Healing of Complex PTSD and Developmental Trauma

I treat clients for what has been called Complex PTSD and is now being referred to more often as Developmental Trauma. These conditions emerge from deliberate or unintentional parental maltreatment of children beginning in utero and continuing until the 18th year. A mother who drinks, smokes cigarettes, smokes meth or lives with an abusive spouse/partner is definitely going to create a storm of stress hormones in the fetal brain. Although the maltreatment of children may take many forms the key aspect is the parent/caregiver's lack of consistent emotional attunement to the child and his/her inability or refusal to meet the human needs of the developing child in timely, appropriate ways that make the child feel seen, heard, safe, and valued. Maltreatment occurs when mentally ill or intoxicated parents scream at, hit or excessively punish their children by confinement or corporeal punishment. It also happens through neglect, favoritism of other siblings or through teaching a child to stuff her emotions because mommy or daddy are too easily irritated to handle a child who cries, makes requests, seeks reassurance or complains. These failures on the part of the parent/caregiver seriously damage the normal process of attachment (parent-child bonding) and this translates into difficulty forming and sustaining healthy relationships later in life.  What are the adult consequences of these kinds of childhood trauma? An adult who was traumatized as a child may experience large gaps in her childhood memories, emotional numbness with recurrent episodes of dissociation, lack of self-confident, self-hatred, a desire or even a compulsion to harm oneself, craving for addictive substances, and a fear of social rejection that drives her to self-isolate or hang out with highly dysfunctional people.  A hallmark of complex PTSD is that you never feel like the Self which exists within you, the Self you were meant to be. There is frustration,  emotional over-reactions, harmful behaviors, and unstable relationships that cause distress and don't feel natural or authentic.  While behavioral therapies can reduce symptoms, they do not go to the root cause of the problem behavior which is childhood trauma. Trauma therapies with proven effectiveness like Cognitive Therapy, Internal Family Systems, EMDR, Compassionate Inquiry, Havening, and Hypnosis, all of which I provide, can put you back in touch with your memories, your feelings and your true Self. They can help you develop resilience, optimism, wholeness, curiosity, creativity, playfulness, and joy.    

IFS or Internal Family Systems is a form of trauma therapy invented during the 1990s by Richard Schwartz. The central concept of IFS is that all human beings have a Self and parts. Parts are like sub-personalities with different roles, functions, and objectives. They are a completely normal part of the human psyche and not a sign of pathology. It is easy to notice some of your own parts whenever you are torn over or ambivalent about making a decision. Parts also announce themselves when you suddenly experience a wave of nostalgia, anxiety, dread or sadness for no apparent reason. The Self has the qualities of curiosity, calm, clarity, compassion, courage, confidence, and creativity. However, the Self was under-developed (much like the brain) during childhood and not strong enough to protect the parts from harm done by dysfunctional parents. The parts, known in IFS as exiles and protectors, lost faith in the Self, pushed it to the side, and took over the emotional system. The parts are driven by the experiences, self-created stories, and perspectives of the distant past, which is why they are out of touch with present day realities and not able to adopt new, more flexible and adaptive behaviors on their own.  

Exiles live in the unconscious. They represent the wounded child who clings to the hurts, fears, and terrors associated with childhood events as if they were still happening now.  The protectors exist to prevent the pain of the exiles from breaking through into consciousness where they would overwhelm our entire emotional system. There are two kind of protectors - managers and firefighters. Managers are on the job every day using coping techniques to sequester the exiles in ways that are not flagrant or life-endangering. Examples are emotional repression, perfectionism, people pleasing and co-dependence. The firefighters are only called to action when traumatic memories have been triggered and the exiles are starting to breakthrough. Firefighters use risky methods without regard to the cost such as getting drunk and fighting or driving; self-starvation; engaging in unsafe sex; and even threatening or attempting suicide. 

To heal childhood trauma IFS uses techniques that restore the faith and trust the parts once had in the Self. This occurs when the client is able to access the healing energy of Self for positive, productive uses. Sometimes the client is empowered to stop a long-running feud between polarized parts that judge each other. The client may also converse with a protector, come to understand why it came into existence, and why it still believes it must fight the exile using childish methods to ensure the client's survival as an adult. When this happens a protector can unburden and release its time-worn agenda, creating an opportunity for transformation and a new, happier purpose. As more protectors are unburdened it becomes possible to bring healing love, compassion, and nurturance to one's exiles so they are no longer carrying old pain. When this occurs the client's entire emotional system becomes balanced and functions in ways that help the client to grow and develop his full potential.

 While not all of my clients respond to IFS some clients love this technique and master it so well that they use for the rest of their lives, even after meeting their therapy goals.

