course materials

1. Reply to the post, state whether you agree with your peers. Read and
respond in
Reply to the post, state whether you agree with your peers. Read and respond in a scholarly
fashion, commenting on how they incorporated theory with evidence-based practice. At a
minimum, your response should be three to four paragraphs of three to four sentences
each.The purpose of this initial discussion post is to provide scholarly discourse for the
perpetuation of knowledge within the student Psychiatric Mental Health Nurse Practitioner.
Specifically, the clinical parameters for identification, assessment, psychotherapeutic
strategies of Client-Centered Therapy (CCT) for utilization in patients that have experienced
trauma. Peer reviewed clinical research will be included within the discussion for the
utilization of different psychotherapeutic techniques of CCT for patients that have
experienced trauma and/or have been diagnosed with Post Traumatic Stress Disorder
(PTSD). CCT for the treatment of PTSD will be discussed for patients throughout the age
spectrum, including children, adolescence, adult, and older populations.Childhood trauma
may manifest within psychiatric disease. This may include post-traumatic stress disorder
(PTSD), acute stress disorder, and adjustment disorder. According to Boland et al. (2022),
PTSD is associated with anxiety following exposure to traumatic stressful events including
but not limited to: accidents, crimes, military combat, assault, natural disaster, diagnosis
with life-threatening illness, and physical or sexual abuse. Patients with PTSD have negative
thoughts associated with the events, experience flashbacks, and avoid reminders that create
these stressors. These patients may organize their lives to contain and mitigate the effects
of the traumatic experiences. Moreover, victims of rape or torture may have difficulty with
physical touch. These patients are hypervigilant and scan their environments for signals,
remain on guard, and on-edge. Other symptoms may include nightmares, dissociative
responses with flashbacks including depersonalization/derealization, impairments of
memory related to the event, negative perceptions of self and others, increased startle
response, and difficulties with concentration. Acute stress disorder mirrors the symptoms
of PTSD with intrusion, avoidance, negative mood, and hyperarousal, but is limited to
occurring 3 days to 1 month following a traumatic event.PTSD is closely related to Adverse
Childhood Experiences (ACEs) experienced by children during early stages of
neurodevelopment. ACEs are repetitive traumatic exposure endured by a child that places
them at risk for chronic health problems, mental illness, and substance abuse in adulthood.
This may include traumatic experiences including but not limited to neglect, witnessing or

2. experiencing violence, having a family member attempt or die by suicide, house hold
challenges, bullying, teen dating violence, and community violence. Risk factors for ACEs are
related to families with caregiving challenges for special needs, children who date early, or
engage in sexual activity, caregivers with limited understanding of a child’s needs or
development, low income, single parents, high levels of parenting or financial stress,
corporal punishment for discipline, isolated families, community risk factors, and high
conflict with negative communication styles. (Centers for Disease Control and Prevention,
n.d.).Corey (2021) describes person-centered theory, created by Carl Rogers, as an
approach that includes fundamental assumptions of patients including their
trustworthiness, potential for understanding themselves, resolving their own problems, and
having an ability for self-directed growth through therapeutic relationships. Thus, Rogers’
approach is based on three major attributes: congruence (genuineness), unconditional
positive regard (acceptance and caring), and accurate empathic understanding (grasping
the subjective world of the other person). The outcome of therapy was related to the
therapist and the relationship between therapist and patient. Theory and techniques were
secondary to the ability of the patient’s capacity for self-healing. Rogers rejected the
psychoanalytical model of therapy and challenged the validity of therapeutic procedures of
providing advice, suggestion, direction, persuasion, teaching, diagnosis, and interpretation
(p.166). He purported that these concepts were often misused and judgmental. Rogers
sought to test his underlying hypothesis of the client-centered approach through research
into psychotherapy. He and his colleagues identified the ingredients for psychotherapy that
could cause a therapeutic change. With confirmation that personal and interpersonal
factors, rather than specific techniques were contributory to therapeutic change, Rogers
essentially theorized that since perspective is subjective, only the subject can be the best
expert on the subject of self (Corey, 2021).Trauma-focused treatment therapies for children
and adolescents are effective in treating core symptoms and usually share several things in
common: 1) parental involvement; 2) development of coping skills and mechanisms; and 3)
therapist-guided structured retelling of the traumatic story (Wilson & Joshi, 2018). Parental
involvement in psychotherapy is thought to be an efficacious treatment for PTSD in children
and adolescents (Brent et al., 2022). This type of therapy addresses the patient’s reactions
to trauma through the parent-child relationship (Brent et al., 2022). Younger children are
seen with their primary caregiver in sessions that focus on emotion regulation and changing
maladaptive behaviors (Brent et al., 2022). Exposure to trauma triggers is usually
encouraged in order to desensitize children and aid in processing the traumatic experience
in a different context (Wilson & Joshi, 2018). This also allows the child to develop coping
skills in managing the emotions and thoughts linked to the traumatic memories (Wilson &
Joshi, 2018). For school-age children, a more structured approach is required and studies
show that strategies that include psychoeducation about the effects of trauma, teaching
coping skills, developing safety skills, and being able to process the traumatic experience
through a constructive narrative are the most effective (Brent et al., 2022). While the parent
is still involved, the sessions may not always be with the parent and child (Brent et al.,
2022). Activities and sessions should be flexible and customized to the needs and
development of the child (Brent et al., 2022). For example, for the younger school-aged

