CPTSD treatment
Before we talk about CPTSD or complex posttraumatic stress disorder, it's helpful to understand a bit more about trauma in general.
What is trauma?
The most common definition of trauma is when there is a threat to life or bodily integrity.
Being in a traumatic situation is when something dangerous happens to you or someone you care about or you witness something dangerous happening to someone else.
A traumatic experience could be physical abuse or domestic abuse, or if you witnessed a crime where someone was physically abused. It can also cover natural disasters and catastrophic experiences such as earthquakes, fires, floods or landslides. It covers accidents where people are hurt or killed and other acts of violence.
Bodily integrity is your sense of safety in your body, so this normally refers to sexual abuse or witnessing sexual violence. This includes incidents of childhood sexual abuse and incidents that occur as an adult.
Trauma in childhood
It's worth noting that children are more susceptible to trauma. Adverse childhood experiences which are also called 'ACE's' are events that cause extreme stress in childhood. These include child abuse such as emotional abuse (name calling, being humiliated or criticised), sexual abuse, physical abuse or physical neglect (where you don't have clean clothes, safety or enough food) or emotional neglect (where you don't feel supported, loved or understood).
Trauma in childhood can lead to longterm problems in adulthood which can affect self esteem, and lead to unhealthy relationships and problems in daily life.
What is fight, flight, freeze, friend, flop?
After a traumatic event, which is an event during which someone feels threatened and overwhelmed the body understands that it it is in danger and will do what it can to protect you. Although the most well known responses to threat is 'fight or flight' there are other responses such as freeze, friend (fawn) and flop.
The fight response occurs when someone tries to protect themselves by fighting.
The flight response is an attempt to flee danger and run away.
The freeze response is common when the body interprets that the first two won't work. People freeze until the danger passes. This frequently happens in children since they are often unable to fight or leave childhood abuse which frequently occurs in the home. It also the most common response in sexual abuse or sexual assault.
The friend or fawn response is an attempt to cooperate with the person who is hurting them.
The flop response is a more extreme version of the freeze response.
What is PTSD?
Most people are familiar with the term PTSD which stands for post-traumatic stress disorder.
PTSD is normally used for single point trauma, that is one episode or incident when something happens. People can develop PTSD after a car accident or being attacked because it is one individual event.
PTSD can cause difficulties functioning in every day life and affect the ability to tolerate everyday activities. People can experience flashbacks or intrusive memories where they see images of traumatic events or relive the distressing memories. These 're-experiencing symptoms' can make it difficult for people to tell that the event has passed and they are no longer in danger. They might also experience physical symptoms such as increased heart rate, sweating or difficulties breathing.
What is CPTSD?
CPTSD or complex ptsd (sometimes written C-PTSD) is a series of traumatic events rather than one single event. It normally occurs over a longer period of time and can be understood as long term trauma.
It's worth noting that some people will use PTSD and CPTSD interchangeably, so you might see reference to childhood PTSD which is actually like to be trauma relating to a series of events rather than one single event.
CPTSD can be the result of childhood trauma which is when someone experience repeated incidents of abuse or neglect. Abuse can be physical, emotional or sexual and neglect can be physical or emotional. You can learn more about the types of abuse and neglect here.
Since children rarely have an option to escape their family or environment, things that might be not scary for an adult can be scary and overwhelming for a child. This means that children are more easily traumatised than adults.
Causes of CPTSD
Complex PTSD can have various causes in that people often have different combinations of trauma that lead to CPTSD.
As I mentioned above CPTSD can develop from childhood abuse or neglect and occurs when someone grows up in a dysfunctional famliy environment and feel unsafe, alone or unable to cope.
If possible, I recommend looking for someone who has experience in your type of trauma, although many therapists will work more generally with various different issues.
