3 Trauma 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”
4 A 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
5 Complex 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
6 Differential Diagnostics Complex PTSD, PTSD, BPD, or Complicated Grief?
7 Common 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.
11 Key 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
12 The 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
14 Safety & stabilization Foundation for all treatmentLongest phase and vital to positive outcomesFeaturesAlliance building; support networksCoping; groundingEducation about the nature of traumaAvoid forced telling or catharsis
15 Initial goalsIncrease client self-reflective capacities and compassion for the struggleSupport appropriate boundariesIncrease positive coping skills and support network
16 Initial 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
17 Talking 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
18 Why talk? Truthfully telling of a silenced narrative At right place, improves client self-efficacyTells the whole storySupports grieving wellBrings faith and experience together
19 Talking dangers Pushing or avoiding the story Believing that telling the story is what healsSeeking catharsis alone
20 Connection and growth Marital work Parenting Conflict resolution Setting appropriate boundariesReconnecting to communities
21 Complex Trauma in the Church Educating the Church, Connecting Victims to God
22 Caring 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
23 Educating 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.
24 Educating 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
25 Educating 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?
26 LamentAn Intervention for Counselors and Clients
27 What 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
28 Does 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]
29 Counselor Self-CarePreventing Vicarious Trauma; Some Directions for Church Leaders
30 Vicarious 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
31 Tend your garden To last the long haul without damage, tend to: Self-careRelationshipsFaith
32 A 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.
33 For additional resources Books, CDs, bibliographies on related topicsOpportunities for case consultationPhil’s personal and professional musingsContact information: