The authors have found that the treatment of Posttraumatic Stress Disorder (PTSD) usually proceeds through several phases: Phase One stabilizes the target symptoms of conditioned emotional and physiological responses. Phase Two confronts emotional detachment, smouldering rage, and self-destructive symptoms. Phase Three involves both controlling intrusive recollections and uncovering the original traumatic experiences. Phase Four focuses on resolving impacted guilt and grief. Reaching Phase Five means that integration has been achieved and Phase Six means finding at-one-ment with God, self and others.

SUMMARY This article focuses on the treatment of couples with a collective personal history of multiple traumatic experiences, and central related concepts. Referred to as the intertrauma couples therapy (InTCT) model, this article outlines an approach to treating trauma victim couples in which each partner has suffered one or more traumatic experiences (i.e., war, rape, criminal assault, incest, community violence, etc.). InTCT is a structured five-phase model of care, derived from a long trauma treatment tradition, and the author's clinical experience in the treatment of multitrauma persons for over 20 years. This comprehensive, integrative approach to treatment is designed to resolve chronic interpersonal hostility, isolation in marriage, fears of intimacy and engulfment, and the persistent revivifications of partners' traumatic memories as a painful product of daily relational encounters. Unfortunately, these encounters represent trauma structures interacting with trauma structures, with no end or relief to the mutual pain-generating interactional patterns. The phases of the treatment takes the couple from disorganization and intense emotional reactivity to stabilization through integration to an end phase with a post-integration life skills building program for lasting results. Also presented are issues such as attachment, specific trauma responses to include interactive concepts of trauma bonding and systems theory in the context of trauma and dissociation. The article also presents a multitrauma couple case study, and discusses the critical role of therapist's functions.

This article discusses the common and unique configurations of stress responses of children to traumatizing experience in the world's warzones like Bosnia-Herzegovina, Croatia, Rwanda, Liberia, Mozambique, El Salvador, the Middle East, and other nations caught up in the throes of declared and undeclared wars. Children are the most vulnerable, and suffer the greatest. The new concepts of “warzone traumatic stress” (WZTrS) and “warzone traumatherapy” (WZTrT) are presented to expand the discussion of the treatment of warzone children beyond today's exclusive focus either on intrapsychic factors alone or on material-resource replenishing alone. These terms are an alternative to current approaches to treatment in which a discrete stressor has been identified as the responsible toxic agent that produced the child's symptoms. Most warzone children have experienced a multiplicity of stressors—a virtual matrix of violent war stressors. The WZTrT model recognizes that the mental, social, and cultural needs of traumatized children change over time—from the time they are exposed to raging toxic war stressors to the time when war hostilities end. Thus warzone traumatherapy attempts to address the child's needs on a continuum based upon a time-referenced intervention model. The model presented here acknowledges the child's adaptational strengths, and the multitheoretical employing of psychodynamic, cognitive, and behavioral techniques grounded in cultural/racial sensitivity and indigenous folk medicine as indispensable tools in warzone therapy for children. Additionally, the model takes into account the special features of relevant international policies of the United Nations (UN) and Non-Governmental Organizations (NGOs) geared to assist in the recovery and integration of warzone traumatized children. WZTrT embraces Western models of interventions integratively and flexibly employed with the personal, cultural, social, spiritual, and economic factors existing in the world of the traumatized child. Hopefully, the article will contribute to creating innovative ways of conceptualizing the mental, physical, social, cultural, and economic needs of warzone children in order to advance conceptual, technical, scientific, and practical aspects of child-relevant warzone interventions.

The current article focuses on the subjective elements of voice in trauma and dissociation, and the manifestation of voice in four phases of group treatment for victims of extreme, catastrophic events. The voice discussed here is no ordinary voice: it captures an attribute of dissociated representational experience that, though not easily defined, is nonetheless replete with “trauma messages “from the depth of somatopsychic processes, expressed in the patient's “nonverbal talking” in gestures, tone of voice, posture, silences, facial expressions, and in rhythm, timbre, movement, and syntax. Dissociation, trauma representational memory, and the phases of a proposed group model are discussed in detail with their respective phase-specific voice.

This article is the second part of a two-part contribution that incorporates the author's learning-from-the-trauma patient originally reported in a paper, “The Reparation of the Self” some 17 years ago. The article discusses the most likely trends in trauma theory and practice, and the multiphase-oriented approach to treatment of biopsychic trauma. Because crystal ball-gazing is not a viable approach to predicting the future of traumatherapy, the present article instead approaches the task of prediction through first understanding historical and contemporary treatment conventions spanning several decades in this century, and describes the principles and processes of the multiphase-oriented treatment model, a system of treating psychological trauma beginning with Pierre Janet.

Many trauma patients are unwittingly led to believe that once their traumatic memory, dreams, irritability, sleep disorder, and intrusive ideation are under greater control that the work of integration is complete. The point of view here is that victims' biopsychobehavioral trauma symptoms contain the nucleus of a damaged identity system that distorts the self-image and relational functioning. This nucleus is linked to a dissociated representational memory system. It is this memory system which is implicated in some incest survivors' profoundly negative self-perception, as seen in the assertion, “I am a tragic, soul-destroyer: look at what I've become!” Or in a veteran's belief that “I am the Devil for what happened in combat.” One crime victim described his dissociated identifications and emotional volatility in terms of a Dr. Jekyll/Mr. Hyde tendency. Cyclical relational pathology seen so pervasively in the lives of victims are related to these self- and other-representational distortions. Though cognitive and behavioral techniques address the narrative trauma memory system and ameliorate associated distress, these may be less useful in integrating the patient's representational memory system. This article argues that in order to foster post-traumatic integration, the representational memory system may require specialized direct therapeutic action, a focus on mutual relational dynamics between patient and therapist.

This paper highlights the contributions of the article, “The Reparation of the Self” to trauma practice and science. The article was written almost 20 years ago at a time when little appeared in main stream literature to guide the theory and clinical practice of psychotherapy with trauma patients. At that time the article introduced a post-traumatic developmental theory, and a systematic approach to the treatment of war stress in particular, and, according to contemporary trauma experts, established a general model for the treatment of psychological trauma in general. As the present article reviews the original article, it highlights core trauma responses and treatment principles that are likely to be applicable to traumatherapy far into the 21st Century.

This article discusses a new personality disorder entity, “traumatic stress personality disorder,” conceptualized as a composite organization with transactional properties that mutually structure post-traumatic stress disorder (PTSD) and personality disorders (PDs). The transactional/synergistic view of PTSD/PD comorbidity derives in part from scientific findings that PTSD's enduring biological effects are discernible in the personality of individuals 30 to 50 years or more after the overwhelming event, and from psychodynamic formulations on the development and structuring of personality defenses. An intertheoretical therapy model is also presented, and consists of multiple therapies actively integrated to meet the patient's complex post-trauma needs. This article argues for the development of theoretical, investigatory, and therapeutic measures to address PTSD/PD configurations in traumatized victims. Basically, the position espoused is that PTSD/PD should be measured as one rather than two entities, with neither component being considered as a confounding but integral factor in measurement. The eight components of traumatic stress personality disorder are discussed, along with a case study to demonstrate the model's clinical applications. The integration of cognitive, behavioral, psychodynamic, and existential treatment approaches is geared to assist the victim to developmental progress to survivor status, and then beyond this level of integration to thriver a person whose adaptational learning in therapy created a “vital psychological immune system” that consistently protects against dissociative regression in response to the daily stresses of life. Transference, countertransference, therapists' self-care and self-monitoring are seen as integral to the treatment of traumatic stress personality disorders.