Tailoring Treatment to the Individual

Even with a foundation of strong therapeutic alliance and a clear rationale for treatment that the patient understands and accepts, and even when the therapist has followed the procedures described in the previous chapters, sometimes the patient does not seem to improve as much as we would expect. Common obstacles to the expected decreases in posttraumatic stress disorder symptoms and related distress include avoidance, being under- or overengaged emotionally during revisiting and recounting the trauma memory, intolerance of emotional distress, and persistent dominance of a specific negative emotion that diminishes the processing of other important emotions that the patient needs to digest.