Unburdened by false humility, postmodern trauma activists claim to have understood for the first time what drives all of human suffering
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CATEGORY: GOVERNMENT PROJECTS  Kim Boswell, MSW, Commissioner of the Alabama Department of Mental Health Source: Alabama Daily News Read time: 2.1 minutes This Happened On February 17, 2025, the Alabama Department of Mental Health (ADMH) announced the launch of a pilot program to train providers across the state in the Trauma Systems Therapy (TST) model. Who Is Doing This? Kim Boswell, MSW, ADMH Commissioner since December 2020, spearheaded the project. The pilot will be conducted in partnership with Gateway, a non-profit organization based in Birmingham. Gateway previously received a federal grant from the Substance Abuse and Mental Health Services Administration to train its own staff in this model. The Premise The attendees at the training will be ADMH leadership and mental health staff who work with schools. The Department hopes to eventually expand the initiative to every provider that works with children in the state. The TST model is designed for children living with poverty, racism, inadequate schools, and community violence [1]. Thus, it is not for all types of trauma victims. The unique TST definition of traumatized children in such systems is those who have difficulty regulating their emotions and behavior, combined with inadequate social environments that are unable to protect them from reminders of threats [2]. Hence, much of the focus in TST is to address systems in which children exist, rather than individual psychotherapy. The model posits a belief that recovery occurs in five hierarchical phases: 1. Surviving, 2. Stabilizing, 3. Enduring, 4. Understanding, and 5. Transcending. Critical to the model is the belief in the theory of toxic stress in which humans are fragile and trauma permanently damages brains. Child victims are so fragile that insensitive classrooms can trigger them emotionally and cause disruptive behaviors and academic failure. The purpose of the trainings is to install the intellectual framework for the TST model. As Boswell stated, “The model really is both a clinical model and an organizational model, and really where you have to start is having your leadership understanding trauma and how that impacts the behavior of kids.” The desired outcomes of the project will be a decrease in the number of children being removed from families, an increase in the number of families willing to foster children, and an overall improvement in child mental wellbeing. The governor’s budget denied ADMH’s request for funding for 2026. But Boswell feels so strongly about the program, she promised to find funds from elsewhere. Analysis Minimal, and mostly negative, evidence exists on the ability of TST to treat trauma. One trial showed improvements but lacked a control group [1,3]. The only existing randomized trial was tiny (10 in TST versus 10 in care-as-usual) and failed to show improvement on total PTSD scores within the TST group [4].
Complex PTSD is another model that conflates stress with trauma. Saxe, however, has opted to develop his own model that shares a highly similar conceptualization of trauma responses. The TST model emphasizes treating attachment and emotional dysregulation, which makes it indistinguishable from complex PTSD. Another concern about TST is the five-phase model is completely unvalidated. There is zero systematic evidence that recovery from stress proceeds according to phases. In the history of psychiatry, whenever sequential phases have been posited, they have always been found to be overly simplistic and unrealistic [6,7]. Dissemination of the TST model across Alabama’s providers who work with children will be a disaster. Not only does if fail to treat true trauma, it will waste resources and funding, it spreads disinformation that humans are fragile and that trauma damages brains, conflates stress with trauma, and promotes the fake complex PTSD concept. References [1] Saxe GN, Ellis BH, Fogler J, Hansen S, and Sorkin B (2005). Comprehensive Care for Traumatized Children. Psychiatric Annals, 35(5), 443–448. DOI: 10.3928/00485713-20050501-10. [2] Navalta CP, Brown AD, Nisewaner A, Ellis BH, and Saxe GN (2013). Trauma systems therapy. In Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models. (pp. 329–347). [3] Ellis BH, Fogler J, Hansen S, Forbes P, Navalta CP, and Saxe G (2012). Trauma systems therapy: 15-month outcomes and the importance of effecting environmental change. Psychological Trauma: Theory, Research, Practice, and Policy, 4(6), 624–630. DOI: 10.1037/a0025192. [4] Saxe GN, Ellis BH, Fogler J, and Navalta CP (2012). Innovations in practice: Preliminary evidence for effective family engagement in treatment for child traumatic stress–trauma systems therapy approach to preventing dropout. Child and Adolescent Mental Health, 17(1), 58–61. DOI: 10.1111/j.1475-3588.2011.00626.x. [5] DePierro J, D’Andrea W, Spinazzola J, Stafford E, van Der Kolk B, Saxe G, Stolbach B, McKernan S, and Ford JD (2022). Beyond PTSD: Client presentations of developmental trauma disorder from a national survey of clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 14(7), 1167–1174. DOI: 10.1037/tra0000532. [6] Littell J, Girvin H (2002). Stages of Change: A Critique. Behavior Modification 26(2):223-23. DOI: 10.1177/0145445502026002006. [7] Stroebe M, Schut H, and Boerner K (2017). Cautioning health-care professionals: bereaved persons are misguided through the stages of grief. Omega 74, 455–473. DOI: 10.1177/0030222817691870. Comments are closed.
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