3. child, puppets or drawing may be appropriate; however, for the older school-aged child,
writing may be more suitable. For adolescents, exposure therapy has been shown to meet
the needs of teens (Brent et al., 2022). It includes psychoeducation about the effects of
trauma as well as training in breathing techniques to manage stressful situations or
traumatic triggers (Brent et al., 2022). Adolescents are carefully exposed to previously
avoided situations or activities associated with the trauma, and are prompted to repeatedly
retell their traumatic story during sessions (Brent et al., 2022). Although parental
involvement is essential, their present is not required or necessary for successful therapy
sessions (Brent et al., 2022).Using a CCT approach, the therapist focuses on building a
trusting relationship with the parent and child and encourages self-efficacy while allowing
the parent and child to be in control (McLean et al., 2017). The idea is that through
empathetic understanding, therapeutic genuineness, and unconditional positive regard, the
therapist can aid in the parent and child’s ability to develop competence to cope with
stressful events (McLean et al., 2017). The emphasis is on rebuilding interpersonal trust
(which may have been disrupted due to the unintentional harm of the child), choice and
control (to address feelings of being out of control), and confidence in the parent and child’s
ability to overcome struggles (McLean et al., 2017). In this kind of therapy, the parent and
child guide the pace and content of the session (Corey, 2021). The therapist acts as a guide
and uses the techniques of active listening, reflection, limited interpretations and little to no
direct advice giving (Corey, 2021). The therapist tries to draw out solutions and strategies
rather than prescribing ideas (Corey, 2021). Play and art materials can be provided for use
to process emotions and expressions such as anger or aggression (McLean et al., 2017).
Parental expression is also encouraged and helps to decrease parental stress so parental
availability for the child is optimized (McLean et al., 2017).Cue-centered treatment is a
method of therapy that addresses symptoms in children who have experienced long-term
chronic trauma (Wilson & Joshi, 2018). It recognizes that children with complex trauma
may not gain optimal benefits from focusing on a single trauma (Wilson & Joshi, 2018).
Rather, this type of treatment focuses on aiding the child to become their own agents of
change through development of coping mechanisms, increasing insight into relationships
between the trauma experiences and emotional and behavior responses (Wilson & Joshi,
2018). This falls in line with the main ideologies of CCT where the key factor is empathy
(Rachamim et al., 2021). Empathy is crucial in the engagement of trauma survivors,
especially those who suffered interpersonal violence and have developed images of others
as distrustful or unhelpful (Rachamim et al., 2021). Offering an empathetic relationship with
unconditional positive regards is more likely to lead to positive outcomes (Rachamim et al.,
2021).The application of CCT within the utilization of PTSD for the adult and older adult
requires a fundamental comprehension in the psychosocial state of the adult. Erik Erikson’s
psychosocial stages for the adult, roughly aged 40 to 65, discusses this period of
development to be the measurement of success of an individual in their usefulness and
accomplishment. At this stage of development, either an individual has become useful, but
otherwise would have a failure in usefulness that would result in a lessened involvement in
the world. This period is commonly discussed as generativity versus stagnation (Corey,
2020). The adult will either gain greater generativity with promotion of acts to propel

