Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD

Drs. Foa and Rothbaum, both well-recognized researchers and practitioners, have written a book delineating how women who are traumatized by rape adapt to this intrusion of violence into their lives and how those who develop posttraumatic stress disorder (PTSD) recover.

In turning the unabashed eyes of scientists to the treatment of PTSD, Foa and Rothbaum present a description of the disorder based on the research literature. From there they develop a rationale for treatment and go on to present a detailed manual for conducting effective treatment programs for patients.

Although the authors describe the treatment of female rape victims, they make a point to encourage the clinician to develop specific treatment programs for individuals who suffer PTSD from other traumas. Because patients differ in why they suffer, they offer guidelines for choosing a treatment program based on the varieties of dysfunctional beliefs held by patients with PTSD.

At the core of the rationale for treatment is Foa's theory of "emotional processing" in which PTSD can be viewed as an impairment in the "emotional processing of a traumatic experience." At the heart of the treatment for this failure in processing is the authors' description of "prolonged exposure" to promote the integrative processing of violence. Why and when to add other, specific anxiety management and cognitive-behavioral techniques are discussed, and how to carry out the treatment is detailed extensively.

As the title describes, this book is a cognitive-behavioral treatment manual. Discussion of psychodynamic and other psychotherapies for PTSD are limited to comparisons based on studies of efficacy. The authors point out problems in methodology in all the studies they review. As far as psychodynamic approaches are concerned, they add that newer studies are employing more rigorous standards and that outcomes from them will permit more objective evaluation of the efficacy of these approaches.

Also, Foa and Rothbaum deliberately do not describe the treatment of PTSD in patients who suffer from more complex constellations of disorders that frequently coexist with PTSD such as dissociative identity disorder or borderline personality disorder. However, the authors suggest, and one can conclude from reading the book, that a clinician could use the techniques described within a broader framework of treatment for individuals with more severe difficulties.

The authors succeed in their aims to describe PTSD, review the research on treatment, and describe a program for recovery. In addition, Treating the Trauma of Rape is imbued with the sense of compassion that they bring to the individuals they treat. This book will be particularly useful to psychologists, psychiatrists, crisis workers, social workers, and others who respond to victims of violence. Foa and Rothbaum address the book to "all mental health professionals who have chosen the difficult but rewarding path of trying to help women overcome the devastating experience of sexual assault." They succeed in helping all of us who work with victims of trauma develop a treatment approach that we can use not only to understand our patients' suffering but also to teach them that recovery can and does occur.