Psychotherapy for Complex Trauma
What is Complex Trauma and who experiences it?
Many people have heard of the term PTSD – Post Traumatic Stress Disorder - a condition that sometimes follows overwhelming and life threatening events such as a road traffic accident, assault, torture or combat experience. PTSD is diagnosed when someone has been suffering symptoms (severe anxiety, flashbacks to the traumatic event and avoidance of reminders) for longer than four months after the event.
What is not widely known is that there are many people who are suffering from the symptoms of severe PTSD without it ever being diagnosed. These are people who have experienced long periods of neglect and/or abuse in their childhood and formative years, or perhaps people who have experienced long periods of domestic violence or bullying as adults. These people are living with the effects of complex trauma…terrifying events repeated over a long period of time.
How does complex trauma affect us?
Children have evolved to attach to their parents and carers and form strong bonds with them. If their carers are abusive, then children have to learn to adapt to this and form bonds with carers who are hurting and neglecting them. This affects the child’s sense of self, attitudes towards the world and other people. The traumatised child will develop an attachment style that instead of being secure is insecure and chaotic. They will expect mistreatment from others based on their repeated experiences and may even believe they deserve to be abused.
Many children cope with their suffering by dissociating before, during and after the terrifying events. This may take the form of physical numbing off or blocking one’s experience so that it does not stay in awareness. Highly traumatised children develop intricate and sophisticated dissociative states.
Sometimes traumatised people use alcohol, food, drugs, self harming, and even sex to cope – these attempts to cope distract them from their traumatic memories. Unfortunately this can lead to even more difficulties as life becomes more complicated as a result.
What kind of psychotherapy heals complex trauma?
Children who are repeatedly traumatised within family relationships grow up to develop insecure and disorganised attachments to other people. They benefit from a psychotherapeutic approach that takes their style of relating to others into account, gives them an opportunity to explore different aspects of their identity and helps them to test their models of reality inorder to create more adaptive and helpful models of the world.
The therapist helps the traumatised person to update their internal model of the world. Learning how to trust again, spotting cues that mean a situation is dangerous, understanding that just because they were hit as children they were not necessarily deserving of that.
Unfortunately traumatised people experience their own models of the world as protective even though they actually keep them trapped in patterns of relating that are retraumatising. For example, people may find themselves repeatedly having affairs that are inappropriate; they may find themselves attracted to people who hurt them; they may keep experiencing bullying in all their relationships and they may be struggling to cope with these painful situations in ways that add to their problems.
What does the trauma therapist do?
Therapists working with complex trauma develop a therapeutic relationship that offers respect, information, a real connection and hope that these difficulties can be overcome. The therapist encourages the traumatised person to overcome destructive relationships, keep behaviour within safe boundaries, become aware of when unhelpful patterns are being repeated and manage their levels of anxiety so they do not feel so much the need to dissociate by for example drinking or self harming.
Certain trauma therapies like EMDR help the traumatic information move from an unprocessed and chaotic memory stored in the body to a memory that is stored in the brain which can be understood and talked about. EMDR is a recommended treatment for simple PTSD (following one off events) and some EMDR therapists have adapted their approach to work with complex trauma .
Trauma therapists’ work is usually conducted in phases.
Phase one – establishes safety, manages anxiety and other symptoms
Phase Two – reprocesses traumatic memories so they stop being traumatic
Phase Three – strengthens new ways of living through repeated practise in the therapy relationship and elsewhere.
Why are short term approaches inappropriate for treating complex trauma?
Because complex trauma changes one’s attachment style, identity and models of the world, short term treatments do not provide the consistently safe therapeutic environment that is needed for such patients to risk change.
In fact short term therapy can have the effect of confirming people in a belief that they are ‘untreatable’, ‘difficult’ or ‘too dependent’ and that there is no person with whom they can form a safe enough relationship. When someone has coped for years with trauma, they need to take time to trust the therapist before they can feel safe enough to talk candidly about their experience.
There is a large and consistent body of evidence to support this view within the trauma field. To find out more see the resources listed in the panel to the right