Phase-based approaches for treating complex trauma: a critical evaluation and case for implementation in the Australian context

ABSTRACT

Phase-based approaches are a recommended treatment option for individuals with complex trauma histories; however, this is based on a limited body of empirical evidence. Phase-based approaches often involve two stages of treatment, with one focusing on safety and stabilisation and phase two on trauma memory processing. Historically, the Australian Better Access Scheme offered a government rebate for up to 10 group and 10 individual psychological sessions annually. In response to the coronavirus pandemic, the number of rebated individual sessions has been increased to 20 through June 2022. Combining individual and group session rebates, phase-based approaches that include both treatment modalities represent a feasible and accessible treatment option for complex trauma. Delivering phase one in a group milieu and providing individual treatment during phase two may be cost effective and optimise outcomes by leveraging the benefits of group and individual treatment for complex trauma. This article aims to provide an overview of the psychological impact of complex trauma, to highlight barriers to seeking mental healthcare, and to critically evaluate phase-based approaches for treating complex trauma. We highlight gaps in the research, followed by a discussion regarding the benefits and limitations of using this approach in the Australian mental health care system.

Key points

What is already known about this topic:

• (1) Individuals with complex trauma face barriers when seeking psychological treatment in Australia, including the affordability of specialised mental health care.

• (2) The number of Medicare-rebated sessions provided by the Better Access Scheme to treat mental health problems is at times inadequate, and clients bear the burden of cost for extra treatment.

• (3) Despite garnering support from trauma experts, phase-based treatments for trauma related disorders have promising but limited empirical support.

What this topic adds:

• (1) Updating prior reviews, a rapid review of the literature identified 15 peer-reviewed papers that examined the delivery of a phase-based treatment for individuals with histories of complex trauma, demonstrating the ongoing implementation of this treatment approach.

• (2) A phase-based treatment approach for complex trauma is a feasible, accessible and cost-effective option under the current Better Access Scheme, which offers rebates for up to 10 individual sessions (increased to 20 in response to the COVID-19 pandemic through June 2022) and 10 group sessions annually.

• (3) A phase-based approach that combines group and individual therapy may enable clients to benefit from both group and individual interventions and facilitate continuity of care.

KEYWORDS:

• Australia
• better access scheme
• complex posttraumatic stress disorder
• phase-based treatment
• complex trauma

Acknowledgments

The researchers would like to acknowledge the Australian Government Research Training Program Stipend award to KdeB and IG.

Disclosure statement

The authors of this publication, namely KdeB, JLM, DW, DE and MN, disclose that they have been involved in developing and implementing a phase-based approach for complex trauma at the The Swinburne University of Technology, which is currently being evaluated.

Supplementary material

Supplemental data for this article can be accessed at https://doi.org/10.1080/00050067.2021.1968274