Psychodynamic Case Formulation: A Roadmap to Protocol Adaptation in CBT

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Cognitive–behavioral approaches are considered the treatment of choice for traumatic stress reactions in childhood. In spite of documented effectiveness of these approaches in reducing traumatic reactions, criticism has been raised regarding difficulties in implementing these treatments effectively in community-based clinical settings. In these settings many of the children suffer from complex and multiple traumatic experiences, live in chaotic households, and have parents that are often traumatized themselves and struggle to provide the support expected in those treatment approaches. Using a case study of a patient with complex trauma, this paper will demonstrate the challenges involved in implementing short-term, evidence-based cognitive–behavioral treatment in the community. It will offer a model for psychodynamically informed protocol adaptation, and demonstrate ways in which integrating psychodynamic case formulation can enable effective implementation of cognitive–behavioral treatment protocols with complex cases.

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