Addressing the Unique Features of CPTSD

Any treatment for cPTSD must take these features into account. It needs to engage with the person holistically, and allow discussion of traumatic material without triggering the suppressive/dissociative reaction. Luckily there are techniques in psychology capable of doing exactly that. But before we get into those, we need a brief explanation of two important concepts: process and transference.

Process refers to any spontaneously arising reactions to therapy as it unfolds. Just about anything can be process – glottal stops, elisions, hesitations, blushing, etc. – as long as it happens in response to something occurring in therapy. A good example might be someone shifting in their seat when the topic of dating arises. A therapeutic intervention based on process might be as simple as the question, “Why do you shift in your seat when you talk about dating?” Or, if the therapist has more context, it might include an interpretation: “You shifting in your seat tells me the date last night didn’t go well.”

Transference refers to how a patient experiences their therapist. Often a patient will experience their therapist as indifferent, or sadistic, or maternal, or seductive, or any number of different things, based more on previous relationships than on anything that the therapist has actually done. An example would be a patient who assumes their therapist is angry with them for rescheduling an appointment. A therapeutic intervention based on transference could take the form of simply asking, “Are you expecting me to be angry with you for rescheduling?” Or, if the therapist has more context, could include an interpretation: “Your mother used to punish you if you allowed anything to come before her, and I think you expect me to do the same.”

Techniques based in process and transference are surprisingly effective with cPTSD. For one thing, there is a substantial qualitative difference between someone asking you to recite your trauma and someone asking you why you are doing something. The former is prescriptive while the latter invites self reflection and understanding. More importantly, though, is how these techniques take the focus off what happened and place it on what is happening now. How is trauma influencing this moment, this choice, this feeling in this instant? This engages the whole person, as they are now, and brings conscious attention to the interplay of trauma and personality. Best of all, I’ve found that approaching traumatic material in this way, through the present moment, does not usually trigger the suppressive/dissociative reaction. It invites someone to be an observer and interpreter instead of a reciter.

PART IV

The Technique in Practice

Something terrible happened to Maria that she knows about but can’t remember. It happened when she was a girl. It was sexual in nature. Beyond that she cannot say.

She has intense reactions she doesn’t understand. One happened during a standard college orientation presentation about sexual assault. Another happened with her girlfriend. Both of these incidents rendered her nonfunctional for weeks. These episodes are accompanied by images. She can’t describe the images because when she tries she immediately dissociates and she feels like she’s floating above herself.

She had given up on therapy. She only agreed to try again because her girlfriend was desperate for her to get help, and someone she trusted recommended me. When she first started she spoke only in monosyllables. She never made eye contact, but never stopped watching me. She sat poised ready to flee, literally.

This excerpt comes from one of these early sessions, when she was just beginning to trust me. It was selected because it demonstrates how a process-based approach can lead to substantive therapeutic work. Name and some details altered to insure anonymity

Therapist: I notice you nod at me when I’m talking.

Maria: (nods)

Therapist: I feel like maybe you do that to reassure me I’m doing a good job.

Maria: (thinking) Maybe.

Therapist: Maybe?

Maria: (nods)

(long silence)

Maria: Some of it is because it fits, what you’re saying. But some of it is that. Reassuring you.

Therapist: Why might it be important to reassure me I’m doing a good job?

Maria: So you get what you want. And I can keep being me. Like underneath.

Therapist: You let me think I’m effective so that I won’t bother you anymore.

Maria: (nods)

Therapist: Where else do you do that?

Maria: (eyes going wide)

Therapist: What?

Maria: Everywhere. I do it everywhere. Meeting with my advisor. Waiting for the train.

Therapist: You seem shocked.

Maria: I didn’t realize I went through life like that.

This was something of a breakthrough. In subsequent conversations Maria explained how this moment really brought home how frightened and cornered she felt whenever she interacted with straight men. It was a feeling she was aware of previously, but only dimly, and took as a normal part of everyday experience. Her broadened understanding rendered these interactions easier. Life got a little better.

CBT or EMDR would have been useless with Maria. She simply could not explicitly confront her trauma. Granted, Maria’s dissociation was especially pronounced, but her case illustrates the point. CPTSD requires techniques that engage with the personality, and avoid the suppressive/dissociative response. Exposure-based therapies like CBT and EMDR might scratch the surface, but they don’t take cPTSD’s nature into account. CPTSD is different, and it needs to be treated differently.

Brian Henley is a clinical psychologist in Los Angeles, California. For more information, visit his website at treatingcomplexptsd.com, or read his recent article at https://doi.org/10.1080/02668734.2023.2231059

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

The year was 2013, and the American Psychiatric Association was putting their final touches on their latest edition of the Diagnostic and Statistical Manual of Mental Disorders; their ponderous compendium of classifications and criteria that has become the standard reference book for mental health practitioners throughout the United States. It’s a very influential book. Each edition sends expanding ripples of consequences throughout the field for years and years. Decades and centuries, arguably. Consider for a moment the effect it had when homosexuality, for one example, was de-pathologized in a previous edition.

In anticipation of this event, there was a major push on to convince the APA to recognize complex PTSD, in some name (DESNOS, dissociative subtype), as a separate diagnosis. If you scan the literature, there is a dramatic increase, a huge swell, in the number of research articles supporting cPTSD right around 2013, as researchers across the world made their case for its inclusion.

Sadly it did not make the cut. The criteria for PTSD in the new DSM-V were amended to reflect some incontrovertible findings, but the APA in its wisdom ruled that cPTSD, as a thing, was not sufficiently distinct to merit its own separate entry.

