1. New Advances in Treating Complex Trauma
New Advances in Treating Complex Trauma
Diane M. Langberg, PhD
Diane Langberg PhD & Associates
Philip G. Monroe, PsyD
Biblical Seminary

2. Session Outline Defining Complex Trauma
CPTSD Review
Diagnostic Differentials
Interventions: Talking, Tears & Time
Safety & Stabilization
Telling the Story
Grief & Lament
Self-Care
Strategies for Renewal

3. Trauma turns complex when:
Terror goes beyond typical PTSD
Stressors are interpersonal, premeditated, planned and caused by humans
Stressors are repeated and chronic in nature
Victims are exploited by “caregivers”

4. A new diagnosis? Complex Trauma Type II PTSD
Judith Herman, Trauma and Recovery
Type II PTSD
Lenore 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 impulses
Attention and consciousness
Self-perception
Perception of the perpetrator
Capacity for relationships
Body and brain responses
Perception 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 future
Intrusive 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.

8. Overlapping diagnoses
Posttraumatic Stress Disorder (PTSD)
Complex PTSD (C-PTSD or DESNOS)
Borderline Personality Disorder (BPD)
Complicated Grief (CG)
Major Depression
Generalized Anxiety

9. How do you tell the difference?
Traumatic Symptoms
BPD
(DTD?)
PTSD
Prolonged
Grief
DESNOS
C-PTSD

10. Anxiety
Depression
Trauma

11. Key differentials DESNOS Anxiety Complicated Grief Primary Affect:
Panic and pain
Worry
Intrusive sad or guilty thinking
Relationships:
Passive, avoidance, re-victimization
Varies; trust relationships likely
Loss of pre-existing good coping skills
Dissociation:
Present
Not likely
Cognitive Focus:
Fear
Future dangers
Loss
Self:
Consistent self loathing
External focus, self in background
Compare/ contrast with self prior to loss
TIME: Key factor in determining intensity of diagnoses

12. The biology of trauma? Amygdala + Hippocampus + Cingulate
Arousal + Evaluate + Decide
Michael Lyles: accelerator, no brakes, no steering
Hypothalamus + pituitary + adrenal
Cortisol/stress feedback loop
In PTSD: low cortisol but more frequent “radar” results in overreaction to weak “signals” and no correction back to norm

13. Treatment Overview
talking, tears, and time

14. Safety & stabilization
Foundation for all treatment
Longest phase and vital to positive outcomes
Features
Alliance building; support networks
Coping; grounding
Education about the nature of trauma
Avoid forced telling or catharsis

15. Initial goals
Increase client self-reflective capacities and compassion for the struggle
Support appropriate boundaries
Increase 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 work
Mastery 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 anxiety
Context: the tendency to leave (dissociate from) the pain
Goal: 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-efficacy
Tells the whole story
Supports grieving well
Brings faith and experience together

19. Talking dangers Pushing or avoiding the story
Believing that telling the story is what heals
Seeking catharsis alone

20. Connection and growth Marital work Parenting Conflict resolution
Setting appropriate boundaries
Reconnecting 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 Church
What 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 trauma
Failure to love violates the imago dei, true religion
5 facets of oppression (the opposite of love)
Abuse of power
Deception and false teaching
Failure to lead
Objectification
Forced false worship
See 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 healing
What 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. Lament
An Intervention for Counselors and Clients

27. What is Lament? Canonized complaints to God Lamentations includes
Complaint against sin and destruction
Agony over personal/corporate sin (in children of God and heathen)
Questioning God
Waiting expectantly for answers
Worship

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-Care
Preventing Vicarious Trauma; Some Directions for Church Leaders

30. Vicarious trauma “Trauma is contagious”
Bearing witness leads to hopelessness, questions of faith, and fear in relationships
Temptation: withdrawal or intrusive action
VT defined: (Saakvitne & Pearlman)
transformation of the therapist's inner experience as a result of empathic engagement with another’s trauma
Transforming the Pain

31. Tend your garden To last the long haul without damage, tend to:
Self-care
Relationships
Faith

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 topics
Opportunities for case consultation
Phil’s personal and professional musings
Contact information: