Most of us have a sense of what trauma is, but what is complex trauma? As the name implies, it is a type of trauma that presents with a greater degree of complexity in symptoms than post-traumatic stress disorder (PTSD). While PTSD can result from even a single traumatic event, such as a natural disaster, complex PTSD (C-PTSD) is a consequence of chronic, relational trauma. Usually, the traumatic experiences related to C-PTSD take the form of child physical, sexual, emotional, and/or spiritual abuse at the hand of someone who is supposed to be a protector (e.g., parent, coach, church leader). The fact that such abuse occurs during the developmentally sensitive years of childhood, the ongoing nature of trauma, and the accompanying sense of personal betrayal are all factors that impact survivors. Therefore, both C-PTSD symptoms and the path toward healing share similarities with PTSD while also differing in some significant ways. This article is more fully developed and referenced in my book, Restoring the Shattered Self (2020), and the co-edited book with my husband, Fred, Treating Trauma in Christian Counseling.

Post-traumatic Symptoms

Survivors of C-PTSD exhibit many of the same post-traumatic symptoms that people with PTSD manifest, such as nightmares and flashbacks, avoiding people or situations that could trigger a trauma response, and undergoing nervous system hyperarousal. Additionally, both experience changes in how they think and feel (e.g., self-blame, depression).

Both PTSD and C-PTSD survivors could potentially fit the Diagnostic and Statistical Manual’s (DSM-5®) diagnostic criteria for the dissociative subtype of PTSD. However, those with C-PTSD are more likely to describe the prerequisite symptoms of depersonalization (i.e., sense of detachment from their bodies/distorted perception of self) or derealization (distorted perception of other people or the external environment).

Impact of Childhood Trauma on Development

Psychologically healthy adults have a solid perception of self, including a positive sense of identity, the ability to regulate emotion, the capacity to integrate life experiences, and the skill set to establish strong relationships. This foundation allows them to bounce back more easily from a traumatic event that occurs in adulthood. However, C-PTSD survivors usually do not evidence such qualities because normal developmental processes have been thwarted due to childhood trauma.

Healthy development depends on attentive primary caregivers. When a newborn cries, a good parent strives to figure out the problem and alleviate it. Does the infant need food? A diaper change? Is he or she in pain, or does it merely need soothing through being held or rocked? Emotional regulation by any of these means initially comes solely through such external mechanisms since newborns are unable to take care of themselves and are totally dependent upon their caregivers. In time, though, if their caregivers have consistently helped them regulate, infants begin to learn how to self-soothe. 

I remember watching in awe as my five-month-old’s arm compulsively moved around his crib until he could find his pacifier and push it into his mouth successfully! When he was three, he hugged his teddy bear for comfort, which allowed him to fall asleep without me in the room. Once he learned to talk, he could begin using words to self-soothe. For example, if I told him he could not have a snack because it was too close to dinner, I might overhear him reassuring Teddy by saying, “I know you’re hungry, but Mommy says we’ll get to eat soon.” 

Not only does attuned, responsive caregiving help give children the skills they need to regulate their emotions in adulthood, but it also helps them develop a secure attachment style. This sense that other people can provide safety and security is necessary for developing intimate relationships throughout life. 

Good parenting also allows children to integrate behavioral and emotional states. For example, newborns instantly shift between a distressed state (e.g., full-fledged crying) to a peaceful, contented state as soon as a particular need is met (e.g., offering a breast or bottle when hungry). The example previously given of my three-year-old talking to his teddy bear kept him from entering a dysregulated state and meant more continuity in his emotions and behavior before and after he noticed hunger pangs; these states were more integrated.

Now imagine that a child is abused (emotionally, physically, sexually, or spiritually) or neglected (emotionally or physically) multiple times a week over many years by someone who is supposed to be safe. The trauma is not only dysregulating in itself, but the child also is hindered from learning how to manage his or her emotions and behavioral states in general because abusive parents are not generally appropriately attentive caregivers. 

