In my last post, “Eating Disorders and Complex PTSD”, I described complex PTSD and listed some of the experiences typical of adults with this unresolved trauma disorder. Since the treatment of complex PTSD is often different from what people are expecting, today I’d like to walk you through some treatment basics.
Treatment for complex PTSD is typically planned to occur in three stages:
- Safety and stabilization In this stage you develop the skills and capacity for tolerating difficult emotions that emerge in trauma treatment and in life. Along with this comes greater ability to manage eating disorder symptoms and other symptoms, such as drinking or drugging, that represent failed efforts at emotion regulation. Issues such as self care will also be addressed. A lot of attention will be paid to the quality of the relationship with your therapist since the early trauma likely involved your relationship with caregivers, what’s called attachment trauma.
- Direct trauma treatment This is the stage in which you directly address trauma memories and work to resolve them. “Resolution” means, among other things, that trauma experiences no longer cause you to be distressed or symptomatic in the present.
- IntegrationIn this final stage of trauma treatment, you are helped to develop life skills trauma may have robbed you of, such as the capacity to assert yourself or establish healthy boundaries in relationships. You are also supported in developing a sense of personal agency, that is, the ability to think about how you’d like your life to be, to set goals for making it happen, and mobilizing yourself to implement your goals. Widening your network of social connection and your engagement in the larger community is another important part of this stage of treatment. Through all of this is woven an increasing capacity to experience yourself and your life in a coherent, organized way—there’s an executive “you” that can see the bigger picture and sense how the pieces fit together.
There are aspects of this three-stage plan that may be disappointing and upsetting for some of you. For instance, you may want to know why, if you are coming for trauma treatment, you can’t just jump right in and go to work on your trauma memories. Often it’s taken a while to get your difficulties diagnosed as trauma, during which time you’ve experienced a lot more pain and suffering. Why not just rip off the bandage right away and get it over with? It’s understandable. But it’s precisely the wrong way to go. Here are a few reasons why:
- Early trauma resulting in complex PTSD means you had experiences that overwhelmed your capacity to cope. Delving into those experiences without having the chance to develop better coping skills is highly likely to reproduce the original overwhelm; in other words, to re–traumatize you.
- Complex PTSD means early trauma has taken up lodging in your nervous system, the part that’s responsible for warning you about danger. This system has become exquisitely sensitized, such that it’s sending you alarm signals all the time, even when nothing threatening is happening. This can be harrowing to live with. You may have learned to numb out or dissociate as a way to protect yourself from the flood of feelings. Perhaps you live most of the time now in a deadened state, or perhaps you cycle between overwhelmed feelings and deadening or dissociation. A severely dysregulated nervous system is a hallmark of complex PTSD. Getting it to function on a more even keel is a first order of business so you can start to feel better and function better.
Another wish or expectation that is generally disappointed in the treatment for complex trauma is the desire for a quick fix. Goodness knows, when you’ve suffered since childhood, you’re entitled to it. If only it were possible! Sadly a number of people give up altogether or jump from treatment to treatment, holding out for instant relief. What you can realistically expect is that when you dig in with the work of treatment, little by little things will start to get better.
A third common wish or expectation that people bring to treatment for complex trauma is that treatment will somehow be done to them rather than in collaboration with them. This makes sense to me because chronic early trauma is likely to leave you feeling helpless about your ability to make things happen in your life. As it turns out, the growing sense of “I can” that develops from collaborative work with your therapist is an important part of the healing you will experience. Learning to tolerate small steps and incremental improvement will make a big contribution to establishing that “I can” sense of yourself.
Chronic early trauma undermines the development of a sturdy, secure self and trust in relationships with other humans. Treatment for this kind of trauma aims at repairing the internal and interpersonal damage done and building up the structures inside that will allow you to relate to yourself and the world in a more confident and resilient way. It’s going to take longer than you hoped it would, but you’ll never make a better investment.
Warmest wishes,
Susan