And yet the diagnosis thrives. In the absence of formal classification (in the United States), it has grown in the public’s awareness and entered the common lexicon, and is in frequent use amongst researchers and clinicians. The reason for this is that cPTSD exists, and it is a useful distinction to make, especially clinically. Saying that someone suffers from cPTSD, if it is understood what that means, immediately provides a wealth of information that might otherwise take a great deal of time to ascertain in a treatment setting. Furthermore, and crucially, knowing that cPTSD is present guides treatment choices, because cPTSD needs to be treated differently than uncomplicated PTSD. I can’t say this enough. I wish I could write it in the sky: cPTSD needs to be treated differently than uncomplicated PTSD.

PART II

Unique Features

The most frequently recommended treatments for cPTSD are Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Look on any website talking about cPTSD, click on their “resources” tab, and there they are: CBT and EMDR.

The problem is that these two don’t work very well with cPTSD. They are based on the exposure model, which was developed before anyone had ever thought of cPTSD. In the exposure model, treatment consists of exposing the patient to the traumatic incident over and over, usually in the form of reciting a trauma script or prompts from the therapist to imagine this or that aspect of the trauma. The feelings this inspires (fear, terror, helplessness) are then processed until they subside.

CPTSD, however, presents with two unique features that confound the exposure model. The first of these is that whereas in uncomplicated PTSD, the trauma represents an atypical event (i.e. someone is going about their lives when something terrible and abnormal occurs), in cPTSD the trauma is formative, in that it is a circumstance or condition under which the person learns and grows (i.e. being raised in an abusive home). In that situation, trauma is adapted to, built upon, and incorporated into the self. In cPTSD, trauma pervades the personality. This makes it much harder to confront through exposure, because the problem isn’t that someone is now triggered by discreet stimuli like dark alleys or specific memories. The problem is that someone is engaging with the entire world, and relating to themselves, from a holistically traumatized standpoint. Addressing that requires a more comprehensive engagement with the person than repeating painful recollections.

The second unique feature of cPTSD that messes with the exposure model is what I call the suppressive/dissociative reaction. I call it that because it isn’t just dissociation. Dissociation is a largely involuntary reaction that can range from simple “spacing out” to severe and exotic phenomena such as depersonalization (when someone feels as if they are outside of their body). Dissociation certainly happens in cPTSD. However, in my experience people with cPTSD suppress as much or more than they dissociate. Suppression is a mostly deliberate, conscious effort to stifle feelings, and operate as if they aren’t there. People with cPTSD suppress all the time, which makes sense: if your trauma was prolonged, you were going to have to pretend that everything was fine a lot. Because both of these processes are present in cPTSD, and serve the same function (managing intolerable emotions), I combine them into a single term: the suppressive/dissociative reaction. The suppressive/dissociative reaction impedes exposure-based therapies by rendering emotions inaccessible. If all someone does when you expose them to a trauma script is shut down or dissociate, the emotions you’re hoping to process won’t show up, and the therapy won’t work.

Last part of this section: why, if they don’t work very well, are CBT and EMDR recommended for cPTSD so much? Well, I have a few theories. One, they were being used to treat PTSD, so when cPTSD came along people naturally thought “Sounds similar, these oughta work on that, too.” Two, insurance companies love CBT and EMDR because they can be manualized, so they get advertised quite a bit. Three, most websites talking about cPTSD are getting the word out, not doing research, so they copy/paste their recommendations from each other. Website content that is auto-filled by AI will also list CBT and EMDR. Four, they do kinda work – most studies done with CBT or EMDR on cPTSD show some symptom reduction; just not as much as they have on PTSD. And five, it might reflect the ongoing push to medicalize psychology.

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

This article, piece one in a series about psychotherapy, will attempt to answer these questions and offer realistic information to those with complex post-traumatic stress disorder and other mental health conditions.

What is Psychotherapy?

Also known as talk therapy, psychotherapy is a tool to treat mental health issues. In psychotherapy, you will talk to a stranger telling them what is bothering you, and the therapist acts like a neutral person reflecting back to you what you have said. The therapist becomes a mirror helping you to find your own path and answers.

The theme of psychotherapy is to help you identify and change your thoughts, behaviors, and troubling emotions. Sometimes medication is used in consort with psychotherapy to help ease some symptoms that surface during treatment.

Psychotherapy is typically practiced in the office of a licensed mental health professional, one-on-one with the therapist. However, group therapy is not uncommon.

The real work begins once the client and psychotherapist have passed the introduction stage. The client shares their wounds with the therapist to be addressed, and the two begin talking about and sometimes feeling the emotions that go along with the issues the client is facing.

Psychotherapy can be a short string of sessions during and after which the client feels better and can function better in their life. However, some disorders may require that a client be in therapy may for a year or even decades.

Why Seek a Therapist?

There are as many reasons to see a therapist as people seeking or needing one, including serious mental health disorders, relationship issues, stress, grief, anger, and substance abuse.

Mental Health. A mental health disorder can lead to anything from mental discomfort to suicidal ideations. Some mental health disorders a therapist treats are anxiety, depression, and addiction.

Relationship Issues. Any married couple can tell you that sometimes they need help to stay together. There might be marital problems such as infidelity or divorce. But treatment for relationship issues does not end with married couples. Anyone, especially those who survived child sexual abuse, can find themselves struggling with relationships and needing help.

Stress. Stress is usually related to either your job or unexpected life changes. Psychotherapy can give you a place to go when times get rough. In therapy, you can vent all your frustrations and let yourself speak about how you are feeling for one hour without judgment.

