chapter  4
Treatment design
Pages 13

Therapeutic processing comprises the gradual alteration or recovery of cognitive schemas. The erratic and overwhelming information that lies deep within when someone has gone through traumatic experiences that cause intense feelings of powerlessness and disrupt someone's life have to be integrated into the person's whole experience. According to the Dutch Multidisciplinary Guidelines for Anxiety Disorders, the 'indicated treatment' for posttraumatic stress disorder (PTSD) is cognitive behavioural therapy in combination with pharmacotherapy if necessary. Most of the evidence for effective treatment is with exposure and Eye Movement Desensitization and Reprocessing (EMDR). Clients will naturally tend to demonstrate avoidance behaviour when dealing with their trauma. The therapist has to encourage clients to be persistent, giving them control over the details they reveal to the therapist. The therapist is confronted with a dilemma and must decide whether it is better to respect the encapsulated memories of the traumatic experiences, or whether the client would benefit more from being confronted.