“Failure to acknowledge the reality of trauma and abuse in the lives of children, and the long-term impact this can have in the lives of adults, is one of the most significant clinical and moral deficits of current mental health approaches.
Trauma in the early years shapes brain and psychological development, sets up vulnerability to stress and to the range of mental health problems.”
Professor Louise Newman, Psychiatrist, Director, Centre for Developmental Psychiatry and Psychology, Monash University (from ASCA Guidelines for Treatment of Complex Trauma1)
With thanks to ASCA for guidance and material extracted (or plagiarized) from their website in writing this article.
Okay, now that I’ve had my say about how underfunded, overwhelmed and inept government services are, there’s a few things survivors absolutely need to know to ensure that they get the correct diagnosis and adequate care – not the least of which is that unless you control your own destiny within the mental health system you’ll typically receive misdiagnosis and inadequate treatment/counselling/medication. The other extremely important thing to understand is that if you were abused as a child by a carer or someone that you should have been able to trust and this was never acknowledged/addressed/treated you, in all probability, suffer from complex trauma, otherwise known as Complex Post Traumatic Stress Disorder (C-PSTD). If you’re seeing a psyche or any other mental health provider raise this with them. Treatment guidelines can be accessed here. Ensure that your therapist is familiar with these.
About Complex Trauma
How a person responds to trauma is dependent on many things, including how pervasive and prolonged the trauma was, the context in which it took place (i.e. family setting, school, institution etc) and type of life experiences before and after the trauma was experienced, particularly in regard to the amount of appropriate care and support you received after the fact.
Complex trauma generally refers to traumatic stressors that are interpersonal. That is, they are premeditated, planned, and caused by other people, such as being violated and/or exploited by another person.
It stands to reason that the most devastating types of trauma are those that occur at the hands of carers. Child abuse, occurring in the context of a trust relationship, involves significant betrayal of the responsibilities of those relationships. In addition, it is often private and the child is cautioned or threatened to not disclose its occurrence. Unfortunately, when such abuse is observed or a child does disclose the abuse, adequate and helpful response is lacking, resulting in another betrayal and another type of trauma that has been labeled secondary traumatization or institutional trauma. It is for these additional reasons that complex traumatisation is often compounded and cumulative and becomes a foundation on which other traumatic experiences occur repeatedly over the course of the individual’s life. Research studies have repeatedly found that when a child is abused early in life, especially sexually, it renders him/her much more vulnerable to additional victimization. As a result surviviors of child abuse can become caught in an ongoing cycle of violence and retraumatization over their life course, especially if the original abuse continues to go unacknowledged and the after-effects unrecognized and untreated.
Recent studies have shown that abuse and other trauma result in changes in a child’s neurophysiological development that, in turn, among other things, result in changes in learning patterns, behavior, beliefs and cognitions, identity development, self-worth, and relations with others. Those who endure trauma for an extended period under the age of twelve are proven to present more devastating outcomes in adulthood than complex trauma afflicted upon someone who is already an adult. This is because morality, social skills, and life skills are all taught in childhood at crucial developmental periods for the brain and the brain develops in accordance to what it learns in relation to these experiences (the good news is that neuroscience has now shown that the brain can change through neuroplasticity).
Because complex trauma commonly results from trauma occurring in early childhood, healing takes more effort, dedication and time. It is imperative that a trauma specialist is familiar with C-PTSD and offers a sensitive, structured treatment plan.
Symptoms of Complex Trauma
- Emotional Regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger. (Difficulty regulating the emotions, swinging from one state to another)
- Consciousness. Includes forgetting traumatic events, reliving traumatic events (flashbacks), or having episodes in which one feels detached from one’s mental processes or body (dissociation)
- Self-Perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
- Distorted Perceptions of the Perpetrator. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
- Relations with Others. Examples include isolation, distrust, or a repeated search for a rescuer.
- One’s System of Meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.
- Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming.
- Survivors may use alcohol or other substances as a way to avoid and numb feelings and thoughts related to the trauma.
- Survivors may engage in self-mutilation and other forms of self-harm (as a way to cope with overwhelming emotion and/or to numb out pain)
- Survivors who have been abused repeatedly are sometimes mistaken as having a “weak character” or are unjustly blamed for the symptoms they experience as a result of victimisation.
Complex Trauma vs. PTSD (Post Traumatic Stress Disorder)
The diagnosis of PTSD accurately describes the symptoms that result when a person experiences a short-lived trauma. For example, car accidents, natural disasters, and rape are considered traumatic events of time-limited duration. However, complex traumas continue or repeat for months or years at a time. Clinicians and researchers have found that the current PTSD diagnosis often does not capture the severe psychological harm that occurs with such prolonged, repeated trauma.
The effect of these traumatic events on the person is cumulative. When a person is repeatedly exposed to traumatic stress, disruptions can occur in brain functions and structures, endocrinological function, immunological function, and central and autonomic nervous system arousal. These biological disruptions interact with psychological, emotional, spiritual, and cognitive processes and a variety of disturbances can result that go beyond the re-experiencing, avoidance/numbing, and arousal symptoms that characterize PTSD.