Grief. Facing a loss and the bereavement accompanying it can significantly affect how you are feeling inside and reacting outside. On the inside, you feel the acute loss as an empty space in your gut, and on the outside, you react by weeping and passing through the five stages of grief. Therapy allows you to mourn without judgment and in a safe place.

Anger. Many people believe they cannot control their anger and that outbursts of yelling or physical behaviors that are unacceptable are common. If you react with anger instead of thinking your options through, you may need a psychotherapist’s services.

Substance Abuse. Substance abuse includes alcohol, all unprescribed drugs, such as meth, AND substances that are prescribed but are not taken as ordered. It is nearly impossible to get sober on your own. You need the help of someone else who can be there when you need them. Therapists can and do help those who live with addiction by helping those suffering from it to understand better what they are burying under the high the drugs or alcohol bring.

Author’s note. People who have substance abuse disorder are not weak or flawed. They are good people entrapped by destructive substances and their brain’s reactions to them.

Different Types of Therapy

There are literally hundreds of forms of psychotherapy, and for the sake of this piece, we shall cover only three of them, cognitive behavioral therapy (CBT), behavioral therapy, and dialectic behavior therapy (DBT).

Cognitive behavioral therapy (CBT) explores the relationship between how a person feels and how they behave. The therapy’s purpose is to teach a client how to control emotions and behaviors.

Behavioral therapy, one of the many forms of psychotherapy, aids one in learning to control their emotions and behaviors. Behavioral therapy has at its base the notion that all behaviors are learned and can be changed. One does this by exchanging potentially destructive and unhealthy behaviors for those that are desired.

Dialectic behavior therapy (DBT) is a form of therapy that is adapted for people who feel intense emotions. The end result of DBT is to help clients understand and accept feelings that are difficult to manage. Acceptance means that the person’s feelings and emotions are valid, and change means that clients need to make positive changes to manage their emotions and move on.

Other therapies include art and music therapy, integrative or holistic treatment, and drama therapy, where the client lives in their adult shoes and goes back in time using their imagination to save themselves as children.

How Therapy Can Help You Overcome

Early childhood experiences of abuse or neglect form complex post-traumatic stress disorder. This mistreatment causes clients to have multiple emotional and physical problems that need addressing.

A few of the physical problems trauma can cause are as follows:

• Headaches
• Nausea
• Chest pain
• Fatigue
• Disturbed sleep
• Being easily startled
• Heart disease

A few of the emotional problems caused by trauma are as follows:

• Anxiety
• Agitation
• Sadness
• Numbness
• Dissociation
• Anger
• Aggressive behavior

Both the physical and emotional symptoms are caused by having no control as a child while someone else abused their bodies and minds.

The best way to overcome these physical and emotional problems that have come from memories and emotions from the past is to learn to live in the now. People who have survived childhood trauma must let go of the past (not forget it, that is impossible) and stop worrying about the future.

Therapy aids you in the process of living in the present and allows the past to become just that, the past.

Ending Our Time Together

I have complex post-traumatic stress disorder and another mental health condition and would not be here if it were not for psychotherapy. Due to the added problems from my second diagnosis, I have spent many years healing myself.

That you heal yourself is critical to understand. The therapist has no special powers over you, nor do they have all the answers you seek. Therapists are simply people with a license trained to diagnose and treat mental health disorders. The therapist’s role is to prompt you to explore a different way of thinking and behaving. You do all the hard work.

No matter your problem, from wanting to quit smoking to learning to handle life on life’s terms, you can find peace of mind and healing in a therapist’s office.

“Be Your Best Without the Stress! Be the director and actor in your movie called My Life.”        — Katrina Radke

“Therapy will take longer than you want, but shorter than what you fear.” – Dr. Paula McNitt

What happens when your therapist lobs an unforced error across the net at you?

This happened to me recently. I was angry and afraid because of what transpired. Ultimately, I decided he made the error inadvertently. Still, I paid a price. He paid a price as well because I chose to sever our appointments completely.

What happened?

On the initial intake form, I stated that my goal in therapy was to deal with residual anger at my mother. I had been diagnosed with PTSD 20 years ago due to childhood sexual abuse, and I wanted to prevent a relapse. The appointments were conducted virtually over Google Meet, and I wasn’t expecting long-term therapy. I just sought a safe place to rant and rave about my mother for a bit.

During our first appointment, I informed him that several years ago I broke my silence and revealed to everyone that my maternal grandfather had been a pedophile who preyed on little girls in our family. In fact, I wrote a book about it that was published in 2020.

In a later appointment, perhaps the third or fourth, he asked if he could read my book. I didn’t mind if he did so. The book is in the public realm, so I couldn’t stop him. I wrote the book very carefully. I stand by everything in it, and I’m not embarrassed by it. I’m very happy that I finally told the truth about being sexually abused when I was nine.

However, I couldn’t shake the feeling that he had already purchased the book, read it, and now wanted to “use” certain information and needed my “permission” to read the book.

During the next appointment, he guided the conversation a bit and asked me to imagine myself as a little girl. He used a lot of imagery from WWII, such as Anne Frank and soldiers. My book has many references to WWII. Moreover, he asked me to “tell us who anger is protecting?” The use of the third person surprised me. In retrospect, I believe it was another reference to my book, which details a murder trial from 2002, where a San Diego man, David Westerfield, was convicted of murdering a seven-year-old girl, Danielle Van Dam.

