Explaining the ‘Complex’ in Complex Post Traumatic Stress Disorder (CPTSD)
In a recent session, a client shared their discomfort around addressing their childhood trauma and wounds with their siblings. They said “I feel like I’m taking too much space. Its just easier to not care.” To which I responded that the client did care because it brought them to therapy. This client was given the Complex PTSD diagnosis a couple of years back and since then they have been trying to unpack it.
One of the major aspects that differentiates Complex PTSD (CPTSD) and PTSD is that the former is caused by a history or prolonged period of trauma characterized by repeated exposure to traumatic events/situations over months or even years, especially during childhood. PTSD, on the other hand, is often caused by one single incident or event.
A person with CPTSD experiences intense interpersonal conflicts, dissociation, flashbacks, deep rupture in sense of self, and other health issues pertaining to chronic pain, gut health and inflammation. Many of these symptoms also coincide with Borderline Personality Disorder and experts are calling for a more trauma-informed description of BPD because of this link.
Shame
Trauma and shame go hand in hand and this propagates intrusive thoughts like “I am not good enough”, “I feel like I’m taking too much space”or “My needs are bad”. The shame can also be situational- about the events themselves leading to victim-blaming. These can lead to a person internalizing the stigma of the traumatic event and taking on the role of the internalized perpetrator. One way we support clients during therapy is by externalizing these two aspects, using trauma-informed techniques from Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT) and Narrative Therapy to complete the story and change the ending.
Dissociation
Individuals with CPTSD also experience dissociation which is disruptive to their wellbeing. There is no one way to explain dissociation as its more of a continuum. A person can move from experiencing daydreaming, denial and repression to dissociating from the body, dissociative amnesia (brain’s protective mechanism where a person loses chunks of time from their memory) or developing Dissociative Identity Disorder. Dissociation during the traumatic events may also lead the person having no memory or feeling of having survived the trauma. This can be particularly challenging for the person as they feel stuck in the traumatic event and their body waiting for the events to happen again. When a client dissociates, we work together on grounding skills, helping them come back to the session and then gently proceed with skills work.
Agency and Consistency
One of the most important aspects of working with trauma survivors & people with CPTSD is consistent support and working towards reclaiming their agency. Repeated exposure to trauma- sexual, physical, emotional or any other kind, means that the person has lived experience of being powerless for several months or years. This is a direct hit at a person’s agency aka their ability to make choices and decisions. Perpetrators target agency so that their control is maintained and they are able to continue traumatizing their victims. A trauma survivor has no choice in the traumatic event which leads to shame, guilt and dissociation. This also leads to paralysis of initiative or the inability to make decisions. Trauma survivors often avoid social contact or events due to a fear of being re-traumatized or triggered. Working with clients on gradually building their agency involves finding examples from their life where they do make decisions, helping them distinguish between active threat in the present and their past experiences, and identifying situations where they can take control of their actions.
In therapy, we uncover the meaning of the traumatic experience for the client, including working through triggers in the present. Exploring the impact of trauma on the person’s belief system, identity, relationships etc more than exploring the incident itself helps us move forward towards healing. One of my key learnings from working with trauma survivors, particularly those with CPTSD, is the importance of being consistent. What does it look like in practical life?
Setting up appointments at the same time every week. This helps build a routine and structure for the client that is predictable and accessible.
Avoiding any major changes in therapy space, especially in the initial sessions. Hyper-vigilance is a major symptom of both CPTSD and PTSD. Individuals notice details of a plant that was moved or new curtains or how the space smells. Being consistent also entails avoiding any big upgrades or changes in the therapy space, especially in the first couple of sessions. Our goal is to provide a safer space that looks and feels consistently the same for better therapy outcomes.
Giving them ample time to prepare for change. Sometimes you cannot avoid change and it is difficult for everyone, especially for someone with CPTSD or PTSD because it can trigger intrusive thoughts, feelings of broken trust, abandonment or feeling unsafe. Giving clients ample time to prepare for change can be helpful in them building coping skills as well as looking forward to what’s next with a curious mind.
Consistency leads to safety and safety leads to agency. The road to healing from trauma is often long and bumpy, but with support, it can also be fulfilling and life changing.
Ending this post with a journal prompt : Reflect on what freedom of choice means to you. How do you define it in your personal life?
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If you would like to know more about how we work with clients who have CPTSD, you can contact us via WhatsApp, email or phone call. You can also book a time for a 20-minute free consultation here.
