One challenge that clients sometimes face in counseling is deciding whether they want to go deeper in the treatment process than was initially anticipated necessary. At times, the counselor may recognize a need for more in-depth work to be done, and the counselor and client must then decide together whether this is the appropriate time for such work. However, clients can become incredibly impatient and demanding of themselves, wishing that they could skip ahead to the happy ending. This seems to be particularly true of those who have experienced complex trauma. They need a much greater degree of safety in the counseling relationship in order to continue to unpack their experiences. This has led me to pursue more understanding of the nature of complex trauma.
Complex Trauma vs PTSD
Heather D. Gingrich (2013), in her book Restoring the Shattered Self, delves into the nature of Complex Trauma Stress Disorder (CTSD) from her clinical experience working with clients struggling with CTSD. Historically, clinicians only talked about Post-traumatic Stress Disorder and Acute Stress Disorder which must be linked to a specific, isolated event in a person’s life (American Psychiatric Association, 2013). However, these diagnoses seem to fall short when attempting to capture the breadth and depth of the impact of repeated trauma events perpetrated by someone intimately involved in a person’s life, such as ongoing childhood sexual abuse by a family member (Gingrich, 2013) or being a hostage or concentration camp survivor (Herman, 1997). Regardless of the specifics, complex trauma is “best conceptualized as a qualitatively more severe subset of traumatic events” (Wamser & Vandenberg, 2013). Even so, the term CTSD is only useful to the extent that it informs treatment. It can never define the person or encapsulate the person’s entire experience.
Before presenting more of Gingrich’s material, I want to caution against the over-application of the word “trauma.” This word is often used casually to include experiences that may have indeed been awful but do not represent trauma. If this word is overused, there is the risk of minimizing the experiences of those who have actually endured trauma and eliminating the distinction between what needs to be treated as trauma and what does not.
CTSD and Human Developmental Tasks
There is considerable overlap between the symptoms for PTSD and Complex Trauma, but Gingrich (2013) helps explain what makes Complex Trauma complex. She argues that the timing of trauma is critical in understanding the impact on the person’s development and current functioning. According to Erikson’s theory of development, young children must learn to trust, then exercise autonomy, take initiative, and gain confidence socially and intellectually (Wong, Hall, Justice, & Hernandez, 2015). If trauma is ongoing anywhere in this process, it can hijack the person’s ability to trust, cope with emotions, and develop a clear sense of identity (Gingrich, 2013). Let’s look at each of these individually.
Trust: The need for safety and security is central to the process of building a secure attachment style. Nothing wrecks a child’s view of a safe world quite as much as having the primary caregiver also be the person representing danger to him or her. The child then becomes very confused who to trust in life because “the source of both safety and danger…resides in the same person” (Gingrich, 2013, p. 32).
Emotions: Without a primary caregiver to turn to for help with handling emotions, children have to learn other ways of dealing with distress. Gingrich (2013) points out that almost every mental health concern has emotional regulation involved, leaving those who have experienced complex trauma more prone to be labeled with a whole host of disorders and reinforcing the unhelpful narrative that they have something innately wrong with them.
Identity: The third aspect of trauma that I want to address from Gingrich’s (2013) writing is the “integration of self” (p. 37). For a person to form a cohesive identity, he or she must be able to apply information learned in one setting to another setting. These are called states. For example, every day we experience states of hunger and tiredness. With a trauma state, the mind and body learn to section this state off from the rest of the person’s experiences as a way of survival. Parts that can be sectioned off or compartmentalized in the person are behaviors, emotions, sensations, or knowledge (Gingrich, 2013). For example, if trauma memories are triggered in an adult who typically is fully functioning, the person will begin to operate according to the only survival skills they had in the midst of the trauma. This often involves freezing. It is as if the mind knows that the person has survived the trauma, but the body does not know that the trauma is over. As Bessel van der Kolk (2014) explains, the time-keeping portion of the brain is deactivated in a trauma state, resulting in the person having no sense of the trauma being in the past.
Attachment, emotional regulation, and identity touch every area of a person’s life as does trauma. However, trauma need not hijack the person’s story indefinitely. It takes much courage to begin the journey of recovering from trauma, but it is possible for the person to begin bringing the parts of their story together, learn again to trust, and feel safe enough to explore their emotions. In fact, they may even discover strengths they have that were forged in the midst of the trauma. This process is best done with a counselor who is specifically trained in trauma and knows how to attend to the client’s cues of needing greater safety. If you or someone you know is looking for a trauma-informed counselor, please reach out to Cherry Hill. We want to support you as you undertake this work of pursuing more healing.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Cross, D., Fani, N., Powers, A., & Bradley, B. (2017). Neurobiological development in the context of childhood trauma. Clinical Psychology: Science and Practice, 24(2), 111–124. https://doi-org.ezproxy.tiu.edu/10.1111/cpsp.12198
Gingrich, H. D. (2013). Restoring the shattered self: A Christian counselor’s guide to complex trauma. Downers Grove, IL: IVP Academic.
Herman, J. (1997). Trauma and recovery. New York, NY: BasicBooks.
Herzog, J. I., Niedtfeld, I., Rausch, S., Thome, J., Mueller-Engelmann, M., Steil, R., … Schmahl, C. (2019). Increased recruitment of cognitive control in the presence of traumatic stimuli in complex PTSD. European Archives of Psychiatry and Clinical Neuroscience, 269(2), 147–159. https://doi-org.ezproxy.tiu.edu/10.1007/s00406-017-0822-x
Thomaes, K., Dorrepaal, E., Draijer, N., de Ruiter, M. B., Elzinga, B. M., Sjoerds, Z., … Veltman, D. J. (2013). Increased anterior cingulate cortex and hippocampus activation in Complex PTSD during encoding of negative words. Social Cognitive & Affective Neuroscience, 8(2), 190–200. https://doi-org.ezproxy.tiu.edu/10.1093/scan/nsr084
Van der Kolk, Bessel A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Random House.
Wamser, N. R., & Vandenberg, B. R. (2013). Empirical Support for the Definition of a Complex Trauma Event in Children and Adolescents. Journal of Traumatic Stress, 26(6), 671–678. https://doi-org.ezproxy.tiu.edu/10.1002/jts.21857
Wong, D. W., Hall, K. R., Justice, C. A. & Hernandez, L. W. (2015). Counseling individuals through the lifespan. Thousand Oaks, CA: Sage Publishing.