Even if the abuser is someone from outside the family, children assume their parents know what is happening and wonder why they are not stopping the abuse, which results in insecure attachment that impacts all future relationships. Without intervention, abused children often grow up still unable to self-soothe or integrate their experiences. The inability to manage emotion and/or behavior is associated with many DSM-5 diagnoses and/or symptoms (e.g., anxiety and depression, substance abuse, impulse control, personality disorders, etc.). 

The Path to Restoration

Post-traumatic symptoms are only part of the picture for survivors of complex trauma. The negative impact of chronic, childhood, relational trauma on the normal development processes means these survivors have a great deal of catching up to do. In addition to processing their trauma, they need to unlearn unhealthy coping strategies and learn how to manage their emotions and thrive in relationships. This progression can take a long time (think months or, more likely, years). A three-phase approach to counseling is the standard of care. This methodology allows for the development of safety and symptom stabilization prior to entering the second stage of trauma processing, followed by the third phase involving the consolidation of gains and restoration of relationships with others and society.

Phase I

Phase I focuses on safety within the therapeutic relationship, safety from others (i.e., both past and potentially current perpetrators), and safety from self-destructive behaviors and post-traumatic symptoms. While a sense of security may be established relatively easily with some counselees, those with C-PTSD were hurt at the hands of another person (or people) who was thought to be safe but was not. As a result, counselors will have to work diligently, with much patience, understanding, and sensitivity, to navigate the pitfalls of Phase I work.

Phase II

Trauma processing is excruciating work. The counselee is encouraged to talk about the trauma in frame-by-frame detail while re-experiencing cognitive, behavioral, emotional, and physical aspects to further integrate all facets of the experience. However, this is different from having a full flashback within the session; the survivor has likely suffered plenty of that trauma at home. The goal is to help clients keep one foot in the past and one in the present as they recount the specific trauma narrative. The new coping skills and grounding techniques that were the focus of Phase I are also put to good use in this phase, as they are used by the counselor to help adequately pace the trauma processing and serve as an aid to containment between sessions. Each traumatic memory is processed in a similar way and integrated into the survivor’s sense of self and identity rather than remaining compartmentalized or dissociated.

Phase III

Even after all trauma memories have been processed, it can still be a challenge for a complex trauma survivor to learn to live life as a whole person. Old ways of doing things no longer work, and experimentation takes place with new ones. Former relationships are now often recognized as unhealthy, so boundaries may need to be set or new, healthier friendships formed. Often a survivor’s view of God has been distorted, so new ways of relating to Him will need to be established.

There is Hope!

There is good news! What Satan set out to destroy through trauma and abuse, God can restore! The bad news is that it is often a painful and slow process. Unfortunately, despite the promise of healing, not all C-PTSD survivors are willing or able to engage fully in the process. I used to try to encourage survivors by telling them the work could be excruciating but would be worth it in the end. Then I realized this was not my decision to make—it was theirs—and I needed to rely on the Holy Spirit for their guidance. I also recognized that timing is crucial. Survivors need to have the mental space and time in their schedules to reflect on the changes taking place, as well as adequate relational support to benefit from Phase II work. Meanwhile, knowing that restoration is a possibility for the future is encouraging. 

Heather Davediuk Gingrich, Ph.D., is a professor of counseling at Denver Seminary. She is a clinical member of the American Association of Marriage and Family Therapy, as well as a member of the Colorado Counseling Association, the International Society for the Study of Trauma and Dissociation, the Rocky Mountain Trauma and Dissociation Society, and a professional affiliate of Division 56 (Trauma Psychology) of the American Psychological Association. Dr. Gingrich is also an advisor for the Philippine Association of Christian Counselors and the Philippine Society for the Study for Trauma and Dissociation.

This article originally appeared in Christian Counseling Today, Vol. 24 No. 4. Christian Counseling Today is the flagship publication of the American Association of Christian Counselors. To learn more about the AACC, click here.

References

Gingrich, H.D. (2020). Restoring the shattered self: A Christian counselor’s guide to complex trauma (2nd ed.). InterVarsity Press.
Gingrich, H.D. & Gingrich, F.C. (Eds) (2017). Treating trauma in Christian Counseling. InterVarsity Press Academic.