Psychologist
Therapy for Complex Developmental Trauma
Complex trauma refers to prolonged or repetitive exposure to traumatic events, often occurring within close interpersonal relationships, such as childhood abuse, neglect, or domestic violence. It does not necessarily require what society would view as a single "severe" event, but rather is the result of repetitive overwhelming experiences. Complex developmental trauma characteristically involves relationship patterns of inconsistency, rejection, abandonment, neglect, or abuse from caregivers or trusted others during childhood and adolescence. Unlike single traumatic incidents, complex trauma involves ongoing experiences that can deeply impact an individual's psychological, emotional, and relational development. Healing from complex trauma often requires psychological approaches that address its multifaceted impacts on an individual's life.
What is complex trauma?
Trauma is not what happens to us
but what we hold inside in the
absence of an empathetic witness.
Peter A. Levine
What are the long term impacts of repetitive childhood trauma?
Complex trauma occurring in childhood disrupts a person's sense of safety, trust, and identity, frequently leading to profound and long-lasting effects on their mental health and well-being. As a person who experienced trauma grows into adulthood it may compromise a their personality, sense of self, and identity. As such, symptoms of complex trauma often include difficulties with emotional regulation, self-compassion, self-esteem, coping, knowing oneself, and the ability to feel safe with intimacy and interpersonal relationships. Moreover, individuals with complex trauma may experience a range of psychological issues such as anxiety, depression, dissociation, and post-traumatic stress disorder (PTSD) or complex PTSD (C-PTSD) symptomology.
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Environments where complex developmental trauma occurs characteristically involve growing up in a home where the needs of others were paramount, and where the child has felt chronically unseen, unheard, or their emotional expression not permitted, tolerated, or supported. Children may take on the shame and sense of "badness" that actually belongs to trusted others in order to preserve their attachment with those others. As such, many individuals with complex trauma backgrounds may forgo, deny, or not recognise their own needs, believing they either don't have needs or must give priority to meeting the needs of others. They may carry a deep sense of shame, feel "not good enough", or criticise themselves harshly. This can lead to experiences of loneliness, disconnection, depression, and feeling alienated, misunderstood, or unseen.
Often people will seek out therapy for latter expressions of trauma such as depression and anxiety, sometimes minimising the impacts of earlier trauma as irrelevant or "not a big deal". However, it is when we are able to recognise the impacts, depth, and complexity of these earlier experiences on our current day selves through trauma therapy that we are able to work through them.
If you put shame in a petri dish, it needs three ingredients to grow exponentially: secrecy, silence, and judgment. If you put the same amount of shame in the petri dish and douse it with empathy, it can't survive.
Brene Brown
About trauma-informed therapy at Indigo Wellbeing
Indigo Wellbeing provides trauma-informed psychology for complex trauma in Northside Brisbane. I operate from a trauma-informed framework when working with compex trauma. This means using a "tri-phasic" model of care which promotes safety, collaboration, choice, empowerment, and meaning making as survivors move through the therapy process. It is important to note that this process does not follow a straight sequence. In fact the phases tend to overlap, and due to complex trauma involving multiple events, there is generally a flowing between and through the phases numerous times for sufficient processing and consolidation to occur. Furthermore, it is important to stress that you always have choice regarding the pace and content of your therapy. We will work together to support your specific needs throughout the process of therapy.
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Phase 1: Safety and Stabilisation
Safety, Trustworthiness, Choice, Collaboration, & Empowerment
The feelings attached to childhood trauma, often triggered to play out in current day relationships, can feel overwhelming and intolerable. As a result, the premature exploration of trauma memories can swiftly switch us into 'survival mode', where our defences (e.g. dissociation, avoidance) are activated and our 'thinking brain' muted. In this situation, remembering trauma can feel retraumatising. However, to process childhood trauma effectively, where the memory is more appropriately placed in the past as a narrative event, rather than being relived through flashbacks and bodily symptoms, we need to be connected to both the emotional and thinking parts of our brain.
With this in mind, the primary task of the initial stage of trauma therapy is to establish a 'secure base' with your psychologist and develop the necessary internal and external resources for individuals to feel safe both in their daily life and in their body to explore their experiences. Developing the internal resources to reflect on what is happening within yourself moment-to-moment, regulating your nervous system and difficult emotions, and staying in the present alone can provide a sense of mastery and relief from the symptoms of complex trauma. These skills also provide the basis for confronting and processing their traumatic experiences in subsequent phases of therapy should clients wish to move onto trauma processing work. Developing external resources might include developing and agreeing upon a safety plan to set out steps you will take should you be experiencing any current risks.
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As clients with a history of complex trauma may have experienced significant abuse, betrayal, humiliation, and/or manipulation, the process of developing a secure base with a psychologist can feel challenging and reveal a number of understandable issues including difficulty with trust, fear of abandonment or coercion, and dependency. The process of working through these issues as they arise within the therapeutic relationship is core to challenging and restructuring inner notions of relationships which promotes healing and the development of safety. Therefore, your experiences of the therapeutic relationship and therapeutic process are always welcomed for discussion.
