Teaching trauma-focused exposure therapy for PTSD: Critical clinical lessons for novice exposure therapists
Open accessAbstract
Over the past 10 years, our experiences delivering exposure therapy and teaching clinicians to deliver exposure therapy for PTSD have taught us some important lessons. We will focus on lessons learned as we have attended to clinicians' experiences as they begin to implement and apply the therapy. Specifically, we highlight common therapist expectations including the beliefs that the exposure therapy requires a new set of clinical skills, therapists themselves will experience a high level of distress hearing about traumatic events, and clients will become overly distressed. We then discuss common clinical challenges in the delivery of exposure therapy and illustrate them with case examples. The challenges addressed include finding the appropriate level of therapist involvement in session, handling client distress during treatment, targeting in-session covert avoidance, and helping the client shift from being trauma-focused to being more present and future oriented. Clinicians training exposure therapists and therapists new to the implementation of exposure therapy for PTSD should find this practical discussion of common expectations and initial clinical challenges reassuring and clinically useful.
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Some clinicians are apprehensive about conducting exposure, reporting fears of harming clients, potential vicarious traumatization, and increased malpractice risk.
“Past research has shown that some clinicians are apprehensive about conducting exposure, endorsing fears of harming clients (Deacon, Lickel, Farrell, Kemp, & Hipol, 2013), potential for vicarious traumatization to the therapist as well as being unacceptably aversive to clients (Zoellner et al., 2011), and increased malpractice risk (Richard & Gloster, 2006).”
From Conducting exposure and response prevention treatment for contamination fears during COVID-19: The behavioral immune system impact on clinician approaches to treatment (2020) · cites this paper as Zoellner et al., 2011
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- Authors
- Zoellner, L. A., Feeny, N. C., Bittinger, J. N., Bedard-Gilligan, M. A., Slagle, D. M., Post, L. M., & Chen, J. A.
- Affiliations
- University of Washington (US)
- Case Western Reserve University (US)
- Venue
- Psychological Trauma: Theory, Research, Practice, and Policy
- Published
- 2011
- Volume
- 3
- Issue
- 3
- Pages
- 300-308
- ISSN
- 1942-9681 (ISSN-L)
- 1942-969X
- PMC
- PMC3188445
- OpenAlex
- W2082104583
- Cited by
- 52
- References
- 13
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 4 · 2015: 1 · 2014: 2 · 2013: 4 · 2012: 1
- FWCI
- 2.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Trauma Theory Research Practice and Policy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01 MH066347, R01 MH066348)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- post-traumatic stress disorder, therapist training, therapist expectations
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