Although all depressions may seem alike (because they share symptoms and may respond to antidepressant medications), there are multiple forms of depression that come from different causes and which vary in how they affect clients and how they should be treated. Some clients experience what the DSM-5 calls persistent depressive disorder (PDD) which must last at least two years for the diagnosis to be made, but which can last a lifetime until properly treated. This kind of depression is a result of maladaptive brain wiring resulting from epigenetic transmission of depression genes, from stress to the developing fetal brain due to mother's depression or from a longstanding pattern of neglect or abuse during one's childhood or teen years. PDD is characterized by a chronic, low grade depression which is virtually always there. While PDD doesn't incline people  toward suicide, PDD makes it very hard to enjoy life. It's like living in a grey cloud without the vital energy, optimism, fun, and joy that others display. Trauma therapies are very helpful here. 

Another type of depression results from facing one or more major stresses without adequate coping skills or social support and failing to adjust to the stressors. This type of depression is like having the camel's back break after carrying too heavy a load for too long. Examples of the stressors that cause depression include chronic conflict with one's spouse, children, adult siblings or boss; chronic pain; serious financial problems or serious legal problems. This sort of depression typically shows up within 3 months of the onset of the stressors and resolves within 6 months of the disappearance of the stressors. Therapies involving CBT, problem-solving, assertiveness training, and coping strategies will help a great deal.

The best known and most serious forms of depression (which can trigger suicidal thoughts or even suicide attempts) are Major Depressive Disorder (MDD) and Bipolar Depression. MDD can occur in a single episode, multiple discrete episodes years apart or in a recurrent form where the depression keeps hitting you like ocean waves. MDD typically results from a painful loss or from adult traumas that involve degradation, humiliation or attacks on your dignity. Painful losses include the loss of a grandparent, parent, spouse, child or close friend; the breakup of a marriage or long-term partnership; the loss of one's home and possessions to a natural disaster; the loss of one's business; and the loss of a limb, bodily function or cognitive function. Examples of degradation/humiliation which trigger MDD include workplace sexual harassment; discrimination on the basis of age, race, gender, gender identity, ethnicity, sexual orientation or religion; the experience of poverty and living in a violent, unsafe neighborhood; hostile treatment as an immigrant or refugee; as well as lack of opportunities for work that provides meaning and purpose. 

The treatment of depression must be both comprehensive and targeted to the cause. Comprehensive treatment can involve some or all of the following: medication; changes in sleep hygiene, diet, and exercise; daily walking; learning to meditate; learning to expand social contacts and make new friends; participating in organizations; volunteering; watching funny videos or movie; and getting out into nature Targeted treatment includes the use of grief work, trauma therapy, humanistic-existentialist therapy, CBT, narrative therapy, reality therapy, Gestalt, Acceptance and Commitment Therapy, and the like.  I am able to use these therapies with my depressed clients. If a major contributing factor to the MDD is a substance addiction, then working the steps in AA or NA and doing individual psychotherapy will help. 

I am trained in the use of EMDR (eye movement desensitization and reprocessing). I have used it to effectively treat clients with PTSD, depression, anxiety, and other disorders. EMDR is an internationally recognized trauma-healing technique created by psychologist Francine Shapiro in 1989. It is endorsed as an effective treatment for PTSD by the American Psychiatric Association, the American Psychological Association, the US Dept. of Veterans Affairs, and the US Dept. of Defense. The treatment involves alternately stimulating each hemisphere of the brain by having the client shift her gaze back and forth while tracking the therapist's moving fingers.  ALBS (alternating bilateral stimulation) unfreezes old traumatic memories which have been stuck since childhood in the right half of the brain, the part of the brain that is visual and emotional but cannot speak. Since Shapiro's original version of EMDR other therapists have adopted other ways of stimulating ALBS. These include using a row of blinking lights, using buzzers held in each hand by the client, alternating customized sounds in the client's ears, and by sequential tapping of the client's knees. Prior to this kind of processing the client is prepared by using guided visualization to feel safe and calm. Next the client is asked to articulate her most painful negative belief about herself (e.g. I am worthless or I am unlovable) and to rate the emotional pain caused by that belief on a 1-10 scale. The client is also asked to describe the location and type of the sensations in her body when she holds this belief in mind. Next the client is invited to describe the positive belief she would like to have about herself (e.g. I am worthy and lovable) and to measure how much she actually believes it on a 1-7 scale. During processing many things can occur. The client may vividly recall events from long ago that she had completely forgotten. She may experience a great variety of feelings tied to childhood events that include fear, shame, sadness or anger. These feelings result less from the actual events and more from the child's interpretation of why terrible things were done to her. Typically the child blames herself for provoking and even deserving the maltreatment. During EMDR the client is able to reprocess the old memories and re-interpret the meaning of the events using her adult intelligence, what Shapiro called AIP or the adaptive information processing network. While the client's AIP is activated she can see herself in a new light and rapidly, automatically reinterpret old events to show how much courage, strength,  creativity, resourcefulness or tenacity she has always had but never given herself credit for. This serves to reframe how the client views herself, liberating herself from negative, self-defeating beliefs borne or childhood trauma and coming to own new positive self-beliefs that potentiate greater self-compassion, self-acceptance, and healthy self-love.