Complex Trauma

autumn stream 960

‘It can perhaps be conjectured that unresolved trauma
is responsible for a majority of the illnesses of modern
mankind’
(Levine, 2010:184)

‘There is more to trauma than PTSD’
(Shapiro, 2010:11).

A major focus of my work relates to trauma, particularly its complex varieties. Trauma stems from overwhelming experience which, if unresolved, has pervasive negative effects across the life-cycle. It is also far more prevalent than is commonly recognised, and comes in many guises. Current research suggests that many otherwise diverse health problems – both psychological and physical – are trauma-related (Felitti, Anda et al, 1998, 2010; van der Kolk, 2011; Cozolino, 2002; Levine, 2010).

Most people have heard of PTSD (post-traumatic stress disorder). But this is far from the only form in which trauma presents. PTSD relates to ‘single-incident’ trauma (i.e. ‘one-off’ incidents and overwhelming events). By contrast, ‘complex’ trauma is cumulative, repetitive and often interpersonally generated (Courtois & Ford, 2009). Complex trauma differs from, and is more common than, single-incident trauma (PTSD). Yet because it manifests in diverse ways it often receives different diagnoses, and the underlying (‘complex’) trauma is undetected.

Because of both its prevalence and intergenerational effects (Hesse, Main et al, 2003) complex trauma is not just an ‘individual’ disorder. It poses an urgent public health challenge (van der Kolk, 2003; Jennings, 2004; Felitti, Anda et al 1998). Yet complex trauma remains underestimated and often unrecognised, even within the area of mental health.

Part of the reason for this is that individualistic paradigms are still common in the ‘psy’ professions, notwithstanding reference to ‘biopsychosocial’ factors. This is in combination with the biomedical paradigm which privileges scientific method, and which is insufficiently attuned to the pervasive role of culture and social environment (Castillo, 1997). This can lead to a focus on ‘symptoms’ (i.e. detached from the context/s in which they have developed) and lack of attention to the interpersonal, relational and social contexts that generate complex trauma in the first place.

‘Individuals’ are always shaped and influenced by the social contexts in which they exist. ‘Relationality rules!’ But key values of our culture imply otherwise, emphasising ‘independence’, ‘autonomy’ and the need to ‘move on’ (with the frequent implication to put ‘the past’ behind us). In seeking to access help, many people who experience unresolved complex trauma are also re-traumatised by the very services from which they have sought assistance (Jennings, 2004:6; Bloom & Farragher, 2011; Davidson, 1997). While not intended to have this effect, individualistic assumptions can reinforce punitive attitudes which are far from healthy, which encourage self-blame, and which do not assist healing.

Complex trauma can be resolved, and its negative effects, including intergenerationally, can be intercepted (Siegel, 2003). Yet resolution does not occur simply with the passage of time, or as the product of ‘will power’. The relationship between overwhelming childhood experiences and emotional and physical ill health in adulthood is now clearly established (Felitti, Anda et at, 1998). Childhood coping mechanisms become risk factors for adult symptoms of ill health if overwhelming stress experienced in childhood is not resolved (ibid).

As co-author of The Last Frontier: Practice Guidelines for Treatment of Complex Trauma and Trauma-Informed Care and Service Delivery I am attuned to the exciting interdisciplinary research on which these guidelines are based. Clinical and neuroscientific findings now converge in a common understanding of the role of overwhelming stress on the brain and body (Bloom & Farragher, 2011; Solomon & Siegel, 2003). Recognising the neuroplasticity of the brain also means that while we are vulnerable to the devastating effects of overwhelming stress, integration of disrupted neural pathways (and thereby resolution of trauma!) can occur to an extent not previously thought possible.

I am available for:

  • consultation, both individual and group, in relation to complex trauma/trauma-related problems
  • one-to-one counselling and psychotherapy for complex trauma/trauma-related problems

 

Bloom, S. L. & Farragher, B. (2011) Destroying Sanctuary: The Crisis in Human Service Delivery Systems. New York: Oxford University Press.
Castillo, R. (1997) Culture and Mental Illness: A Client-Centered Approach. Pacific Grove, CA: Brooks/Cole.
Courtois, C. A. & Ford, J. D. ed. (2009) Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide. New York: The Guilford Press.
Cozolino, L. (2002) The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain. New York: Norton.
Davidson, J. (1997) Every Boundary Broken: Sexual Abuse of Women Patients in Psychiatric Institutions. NSW Department for Women and the NSW Health Department.
Felitti, V.J. & Anda, R.F. (2010) ‘The Relationship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders and Sexual Behavior: Implications for Healthcare’. Ch. 8 in Lanius. R.A., Vermetten, E. & C. Pain, The Impact of Early Life Trauma on Health and Disease. Cambridge University Press, pp.77-87.
Felitti, V. J. Anda, R. F. et. al (1998) ‘Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study’, American Journal of Preventive Medicine. 14 (4), pp.245-258.
Hesse, E., Main, M. et al (2003) ‘Unresolved States Regarding Loss or Abuse Can Have ‘Second Generation’ Effects: Disorganization, Role Inversion, and Frightening Ideation in the Offspring of Traumatized, Non-Maltreating Parents’, in Solomon, M.F. & Siegel, D.J., ed. Healing Trauma. New York: Norton, pp.57-106.
Jennings, A. (2004) ‘Models for Developing Trauma-Informed Behavioral Health Systems and Trauma-Specific Services’. Report produced by the National Association of State Mental Health Program Directors (NASMHPD) and the National Technical Assistance Center for State Mental Health Planning (NTAC) United States.
Levine, P. (2010) In an Unspoken Voice. Berkeley, CA: North Atlantic Books.
Shapiro, R. (2010) The Trauma Treatment Handbook: Protocols Across the Spectrum. New York: Norton.
Siegel, D.J. (2003) ‘An Interpersonal Neurobiology of Psychotherapy: The Developing Mind and the Resolution of Trauma’, in Solomon & Siegel, ed. Healing Trauma, pp.1-56.
van der Kolk, B.A. (2011) ‘Foreword’, in Porges S.The Polyvagal Theory. New York: Norton, pp.xi-xvii.