Treating complex trauma

Treatment of complex trauma is a delicate process that needs to be managed carefully and with skill in order to be successful. Many of my patients come in after having consulted numerous other therapists and having tried a multitude of different therapies. Sadly, despite initial dizzy promises, nothing ended up working. This is where being a « senior » therapist really helps. The therapist treating complex trauma, especially that which stems from childhood, needs to be stable, reliable and not easily frightened. Moreover, they need to be containing yet « non-directive » in order to give the patient sufficient autonomy and stength to build their self-esteem.

Complex trauma generally involves violence, abuse and/or neglect in the home. As a rule, these experiences are not isolated, i.e. they only happenned once or twice, but are a string of experiences that often unfolded over years if not decades of a person’s life. This affects not only the victim’s reactions, but their whole outlook on the world, their whole biology. Their are massive trust issues, there is a very fearful attachment style, and there is often a whole string of psychosomatic complaints.

The symptoms are many, some manageable, and some so intense they make daily functioning in the work place and at home extremely difficult if not impossible. They can include persistent sadness, difficulty regulating emotions, chronic anxiety, chronic guilt, flashbacks, hypervigilance and dissociation. Moreover, the symptoms can be trigerred by seemingly innocent situations, such as not responding to a text message quickly enough, being five minutes late for a meeting, or speaking in a loud voice.

To give a typical example, one of the things I see often in my office is when a female client sends a text to her boyfriend and doesn’t get an immediate response. The first reaction is anxiety, if not panic. Then, when the initial stage of severe anxiety subsides, she is easily trigerred to anger, outbursts and oppositional behaviours, even in the case where the boyfriend or husband replies to the text half an hour or so later, after his work meeting is over. My clients, being so extremely sensitive and jumpy, are using these extreme reactions as their only available defense mechanisms to feeling under threat. But under threat of what? Of abandonment, neglect or abuse, often all three. Because it’s what they experienced as a child, they are constantly relieving the experience, even recreating it although there is no threat in sight.