins of commission and omission). The occasional extremely uncomfortable reactions engendered among conference delegates were counterbalanced by the recognition of what can be achieved through remembering and not turning away from evidence.

During the closing session, the conference recognized the scope and direction for growth that may be possible in the wake of trauma. This is so not only at the individual level or that of a whole nation, but also for the crucial processes of regional transformation being promoted through the European Union.

The opening sessions of the conference featured keynote speakers from outside the field of psychotraumatology. Rita Sussmut, president of the Deutsche Bundestag and patroness of the Fifth ECOTS, Shevach Weiss, deputy speaker of the Knesset, and Els Borst-Eilers, Dutch minister of health, welfare and sports (surely, a salutogenic ministerial brief) set the theme of salutogenesis by speaking of their resolve to stand up against the forces that maintain states of denial. This was elaborated upon during keynote addresses on subsequent days of the conference. Trude Simonsohn, chair of the Council of the Jewish Community in Frankfurt spoke of her experiences of living in Germany during the Nazi era. Her reflections on the predicament of being a Holocaust survivor now provides the material for speeches to German audiences.

Simonsohn aims to create opportunities for those present to develop their own narratives on this aspect of European history and the continuing impact this has on their lives more than 50 years after the end of the Second World War. A Swiss author, Professor Adolf Muschg used literary references from The Red Knight, his own rewriting of W. von Eschenbach's Percival, to allude to the massively destructive consequences that arise from denial and a refusal to know. But his text also conveyed the restorative, health-enhancing and salutogenic potential of being open to truth and letting narratives develop from it. On the final conference day two filmmakers from Europe, Katrin Seybold and Tom Verheul demonstrated how their medium lends itself to challenging the apparent disinclination of Europe's vast television audiences and media empires to lend their attention to the 'trauma realism' of recent European history.

Legacies of relatively recent instances of state-sponsored violence were linked to the processes by which transgenerational perpetuation of violence can occur. The filmmakers brought a recognition that campaigners against denial assume the mantle of resistance workers. Each age sees individuals unwittingly cast in the role of resistance workers and their movements are as diverse as the democracies that foster them are tolerant of evidence-based narratives.

In the closing session conference delegates could appreciate how the narrative community they had helped create delivered a challenge to all involved in the field of psychotraumatology not to be silenced. We came to this realization at a time when opportunities for publicly proclaiming the nature of evidence about trauma and the many issues that arise from it are more favorable in Europe than any other time this century. The purpose and aims of future ECOTS will be defined in full recognition of the costs associated with silence and denial. In turn the ESTSS has an opportunity to frame policies and action plans that foster narratives rooted in evidence.


ECOTS Focuses on Historic European Issues

By William Yule, PhD
Contributing editor, child trauma

The European Society for Traumatic Stress Studies' Fifth European Conference in Maastricht reflected the different histories of traumatic stress studies in Europe and United States, with a greater emphasis on the effects of the Second World War on people in continental Europe. There was moving testimony from Trudi Simonsohn on her experiences in Nazi concentration camps and how she survived to live a full life. In answer to a question from the floor, she said that forgiveness did not play a part in her adjustment, as only the dead could forgive, neatly challenging some of the current views on reparation and forgiveness between victim and perpetrator.

As far as work with children and adolescents is concerned, there was a tour-de-force keynote from ISTSS Past President Bob Pynoos, but no obvious child track throughout the meeting, other than continuing concerns with the impact of child abuse. There were indirect contributions to child and adolescent work from papers, particularly from the Netherlands and Scandinavia, presenting work with refugees. There are increasingly sophisticated models for delivering psychosocial services in different cultures following major upheavals, be they natural disasters or civil war. It was, therefore, all the more disappointing that UNICEF and other NGOs did not use the meeting to have a constructive look at their psychosocial programs in former Yugoslavia, particularly given the current opposition in New York to considering child trauma in the wake of war.

It is difficult to encapsulate the different ambience of the ESTSS meeting from the larger ISTSS ones. With Past President Wolter de Loos giving a number of excellent recitals on cello early in the meeting and with Adolf Muschg, a respected German writer presenting a keynote address entitled "Parzifal's Question: Sire, What About Your Illness? The Narrative as a Means to Cope with Trauma," the impression was of a group wrestling with age-old dilemmas, bravely developing interventions in difficult circumstances, but yet connecting to modern findings from basic studies in experimental psychology laboratories.


MEDIA MATTERS

Journalism Students Learn Victim Interaction Skills Through Role-Playing

By Roger Simpson, Ph.D.
Journalism and Trauma Program
University of Washington at Seattle

Journalism students aren't usually this grim when a news reporting class begins. Today, though, they face the "trauma unit," an experience they've heard will test them in ways that few, if any, of their college courses do.

University of Washington advanced news-reporting students are doing work few of their peers around the country ever experience: Exploring how post-traumatic emotion can affect the people they will interview.

Unsmiling faces and guarded body language tell us that the students are uneasy as we brief them about trauma, talk about the inevitability that journalists and traumatized persons will meet, and consider how to make interviews humane rather than hurtful. \ Although the subject raises pulse rates for some students, the three speakers are open, helpful, and not threatening.