Perhaps he was expecting a verbal response from me. However, that’s not what transpired. I remember when he asked me to “tell us who anger is protecting?” Then he said that he had just given me a lot of information and asked me to summarize it back to him. He wanted to ensure that I understood.

Suddenly, I became aware of a “black hole” in my brain. I couldn’t recall anything between “Who is anger protecting?” and “summarize back.” I had slipped into a dissociative episode, and it shocked me. I had been stable for over 20 years, and I didn’t believe this was possible again. I quickly ended the appointment and closed the laptop.

An alarm bell rang in my head

However, before I closed the laptop, he mentioned that I had given him a lot to work with and thanked me for being so vulnerable. An alarm bell rang in my head.

I called a friend who is a counselor to talk through what happened. Her comments were, “Sometimes, the therapist is sicker than the client,” and “You’ve only seen him a few times. You don’t have much invested in him, and you can always find someone else.” But then she started talking about her sciatica and how much pain she was in. I concluded that she didn’t really hear me and offered me a platitude.

It took me a couple more appointments to tell my therapist what she had said and to explain how the episode had frightened me. I was now spending a considerable amount of time during the day, wary that I would encounter evidence that I had done something that I didn’t remember doing. I did not use the word “dissociation” or any variation of it.

He attempted to reassure me and mentioned that he had personal experience with what had happened. That set off more alarm bells in my mind, whether rightly or not.

I met with him a few more times, even though I had already decided to move on. We only had seven or eight appointments total, and I wanted to get a better sense of him, which can be difficult in virtual meetings. He seemed very caring, compassionate, and empathetic, not as a façade for therapy, but genuinely so. He appeared to be in his early to mid-50s, yet his license was issued only a few years ago. Perhaps this was a career change, which is admirable. He seemed to have a good sense of humor. I had found him through a service for Christian counselors, and we shared our faith in God. And he seemed genuinely surprised when I mentioned “wrapping things up.”

So, what was the true unforced error here? Was he overly eager? Did he fail to truly understand my history with PTSD? Should he have been more transparent about his “personal experience?” Should he have initiated a frank conversation about the episode? Was it a mistake to wait for me to talk about it? One thing is certain, he avoided any more imagery about WWII and didn’t speak using the third person again.

Did I err? I said nothing about dissociative amnesia on the intake form, and even after the episode, I avoided the words completely. Should I have insisted on more transparency about his “personal experience?”

One thing I learned is this: Therapists often talk about the power differential in the therapeutic relationship. They assert that the balance of power is tilted toward the therapist. That’s an illusion, in my opinion. Ultimately, I held the power and the choice to no longer continue paying for appointments.

In tennis, when one player makes an unforced error, the other player wins the point. In this case, the unforced error was a lose-lose situation.

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

I am not going to lie; I was really skeptical at first. The thought that staring at a pointer would resolve decades of trauma stored in my brain seemed too good to be true. Nevertheless, I adore and wholeheartedly trust my therapist, so I reluctantly agreed to try it.

Our first session was called an intensive, which means 3-hours of therapy in back-to-back sessions. I’m not sure why I thought that was a good idea, but again, I trusted her, so I did. We did three different targets, which will take too long to handle in a single blog, so I will break this into two parts (one target I am not willing to share at this time).

The target I want to share with you today is related to a near-drowning accident that I experienced when I was ~ 4 years old. The gist of the story is that I left the patio at my aunt’s house to feed the ducks (they had a house on the lagoon), and I fell in the water. I don’t remember falling in the water, and for years, I didn’t remember much about it, but the story was repeated every time family got together. After a while, I started having flashes of memories pop up, but they weren’t connected.

I remember being in the water and trying to keep my head above water, but, of course, I couldn’t swim. I remember some teenagers jumping off the pier a couple of houses down from where I was, and I also remember calling out for help. I remember the green-brown water over my head, seeing the light above the water, and thinking I was going to die.

Obviously, I didn’t die, or I wouldn’t be writing this. The story goes that the teenage neighbor girl saw me fall in the water and rescued me. She brought me soaking wet to my aunt’s front door and rang the doorbell. I don’t remember any of that, but I’m pretty sure I was in shock at that point. I am sure I must’ve given my poor aunt a heart attack. Can you imagine her having to tell my mother that I drowned in the lagoon? Thankfully, God spared me.

Amazingly, this incident never caused me to be afraid of water or not want to swim, or even go onto the dock again. As the memories started to surface (pun intended), I became aware of some strange behavior I was exhibiting in the workplace, and I had no idea why I was doing those things.

When I first read The Body Keeps the Score by Bessel van der Kolk, I balked at the part where he talked about how, according to Freud, trauma victims had the compulsion to repeat portions of their trauma as an “unconscious attempt to get control over a painful situation and that they eventually could lead to mastery and resolution.” (Kolk MD, Bessel van der. The Body Keeps the Score (p. 32). Penguin Publishing Group. Kindle Edition.) In my mind, why would anyone want to repeat something traumatic repeatedly?

But that is precisely what I saw…in myself.

At work, I would always stand on the periphery in crowds and was compulsively “trying to get noticed.” I realized that I was trying to make sure I could be seen so that someone could save me.

I also heard myself repeatedly saying, “I’m drowning” at work, which led to being overwhelmed and unable to function. I would get upset when my boss or co-workers didn’t rescue me. It kept coming up in weird ways, so I thought, let’s deal with this target. Sure. Why not?

We started by talking about the sensation I was having in my body around, feeling like I was drowning in emails. Once that was activated in my body, my therapist held up this pointer and moved it horizontally across my visual field until I located the spot that was the most activated and fine-tuned it by moving the pointer vertically. (You absolutely can’t make this crap up. It really works.)

