Psychotherapy for Complex PTSD
What is Complex PTSD?
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Many of us have heard of Post Traumatic Stress Disorder (PTSD). We often associate this mental health condition with war veterans or those who have experienced natural disasters or life threatening accidents. Such experiences can lead to the development of PTSD, which can be characterised by some of the following symptoms:
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Flashbacks where individuals re-experience the same dread, fear, and anxiety that coloured the traumatic event.
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Avoiding people and places that remind the individual of the traumatic event.
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Significant and debilitating psychological stress, anxiety, and/or depression.
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More recent research, however, has brought to light a subtype of PTSD often experienced by those who have been exposed to prolonged and recurrent trauma, previously not captured by the diagnostic criteria of PTSD: Complex PTSD.
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PTSD or Complex PTSD?
Complex PTSD is characterised by both symptoms of PTSD and disturbances in self-organisation. Self-organisation refers to how we regulate our emotions, how we perceive our identity, and how we relate to others. Individuals who experience prolonged, chronic, and recurrent trauma, such as child sexual abuse, domestic violence, or living in a long-term war zone, often have to develop ways of thinking and being in the world that will keep them safe. Some examples may be that a child learns not to trust people, or develops the belief that there is something inherently wrong with them to explain why their caregivers would abuse them, or they learn to dissociate when feeling under threat. Whilst ingeniously adaptive at the time, these behaviours and beliefs can become maladaptive and start to negatively impact individuals' lives when they become adults.
The Symptoms of Complex PSTD
In combination with PTSD symptoms, individuals with cPTSD often also struggle in the following ways:
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Difficulty regulating emotions
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Challenges seeking and maintaining healthy relationships or friendships
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A negative and/or limiting self-image
Individuals who chronically experience these symptoms may begin to have feelings of isolation, shame, frustration, anxiety, and depression, which can in turn perpetuate and exacerbate these disturbances in self-organisation. Whilst those with PTSD may find that their symptoms arise when they are around people or places that remind them of the traumatic event they endured, individuals with cPTSD are often struggling with their symptoms in most, if not all, domains of their life on a daily basis.
Healing at every level
- Holistic treatment for cPTSD
The Clinicians at The Spring Clinic take a holistic approach to change, where every level of experience is engaged as a vehicle for change. Our holistic approach is particularly important for those suffering with complex PTSD, wherein early experiences create a ripple effect throughout the development of mind, body and relationships.
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Cognition (Thoughts)​
The way complex PTSD influences our cognition is complex and multifaceted. One example is how it can shape our beliefs about ourselves and the world around us. Our worldview is strongly influenced by our early experiences in life. If children are exposed to recurrent acts of violence toward themselves or others, they are likely to develop the belief that the world is a dangerous place, people cannot be trusted, and they are not worthy of safety or love. On the other hand, children who live in stable, safe homes, where their needs are met, are likely to develop the belief that the world can be a safe place, people can indeed be trusted, and they are worthy of love and safety.
Affect (Emotions)
Complex PTSD can also shape our experience of emotions. Whilst we all experience shock and fear when confronted with a perceived threat, these emotions tend to dissipate when we are no longer in harm’s way. Those with complex PTSD not only tend to perceive more situations as threatening than those without, but they are also more likely to find it difficult to have the emotion move through and out of them. What this means is that they can experience much more frequent and prolonged experiences of difficult emotions, such as fear, anxiety, and stress. This can lead to emotional burnout, numbing, dissociation, and depression.
Sensate (Bodily feelings)
Complex PTSD can also lead to distressing sensory experiences. Due to the prolonged hypervigilance and anxiety that often colours the experience of those with complex PTSD, physical tension can build in the body. This can manifest as lower back pain, jaw clenching, indigestion, and headaches to name a few symptoms. Heart palpitations, chest pressure, and panic attacks are other difficult bodily experiences that those with complex PTSD can come up against.
Furthermore, when someone with cPTSD gets to a stage of burnout, they can lose connection to previously pleasurable sensations. An example of this would be previously delicious food not eliciting the same taste or a partner’s touch no longer being experienced as pleasurable.​
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Intrapsychic (the experience in our minds)
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A commonly known symptom of cPTSD is flashbacks, i.e. re-experiencing past traumatic events. Despite the event having occurred often decades ago, this re-experiencing can feel as though it is happening in the present. The fear, shame, disgust, outrage, psychological pain, or distress felt at the time of the trauma can arise and give the individual the impression that they are reliving the experience.
Another way cPTSD can influence the way the mind works is by attributing blame for the trauma experienced to the individual themselves. The reason this is such a common experience for those with cPTSD is that often the recurrent trauma, such as abuse, they experienced was in childhood and was perpetrated by their guardians, family, or other adults in their life. In order for a child to survive, they need to trust that their caregivers will look after them. So, if a caregiver abuses a child, then the child tends to interpret this harm as being deserved or caused by the child themselves. This allows them to continue to trust their caregivers, to whom their survival depends. Whilst a very adaptive response at the time, in adulthood this self-blame can become debilitating and extremely limiting, leading to significant intrapsychic distress.
Interpersonal (the experience in relationships)
Complex PTSD can influence the way we are in relationships. For example, if children experience security, love, care, and healthy boundaries from their parents or guardians, then they will likely have secure attachments with other people in their life later on. If children experience abuse from their caregivers or guardians, on the other hand, then they can learn that abuse can be a part of, or even necessary, for love relationships. This can mean that people with these experiences find themselves in dangerous and harmful partnerships.
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Another example of how cPTSD can influence the way we relate to others comes in the form of hyper-independence. When children grow up in an unstable environment, or their guardians were unpredictable, and care was not something they could rely on, they are required to become independent much earlier than developmentally appropriate. What this can mean later on in their lives is that they can find it difficult to accept support from their friends and partners. This can prevent the development of a mutual sense of safety and connection with people, which in turn can hinder the development of deep relationships. Lack of good connections with people further fuels the perceived need for independence, and so the cycle continues.
The Therapeutic Relationship in the treatment of cPTSD
The clinicians at The Spring Clinic utilise the therapeutic relationship as a unique and helpful way to understand and resolve complex PTSD.
As the origins of complex PTSD often originate in relational experiences, our memory associations from these events and our historical map for coping with these events are often re-enacted in relationships. This may lead to difficulties that the client is aware or not yet aware of in their friendships, familial, work or intimate relationships. These interpersonal challenges also usually reappear in the therapeutic relationship and we embrace these instances as an opportunity for healing.
Your therapist will take a collaborative, gentle and kind approach to supporting individuals with complex PTSD to reflect upon how they are experiencing the therapeutic relationship, predicting responses and enacting protective strategies which may mirror their ways of coping with relational experiences in the difficult experiences which led to complex PTSD. This provides an opportunity for a corrective experience, where you can have a healing experience of your therapist being a compassionate and different ‘other’, to the original person whom caused the distress. This allows you to notice and understand your feelings and thoughts in the present moment; and the potential for trying our new, more adaptive interpersonal solutions to difficult relational feelings.
This interpersonal method of working with complex PTSD is guided by our clinicians training and interest in psychodynamic and mentalisation based approaches to therapy.