Mindful Counseling for Complex Trauma: Anxiety, Shame, Stuckness
We do not grow absolutely, chronologically. We grow sometimes in one dimension, and not in another; unevenly. We grow partially. We are relative. We are mature in one realm, childish in another. The past, present, and future mingle and pull us backward, forward, or fix us in the present. We are made up of layers, cells, constellations.
Complex Trauma, PTSD, Complex Posttraumatic Stress Disorder (C-PTSD or CPTSD), Disorders of Extreme Stress Not Otherwise Specified (DESNOS), Developmental Trauma, Attachment Trauma, Interpersonal Trauma, any Personality ‘Disorder’ – including Borderline Personality Disorder (BPD), Dissociative Disorders
The Many Faces of Complex Trauma
Complex trauma represents our structured or reactive organization of experience after ongoing or recurring interpersonal abuse/neglect. This directly influences our ability to self-regulate and stay present, and changes our beliefs about Self, Other, and World. With such a vast range of potential life strategies following every childhood experience, the confusing part – for those counseling and those seeking support – lies in identifying the underlying cause versus focus on individual symptoms. Complex trauma presents in more-obvious forms: suicidal ideation, dissociation, PTSD, relationship struggles and personality ‘disorders’. It also presents in less-obvious, more ‘benign’ forms, such as anxiety, depression, confusion, codependence, shame, addictions, and unwanted habits or patterns. And sometimes it presents in ways that initially seem unrelated: headaches, stomach pain, IBS, ADHD, cancer, weight loss or gain, hyper- or hypo-sexuality, sexual dysfunction, fear of abandonment, anger issues, failure to maintain work, hoarding, infidelity, isolation, lack of direction or purpose, derealization, depersonalization, a sense of continual crisis, complex or endless grieving, mood swings, panic attacks, fatalism, religious discontentment, caretaking, expectation of judgment, always questioning, inability to relax, inability to appreciate the present moment, or appreciation only in retrospect.
The language of mental health is constantly transitioning. Traumatology, in mental health, refers to the study and support of individuals exposed to traumatic (biopsychosocially overwhelming) events including…
- actual or perceived material, physical, or relational loss (including events such as: violence, criminal or familial abuse or benign/malignant neglect, hospitalization, bodily harm, sudden unemployment or loss of resources)
- actual or perceived loss of agency (physical, psychological, or relational events such as: major illness, abusive control or oppression, dependent/enmeshed parent, unpredictable dependent relationships such as a parent or caretaker with addiction or personality disorder)
Traumatic events prove particularly transforming when they are interpersonal, sudden, without support, without option of fight or flight, repeating/confirming negative beliefs developed from past trauma, or occurring to those that are genetically/generationally predisposed to stress reactivity.
The complexity of complex trauma
In adaptive response to experience, we sometimes split from parts of self or develop competing neural networks that create a sense of internal conflict. We choose sides in the conflict and polarize our own behavior. Those close to us might notice our behavioral patterns moving to extremes of rigidity or chaos. Even in counseling, when we learn to quiet and calm ourselves and begin our self-discovery, we notice that certain strategies or thought patterns trigger others, become confusingly entangled. This is where a knowledgeable and present therapist can help us identify and begin to differentiate our many ‘parts’, mediating between parts, honoring them, and bringing them closer to integration: internal cooperation and negotiation versus conflict and oppression.
How can complex trauma refer to such a wide range of psychological struggles?
The focus in this approach lies in transformation of underlying core beliefs. If you’re a cook or a chemist, consider the variety of recipes available from just a few basic ingredients. In work with complex trauma, we focus not on the recipe or on individual symptoms. We focus on adjusting the basic underlying ingredients. This affects the many strategies, perspectives, expectations, and habits that have built on that primary foundation. We focus on recognition, acceptance, honoring, and integration of all our conflicting internal ‘parts’, allowing release of long-held defenses, a greater sense of calm, increased ability to live in the present moment, and increased sense of Self and purpose.
When you’re born a light is switched on, a light which shines up through your life. As you get older the light still reaches you, sparkling as it comes up through your memories. And if you’re lucky as you travel forward through time, you’ll bring the whole of yourself along with you, gathering your skirts and leaving nothing behind, nothing to obscure the light. But if a Bad Thing happens part of you is seared into place, and trapped for ever at that time. The rest of you moves onward, dealing with all the todays and tomorrows, but something, some part of you, is left behind. That part blocks the light, colours the rest of your life, but worse than that, it’s alive. Trapped for ever at that moment, and alone in the dark, that part of you is still alive.
~ Michael Marshall Smith, Only Forward
How is complex trauma treated?
Studies have shown therapy to be more effective than medications in the treatment of complex trauma/developmental trauma/childhood trauma. (In fact, the Veteran’s Administration and other official entities have mounted campaigns against benzodiazepine prescription, noting that that these common anti-anxiety medications are contraindicated in cases of PTSD.) The most effective therapies include mindful, body-based, schema-based (focused on beliefs formed in childhood) approaches. Hakomi Therapy includes all of these approaches.
What is Complex Trauma?
Related and sometimes interchangeable terms include:
- Complex Trauma
- Complex PTSD (CPTSD)
- Developmental Trauma Disorder
- Attachment Disorder
- Disorganized Attachment
- Multiple Interrelated Post Traumatic Stress Disorder
- Disorders of Extreme Stress, not otherwise specified (DESNOS)
- Borderline Personality Disorder*
* Many practitioners see the overlap between BPD and Complex Trauma, and the designation either way remains debated.
