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NEW ADVANCES IN TREATING COMPLEX TRAUMA
Diane M. Langberg, PhD
Diane Langberg PhD & Associates
Philip G. Monroe, PsyD
Biblical Seminary
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: [email protected]