ABSTRACT
The efficacy of psychological therapies is determined by randomised controlled trials (RCTs). However, the translation of positive findings in RCTs to routine practice is problematic, if the two contexts differ substantially. For example, if the education level in an RCT is markedly higher than in the context to which treatment is to be applied or if clients with significant pain were ruled out of the RCT. Rarely is the effectiveness of a psychological treatment evaluated in routine practice, without the input of researchers involved in the development of the original treatment protocols and evaluated independently by clinicians. Despite this, trauma-focussed CBT or EMDR have been held up as the model treatments for trauma victims with PTSD, yet the RCTs demonstrate an at most 50% recovery rate, in the sense of clients losing their diagnostic status. Further, there is a paucity of evidence as to the trajectory followed by responders to these treatments. Even less is known about the effectiveness of psychological treatments for non-PTSD disorders that may arise post-trauma. There is clearly much room for improvement in the quality of psychological services delivered in routine practice. The evidence is that client's wish for all their disorders to be addressed not just one. This makes comprehensive screening essential and options for conducting this are considered in this chapter.
