Neglect of the complex: why psychotherapy for post-traumatic clinical presentations is often ineffective


Evidence of efficacy in studies of post-traumatic conditions is largely
derived from studies in which variables are kept to a minimum. Extrapolation of
treatments from uncomplicated disorders to complex conditions may therefore be
called evidence-based without being evidenced. Complex conditions with polysymptomatic
presentations and extensive comorbidity are being denied proper
evaluation, and patients most severely traumatised from the early stages of their
development are not provided with rigorously evaluated psychotherapies because
they are more difficult to study in the manner approved by research protocols. Such
evidence as there is suggests that the simple extension of treatments for
uncomplicated disorders is seriously inadequate. This has significant implications for
health services responsible for the provision of the most efficacious treatments to
those whose disorders arise from severe trauma, often very early in their life.

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