Treating Complex Trauma: Combined Theories and Methods

Chapter One

The Need for Utilizing Multiple Approaches for Complex PTSD: No Theory Has It All

Introduction: Complex Clients Need Multiple Approaches

What is Trauma and Who Gets to Define It?

Difficulties in the Study of Complex Trauma

PTSD vs. cPTSD: Important Distinctions

Therapeutic Efficacy and the Therapeutic Alliance

Multiple Treatments, Equal Efficacy

Commonalities Among All Approaches

The Therapy Relationship and Clinical Hypothesis Testing

Negotiating the Beginning of Therapy

Conclusion

References

Chapter Two: How Trauma Stokes Fear: Considerations in Beginning of Therapy

            The Neurobiology of Trauma

            Evidence for Intergenerational Trauma Effects

            Fear: Known, Unknown, and Acted Out

            Clinical Hypothesis Testing and Introducing the Concept of Fear

            The Unhelpful Link between cPTSD and Personality Disorders

            How Trauma Can Lead to Incorrect Diagnoses

            Assessing Character Style

            Managing Fear in the Beginning of Therapy

            Conclusion

            Initial Goals in the Beginning of Therapy for People with cPTSD

Chapter Three: Nurturing the Therapeutic Alliance: Mentalizing and Emotional Safety

            Characteristics of Therapists Who Have Good Outcomes

-The Effective Therapist Has an Ability to Explain A Client's Distress and Takes the Client's Unique Experience into Account

- The Effective Therapist Is Persuasive About Treatment Ideas And Monitors Progress in An Authentic Way

- The Effective Therapist Can Deal with Difficult Material While Communicating Hope and Optimism

- The Effective Therapist Is Keenly Aware of Their Own Psychology

- The Effective Therapist Stays Aware of Relevant Research and Strives to Continually Improve

Trust and the Mentalizing Therapist

            Normalizing and Managing Shame

            Creating Safety Though Respecting Avoidance

            How Much Should We Encourage the Processing of Memories?

            Conclusion

            Interventions for Mentalizing and Maintaining Emotional Safety

References

Chapter Four: The Therapeutic Alliance and Maintaining Physical Safety

Trauma, Suicidal Ideation and Deaths of Despair

The Alarming Epidemic of Suicide

Avoidance and Therapist Feelings About Suicidal Clients

Risk Factors for Suicide  

The Trauma of a Suicidal Crisis

Clinical Management of Suicidality

Crisis Response Plans

Conclusion

References

Chapter Five: Dissociation: Controversies and Clinical Strategies

            Normal vs. Trauma Related Dissociation

Controversies Regarding Dissociation: TM vs. SCM

A Combined Model of Dissociation?

Dissociation of Trauma in the Mental Health Field

Treating Dissociative Disorders

Conclusion

Interventions for Working with Dissociative Clients

References

Chapter Six: The Need to Numb: Substance Abuse and Therapeutic Management

Substance Use Problems: Evolving Social Perceptions and Reality

The Increase in Problematic Substance Use 

Links Between Trauma and Substance Use

Combined Vulnerability: Psychological and Biological Models

Assessing Substance Use

Treatment Approaches for cPTSD and Substance Use

Treatment Approaches Specifically for Substance Use

Interventions for Helping People with Excessive Substance Use

References

Chapter Seven: When Trauma is in the Body: Managing Physical Concerns

Effects of Trauma on the Body

Links Between Childhood Adversity and Physical Illness

Proposed Mechanisms Explaining the Trauma Illness Connection

Relationships and the Buffer Against Illness

Research on the Decrease of Physical Symptoms in Therapy

Treating People Who are Somatically Focused

Conclusion

Interventions for Helping People who Are Physically Focused

References

Chapter Eight: When Fight Impulses Dominate: Managing Anger

            Anger and Clinical Avoidance

Links Between Aggression and Trauma

Anger as a Result of Feeling Over-Responsible

Mind, Body and Brain: The Neuropsychology of Anger

Anger And Problems Regarding Ideas of Transference

When the Therapist is the Focus of Anger

Treating Anger and Aggression

Conclusion

Interventions for Treating Angry and Aggressive Clients

References

Chapter Nine: Sociocultural Consideration in Trauma Treatment

Culture and the Culture of Avoidance: Thinking about Differences Between Therapist and Client

Trauma, Microaggressions and Race and Class

Trauma, Microaggressions and LGBT Persons

Stereotypes and Stereotype Threats

Talking about Differences

Conclusion

References

Chapter Ten: Vicarious Trauma and Self Care for the Trauma Therapist

            Compassion Fatigue and the Impact of Vicarious Trauma

            Too Much Empathy? The Risk of Burnout and Potential Consequences

            Therapist Vulnerabilities

Countertransference and the Importance of Therapist's Emotions

Over-Responsibility and the Trappings of the Super Therapist

Therapist Self-Care

Conclusion

Self-Care Interventions

References