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Christine A. Courtois Biography

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Trust Abuse Betrayal Therapy Childhood Abuse Complex Ptsd Complex Trauma Developmental Trauma Interpersonal Trauma

Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Source: Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“The overarching principle of a therapeutic relationship is that therapists should be ever mindful of a variant of the Hippocratic oath and, to the degree possible, strive to "do no more harm" (Courtois, 2010). Complex trauma clients have already experienced considerable harm, much of it at the hands of other human beings. As a result of the ubiquitous processes of transference, attachment styles, and IWM [Internal working models], these clients often view the therapist's behavior and their relationship through the lens of their trauma-related negative interpersonal expectancies and unhealed emotional wounds and injuries. Therapists should not be surprised to be "guilty until proven innocent", not because clients with complex trauma histories are "unfair" or "unreasonable" but precisely the opposite - because the most realistic self-protective stance for them (given the fact that betrayal and harm have been more the rule than the exception) is to "distrust first and verify" (or to be hypervigilant) rather than to start with an expectation of safety and trustworthiness.”

Trust Safety Therapy Childhood Abuse Complex Ptsd Therapist Complex Trauma

Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Source: Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“If the therapist understands and does not take mistrust as personal affront, the therapeutic relationship can evolve gradually. The client can begin to recognize that the therapist actually "gets" why he or she is initially skeptical, self-protective, or "realistically paranoid" and does not pressure the client to be a "happy camper" but instead works to earn trust by being honorable, reliable, and consistent. This also implies a view of the client's initial mistrust as expectable in light of the client's history - that is, as a strength rather than as a deficiency or pathology.”

Trust Therapy Childhood Abuse Complex Trauma Developmental Trauma Interpersonal Trauma

Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Source: Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“Therapy must begin with empathy - not a patronizing sympathy, but instead one that is unflinching (Marotta, 2003). Empathy of this sort is highly attuned to the client, no matter the circumstance. The therapist strives to "travel in the client's shoes" or to "view the world from the client's perspective" in order to really understand his or her emotions, cognitions, and beliefs - in short, to understand from the perspective of the other (Wilson & Thomas, 2004). Treatment involves understanding that a client's defeatist and apparently helpless, disempowered, or "masochistic" perspectives can be a logical outgrowth of formative traumatic experiences and, further, may be highly creative means of self-protection. The therapist must not attempt to undo or "make up for" past abandonment or betrayals by their client's caregivers or in their close relationships, but instead first understand the client's perspective and approach to the world, while working to provide alternative perspectives on both past and present that promote change.”

Empathy Therapy Childhood Abuse Therapist Complex Trauma Developmental Trauma

Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Source: Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“With regard to complex trauma survivors, self-determination and autonomy require that the therapist treat each client as the "authority" in determining the meaning and interpretation of his or her personal life history, including (but not limited to) traumatic experiences (Harvey, 1996). Therapists can inadvertently misappropriate the client's authority over the meaning and significance of her or his memories (and associated symptoms, such as intrusive reexperiencing or dissociative flashbacks) by suggesting specific "expert" interpretations of the memories or symptoms. Clients who feel profoundly abandoned by key caregivers may appear deeply grateful for such interpretations and pronouncements by their therapists, because they can fulfill a deep longing for a substitute parent who makes sense of the world or takes care of them. However, this delegation of authority to the therapist can backfire if the client cannot, or does not, take ownership of her or his own memories or life story by determining their personal meaning.Moreover, the client can be trapped in a stance of avoidance because trauma memories are never experienced, processed, and put to rest. Helping a client to develop a core sense of relational security and the capacity to regulate (and recover from) extreme hyper- or hypoarousal is essential if the client is to achieve a self-determined and autonomous approach to defining the meaning and impact of trauma memories, a crucial goal of posttraumatic therapy.”

Authority Therapy Self Determination Autonomy Complex Ptsd Complex Trauma Developmental Trauma Interpersonal Trauma

Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Source: Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“The act of consciously and purposefully paying attention to symptoms and their antecedents and consequences makes the symptoms more an objective target for thoughtful observation than an intolerable source of subjective anxiety, dysphoria, and frustration. In ACT, the act of accepting the symptoms as an expectable feature of a disorder or illness, has been shown to be associated with relief rather than increased distress (Hayes et al., 2006). From a traumatic stress perspective, any symptom can be reframed as an understandable, albeit unpleasant and difficult to cope with, reaction or survival skill (Ford, 2009b, 2009c). In this way, monitoring symptoms and their environmental or experiential/body state "triggers" can enhance client's willingness and ability to reflectively observe them without feeling overwhelmed, terrified, or powerless. This is not only beneficial for personal and life stabilization but is also essential to the successful processing of traumatic events and reactions that occur in the next phase of therapy (Ford & Russo, 2006).”

