“A person is a fluid process, not a fixed and static entity; a flowing river of change, not a block of solid material; a continually changing constellation of potentialities, not a fixed quantity of traits.”
~ Carl R. Rogers (On Becoming a Person: A Therapist’s View of Psychotherapy)
My personal and professional experience as a trauma survivor and a trauma therapist has made it clear to me that navigating through the rigorous process of restoring and reclaiming a cohesive authentic self in the aftermath of systemic traumatic abuse, is an inconceivably huge task.
Complex PTSD is linked to early trauma and results from ongoing or repeated interpersonal abuse (emotional/sexual/physical, neglect/abandonment, domestic violence) over which the child or adult has little or no control, and from which there is no real or perceived hope of escape. Complex PTSD rooted in systemic child abuse leads to subsequent traumas, such as relational re-enactments that put the survivor at risk for further abuse.
The National Survey of Children’s Health determined that nearly 35 million U.S. children have experienced one or more types of childhood trauma and adversity.
This study also concluded that nearly a third of U.S. youth have experienced the sort of traumatic adversity that would negatively impact their ongoing physical and mental health.
Hence, the children who do not receive treatment are likely to develop Complex PTSD and co-morbid physical and mental health conditions which involve ongoing costs for treatment and support services in adulthood.
Although the aforementioned statistical data suggests it is inevitable that mental health clinicians will encounter prospective clients seeking treatment for complex trauma and sundry concurrent disorders, proper assessment practices and training are lacking. Mental health professionals do not routinely enquire about childhood sexual abuse during mental health assessment in acute mental health settings (Hepworth I, McGowen L) and trauma psychology is not currently an integral component of the standard curricula in graduate-level education.
I can enumerate countless examples of men and women whose histories of systemic complex traumatic physical, psychological and sexual abuse were minimized and misdiagnosed by clinicians who were not willing or equipped to bear witness to a history fraught with inhumanity, while offering empathy, insight and containment. One such client had a history of early childhood sexual abuse discounted. When her dissociative symptoms and emotional flashbacks escalated she was hospitalized with bipolar disorder with psychotic features. Although she was incoherently babbling about rape trauma throughout her inpatient stay, the content of her communication was never addressed.
Undoubtedly the ability to diagnostically assess and treat complex trauma is predicated on a comprehensive understanding of the presentation and needs of a trauma survivor, as well as the approaches and techniques specific to trauma therapy.
Clinicians not versed in treating complex trauma often mistake the vacillating symptoms of dissociation and flooding for bipolar disorder.
Along these lines, therapists may erroneously emphasize a character pathology framework, failing to distinguish symptoms rooted in systemic childhood abuse and attachment injuries from relational volatility rooted in the absence of a coherent sense of self. This oversight can result in a reduction of psychiatric symptoms, but precludes the processing of traumatic memories so that full integration and healing can occur.
Since the World Health Organization formally recognized complex trauma as a classifiable psychiatric disorder in 2018, the need for trauma informed guidelines for treatment is receiving greater recognition.
This has set the stage for conceptualizing complex trauma as a differential diagnosis and a public health issue.
However, for clinicians who are attuned to the comprehensive needs of the complex trauma survivor, there are logistical concerns that impede treatment. Often comprehensive trauma informed therapy needs to be authorized for reimbursement by insurance providers.
Unfortunately, the Affordable Care Act was authored by healthcare industry providers, servicing their interests, not the fundamental rights of those insured.
Hence, it’s not all that surprising that in the United States healthcare costs are responsible for 66.5% of bankruptcy claims (American Public Health Association). It is an untenable situation.
Multinational pharmaceutical corporations are maximizing profits by touting drugs as the panacea to every conceivable ailment known to man. In a brilliant marketing and lobbying strategy Big Pharma has aligned with prominent ‘patient rights’ groups (APA, NAMI, NIMH to name a few) to ensure the promotion of psychiatric drugs. This landscape further complicates the acquisition of appropriate services necessary to stabilize and heal from the ravages of complex trauma.
Considering that 60% of adults report experiencing familial abuse during childhood (National Center for Mental Health Promotion & Youth Violence Prevention, “Childhood Trauma and it’s Effects on Healthy Development,” July 2012) and that child abuse crosses all socioeconomic and educational levels, religions, ethnic and cultural groups, it is clear that there is a tremendous need for resources that provide a clear trajectory of healing from complex trauma, spanning the early stages of healing and treatment to the reclamation stage of thriving.
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