NEW ADVANCES IN TREATING COMPLEX TRAUMA

Diane M. Langberg, PhD

Diane Langberg PhD & Associates

Philip G. Monroe, PsyD

Biblical Seminary

pmonroe@biblical.eduwww.dianelangberg.com

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

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”

A new diagnosis?

Complex Trauma 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

Complex trauma alters a person’s

1. Ability to regulate affect and impulses2. Attention and consciousness3. Self-perception4. Perception of the perpetrator5. Capacity for relationships6. Body and brain responses7. Perception of meaning and faith

Complex PTSD, PTSD, BPD, or Complicated Grief?

Differential Diagnostics

Common trauma experiencesIntense 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

Overlapping diagnoses

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

How do you tell the difference?

Traumatic Symptoms

BPD(DTD?)

PTSDProlonge

dGrief

DESNOSC-PTSD

Depression

Anxiety

Trauma

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 Not likely

Cognitive Focus:

Fear Future dangers

Loss

Self: Consistent self loathing

External focus, self in background

Compare/ contrast with self prior to lossTIME: Key factor in determining intensity of diagnoses

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

talking, tears, and time

Treatment Overview

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

Initial goals

Increase client self-reflective capacities and compassion for the struggle

Support appropriate boundaries Increase positive coping skills and

support network

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

Talking dangers

Pushing or avoiding the story Believing that telling the story is what

heals Seeking catharsis alone

Educating the Church, Connecting Victims to God

Complex Trauma in the Church

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

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.

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

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?

An Intervention for Counselors and Clients

Lament

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

Does lament resolve hurt/anger?

Answers from Scripture? Answers from Science?

Preventing Vicarious Trauma; Some Directions for Church Leaders

Counselor Self-Care

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

Tend your garden

To last the long haul without damage, tend to: Self-care Relationships Faith

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.

For additional resources

www.dianelangberg.com Books, CDs, bibliographies on related topics Opportunities for case consultation

www.wisecounsel.wordpress.com Phil’s personal and professional musings Contact information: pmonroe@biblical.edu