CPTSD from domestic violence
When CPTSD is caused by domestic violence for example, I would recommend looking for someone who specialises in working in this type of trauma. Long term domestic violence can require specialist support as there are often other risk factors such as threats to children or their mental health. Children who grow up in a home where domestic abuse occurs can suffer from various mental health issues such as negative self view (feeling bad about themselves or feeling not good enough), difficulties with emotional regulation such as finding it hard to control their emotional reactions and getting angry or self harming.
Other people develop CPTSD from exposure to trauma by working or living in a war zone, and experiencing the ongoing trauma of lack of safety, displacement and violence that ensues from this. Again, it's best to seek support from someone with experience of working with military ptsd or refugees if possible. There are often charities who specialise in these areas and have therapists who have experience of working with people from these backgrounds.
If you've been looking for C-PTSD treatment you might feel frustrated at the lack of available information or be confused about the best approach to take. You might have had a lot of therapy previously but not found it helpful and wonder what other options are available. It can be hard to have hope that your situation can improve when you've been disappointed in the past.
Can you get CPTSD from emotional abuse?
The type of CPTSD that I work with comes mostly from emotional abuse and emotional neglect.
It can be very hard for people to acknowledge that they have Complex PTSD as a result of their childhood.
Children are supposed to love their parents, and even as adults many children find it hard to criticise the parenting they received or acknowledge how much damage happened in their childhood. People often feel incredible loyalty towards their family and spend decades hoping that things will get better. If you're wondering whether your childhood was 'bad enough' to have caused your CPTSD or to feel like an imposter for suspecting you have childhood trauma you are not alone.
It's common for CPTSD to severely affect your quality of life, although this may be difficult for others to notice. Despite the idea that people with mental health conditions such as CPTSD are unable to work, this is not always the case. Many people with chronic trauma are able to work and hold down relationships even if they experience difficult with relationships or frequently feel triggered. They may still suffer internally and find it difficult to share with others how they are feeling. Common symptoms involve feeling overwhelmed, empty and persistent sadness.
There might also be somatic symptoms including pain without any known cause, fatigue, IBS or other unexplained physical symptoms. A history of trauma increases stress in the body which can cause unwanted physical effects.
CPTSD flashbacks
CPTSD can also cause 'emotional flashbacks' or 'feeling flashbacks' which is where people re-experience an intense feeling from their past in the present day when triggered by a particular event. Because of the intensity of the past event and the difficulty dealing with emotional distress that this caused, people can have what looks like and overreaction or an exaggerated emotional response to others. People might describe their reactions as disproportionate after the event but find it difficult to explain why they experienced extreme feeling of worthlessness or intense feelings of shame. Part of therapy is therefore making sense of these reactions and learning to recognise the patterns of feeling overwhelmed to avoid these intense reactions that cause problems in the present.
Emotional flashbacks can feel incredible isolating and shameful and exacerbate an already negative self belief that one is bad or faulty. It might also cause people to feel they are going mad or are losing their grasp on reality which can be frightening and overwhelming.
How I work with CPTSD from emotional abuse and emotional neglect
I work with CPTSD from emotional abuse and emotional neglect on two levels:
Theory
Practice
Theory is understanding what happened to you, the impact that it had on you, which parts of your thinking and behaviour have been affected by CPTSD. This is more logical work and might be similar to the kind of information that you have read about CPTSD.
I often find that even when people have a good understanding of trauma that they have many questions about how to change or how to handle setbacks that aren't handled in the books that they've read.
Practice, is in my experience more complex. Practice, is how you are in therapy. What does that mean? It means how much you talk, whether you can talk about your feelings, it's when you try your best to be entertaining and ‘not too much trouble'. It's an example of who you are in the ‘real world' and it's a subconscious copy of what you learned in your family of origin.
I think practice is more tricky for a few reasons. A lot of people are praised growing up for being clever. We are encouraged to be analytical at school and we are often encouraged to be independent. For complex trauma survivors, they often need to shift more towards feeling than thinking and learn how to reach out and ask for help. This can look like being less independent and there can be a fear of being judged by others or it can simply feel too scary to be oneself.
