Presentation on theme: "New Advances in Treating Complex Trauma"— Presentation transcript:
1New Advances in Treating Complex Trauma New Advances in Treating Complex TraumaDiane M. Langberg, PhDDiane Langberg PhD & AssociatesPhilip G. Monroe, PsyDBiblical Seminary
2Session Outline Defining Complex Trauma CPTSD ReviewDiagnostic DifferentialsInterventions: Talking, Tears & TimeSafety & StabilizationTelling the StoryGrief & LamentSelf-CareStrategies for Renewal
3Trauma turns complex when: Terror goes beyond typical PTSDStressors are interpersonal, premeditated, planned and caused by humansStressors are repeated and chronic in natureVictims are exploited by “caregivers”
4A new diagnosis? Complex Trauma Type II PTSD Judith Herman, Trauma and RecoveryType II PTSDLenore Terr, Too Scared to Cry?Disorders of Extremes Stress (DES NOS)Besel Van der Kolk, Trauma Center
5Complex trauma alters a person’s Ability to regulate affect and impulsesAttention and consciousnessSelf-perceptionPerception of the perpetratorCapacity for relationshipsBody and brain responsesPerception of meaning and faith
6Differential Diagnostics Complex PTSD, PTSD, BPD, or Complicated Grief?
7Common trauma experiences Intense fear, paralysis/helplessness, inability to effect any change, threat of annihilation, leading to experience of, Loss of voice, control, connection, and meaning, resulting in, Disorganized physical, cognitive, and emotional response system thereby increasing, Relational pain, distrust, self-contempt, overwhelming anxiety, evidenced as, Running from the past, afraid of the futureIntrusive re-experiencing, persistence in avoidance of, but heightened arousal…How does childhood trauma differ from adult trauma? The child does not have the a solid identity nor an ability to contextualize the abuse and so develops a childlike understanding of self and world where safety is absent.
11Key differentials DESNOS Anxiety Complicated Grief Primary Affect: Panic and painWorryIntrusive sad or guilty thinkingRelationships:Passive, avoidance, re-victimizationVaries; trust relationships likelyLoss of pre-existing good coping skillsDissociation:PresentNot likelyCognitive Focus:FearFuture dangersLossSelf:Consistent self loathingExternal focus, self in backgroundCompare/ contrast with self prior to lossTIME: Key factor in determining intensity of diagnoses
12The biology of trauma? Amygdala + Hippocampus + Cingulate Arousal + Evaluate + DecideMichael Lyles: accelerator, no brakes, no steeringHypothalamus + pituitary + adrenalCortisol/stress feedback loopIn PTSD: low cortisol but more frequent “radar” results in overreaction to weak “signals” and no correction back to norm
14Safety & stabilization Foundation for all treatmentLongest phase and vital to positive outcomesFeaturesAlliance building; support networksCoping; groundingEducation about the nature of traumaAvoid forced telling or catharsis
15Initial goalsIncrease client self-reflective capacities and compassion for the struggleSupport appropriate boundariesIncrease positive coping skills and support network
16Initial dangers Diving into trauma work before building coping skills Failing to return to phase one during trauma memory workMastery over frightening and reactive responses must be attained before proceeding to phase two
17Talking Memory work done in concert with phase one skills Focus: grief, loss, shame, anger rather than anxietyContext: the tendency to leave (dissociate from) the painGoal: Small amounts of memory work with frequent self-care and stabilization
18Why talk? Truthfully telling of a silenced narrative At right place, improves client self-efficacyTells the whole storySupports grieving wellBrings faith and experience together
19Talking dangers Pushing or avoiding the story Believing that telling the story is what healsSeeking catharsis alone
20Connection and growth Marital work Parenting Conflict resolution Setting appropriate boundariesReconnecting to communities
21Complex Trauma in the Church Educating the Church, Connecting Victims to God
22Caring church leaders may grow weary in well-doing Educating the ChurchWhat might it mean if CT clients appear to be resistant, refusing good advice, yet dependant at the same time?Are they sinfully anxious?Are they demon possessed?Are they rebellious?Are they refusing to forgive or get better?Caring church leaders may grow weary in well-doing
23Educating the Church: key areas Develop a theology of oppression to explain impact of traumaFailure to love violates the imago dei, true religion5 facets of oppression (the opposite of love)Abuse of powerDeception and false teachingFailure to leadObjectificationForced false worshipSee my “The nature of Evil in CSA: Theological considerations of oppression and its consequences” in the 2012 Schmutzer, A (ed.) The Long Journey Home: Understanding and Ministering to the Sexually Abused. Wipf & Stock.
24Educating the Church: key areas Develop a larger view of healingWhat constitutes healing?How do we participate in God’s healing?Support? Mercy? Prayer? Listen? Play?Remember: some healing is immediate, other healing grows day by day
25Educating the Church: key areas Explore ancillary themes: forgiveness, reconciliation, restoration, restitution, etc.What is the rush?Why forgiveness now?Point in time? Attitude?Why reconciliation now? What bothers us most about brokenness?What does repentance look like?What about restitution?
26LamentAn Intervention for Counselors and Clients
27What is Lament? Canonized complaints to God Lamentations includes Complaint against sin and destructionAgony over personal/corporate sin (in children of God and heathen)Questioning GodWaiting expectantly for answersWorship
28Does lament resolve hurt/anger? Answers from Scripture?Answers from Science?Snow, McMinn, Bufford & Brendlinger (2011). Resolving anger toward God: Lament as an avenue toward attachment. Journal of Psychology and Theology, 39, [study of 192 college students. Lament may increase communion with God but does not seem to decrease anger toward God]
29Counselor Self-CarePreventing Vicarious Trauma; Some Directions for Church Leaders
30Vicarious trauma “Trauma is contagious” Bearing witness leads to hopelessness, questions of faith, and fear in relationshipsTemptation: withdrawal or intrusive actionVT defined: (Saakvitne & Pearlman)transformation of the therapist's inner experience as a result of empathic engagement with another’s traumaTransforming the Pain
31Tend your garden To last the long haul without damage, tend to: Self-careRelationshipsFaith
32A temptation to avoid self-care? I find many therapists feel guilty pursuing beauty and peace and order in their own lives... It is as if somehow they should not have good in their lives while others suffer. However, the Word of God says that He gives us richly all good things to enjoy. To turn from such things is to turn from the gifts in His hand.
33For additional resources Books, CDs, bibliographies on related topicsOpportunities for case consultationPhil’s personal and professional musingsContact information: