Today CPTSD is recognized as needing long-term treatment because of the damages done to a person’s self-identity, deficits in self-regulation and their inability to see there is hope and healing available to them. Fear and hopelessness can be a daily reality for most survivors living with CPTSD symptoms. Therapists choosing to collaborate with patients living with CPTSD symptoms must take the time to receive the education they need to provide trauma-informed care. Additionally, they will need to understand that with the resolution of one issue—there will come others popping up seemingly out of nowhere. This is the nature of CPTSD.
The understanding of the day-to-day difficulty’s patients faces while living with complex post-traumatic stress disorder is a necessary part of trauma-informed care. Patience and unconditional warm regard are key if we are ever to help anyone have the hope they need to heal.
Trauma-informed care is an approach which sprang from the Substance Abuse and Mental Health Administration (SAMHSA), and its recognition of trauma is a significant role in the formation of women’s issues and gender-specific treatments in the 1990s. Over the next two decades, a lot was learned about diagnosing post-traumatic stress disorder and the diagnostic criteria and treatments for it.
The core ideas for trauma-informed care started to take shape and spread during the ACEs study mentioned in previous articles, as well as the launching of the Women, Co-Occurring Disorders and Violence Study in 1998 which was sponsored by SAMHSA. This study began the search for plans to help women who were victims of trauma and who also had co-occurring diagnoses of mental health disorders and substance abuse disorders.
The researchers recommended for “trauma-integrated services counseling” which has morphed into trauma-informed care today.
Trauma-Informed Care: The Basics
To save time and get to where we learn about the different forms of therapy used to treat CPSTD, I’m only briefly going to touch on the different goals of trauma-informed care. In future articles, we will discuss this subject in much more depth.
There are six basic aspects a trauma-informed therapist works towards; these include forming a therapeutic alliance, guiding you away from certain topics, helping you to understand where your behaviors and symptoms stem from, setting recovery as the goal for treatment, focusing on your strengths rather than your illness, and learning resiliency.
The first goal is covered extensively toward the bottom of this article, so we will discuss these aspects out of order.
Guiding You Away from Certain Topics. Your therapist will do their best to guide you away from topics charged with emotions. At first glance, this step may seem counterproductive. Isn’t tackling the issues which drove you to therapy the most crucial part of your recovery? However, a therapist trained in trauma-informed care understands you must first learn to cope with the inevitable pain which will come up while working on your past before you may safely face it.
Helping You Understand Where Your Behaviors and Symptoms Stem From. Trauma-informed therapists know unhealthy coping mechanisms, like shutting down in sessions and dissociation, are coping mechanisms which stem from your adverse childhood experiences. Trauma-informed therapists help you to understand these are indeed coping strategies you have used and may still use, to deal with your overwhelming emotional pain.
Trauma-informed practitioners will also make a significant statement to you, that at first, you may not accept: “What happened to you so long ago was never and shall never be your fault. You were a victim. However, now that you have achieved adulthood you and only you are responsible for your life today.” Adult survivors of adverse childhood experiences have an exceedingly tough time believing they are not to blame for their trauma and abuse.
Setting Recovery as a Goal for Treatment. Although co-occurring problems may exist, it is vital for your trauma-informed therapist to help you understand they will get better as you work through what happened in your past. The other symptoms or disorders, such as depression and anxiety, are not the overarching concerns, but rather effects from working on your recovery from complex post-traumatic stress disorder.
Focusing on Your Strengths Rather Than Your Illness. Many skills can be learned to cope with childhood trauma, and a trauma-informed therapist will collaborate with you to use them. Your therapist may ask your questions to help you think and keep focused on the future such as, “What are some of your accomplishments which make you feel proud?” By using positive language, your therapist will help you recognize you are capable of coping well even with tough experiences.
Learning Resiliency. Resiliency’s best described as the ability to overcome challenges of all types—including tragedy and personal crises—and bounce back stronger than before. Most of us who have survived childhood trauma is already very resilient. However, we often overreact or do not respond appropriately when faced with problems in our adult lives. Your trauma-informed therapist can help you understand some fundamental concepts such as how life is not fair, or how life is not easy. Once you have these lessons under your belt, events such as life changes, struggles, and death take on a new perspective, as they are just parts of life which all humans share.
The Importance of Establishing the Therapeutic Alliance
For we who were victimized in childhood and did not have a chance to establish a safe base with someone we trust, beginning to see a therapist feels very risky. The bond which forms between our therapists and us forms a connection where they can engage with us and help us to recognize our old behaviors and learn new ones.
This relationship is called the therapeutic alliance, and it isn’t one-sided or static. This relationship with your trauma-informed practitioner will be reciprocal—in fact, it is worth noting, a hallmark sign of all healthy relationships is reciprocity. This is not to say all relationships which have reciprocity are safe and healthy relationships, however, any relationship lacking reciprocity is worth looking at closely and determining whether or not it is safe or healthy.
It is also worth noting, therapists are humans too and can become emotionally attached to their clients. To help themselves, therapists must practice excellent self-care, such as setting healthy boundaries and taking ample time off from work for vacations. Therapists, like all humans, have flaws, but they can find ways to use those flaws to help us understand our recovery journey and to connect with us.
As the relationship between you and your therapist goes on, it will change and not remain static.
At first, you may feel uncomfortable and unable to share your feelings. However, after a bond forms and you begin to trust, you will relax into the relationship. You will then become open and honest about not just how you are feeling but you’ll also feel safer telling your therapist about any dangerous behaviors or thoughts you might be having.
This is when therapy and recovery can begin.
It is safe to say that a tremendous therapeutic bond is absolutely vital to anyone living with symptoms of complex post-traumatic stress disorder, especially if we are to ever face and accept the indescribable pain of what happened in childhood.
Once you feel comfortable with your therapist, it will be easier to begin the demanding work of facing what happened to you head-on, and ways you can heal.
Some of the safety issues which need to be tackled before the healing work begins are:
- Impulsive Behaviors
- Self-Destructive Thoughts and Behaviors
- Dangerous Relationships
- Suicidal Thoughts and Behaviors
It is clear, all the above safety concerns can be highly re-traumatizing, and suicidal ideation/behaviors can lead to death. To mitigate these threats to life, a trauma-informed therapist must seek to replace the need for these behaviors. This happens through agreeing on a safety plan. This is always done with you.
A safety plan may include you learning how to contact your therapist if you are having problems between sessions. However, your therapist may have rules about the ways you may contact them, such as at the office only or via email.
Your therapist may also ask you to sign an agreement with them stating you will not try to die by suicide. Instead, you promise you will reach out to someone you have listed on your safety plan or agreement.
Some therapists may ask you to attend Wellness Recovery Action Plan (WRAP) classes so you can make a detailed plan of what you will do in case you find yourself in trouble and having thoughts of self-harm or suicide.