Finding a complex PTSD therapist in the UK
If you've tried to find a therapist who treats CPTSD (and by the time most people reach me they've had several) you've probably been frustrated by the number of people that claim to specialise in everything. Unfortunately this doesn’t always mean that you get the help that you’re looking for.
You want someone who gets it. Many people tell me they are looking for more direction, answers and guidance that they got in previous therapies. Being expected to figure things out for yourself can lead to feelings of shame and extreme distress and may even cause panic attacks.
What type of therapy is best for CPTSD?
Firstly, the best type of therapy is one that suits you. Although many therapists advocate for one particular type of therapy, it's important to consider what you want, how the trauma occurred and the fit between the therapist and client (the better the connection between the therapist and the client, the higher the chances of a good outcome in therapy and that you will feel better).
Some people hear about a particular approach and believe that's the only way to get help. I often find that new approaches which are described as ‘ground breaking' or ‘revolutionary' are a mix of existing approaches or an attempt to sell a particular training to other therapists.
It's important that you feel like your therapist is someone you can talk to, and that you like them. If you don't like your therapist, I think it's an upward struggle. And you're already suffering so don't make things harder for yourself.
What is relational Trauma?
Relational Trauma is trauma that occurred in a relationship
My preferred method of working with relational trauma, that is trauma that happened in the family is to work relationally. This means that the client can talk about how they experience the therapist and vice versa.
So if you wonder if I'm annoyed with you, you can ask me and we can talk about what that's like for you, how you experienced your parents being annoyed with you growing up and whether this occurs with other friends, your partner or colleagues.
If you feel embarrassed if I give you a compliment, we can talk about what that's like, why it's happening and how it occurs in everyday life.
What if I’ve had therapy for CPTSD before and it didn’t work?
A lot of people I speak to have had therapy in the past where they've received validation and empathy but the therapist hasn't know what they need to do differently. Or they've felt alone in therapy and the therapist doesn't speak very much, sometimes they even experience panic attacks or are triggered by therapy.
Some people are even invalidated by their therapists and told that what happened wasn't that bad, wasn't abusive, or that they just need to move on. If this is you, know that you are not alone and you don't have to accept being treated this way.
Online trauma therapy
I work online, so I'm happy to work with anyone who is in the UK, as long as I believe I can help and you don't meet any of my contraindications for working together.
I also have clients throughout Europe, so if you're based elsewhere but would like to work with me, this could also be possible.
I've found that clients that feel a good connection to me initially make the best progress. If I'm not your person, don't worry. I'll try and point you in the direction of someone who I believe would be a better fit for you.
EMDR for complex trauma
EMDR stands for Eye Movement Desensitization and Reprocessing.
EMDR is often used as a treatment option for PTSD and is sometimes offered as treatment for CPTSD.
Personally, I haven't seen enough evidence that EMDR is the answer that it's sometimes sold as.
I've had clients who came for therapy already having had EMDR who didn't get the answers they were looking for. I don't believe it's helpful for everyone.
I think tools are just that; tools. I think they can be helpful for symptom reduction but I also believe that understanding yourself and your process is very important in CPTSD.
Of course it's your decision, if you want to try EMDR, then you are allowed to make a choice based on you what you believe suits you best.
Do you recommend medication for CPTSD?
As I'm not a medical doctor, I don't prescribe or advise on medication. I believe that's a decision for you to make with your doctor or psychiatrist.
If you do not want to take medication, I am happy to support you with this.
If you feel medication is the right choice for you, then that's fine too!
It really depends on how you feel on a day to day basis and how much you are struggling. Sometimes medication can give you the energy to help yourself more or can help you cope with difficult and painful feelings that feel overwhelming.
How do I start online trauma therapy with you?
To find out how I can help you, book a free 15 minute call here
If we're a good fit and I can help you, I'll let you know my available slots and we'll start straight away.