Once we found the spot, all I had to do was stare at this dumb pointer. It does feel dumb to stare at a pointer and think something amazing will happen, but that is exactly what happened. The feeling of helplessness rose to the surface, as well as the words, “I’m gonna die.” There was a resignation that I could NOT save myself. I didn’t know how to swim, and there was nothing I could do.

Then, I could hear the voice of the Spirit of God in my ear, reminding me He was with me, and all I needed to do was to call out to Him…so I did. He told me I was never designed to save myself; that was His job. He showed me that He was the one that sent that neighbor girl to rescue me. He never lost sight of me. He was waiting for me to stop struggling in my own strength to save myself before He sent help. That is exactly what they teach in lifeguard school.

That was super powerful, but my therapist told me to stick with it to see if anything else came up. I could hear this voice saying, “giving up is failure.” Again, I could hear the voice of the Lord speaking the words of truth to me. He said I didn’t give up; I called out to the One that could help me, and He did. He has all the resources I need at His disposal.

I have lived with this compulsion to try to save myself for five decades. I wouldn’t let people help me because I had to save myself.

I wouldn’t ask people to help me because that was admitting defeat. All this time, I’ve had the complete regimen of resources of the God of the universe at my disposal, and I refused to ask for help because I felt like I had to save myself.

I was absolutely amazed that the compulsion was gone. I mean gone, gone. I tried for a week to re-activate that spot again, and I couldn’t. Wow!! I cannot explain it, but I will tell you that I have already seen evidence of it being gone in how I’ve reached out to people for help and didn’t try to do things on my own. I can’t tell you how many times over the years my therapist would say to me that I don’t have to do this alone, but I still felt like I had to, but not anymore. I feel more open to asking for and receiving help from others. I don’t feel like I have to do it all alone.

It is so freeing to finally realize that the God of the Universe knows exactly where I am at all times. He never loses track of me. He is waiting for me to call out to Him, and He is ALWAYS there when I do. He has all the resources of the universe at His disposal. I was never meant to save myself; that is His job. He really does save…spiritually, physically, and emotionally.

What an amazing experience and that was just the second target of three. The depth that this got to in my brain was truly remarkable. I am encouraged to continue this journey and see how the Lord can use this modality in my healing journey.

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

My boss is a great lady who genuinely cares about and takes care of her people. On this trip, she really took care of us by renting a mini-van to drive us back and forth to the hotel, paying for dinners on her corporate card, and looking for opportunities for us to have fun (like stopping for Philly cheesesteaks on the way to the airport).

Pushing Back Against Bing Cared For 

Early in the trip, I found myself pushing back against being cared for, so I got a little curious about that. As a trauma survivor with severe attachment wounds, it is understandable that I sometimes have issues with authorities in my life. The catch here was that she was doing nothing wrong or bad…everything she was doing was with kindness and gentleness to care for us, but I was resisting that.

I started to ask myself what that was about. It was definitely a trauma response. I quickly realized this was related to the bind children experience when they naturally turn to their caregivers for comfort/support, and those caregivers are abusive like my dad was.

In Janina Fisher’s book, Healing the Fragmented Selves of Trauma Survivors, she says, “When attachment figures are abusive, the child’s only source of safety and protection becomes simultaneously the source of immediate danger, leaving the child caught between two conflicting sets of instincts. On the one hand, they are driven by the attachment instinct to seek proximity, comfort, and protection from attachment figures. On the other, they are driven by equally strong animal defense instincts to freeze, fight, flee, or submit or dissociate before they get too close to the frightening parent”(p. 24).

While that made sense to me, I recognized it as part of the living legacy of trauma under which I no longer had to operate. As trauma survivors, it is important for us to live in the “NOW” because that is where we have our POWER. As children, we did not have the ability or the power to protect and care for ourselves, but we do NOW.

Attachment in the Workplace

The residual effect of attachment wounds as children show up all the time in the workplace, but we may not recognize it. Have you ever observed a person at work who has to do everything for themselves and doesn’t want anyone mucking around in their sandbox? Have you ever seen someone or even experienced yourself being overwhelmed by being over capacity and swirling because they/you could not ask for help?

Sometimes this behavior is even rewarded both in childhood and adulthood, which makes it harder to recognize. Parents or teachers are often thrilled by a child who takes responsibility for their own care and is less of a drag on their already thin emotional resources. As managers/leaders, we are relieved when we have a self-sufficient employee who doesn’t require much care and feeding. They are low maintenance.

What we don’t see is that on the inside, these children and adults are functioning in full-on survival mode. They are doing only what is necessary for safety and survival. When we constantly operate out of survival mode, it starts to break down our health due to increased cortisol levels and the inability to relax. It is not sustainable and will eventually result in anxiety, fatigue, and depression.

Sinking into Support

Even though I have done a lot of work in therapy, the habitual pattern of thinking that I have to take care of myself still creeps up at times, as it did on my trip; only now, I have the tools to be able to manage it.

I acknowledged that this was related to my attachment wounds and reminded myself that my boss was not my father. So, basically, I became more present with the current situation and put my past back in its place. Once I addressed that old thinking, I was able to sink into my manager’s care without feeling threatened by it.

Since this is a relatively new experience for me, I want to describe what it felt like for me. It felt like laying down in the middle of a bed that had a super duper mattress topper on it and then being covered up with blankets. It felt like being held and rocked as a child. I felt safe and cared for…and relaxed. It was like the 1,000-pound gorilla was no longer on my back. It was awesome. I was amazed by how good it felt.