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Phase 2: Processing Trauma
Traumatic memory is a memory that has not been sufficiently processed and therefore remains active in present day life. Phase two therefore focusses on processing trauma memory so that a survivor's unwanted automatic responses to trauma reminders are positively changed on an implicit level. This is a process that requires self-compassion and awareness of one's bodily and internal states to be able to identify, reflect upon, and regulate trauma-based responses with the support of your psychologist. Processing trauma does not necessarily involve recounting the details of the traumatic experiences of the past, however some individuals wish to do so when this is part of their personal model of healing. For those individuals we are able to use therapeutic approaches such as imagery rescripting. Rather, processing trauma is about memory resolution, that is, purposely sitting with and observing trauma-related experiences that arise in the present, rather than avoiding them, in the presence of an empathic other during psychotherapy. It is important to note here that avoidance and other strategies that survivors have used to manage daily life with trauma have formed out of a previous need to survive and are therefore not radically dismissed and discarded. Rather, we aim to become aware of and modulate our defences purposefully so that resolution and growth can occur at a safe pace during therapy and new coping strategies can become more practiced and automatic so that mastery can develop. Processing trauma memory ultimately aims to relocate the visual, emotional, and somatic (bodily) memories of traumatic events more appropriately in the past and with the people to which they belong so that they cease to interrupt current day life and relationships.
Processing trauma involves developing an awareness and understanding of how past trauma is being relived in the body and present day life. Past trauma living on in the present may look like: flashbacks involving visual, bodily, or emotional memories misplaced in time and/or person; hypervigilance to potential danger in the absence of actual danger or ignoring one's instincts when confronted with actual danger; avoidance of conscious and unconscious reminders of the trauma (e.g. avoidance of relationships); compulsions to harm oneself; feelings of numbness, emptiness, and hopelessness; and physical symptoms such as physiological arousal to triggers or ongoing physical ailments (e.g. headaches, gastrointestinal upsets, muscle tension). Each session we will explore these kinds of experiences that have come up over the week and during the therapy process itself. Processing trauma involves you and your therapist 'being with' these experiences and your previously avoided emotions in an empathic manner, so that the pain experienced, the loss of what childhood should have been like, and the subsequent losses that followed the trauma, can been can be properly grieved in a supported way.
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Phase 3: Consolidation, Integration, and Reconnection
Phase three continues in a meaning making process and generally follows the point at which the trauma has receded into the past. Often individuals automatically begin to relate to themselves in new, more compassionate ways having processed much of their trauma in phase two. Phase three then tends to focus on the issues individuals with trauma backgrounds enter therapy such as issues identity, relationships, and intimacy. For example, experiencing complex trauma can be incorporated into an individual's identity, clouding one's sense of knowing who they are. Therefore, getting to know who you are and integrating aspects of the self that feel disconnected can form part of the therapeutic process. Some of this identity integration will have already begun as split off memories and emotions are processed in phase two. Part of identity and integration work may also involve getting to know and identifying any aspects of the self perceived as "bad", "shameful", or "wrong", which are often parts internalised from an abandoning, critical, or abusive other, and either placing these aspects more appropriately back with that person or else re-tasking these parts of the self with more adaptive roles so that they cease their harmful impacts on the self in the present.
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Integration during phase three involves building new ways of being in the world relevant to what one has learned about oneself through therapy. For example, if one of the manisfestations of trauma was to be self-sufficient and isolated when facing life difficulties, a major integrative step may be to begin building social supports or the capacity to accept support from selected close friends or family. Other common issues individuals address at this stage include: increasing independence, exploring issues relating to sexuality and intimacy, addressing parenting challenges, navigating disclosure of abuse to others, overcoming harsh self-criticism and finding new more compassionate ways of relating to oneself, and forming more satisfying ways of being in relationship with others.
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It is common and okay during this phase, where a new way of being in life comes into view for the first time, for new content, inner conflicts, and strong feelings to emerge. Phase three allows space to work through feelings of fear, anger, injustice, and hatred that may come up for the first time as new realisations about the impacts of past trauma emerge. This allows for adequate grieving of the losses experienced due to the trauma to take place. Mourning these losses provides the freedom for new ways of being to develop. New feelings also provide the opportunity to revisit phase one and two to reinforce previously acquired skills and learnings. This moving between phases is a normal part of the process of recovery and part of expanding one's coping and 'window of tolerance' (the optimal amount of intensity/activation at which an individual is able to function and process trauma-related experiences) as new situations, realisations, and memories arise. Whilst the prospect of living in a more fulfilling manner can feel hopeful and exciting, it also involves living life in a somewhat new 'role', an unfamiliar and different way of being which can understandably feel terrifying for many people. Phase three aims to address these fears and support the prospect that, although difficult and confronting, the individual can proceed to live a more genuine, satisfying, and free life.
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