Why I specialise in therapy for complex trauma and CPTSD

Hi I’m Sarah! I’m a Manchester psychotherapist, working worldwide via Zoom.

If you’re looking for help dealing with CPTSD, you might be wondering how to find a therapist that really understands what you’re going through and how to help. Maybe you aren’t even sure if what you’ve been through is ‘serious enough’ to be considered traumatic - this is a common concern for clients who also worry about being dismissed in therapy as they have been with well meaning friends, family or sometimes doctors or previous therapists. Perhaps you’ve read Pete Walker’s excellent book ‘From Surviving to Thriving’ and are wondering what to do next and are having trouble finding a therapist who understands what you’re looking for.

My fascination with CPTSD began when I experienced what I now know to be an emotional flashback during the second year of my psychotherapy training course. We’d been asked to complete an exercise; to spend 5 minutes reflecting on what it was like to be depressed. As the room fell quiet and people started to concentrate on the task at hand, I could feel myself starting to panic. The room began to feel at once restrictive and oppressive yet somehow too vast to feel safe in. My heart began to beat faster and I could feel my chest tightening. Although I wasn’t aware of it, my breathing began to increase and become more shallow and I could hear the words ‘I can’t’ on a loop in my head. I knew I had to get out but I didn’t know why or what was happening. I couldn’t think straight. I stood up and left the room, retreating to a friend’s car where I sat crying unable to explain what had happened or why I was so upset. I could only say ‘I can’t'…’ but could not complete my sentence.

At home, trying to work out what had happened to me and why it had felt so alien and ‘not quite’ connected to my course, I stumbled across the term ‘amygdala hijack’. First coined by Daniel Goleman, the amygdala is a part of our brain responsible for emotional memory and when ‘hijacked’ or triggered, it can respond as if what happened before is happening right now. These events often appear ‘excessive’ or disproportionate to those around us who cannot understand why someone would have such a big response to a small event (in my case the exercise to imagine what it would be like to be depressed). These emotional flashbacks or ‘amygdala hijacks’ can trigger intense feelings of overwhelm and panic connected to our past. They can cause survival responses known as ‘the 5 F’s’ - fight, flight, freeze, friend/fawn, flop. In my example above, I experienced both a freeze and a flight response, simultaneously freezing and then fleeing from the situation that my brain perceived as as a threat.

As someone who had spent many years depressed, my brain processed the exercise as a request to re-experience my depression and I was not willing (or able) to do this. Hence the words running through my head ‘I can’t’, which I later understood to be ‘I can’t… do this again’.

I began to read more on the topic, and could identify in my clients the same responses that I had read about. Although some clients had quite clear memories of abuse from the families that they grew up in, having experienced physical or sexual abuse, many more felt they had less clear cut grounds to be traumatised. Yet as we explored how they had grown up, the feelings they had experienced or the thoughts that they had, where they had felt safe and unsafe, the relationships they had been in or their sudden urges to ‘run away’ from everything the picture began to build.

Already having an interest in CPTSD, I focussed my professional development studies on trauma, complex trauma, emotional abuse and developmental trauma. Through my website and listings, the majority of my clients were people looking for answers to something they hadn’t yet been able to understand. Many of them had been in therapy before, sometimes with therapists that pushed them too soon for details of abuse or who unwittingly did something triggering and could not rescue the ensuing situation. Some helped for a short time, but did not address the underlying reasons for what the client was experiencing. Some did not challenge and mostly just listened and the usefulness of venting did not prove to be enough to address the symptoms and complications the client experienced.

For this reason, I have many years of experience working with clients with CPTSD, many of whom have found clarity in what was once a fog of misunderstanding. They no longer doubt their own experiences, and have learned to advocate for themselves, to put themselves first. They have been able to identify triggers either in past events or in ongoing situations and have learned to manage their triggers and seek support from friends and family. Clients who once sat blankly and sadly in my office, now happily tell me about fulfilling relationships, a sense of lightness and the relief of having tools and understanding to support themselves.

Recovery from CPTSD is not the ‘quick fix’ promised by some therapeutic approaches, and I have found that my clients benefit from weekly, long term therapy until they feel more stable. This allows us to both investigate events from their past and ongoing triggering situations that arise in their everyday life. They have time to put our discussions into practice and feed back what’s working for them and where they’re getting stuck. Over time, and as triggers become better understood, the ‘downtime’ where they feel overwhelmed and cut off following a trigger begins to shorten, the recovery period is initiated quicker and they are better able to reach out and ask for support.