That is how support is supposed to feel. It should hold you up. It should take the weight off of you. It should assist you and enable you to function at a higher level.

This is what I do as a coach, which is why I love what I do. I want my folks to feel the support that they might never have experienced in their lives before. I want to help them live in the present and achieve the career goals they have set for themselves. I want to enable them to function at a higher level in the workplace.

You don’t have to do this alone

If you are struggling with overcoming the living legacy of trauma in your work life, you are not alone, and you don’t have to manage it alone. We were never meant to carry this burden or walk the path to healing alone. The weight is too heavy, and the journey is too long.

What about you? Where are you in your healing journey? Are you still trying to go it alone? Are you curious about what it would be like to have support? Are you just plain tired of having to pull yourself up by your bootstraps over and over again…alone?

I’m here for you. You can find me at www.cyndibennettconsulting.com. Schedule your complimentary discovery call today.

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Credit: Karla Ruiz

What is Betrayal Trauma?

• How do you begin to heal when you discover that your partner has been unfaithful?
• How do you learn to trust again when a family member has betrayed you?
• How do you move forward when your boss abused their position of power and sexually harassed you?

In the wake of a betrayal, many people feel their world has been shattered. Some are left wondering whether they even have a future at all. Betrayal and the ensuing sense of despondence can leave victims with chronic distrust problems and crippling self-doubt. Being betrayed by a trusted person can have a long-lasting impact on physical and mental well-being and compromises the ability to form lasting relationships with others.

In her article ‘Understanding Complex Trauma, Complex Reactions, and Treatment Approaches’  Dr. Christine Courtois highlights the interconnectedness of betrayal trauma and Complex Post-Traumatic Stress Disorder (CPTSD), stating that “complex trauma generally refers to traumatic stressors that are interpersonal, that is, they are premeditated, planned, and caused by other humans, such as violating and/or exploitation of another person” (Courtois, 2019). Betrayal causes immense emotional pain and has far-reaching physical and psychological consequences, which are not easily overcome in a day, a week, a month, or even a year. Some people never get over the impact of betrayal. Healing from betrayal requires intense reflection and work on personal growth to rebuild a sense of worthiness, self-confidence, and belonging. Learning to trust others is one of the most difficult hurdles to overcome. Recovery from betrayal is isolating and painfully difficult and often leads to a transformation of the self.

Types of Betrayal

The most common types of betrayal include the disclosing of confidential information, disloyalty, infidelity, and dishonesty. At the least, betrayal causes shock, loss, anger, and grief; at worst, it can cause anxiety disorders and PTSD (Rachman, 2010).

Examples of betrayal:

• Discovering that your husband/wife/partner had a physical, emotional or online affair.
• Finding out that your husband/wife/partner has engaged in addictive behaviour, e.g. drug-taking, gambling, porn.
• Experiencing sexual, physical and emotional abuse at the hands of a family member or by a key relationship.
• Discovering that your friend told someone a secret that you entrusted them with.
• Finding out that your co-worker used your work as their own to elevate their status.
• When your family justifies your partner’s abusive behaviour.
• When a boss abuses their position of power and takes advantage of you.
• Failure to offer or provide support and assistance during times of physical or emotional need.

Types of Betrayal Trauma

• Institutional
• Parental
• Partner
• Interpersonal, e.g. friends.

Additionally, any of these types of betrayal trauma may be accompanied by ‘betrayal blindness’,  an unawareness or forgetting of the act of betrayal. (Freyd, 1999).  This adaptive response may be associated with betrayals not traditionally recognised as trauma, such as adultery, inequities in the workplace and society, etc. Victims may unwittingly manifest symptoms of betrayal blindness to preserve the relationships and social systems upon which they depend. (Freyd, 2021). 

Symptoms of Betrayal Trauma 

• Chronic mistrust
• Commitment issues
• Flashbacks
• Nightmares
• Hopelessness
• Dissociation
• OCD
• Emotional dysregulation
• Confusion & self-doubt
• Panic, anxiety & depression
• Irritability and rage
• Fear
• Toxic shame and guilt
• Low self-esteem
• Loss of confidence & self-worth
• Extreme exhaustion
• Withdrawal from social interactions
• Difficulty maintaining relationships

Childhood trauma and the associated betrayal can elicit symptoms that continue through adulthood and often prevent the formation of deep, intimate relationships due to past experiences. The severity of betrayal trauma is complex because it concerns not only the experience of the act of abuse but also the experience of being betrayed by a trusted person or someone the victim relies on for support and survival. Symptoms of betrayal trauma do not meet the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) diagnostic criteria for PTSD. However, symptoms of betrayal trauma are closely related to those of CPTSD which occurs as a result of abuse and ongoing trauma. (Diagnostic and statistical manual of mental disorders: DSM-5-TR 2022)

Feelings and effects of betrayal such as degradation, rejection, and humiliation can be catastrophic and life-changing. Betrayal on any level causes immense emotional pain and can be incredibly isolating, but with professional help, therapy, and support, many trauma victims go on to live fulfilling lives. Trauma-informed therapy, such as that offered by the C-PTSD Foundation, helps individuals move forward in their personal and professional lives with ongoing support that promotes healing and recovery. Some individuals with extensive trauma histories may remain in therapy for years; however, recovery is possible with a trauma-informed approach and lots of determination and support.