4. themselves and their community forward. It is described as a period in which the adult
raises children, gives back to society, becomes active in their community, and develops
themselves within the greater good. However, the lack of development of generativity
results in stagnation, a lack of involvement within the world related to unproductivity,
disconnection, and isolation.Within the older adult, aged 65 and older, Erikson described
ego integrity versus despair as the final stage within psychosocial developmental stages.
This stage is described by Erikson as a reflective view of the past. The older adult
comprehensively evaluates their previous actions and events with success encompassing
fulfillment of wisdom and ego integrity. A failure in the reflective view upon life is met with
guilt, dissatisfaction, and ultimately despair within the older adult (Corey, 2020).As
previously discussed CCT requires the utilization of the patient to have a potential to
understand themselves and resolve their own problems. When applied to PTSD, the patient
may carry over trauma suffered throughout their life with maladaptive self-processing. The
adult patient will typically follow the American Psychiatric Association’s (2013) DSM
qualifications including traumatic event with negative thoughts, flashbacks, avoiding
reminders, fearfulness, hypervigilance, nightmares, dissociation,
depersonalization/derealization, and memory impairments. These symptoms can also
manifest within the setting of other mental illness related clinical features, including but not
limited to depression disorders, anxiety, and substance use disorders (Sareen, 2023). The
concurrent diagnoses with PTSD require the utilization of different, evidence-based
psychotherapeutic techniques. Specifically, solution-focused behavioral therapy, and
motivational interviewing for substance use disorder. However, the integration of CCT can
still be applied, especially within the onset of therapy, and building of patient rapport.The
psychotherapist within the CCT role employs congruence, unconditional positive regard,
and accurate empathetic understanding (Corey, 2020). Therefore relationship building with
determination of the patient’s maladaptive behaviors within the setting of their past trauma
allows the adult and older adult patient to provide their personal experiences. The
increased clinical distress of living throughout a life, and into adulthood with poor
adaptation to previous trauma can provide difficulty. Specifically, complex relational and
interpersonal difficulties related to previous childhood abuse and trauma carried into
adulthood can be difficult to treat. The treatment recommendations are primarily for
cognitive behavioral therapy and eye movement desensitization for PTSD. However, these
therapies are based within the humanistic-experimental psychotherapies. A randomized
controlled trial looking at the effects of emotional processing in therapy with patients with
childhood abuse found that emotion self regulation or support counseling with exposure
was better than exposure alone (Cloitre et al., 2010).Exposure therapy is intended to
facilitate emotional processing, but without attending to emotional regulation or within a
well-established counseling relationship is clearly less effective. A key factor within the
person-centered therapies is empathy. Those that have suffered interpersonal violence or
abuse. Offering a genuine caring relationship, based within empathy is crucial to long-term
success. This may be related to the continued rapport developed between the patient and
the psychotherapist, with better engagement. Nevertheless, CCT is grounded within the
relationship based practices shows a small, but ever growing evidence for its utilization

5. within trauma-focused disorders.Limitations to Rogers’ person-centered theory are the
requirement for a non-judgmental, empathetic, and genuine therapist. Roger was constantly
adapting his approach and evolving its usage with contexts spanning individualized therapy
to politics in efforts to achieve world peace. The positivity, and promotion of a patient has
usage in people that generally have an aptitude for personal growth or can self-compensate
for their mental illness’. However, with more pronounced and severe cases of mental illness,
this approach may have limited success.