Treatment Stages

"[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.