References

• Courtois, C. A. (2019). Understanding Complex Trauma, Complex Reactions, and Treatment Approaches. Understanding complex trauma, complex reactions, and treatment approaches – Gift From Within. Retrieved from
• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Dsm-5-Tr. 
• Freyd, J. J. (1999, June). Blind to Betrayal: New Perspectives on Memory for Trauma. Retrieved from https://dynamic.uoregon.edu/jjf/articles/freyd99.pdf
• Freyd, J. J. (2021). What is a Betrayal Trauma? What is Betrayal Trauma Theory? Definition of Betrayal Trauma Theory. Retrieved from https://dynamic.uoregon.edu/jjf/defineBT.html
• Rachman, S. (2010). Betrayal: A psychological analysis. Behaviour Research and Therapy, 48(4), 304–311. https://doi.org/10.1016/j.brat.2009.12.002

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

This article was originally published on The Mighty.

There are two questions I often don’t know what to do with.

“Where do you feel that in your body?”

and

“Can you describe that a little more for me?

My reply is typically a shrug of the shoulders.

I’m not attempting to be aloof, I’m genuinely unsure of how to answer. Whether the questions are coming from my therapist, a doctor, or some other sort of other professional — I struggle to find the words to explain what’s going on inside of me. I used to think it was just a weird quirk, but eventually, I learned this is common for folks with a history like mine.

In my case, this trouble stems from past trauma, the trauma that also developed into complex PTSD. Disconnecting my mind and body was a useful survival skill, especially when it was needed.

It turns out that once safety is found, re-engaging the mind/body connection is not like flipping a switch — it takes patience and hard work. I’ve now reached a place where I notice what’s going on with my body a lot more, but I still get a little stuck on understanding what the feeling is exactly.

Cue my therapist.

Have you heard of the Body Sensations Wheel?

Nope! I’ve heard of just about every other type of therapy wheel. Heck, I’ve created my own scales, cards, and similar things. But I hadn’t heard of this one. So naturally, I had to have it.

It looks like this: 

Each card represents an area of the body. It then expands to what sensation you might feel there and what that could represent emotionally. I find it to be straightforward and (at least in my case) pretty accurate.

I use it in a few different ways.

1. Random check-ins.

I started off using it this way, as I was unsure if I would remember to look at it when I was feeling upset or disconnected. This has helped me realize that even when I’m in a neutral place if I slow down and scan myself, there are still things to notice.

2. When I know I’m feeling something, but don’t know what. 

As I mentioned prior, I’ve had more success with a general awareness of sensations — but I tend to struggle with naming them. So with this tool, I can pick out the body part without much effort, then look over the card and search for a match. Most of the time I find one, and that simple act of naming things can be a stabilizing force when things get wobbly.

3. When I’m feeling a lot, but need to connect to my body. 

On the other hand, there are also times when I know exactly what emotion I’m feeling, but fail to connect it with my body. In this case, I can use the wheel in a bit of a backward way — find the emotion on the outer part of the card, then do a little detective work and see if it corresponds to a sensation and where on the body it is. This backward method doesn’t always work, but even so, it engages my thinking brain in a way that is not the norm for me. I also sometimes figure out what something is based on what it is not. It’s a useful experiment!

4. Figuring out what to do about it.

The natural last step for me seems to be asking myself if I’d like to do something with this feeling. Sometimes the answer is no. It just needs a place to exist, it wants recognition, or it’s already passed. Other times I need to experiment. OK, maybe this feeling would be like a nap or a gentle walk. I try it and get to learn what ends up being helpful. Then there are the times I know exactly what’s needed, like ice cream or a hug. And sometimes, because life is like this, I choose to acknowledge it but then not really do anything with it. Sometimes we are busy or don’t feel we have the energy to “do the thing.” And that’s OK too. 

I’ve only been using these cards for a little over a month, so I know I will continue to learn and grow as I use them. I also know they are not a magic wand, for me or anyone else. Yet like most things mental health-related, they can be another awesome tool in our toolbox. If you like the idea, but find what’s provided doesn’t mirror your experience, you could even get creative and make your own. And how cool is that?

Have you heard of a Body Sensations Wheel? Have you used this one or something similar? Did you learn anything that surprised you? Any tips or tricks on ways to use it? Let me know in the comments below!

If you’d like to follow along with my journey, you can find me on Instagram as @mentalhealthyxe.

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

In the last several years, when the world has felt so tough, I have dreamed of a world led by someone on a trauma-informed platform. I have even joked with my family and friends that I wanted to run for president on the platform of safety, kindness, and compassion.  And as I’m unable to do that, at least I can do this: Help encourage people to view the world through a more trauma-informed lens. This is the way to bring us closer to safety together, instead of further apart.

Living in a world that feels safe, compassionate, and understanding, where you can be seen and heard, is ideal. So many trauma survivors are triggered in everyday life by the fears or dangers familiar from the past. The difference between viewing life through a trauma-informed lens and viewing life through an active trauma lens is startling.

What does a trauma-informed view look like?

Trauma-informed care recognizes how life experiences and trauma impact the brain.  When viewing the world through a trauma-informed lens, we prioritize safety – we consider the physical and emotional effects trauma can have.  We work hard to respect and honor how behaviors and views make sense, given personal history. We consider what happened to them. Like the book authored by Dr. Bruce Perry and Oprah, What Happened to You?  Conversations on Trauma, Resilience and Healing.  We understand that there’s a story, that people are doing anything they can to survive life, and that their beliefs are impacted by everything — their upbringing, knowledge, education, and life experiences.

