First, the good news about CPTSD. It is a set of learned responses and a failure to complete numerous important developmental tasks. This means that it is environmentally, not genetically, caused. In other words, unlike most of the diagnoses it is confused with, it is neither inborn nor characterological. As such it is learned. It is not inscribed in your DNA. It is a disorder caused by nurture (or lack thereof), not nature. - Pete Walker, MA
..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. - Christine Courtois, PhD
….the past 20 years have brought us extraordinary, evidence-based breakthroughs in the treatment and healing of trauma. In a wide range of fields, psychologists, neuroscientists, pioneering therapists, and traditional healers are making enormous progress in helping us to recover—and to turn our energies toward our greater dreams and life purpose. - The Healing Trauma Summit, June 2018
“Watch carefully the magic that occurs when you give a person enough comfort to just be themselves.” Atticus
Types of Therapy/Treatment
There are a multitude of approaches currently used to treat Complex PTSD including: Relational Therapy, Eye Movement Desensitization and Reprocessing (EMDR), Emotion Focused Therapy, Prolonged Exposure Therapy, Cognitive Behavioural Therapy (CBT), and Interpersonal Psychotherapy, Sensorimotor Psychotherapy, Experiential Therapy, and various Mindfulness approaches. Ford and Courtois (2020) reviewed most of these and while they found many to be effective to some degree they did suggests that “the crucial question of when and for whom different evidence-based treatment models or their components are recommended remains unanswered”. Dr. Judith Herman (Ford & Courtois, 2020) suggests researchers and clinicians must next focus on what components of the numerous models are most effective in treating complex trauma. "Since it is not realistic to expect that practitioners will become expert in numerous different, specialized techniques, some researchers now suggest that we might be ready to shift our focus from studies of competing models to studies that elucidate the common features of effective therapies" (2020). Given many (most) survivors experience difficulty wading through the numerous approaches and choosing one that works for them, having fewer but more specific, evidence based models for Complex PTSD would be a welcome change.
For further information about current therapeutic models/approaches, there are two bibliographies below of research articles and books. While written for researchers and clinicians for the most part, they can be useful in helping you to dig a little deeper into various models. Beyond these resources a simple Google search will bring up many articles about various treatments for trauma (a word of caution here - not all models/approached are evidence-based).
Assessment and Treatment Research Articles
Treatment Stages
Although it is not yet clear which features of available approaches are most effective with CPTSD, there is general agreement among researchers and clinicians that three general stages of treatment are important (Courtois, 2014; Ford & Courtois, 2020; Herman 2015; Kezelman & Stavropoulos, 2012):
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).
Further, there is growing recognition that treatment must include the whole person. According to Kezelman and Stavropoulos (2012), " `Core’ elements include phased treatment, engagement of right-brain processes and implicit memory, and attentiveness to physical as well as emotional and cognitive processes" ( p. 82).
Advocating for More Accessible Treatment
Therapy for Complex PTSD until recently has only been available in large cities where therapists with knowledge and experience of this type of trauma tend to cluster. More and more, however, treatment is offered virtually. While this means therapy is now more accessible geographically, it remains financially inaccessible for most survivors. In most countries, a limited number of sessions are covered by government or Insurance plans, after which survivors must pay out of pocket and it is prohibitively expensive. Sessions run from $175 to $250 and what this means is that survivors go without treatment or pay dearly $700 to $1,000 monthly. In short, many survivors simply cannot afford to get well. This must change. Mental health is not separate from physical health, they are intertwined and should be treated as such. Hopefully as more and more survivors find each other in forums like this, as more trauma organizations serving complex trauma survivors are formed, we will join voices and make enough noise to get this message to the ears that need to hear it.
References:
Cloitre, M., et al. 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.
Ford, J. & Courtois, C. (Eds.) (2020). Treating Complex Stress Disorders in Adults: Scientific Foundations and Therapeutic Models (2nd Ed). New York, NY: Guildford Press.
Kezelman, C. & Stavropoulos P. (2012). Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery.