Then we ask the students to write about the session. Their comments are courteous, a bit abstract and stilted, and deferential to the speakers. Few students stop writing, though, before they ask the burning questions: "How do you start asking questions and what would be a good starting question to ask?"

A few days later, the students face the test that was implicit in the friendly briefing about trauma: They take turns interviewing a trauma victim played by a skilled actor. For two hours, every student moves closer to understanding how the shock waves of a traumatic event roll out over victims and then over those who come to talk to victims. Their dutiful notebook notations about reporters retraumatizing a victim become a vivid reality.

After two hours, we debrief the group orally, allowing the actors, interviewers, teachers and students to talk freely about the experience, to release the tension the exercise inevitably creates. Then students write for a few minutes about the exercise.

The courteous formulations of the previous class are replaced by words finely etched by new emotions. The students speak frankly about how they came to think about humane responses in a classroom crucible offering no escape from peers, teachers, and most important, "the victim."

"At first, I smiled thinking that it wasn't me up there asking questions. If it was me up there, I would have stopped asking questions, tried to calm him down and waiting until he relaxed a bit. But I was scared and uncertain of what to do..."

"[The victim's] excitement made me excited. Questions that I had in my mind didn't apply. I expected something different, like a tearful person that could respond to calming."

"Then I wanted [the victim] to talk to me, as if I could offer him condolences and the help he needs. I wanted to make things right, if only to calm myself down."

"It made me see that a journalist talking to people in a traumatic situation is possible and not a completely evil thing to do."

As students work out their reactions, the tension of a safe classroom paves the way for more humane and effective journalism.

This regular Stresspoints column, Media Matters, brings news of journalism innovations to ISTSS members. We are particularly interested in advances in media education that equip young reporters to better understand trauma and traumatized individuals. Write to us at StressPoints if you have relevant information. And note that Roger Simpson, guest columnist today, not only teaches journalism courses on victimization, but chairs a new interest area group at ISTSS on victims and the media. You can reach Professor Simpson by e-mail: newsboy@u.washington.edu

-- Frank M Ochberg, MD, contributing editor, media

 


TREATMENT

Therapist Self-Disclosure Can Be a Balancing Act

By Ingrid Carlier, PhD, AZVA, Amsterdam, The Netherlands, and Berthold Gersons, MD, University of Amsterdam, Amsterdam, The Netherlands

A trauma group I run recently participated in a ropes course. This was at the request of the group as a means of furthering their ability to connect with each other on a deeper level. Ropes courses are designed to foster team building and group problem solving, and provide for individual challenges and safe risk-taking. My task was to negotiate the balance between therapist and group participant. As I have a fear of heights, I knew that this would be particularly challenging. I felt however that the group was ready to see me as an individual and was ready to explore the dynamics such an experience would generate.

The results were overwhelmingly positive. From the beginning of the day there was a reversal in roles. In most activities, my group members became the leaders, with me experiencing the most difficulties and fear. I was real that day in a way that is not available in the usual therapeutic milieu. I shook with fear, took risks and also chose not to take others. I was able to share the very heart of myself, without needing to share any of the details of my life.

One of the many issues associated with doing trauma work is the question of therapist self-disclosure. I have chosen carefully over the years to disclose something when I think it will be therapeutically helpful. Usually I lean toward minimal disclosure. While I think that this has best served my clients' interests, it has in some situations created a barrier.

A door has opened for the group to explore intimacy on a deeper level. We have a new set of metaphors to describe experiences, and I am now part of them. This is a milestone in the group process, as it lets me into their circle in a way I could never be part of before.

While I expected there to be large shifts in the group after the course, I never imagined the impact on me. The therapist's chair provides a safe haven for choosing to be, or not be, intimate. I realize how protected I am as a therapist. I am embarking on a new journey with this group, one in which I am more intimate and therefore more empathic. Martha Manning (New York Times Book Review, p. 32, Nov. 2, 1997) describes empathy as "a dynamic process, involving two people's ability to express their thoughts and feelings to each other in ways that add, change and, most important continue the relationship." These are goals central to my work.

I believe that when we as therapists can be human, the greatest healing can happen. This can happen when you cry for a client who has never been able to cry for herself. Or it can happen when you walk across a beam forty feet in the air, with your legs shaking so badly that you are sure you can hardly stand.


PTSD Prominent at British Conference

By William Yule, PhD
Contributing editor, child trauma

The British Association for Behavioural and Cognitive Psychotherapy held its 25th Anniversary Conference July 8­12, 1997. From very small beginnings in London, the group has grown to be a multidisciplinary organization that can host a meeting for over 1,000 delegates. Prominent among the subjects considered was PTSD.