There are several guiding principles in viewing life from a trauma-informed lens that allows us to see what has happened to people and the impact that makes on their lives. Viewing others with more empathy allows for the baseline of safety needed for a healthy society.  A trauma-informed lens requires us to build a foundation that includes:

1. Safety – on both a physical and emotional level
2. Trustworthiness & transparency – in relationships and in the process of life
3. Peer support – having support and empathy, as well as belonging
4. Collaboration & mutuality – partnering and leveling power differences
5. Empowerment & choice – around decision-making in life
6. Cultural, historical & gender issues – inclusivity for all people

Through a trauma-informed lens, all experiences and needs are valued.  Therefore, being able to look at the world through the healthiest sense of yourself — keeping in mind the ideas named by Internal Family Systems Founder, Dick Schwartz, Ph.D. and his 8 C’s of self:

1. Calmness
2. Clarity
3. Curiosity
4. Compassion
5. Confidence
6. Courage
7. Creativity
8. Connectedness

The ability to look at the world this way, through the 8 C’s, requires a large window of tolerance and the ability to cope with the hard parts of life. Trauma survivors do not usually start off with a trauma-informed view of the world. Because of what’s happened to them, it’s more likely that they initially look at the world through a traumatized view.

What does a traumatized view look like?

Because of what happened to them, trauma survivors learned to keep themselves alive through whatever means necessary. They learned to not trust, to live in fear and always wonder when the other shoe will drop. This view keeps their windows of tolerance, and their ability to feel difficult feelings, very narrow or small. They may see the world and new viewpoints living from a place of:

• fear
• rigidity or black or white thinking
• doing anything possible to survive
• being triggered into the fight, flight, or freeze
• eliminating options because gray areas feel unsafe

As someone living with unresolved trauma, different views and beliefs may be very dysregulating. They may be reminders of how dangerous life can be, and in response, may feel the need to do whatever is possible to survive, trying to just feel safe enough. In order to feel better or less badly, trauma survivors may go into a state of hyperarousal and try to control the situation as best they can, making rules and eliminating options because anything outside of their beliefs feels unsafe.

Even people in power, who are making the rules, are sometimes living inside trauma and have very small windows of tolerance. Not able to tolerate differing views to find the gray area. Likely to attract support from others who view the world similarly, with small windows of tolerance who are also trying to feel safe inside their traumatized view.

People who are living with unresolved trauma don’t feel safe. They don’t understand why or how people are able to trust or see the world with curiosity and kindness. They are adapting, doing what they can to survive. This is why trauma survivors may continue on the same path for a long time – looking at only certain issues, or the short-term because change feels extra scary for them.

By being able to ground in the present and consider — how dangerous is this situation or understanding me today? — it can be possible to notice safety and bring a trauma-informed perspective to the table, instead of a traumatized one. Wouldn’t it be wonderful to be able to say: life today is safe and I can make my choices from my wise adult thinking brain.

In today’s world, how do we show up with a trauma-informed lens?

Beyond what we see in the flashy headlines, here are some person-to-person examples that we may encounter in our daily lives:

• someone you know is abusing substances, and we are curious about the pain they carry that they are trying not to feel
• someone you know who is pregnant and can’t carry to term in a healthy way, and we are compassionate to how scared or triggered they may be
• someone you know who wants to terminate a pregnancy, and we honor their courage of knowing they are not ready to be a parent
• someone who is fighting for women’s rights, and we connect with their confidence
• someone who wants to assist Ukrainian refugees, and we admire the creative ways they do
• someone who won’t get vaccinated, and we remain curious about their fears in order to help them understand the science
• someone who does not support Black Lives Matter, and we calmly try and help bring clarity to their beliefs and help them connect to all people
• someone who is transgender, and we bring compassion to their courageous want for an authentic life, wanting to connect with their true self
• someone who believes being gay is wrong, and we calmly and curiously talk to them about honoring all people, bringing compassion
• someone who committed a crime, and we bring wonder and curiosity to what happened to them to fuel this behavior
• someone kills others, and we wonder how our society can help build structure and safety so that is no longer as easily possible
• someone who votes differently from you, and we hold curiosity for their connection to their views

A trauma-informed view looks at these people with compassion, curiosity, and shared humanity:

• How did you get to the views you have?
• What happened to you?
• What has been your life experience?
• What informed your decisions?
• How does your choice take care of you?
• How can I understand you better?
• How can we help you heal?

A person with a trauma-informed view works hard to look at people with kindness and compassion — even if those people live in a way, or are making decisions or choices, that make them or us feel uncomfortable.

Trauma-informed humans are always working to expand their windows of tolerance so they can approach uncomfortable situations with an open heart and mind, in a way in which they can feel safe.

From LGBTQ+ issues and the war, gun violence to abortion, racism, COVID, and the Johnny Depp / Amber Heard trial — everything that’s in the news can be seen through a trauma-informed lens or a traumatized one.

Certainly, because of COVID, everyone in the world has now experienced some sense of lack of safety and stability – trauma – and might even be called a trauma survivor. Most people have endured multiple traumas. Many people have grown up with childhood trauma. If everyone is a trauma survivor, what are you going to do about it?

Here’s my hope:

• Make trauma your superpower
• Continue to expand your window of tolerance
• Own that you were powerless over the trauma
• Be a helper
• Seek out reparative relationships
• Use self-compassion
• Find the self-care that works for you
• Reduce the stigma around mental health care
• Deepen your knowledge
• Build a safer world for us all!

Seeking a more trauma-informed view of the world?

Trauma-informed therapy can help.

This blog originally appeared on https://brickelandassociates.com/how-to-be-trauma-informed/

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.