Can I Recover?
Complex PTSD is a set of learned responses to ongoing stress and trauma of an interpersonal nature, and as a result, does respond to treatment. According to Courtois (2014): "...there is no need for despair because, along with all the other things we have learned about trauma over the course of the past several decades, a number of treatment methods have been developed, tested, and proven effective" (p. 74). It is important to seek out a therapist who is knowledgeable about trauma, specifically Complex PTSD so that the treatment you receive is both relevant and effective.
Trauma Informed Treatment
There is a wide range of therapeutic approaches available, but what is crucial is to find a therapist who has specialized knowledge and experience in treating trauma disorders, specifically Complex PTSD (i.e., given it differs from PTSD). Depending on the type of therapist you see, you may require a referral from your General Physician (GP) who may or may not be familiar with Complex PTSD. As such, it may be helpful to to complete the OOTS form Causes and Symptoms of Complex PTSD, and take copies of the OOTS information sheets, The Diagnosis of Complex PTSD and the Fact Sheet about Complex Trauma for GPs developed by the Blue Knot Foundation. Your GP should be able to assist you with locating a suitable therapist, but if not there are a number of online databases to help you search for one.
- Good Therapy - http://www.goodtherapy.org/find-therapist.html
- The International Society for Traumatic Stress Studies - http://www.istss.org/source/cliniciandirectory/
- The Sidran Institute [for trauma] - You can't search directly at this site, but there is a help desk. Please note that the email listed is incorrect and should be firstname.lastname@example.org
United States and Canada
- Psychology Today - http://therapists.psychologytoday.com/rms/prof_search.php
- Theravive - http://www.theravive.com/. Note: This DB also lists therapists who offer distance therapy at http://www.theravive.com/therapists/e-counseling.aspx
You may wish to review and take a copy of the foundation's Fact Sheet for Health Practitioners when going to meet with a therapist. Courtois (2014) recommends asking the following questions to gauge the therapist's knowledge and training in trauma informed treatment:
- What professional organizations do you belong to? Are you active in these organizations?
- Do you understand complex trauma [Complex PTSD]? How do you define it?
- Have you ever treated a complex trauma survivor? How many?
- If so, what methods did you use, and why? Have you had specific training and supervision in that method? How long have you practiced it?
- Do you have experience treating common co-occurring conditions (addiction, dissociation, etc)?
- Do you know how to help me to establish safety in the moment? In the long run?
"[E]ducation regarding the connection of past trauma to present-day behaviors should start early in the treatment process to provide a context. This is known as trauma informed treatment" (Courtois, 2014, p. 23). Although there are any number of therapeutic approaches available, research (Courtois, 2014; Kezelman & Stavropoulos, 2012), suggests there are three general stages that are most effective in the treatment of Complex PTSD:
- Assessment, stabilization and development of self-care and protection skills – this may include: identification of other disorders/issues such as substance addiction; education about the causes and effects of trauma; development of skills such as setting healthy boundaries and managing flashbacks/toxic shame/self-criticism; and, medication for physical and/or emotional symptoms
- Processing of trauma – this stage involves bringing the trauma to the surface and working through it cognitively (how the sufferer perceives or thinks about the trauma), and affectively (how the sufferer deals emotionally with the trauma), with an emphasis on the self-care and self-protection skills the sufferer can now use to manage pain, grief, abandonment fears, and anger
- Integration of trauma and adjusting to one’s new sense of self - emphasis in this stage is on openly acknowledging trauma and letting it blend into one’s sense of who one is, and of learning to be more comfortable with what this integration can bring to one’s life (e.g., more intimacy with others, joy, increased energy, ability to deal with pain and stress in a healthier way).
According to Kezelman and Stavropoulos (2012), " `Core’ elements [of treatment of Complex PTSD] include phased treatment, engagement of right-brain processes and implicit memory, and attentiveness to physical as well as emotional and cognitive processes" ( p. 82) (e.g., Trauma Focused Cognitive Behavioural therapy, Relational therapy, Somatic Experiencing therapy.
Cloitre, M., Courtois, C., Ford, J. Green, B., Alexander, P., Briere, J., Herman, J. Lanius, R., Pearlman, L., Stolbach, B., Spinazzola, J. & van der Hart, O. (2012). ISTSS expert consensus treatment guidelines for Complex PTSD in adults. International Society for Traumatic Stress Studies.
Courtois. C. (n.d.). Understanding Complex Trauma, Complex Reactions, and Treatment Approaches.
Courtois, C. (2014). It’s not you, it’s what happened to you: Complex trauma and treatment. United States; Telemachus Press.
Kezelman, C. & Stavropoulos P. (2012). Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery.