The book’s introduction offers an interesting exploration of why the empirical treatment literature does not always guide common clinical practice. Most obvious is the fact that many important treatment questions have not yet been addressed empirically. For example, few, if any, well-controlled studies examine combined treatment with medications and psychotherapy or the use of multiple medications. More fundamentally, clinicians and researchers are often separated by boundaries of inconvenience. Clinicians use techniques with which they are familiar, and researchers favor interventions, treatment settings, and diagnoses that are tractable to study. Therefore, most intervention studies exclude complicated patients (such as those with medical problems, substance abuse, or suicidal behavior) with whom clinicians struggle most. Additionally, outcome studies do not speak to the crucial processes of identifying and linking trauma to symptoms, establishing a therapeutic contract, and engaging patients in treatment planning. As the authors of chapter 1 point out, "Rather than studying the initiation of the treatment relationship, clinical trials begin at the end of this process."