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PTSD Professional Perspective: Understanding Complex PTSD Treatment, Part 2

Posted Feb 11 2011 5:20pm

Finally! Our server problems are fixed and we can resume posting by squeaking in just under the wire with today’s Professional Perspective post.

Over the past 5 months we have travelled with Dr. Christine Courtois as she made us aware of complex PTSD trauma ( Part PTSD, Professional Perspective, A Gift From Within 1 and Part 2 ) and complex PTSD reactions ( Part 1 and Part 2 ). Last month she began showing us how to get treatment. In this last installment, we complete the process.

The middle stage of treatment begins only after stabilization skills have been developed and are utilized as needed. This stage involves revisiting and reworking the trauma with careful processing to integrate traumatic material along with its associated but often avoided emotion. This stage typically involves the expression of pain and profound grief but with the support and witnessing of the therapist. The re-working of trauma is always destabilizing, so the skills learned in the early stage of treatment provide the frame and skill-set needed to face and integrate the previously avoided traumatic material. A wide variety of techniques have been developed for processing trauma that are applicable to this treatment stage including prolonged or graduated exposure, cognitive processing therapy, cognitive restructuring, narrative exposure, and reprocessing, testimony, and Eye Movement Desensitization and Reprocessing, to name the most common.

The late stage of treatment involves identity and self-esteem development and concurrent development of improved relational skills and relationships. The important issues of intimacy, sexuality, and current life choices, including whether to continue certain relationships and vocational choices typically occurs in this stage, if they have not been addressed earlier. Additionally, clients at this stage often encounter an existential crisis associated with a new sense of self and must struggle with the meaning of the now integrated trauma memories and with the losses they have endured. Survivors at this stage often struggle to embrace life with renewed energy and hope for the future. For some, meaning-making may involve a commitment to make a difference in the world, particularly with respect to decreasing violence. This is sometimes referred to as a “survivor mission.”

The course of treatment and its duration can vary quite dramatically and a variety of different treatment strategies might be used across the stages of treatment. Some clients stay in therapy for years (especially those with the most extensive trauma histories and those with insecure attachment styles) may never move beyond the first stage, while others move through the three stages in much less time, and still others only engage in treatment episodically as needed. Shorter-term and “hybrid” approaches (Cloitre, Cohen, & Koenen, 2006; Ford & Russo, 2006; Gold, 2000) are now under development. The important consideration is that new and different approaches to the treatment of complex trauma are now available and effective. Survivors who were once confused by their symptoms and who despaired of ever receiving understanding and assistance now have the opportunity to receive effective treatment, to heal, and to get their lives back and on track.

Christine A Courtois, PhD & Associates, PLC is a private practice that specializes in the treatment of adults experiencing the effects of childhood incest/sexual abuse and other types of trauma. Dr.Courtois has worked with these issues for 30 years and has developed treatment approaches for complex posttraumatic and dissociative conditions for which she has received international recognition.

For more information: www.drchristinecourtois Email:

Reprinted with permission from  Gift from Within .


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