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BOOK REVIEW

October 1, 1999

Paul Valent, co-founder of the Australasian Society for Traumatic Stress Studies, has written two books that examine the variety of adverse effects experienced by victims of trauma and the various treatment methods and techniques to treat these effects.

In Trauma and Fulfillment Therapy: A Wholist Framework, Valent describes his wholistic framework in detail. First, he defines the field of traumatology as the study of serious threats to the survival and fulfillment of life. According to his definition, then, trauma potentially disrupts every aspect of human fulfillment. In his approach to treatment, he relies upon a triaxial framework with axes of process, parameters and depth. The process axis is the process from stressors to trauma to illnesses or adaptations. The parameter axis describes parameters of the situation including the type of trauma, phases of disaster, life cycle phase of victims and social parameters. The depth axis defines the level of human function in all its aspects (moral, value-based, spiritual, physiological and instinctive). The wholist perspective described in this book helps to make sense of and bring meaningful categorization to the trauma that plagues humans.

The book also describes overarching treatment principles (called treatment elements or ingredients) in detail. They include recognition and diagnosis of trauma and its ramifications, non-specific therapy, symptomatic treatment, and specific trauma and fulfillment treatment.

There are many case studies throughout the book. Several of them examine the clinical application of the wholist perspective. A well-made point by Valent is that even the most extreme adaptation to trauma can benefit from therapy. The wholist perspective in therapy places traumatic material in perspective and explores adaptive alternatives and possibilities for future happiness and resolution. Wholist treatment may also be tailored to early treatment situations as it broadens views of symptoms, while still placing those symptoms within sensible diagnostic categories.

In the second book, Valent presents the history of PTSD treatment and then looks at four common principles: (1) recognition of trauma, its effects and amenability to treatment; (2) nonspecific aspects of the therapeutic milieu and a safe and caring environment, (3), treatment of symptoms through drugs, relaxation and anger management; and (4) specifics of trauma treatment.

According to Valent, there is a recognized understanding that individuals experience stress and enter a state of trauma when stressors challenge life-enhancing equilibria. This stress response can have biological, psychological and social ramifications. Individual vulnerabilities and strengths that facilitate the noxious effect of stressors affect these responses. These factors include background and disaster characteristics, vulnerabilities arising from previous traumas, transgenerational (genetic, cultural and trauma-specific) experiences and individual strengths. Collectively these factors create an individual repertoire of defenses that mitigate the potential and actual effects of trauma and serve as survival strategies in each person. Traumatic memories are the reverberations of these events and their defenses.

The book, From Survival to Fulfillment: A Framework for the Life-Trauma Dialectic, provides a means of understanding the wide variety of trauma and fulfillment responses and a framework that can be applied to make sense of the diverse treatments for traumatic stress.