Complex trauma influences deep layers of the personality. Some of the phenomena parallel those that appear in “regular” PTSD but some do not. In general, people who have experienced complex trauma tend to act in ways that endanger themselves –not only do they have difficulty controlling urges and emotions, they have trouble remaining in therapy.
Is the treatment of complex trauma different to that of PTSD?
Yes. Since the difficulties affect the deepest level of the personality –belief system, self-image and control of emotions and urges – treatment does not focus directly or solely on the trauma but rather on the entire person. For this reason, and because the victim has trouble maintaining a therapeutic alliance with a therapist, treatment lasts longer than therapy focused PTSD. CBT (Cognitive Behavioral Therapy) approaches can be useful for PTSD and even for C-PTSD to a degree, but will most often not be enough for someone seeking to heal from C-PTSD, as the approach needs to go deeper and be more holistic.
What Is Good Trauma Therapy? What Is a Good Trauma Therapist?
Historically, mental health treatment has been treated according to the “medical model”: the “sick” patient treated by the all-knowing doctor, who has the responsibility, the expertise, and the tools to cure the illness. The patient’s job is to be compliant and to follow orders. Don’t buy into this rubbish EVER!
As Dr Carl Rogers stated in 1957, “The clinician needs to be a “real” human being. Not an all knowing, all powerful, rigid, and controlling figure.”2
Thus, an effective trauma therapist empowers the survivor rather than imposes a cure. The idea of the therapist and client working together as partners, sharing responsibility and expertise, is still radical in many mental health settings. However, for trauma survivors, this is in many ways the key to success in therapy.
Studies in the past decade have determined that a core factor of positive therapeutic outcome is the therapeutic relationship. The strength of this is often more significant than the approach (or modality used). For instance, Lambert M.J. et al states:
“Common factors such as empathy, warmth, and the therapeutic relationship have been shown to correlate more highly with client outcome than specialized treatment interventions. The common factors most frequently studied have been the person-centered facilitative conditions (empathy, warmth, congruence) and the therapeutic alliance.” 2
For this reason, it is imperative that survivors seek out a therapist who they feel safe with and can trust. Sometimes people may get an immediate “vibe” from a therapist, but otherwise it would be fair to, at least, attend for several sessions to be clear about the decision to continue, or otherwise.
It is important to note is there are many approaches to therapy, and most good therapists are trained in several approaches and use them in combination. Approaches may be long or short-term and may be focused primarily on the past or on the present, but all should aim to alleviate distress and help you to learn how to acquire more effective coping strategies.
A lot of the process of healing is completely subjective and shaped by what is needed at the time. This also applies more broadly to the types of therapists and how to find one. Where a survivor is at and how successfully the therapist can work with them safely and appropriately is of utmost importance.
Different therapists and approaches are valid for someone and may simply not be right for another at that point in their journey. So, there is not a single answer to treatment, but a professional understanding of the client’s issues and past and competence to support that is critical, as is them being a person with whom an empathic, safe and supportive rapport can be established.
The four most important things a therapist has to offer a survivor are:
Consumers of mental health services have contributed to the following list of things to look for in a therapist:
- Find a therapist you feel comfortable with. Therapy is not an easy process and your therapist is not there to be your friend.
- Find a therapist who respects your individuality, opinions, and self.
- Find a therapist who will not get upset if you disagree with what he or she has said, but instead encourages you to express yourself when you do not agree.
- Find a therapist who never minimises your experiences and always respects your feelings.
- Find a therapist who will not try to force you to talk about things that you might not be ready for.
- Find a therapist who does not spend time talking about his or her own problems. Those sessions are for you, not your therapist.
- Find a therapist who wants neither a friendship nor a sexual relationship with you outside of your counseling sessions.
- Find a therapist who is more than willing to discuss problems that might arise between the two of you within the therapist/client relationship.
- Find a therapist who will help teach you new and healthier ways to cope.
- Find a therapist who will never make you feel like a failure or cause you to believe they are disappointed in you if you have a slip or a relapse. (Source: http://www.sidran.org/sub.cfm?contentID=62§ionid=4)
For more information on complex trauma and treatment options contact:
ASCA (Adults Surviving Child Abuse) at http://www.asca.org.au/
Professional Support Line: 1300 657 380
MSSAT (Male Survivors of Sexual Abuse Trust) www.survivor.org.nz/
Phone/Fax: +64 (03) 377 6747
Online Resources (with thanks to Dragan from ASCA for the link) http://www.klinic.mb.ca/resources.htm
Material for this article sourced (or extracted/plagiarized) from:
Special thanks to Dragan and Leo from ASCA for input and material (content) in drafting this article.
- Adults Surviving Child Abuse 2012 Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery Adults Surviving Child Abuse: Authors Kezelman C.A. & Stavropoulos P.A
- Rogers, C. R. (1957). The Necessary and Sufficient Conditions of Therapeutic Personality Change. Journal of Consulting Psychology, 21, 95-103.
- By Lambert, Michael J.; Barley, Dean E. Psychotherapy: Theory, Research, Practice, Training, Vol 38(4), 2001, 357-361.