A Critique of the American Psychological Association Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults

The American Psychological Association (APA) Guideline Development Panel for the Treatment of PTSD in Adults published the Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults in 2017, which is the first of a series of practice guidelines that will roll out over the next several years. Although the Guideline is the product of tremendous effort and expertise, it is problematic for several reasons, including hidden and flawed economic assumptions and consequences, exclusive reliance on evidence from randomized clinical trials (RCT), the limited definitions of critical outcomes, the unquestioned virtues of guidelines, inconsistencies with APA's (2012) resolution Recognition of Psychotherapy Effectiveness and the emphasis on therapy packages/brands, the formulaic connection between diagnosis and treatment, among other issues. Psychoanalysts and psychoanalytic psychotherapists should be concerned about the absence of psychoanalytic/psychodynamic therapies from the Guideline, not only because of the long history psychoanalysis has with treating PTSD, but also because the Guideline could become a template for other guidelines and could limit psychoanalytic models of therapeutic practice, exert too powerful an influence over what constitutes ethical practice, and adversely affect funding (both third party payers as well as federal funding for research). Those invested in psychoanalysis must be active in the process of developing, reviewing and approving these guidelines.