The term ‘Complex Trauma’ refers to a collection of symptoms that develop (often in childhood) when exposed to high levels of chronic stress, commonly the result of ongoing or long-term interpersonal trauma, especially during specific windows of neurological development. When considering the storage of data in our brains, implicit memory refers to the storage subconscious information separate from time and event. This can be procedural or emotional memories not connected to memories of an event. For those that carry complex trauma, this means memories arise as felt states without a connected narrative. It means we experience an idea or a sense that we are living in a time of immediate threat — we are that abused child living in a world where we are not wanted or our life is actually in mortal danger. In PTSD, this can be referred to as a flashback. In Complex Trauma, it is more a flashback or return to a time of physical or social threat.
While PTSD (versus CPTSD) presents similar challenges, it sets itself apart from all of the terms above as it is generally considered to derive from a single, identifiable traumatic event rather than ongoing loss of agency / choice / purpose / life. Where PTSD is sometimes characterized by flashbacks, complex trauma results in state shifts – experiencing a physical activation while perceiving the world through the eyes of a younger self. Each state comes with its own state-dependent memories and perceptions of self, other, and world.
According to Ford and Kidd, complex trauma develops “when extreme trauma compromises the fundamental sense of self and relational trust at critical developmental periods.” (Feb 1999 issue of Journal of Consulting and Clinical Psychology)
What are the effects of Complex Trauma?
Years after traumatic experience, the effects may remain active in mind and body. Complex Trauma may result in chronic over-activation of an individual’s autonomic nervous system as seemingly innocent cues or relatively minor stressors trigger fight-flight-freeze responses. The result is an ongoing sense of anxiety or overwhelm.
As those surviving Complex Trauma struggle to adapt to a world that forced them to separate from parts of Self, problems with accurately perceiving, evaluating, and responding to incoming stimuli exacerbate the struggle. General symptoms include physical dysregulation, separation from body and from the present moment, and alterations in views of Self, Other, and World.
Chronic or repeated exposure to traumatic stress can cause disruption in brain function and structural development, immunological function, nervous system regulation, and endocrine regulation. The chronic stress of early childhood abuse has been shown to influence genetic expression and predict greater chance of various health issues over a lifetime. The physical body becomes repeatedly activated, and character develops around these traumatic disruptions, sometimes leaving developmental stages or structures incomplete. Over time, conflict and oppression between internal parts leads to a wide variety of mental and physical symptoms and dis-integrated living.
Can Complex Trauma be cured?
Transformative therapies – the ones that create a real, felt sense of growth and healing – cannot change the past or remove the memory. In fact, therapy for trauma often leads to uncomfortable places by accessing these memories (from a calm, controlled, monitored, and resourced vantage point). Particularly for those that have moved into ‘freeze’, stepping back into life often leads straight into waves of fight-or-flight.
Part of the process of therapy is preparation for processing the past in a calm, secure manner — a mindful approach — where the memories are visualized, the body reactions are noticed, the state-change is observed, and from a resourced, supported vantage point the bodily experience of the memory changes. In simple terms, the terrifying, overwhelming fight/flight reaction is removed from the memory. Rather than putting energy into carrying and forever trying to fit this morphing puzzle piece, once the panic is detached, the memory can simply be filed away like any other memory – retrievable but no longer triggering.
How long does it take?
Sometimes we traverse levels of awareness gradually, returning to therapy from time to time over the years. Sometimes it happens all at once. Sometimes it’s about willingness and building tolerance, and sometimes it’s just about experiencing the right connection at the right time.
As trauma reactions develop uniquely for each individual, so recovery for each person remains a unique journey.
The good news: while the traumatic memories remain, they need not remain ‘traumatic’. They can be just memories.
Counseling is a place to calm, to separate from judgment, to reassess present needs, to begin providing for those needs versus defaulting to automatic reactions or returning to old needs. We cannot change the past. We can change beliefs that formed in the past and create unnecessary suffering in present life.
I look forward to meeting you.
“Mindfulness is undefended consciousness.”
One of the paradoxical and transformative aspects of implicit traumatic memory is that once it is accessed in a resourced way (through the felt sense), it, by its very nature, changes.
Below: Six primary areas of change associated with complex trauma (drawn primarily from Bessel van der Kolk’s definition of Disorders of Extreme Stress).
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Alterations in Affect Regulation and Impulse
- Affect regulation
- Modulation of anger
- Lethargy or hyper-activity
- Suicidal preoccupation
- Difficulty modulating sexual impulses
- Excessive risk-taking
Alterations in Attention or Consciousness
- Numbness or separation from body
- A draw to fantasy and/or analysis
- Aware of past or future, but not present
- Lack of context or ‘center’
- Digestive system
- Chronic pain
- Cardiopulmonary symptoms
- Conversion symptoms
- Sensory anomalies
- Sexual symptoms
Alterations in view of SELF
- ‘Permanently damaged’
- Guilt and responsibility
- ‘Nobody can understand.’
- Learned Helplessness
Alterations in view of OTHER
- Inability to trust
- Recreation of painful patterns
- Victimizing others
- Compliant and/or rebellious