Two of the keynote speakers, Edna Foa and Chris Brewin, addressed the topic of treatment and of memory, depression and PTSD respectively. Two symposia were devoted to considerations of clinical aspects of PTSD, as well as implications from current cognitive psychology for both theory and treatment. In addition, there was a debate on false memories. Of equal importance was the meeting's emphasis on examining normal mechanisms of memory, including normal inhibitory processes. Michael Eysenck, Chris Brewin, Andrew Matthews, John Teasdale, Tim Dalgleish and others examined developments in cognitive science and particularly looked at the implications for PTSD.

Those interested in traumatic stress -- and that included a very high proportion of the delegates -- were treated to a feast of thoughtful discussions, as more and more academic clinicians have realized that PTSD provides a natural laboratory for exploring the relationship between emotional reactions and psychopathology. The relevance of current studies in depression, anxiety, panic and worry was made explicit. Models of memory were revisited, and the need to look at traumatic stress reactions beyond the narrow confines of DSM and ICD was emphasized by many contributors.

As more clinical investigators seek to apply Beck-inspired cognitive therapies, the number of treatment sessions seems to increase exponentially, while little attention was paid to rapid treatment approaches, with individual contributions only mentioning EMDR and CISD in passing.

Interest in PTSD, its treatment and theoretical understanding, is alive and well in the United Kingdom.


2nd Dutch Conference Set

The Research Institute for Psychology & Health, in collaboration with the Dutch journal 'Gedrag & Gezondheid,' is organizing the Second Dutch Conference on Psychology and Health, May 25­27, Kerkrade, The Netherlands. Invited keynote lecturers include. Alexander MacFarlane, Nico Frijda, Marie Johnston, Robert Karasek, and Susan Nolen-Hoeksema. The conference will cover a broad range of topical research issues.

For more information, contact L. Hockert, RIPH, P.O. Box 80.140, 3508 TC Utrecht, Ther Netherlands; tel. (31) 30-2539216; fax (31) 30-2537482; e-mail penh@fsw.ruu.nl.

Resources

RESEARCH
Recently Published

Compiled by Arthur S. Blank Jr., MD

Readers who have recently published or have seen a new article on a traumatic stress topic can have it listed here by sending a copy to Art Blank, Jr., MD, 8 Carderock Ct., Bethesda, MD 20817. If you have recently authored or seen a relevant book, please send a publisher's brochure or other material describing the book.

The following references were published in 1997, unless otherwise noted.

Articles

Adamec R. Transmitter systems involved in neural plasticity underlying increased anxiety and defense -- implications for understanding anxiety following traumatic stress. Neurosci. & Biobehavioral Rev. 21(6): 755.

Amdur RL and Liberzon I. Dimensionality of dissociation in subjects with PTSD. Dissociation 9(2): 118

Annon JS. Guidelines for psychologists who receive a subpoena for their records. Issues in Child Abuse Accusations 9(1­2): 54

Banyard VL. The impact of childhood sexual abuse and family functioning on four dimensions of women's later parenting. Child Abuse & Neglect 21(12): 1095

Basoglu M, Mineka S and Gok S. Psychological preparedness for trauma as a protective factor in survivors of torture. Psychologic. Med. 27(6): 1421.

Beckham JC, Braxton LE and Palmer S. MMPI profiles of Vietnam combat veterans with PTSD and their children. J. Clin. Psychol.53(8): 847.

Beckham JC, Feldman ME and Moore SD. Interpersonal violence and its correlates in Vietnam veterans with chronic PTSD. J. Clin. Psychol. 53(8): 859.

Beckham JC, Crawford AL and Moore SD. Chronic PTSD and chronic pain in Vietnam combat veterans. J. Psychosomat. Res. 43(4): 379.

Brophy AL. Note on an MMPI-2 scale of early sexual abuse. Psychologic. Reports 81(3): 752.

Bryant R and Harvey A. Acute stress disorder: A critical review of diagnostic issues. Clin. Psychol. Rev. 17: 757.

Bryant SL and Range LM: Type and severity of child abuse and College students' lifetime suicidality. Child Abuse & Neglect 21(12): 1169

Carlson EB, Furby L, Armstrong J. et al. A conceptual framework for the long-term psychological effects of traumatic childhood abuse.Child Maltreatment 2: 272.

Charlesworth LW and Rodwell MK. Focus groups with children: A resource for sexual abuse prevention program evaluation. Child Abuse & Neglect 21(12): 1205

Clark DB, Lesnick L and Hegedus, AM. Traumas and other adverse life events in adolescents with alcohol abuse and dependence. J. Am. Acad. Child & Adolescent Psychiatr. 36(12): 1744

Craig RJ and Olson R. Assessing PTSD with the Millon Clinical Multiaxial Inventory-III. J. Clin. Psychol. 53(8): 943.

Davis GC, Schultz LR and Breslau N. Sex differences in PTSD. Arch. Gen. Psychiatr. 54(11): 1044.

Echeburua E, De Corral P and Sarasua B. Psychological treatment of chronic PTSD in victims of sexual aggression. Behav. Modification 21(4): 433.

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Books

Bloom SL: Creating Sanctuary: Toward the Evolution of Sane Societies, New York: Routledge.

Carlson EB: Trauma Assessments: A Clinician's Guide. New York: Guilford.