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Treating Attachment Trauma with Plain Old Therapy

In our quest to hew to evidence-based practice, we therapists are victims of our professional fecundity: “Unless there is functional equivalence among different manualized renditions of the same treatment, the practitioner who wants to apply ESTs [empirically supported treatments] to his or her practice is faced with the daunting problem of learning 150+ specific manualized treatments” (Malik, Beutler, Alimohamed, Gallagher-Thompson, & Thompson, 2003, p. 151). In the face of the daunting challenge of mastering an array of therapies, a comprehensive review of decades of psychotherapy research yields the following irony: “It is hard to find a treatment that works better than another treatment and all seem to be better than doing nothing” (Beutler & Castonguay, 2006, p. 5). In the trauma field, concerted efforts have been made to sort the wheat from the chaff in grading treatments according to the extent and quality of research on their effectiveness (Foa, Keane, Friedman, & Cohen, 2009). Leading contenders for treating posttraumatic stress disorder (PTSD) include prolonged exposure and cognitive therapy, with significant overlap between them. Although exposure therapy is to be commended for the sheer extent of supportive research and the relative simplicity of the treatment protocol, its efficacy is not demonstrably superior to other effective therapies. It also bears noting that—to varying degrees—exposure is common to trauma therapies of different varieties; moreover, the mechanisms by which exposure works are anything but straightforward. Various brands of therapy have evolved and been researched in relation to narrowly defined psychiatric disorders, PTSD among them. Yet Foa and