Acceptance Mindfulness Trauma Therapy Coping Rumination Complex Trauma

Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Source: Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“Kaffman (2009) described childhood victimization as a "silent epidemic", and Finkelhor, Turner, Ormrod, and Hamby (2010) reported that children are the most traumatized class of humans around the globe. The findings of these researchers are at odds with the view that children have protected status in most families, societies, and cultures. Instead, Finkelhor reports that children are prime targets and highly vulnerable, due principally to their small size, their physical and emotional immaturity with its associated lack of control, power and resources; and their related dependency on caregivers. They are subjected to many forms of exploitation on an ongoing basis, imposed on them by individuals with greater power, strength, knowledge, and resources, many of whom are, paradoxically and tragically, responsible for their care and welfare. These traumas are interpersonal in nature and involve personal transgression, violation and exploitation of the child by those who rely on the child's lesser physical abilities, innocence, and immaturity to intimidate, bully, confuse, blackmail, exploit, or otherwise coerce. In the worst-case scenario, a parent or other significant caregiver directly and repeatedly abuses a child or does not respond to or protect a child or other vulnerable individual who is being abused and mistreated and isolates the child from others through threats or with direct violence. Consequently, such an abusive, nonprotective, or malevolently exploitative circumstance (Chefetz has coined the term "attack-ment" to describe these dynamics) has a profound impact on victim's ability to trust others. It also affects the victim's identity and self-concept, usually in negative ways that include self-hatred, low self-worth, and lack of self-confidence. As a result, both relationships, and the individual's sense of self and internal states (feelings, thoughts, and perceptions) can become sources of fear, despair, rage, or other extreme dysphoria or numbed and dissociated reactions. This state of alienation from self and others is further exacerbated when the occurrence of abuse or other victimization involves betrayal and is repeated and becomes chronic, in the process leading the victim to remain in a state of either hyperarousal/anticipation/hypervigilance or hypoarousal/numbing (or to alternate between these two states) and to develop strong protective mechanisms, such as dissociation, in order to endure recurrences. When these additional victimizations recur, they unfortunately tend to escalate in severity and intrusiveness over time, causing additional traumatization (Duckworth & Follette, 2011). In many cases of child maltreatment, emotional or psychological coercion and the use of the adult's authority and dominant power rather than physical force or violence is the fulcrum and weapon used against the child; however, force and violence are common in some settings and in some forms of abuse (sometimes in conjunction with extreme isolation and drugging of the child), as they are used to further control or terrorize the victim into submission. The use of force and violence is more commonplace and prevalent in some families, communities, religions, cultural/ethnic groups, and societies based on the views and values about adult prerogatives with children that are espoused. They may also be based on the sociopathy of the perpetrators.”

Childhood Trauma Childhood Abuse Victimization Developmental Trauma

Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Source: Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“Type II trauma also often occurs within a closed context - such as a family, a religious group, a workplace, a chain of command, or a battle group - usually perpetrated by someone related or known to the victim. As such, it often involves fundamental betrayal of the relationship between the victim and the perpetrator and within the community (Freyd, 1994). It may also involve the betrayal of a particular role and the responsibility associated with the relationship (i.e., parent-child, family member-child, therapist-client, teacher-student, clergy-child/adult congregant, supervisor-employee, military officer-enlisted man or woman). Relational dynamics of this sort have the effect of further complicating the victim's survival adaptations, especially when a superficially caring, loving or seductive relationship is cultivated with the victim (e.g., by an adult mentor such as a priest, coach, or teacher; by an adult who offers a child special favors for compliance; by a superior who acts as a protector or who can offer special favors and career advancement). In a process labelled "selection and grooming", potential abusers seek out as potential victims those who appear insecure, are needy and without resources, and are isolated from others or are obviously neglected by caregivers or those who are in crisis or distress for which they are seeking assistance. This status is then used against the victim to seduce, coerce, and exploit. Such a scenario can lead to trauma bonding between victim and perpetrator (i.e., the development of an attachment bond based on the traumatic relationship and the physical and social contact), creating additional distress and confusion for the victim who takes on the responsibility and guilt for what transpired, often with the encouragement or insinuation of the perpetrator(s) to do so.”

Abuse Victim Trauma Manipulation Perpetrator Power Abuse

Author:Christine A. Courtois

“Their experiences led them to create assumptions about others and related beliefs about themselves such as "this is my lot in life" and "this is what I deserve". Some also learned that personal safety and happiness are of lower priority than survival and that it may be safer to give in than to actively fight off additional abuse and victimization. When abuse is perpetrated by intimates, it is additionally confounding in terms of attachment, betrayal, and trust. Victims may be unable to leave or to fight back due to strong, albeit insecure and disorganized, attachment and misplaced loyalty to abusers. They may have also experienced trauma bonding over the course of their victimization, that is, a bond of specialness with or dependence on the abuser.”

Abuse Complex Ptsd Trauma Bonding

Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Source: Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“The development of a working alliance is crucial because it addresses a psychic phobia associated with relationships that is common in complex trauma clients. As we discussed, when primary relationships are sources of profound disillusionment, betrayal, and emotional pain, any subsequent relationship with an authority figure who offers an emotional bond or other assistance might be met with a range of emotions, such as fear, suspicion, anger, or hopelessness on the negative end of the continuum and idealization, hope, overdependence, and entitlement on the positive. Therapy offers a compensatory relationship, albeit within a professional framework, that has differences from and restrictions not found in other relationships. On the one hand, the therapist works within professional and ethical boundaries and limitations in a role of higher status and education and is therefore somewhat unattainable for the client. On the other, the therapist's ethical and professional mandate is the welfare of the client, creating a perception of an obligation to meet the client's needs and solve his or her problems. Furthermore, the therapist is expected to both respect the client's privacy and accept emotional and behavioral difficulties without judgment, while simultaneously being entitled to ask the client about his or her most personal and distressing feelings, thoughts and experiences. Developing a sense of trust in the therapist, therefore, is both expected and fraught with inherent difficulties that are amplified by each client's unique history of betrayal trauma, loss, and relational distress.”

Relationships Therapy Complex Trauma Relational Trauma

Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Source: Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“... every therapist must develop enough personal maturity, clinical wisdom, and capacity for good judgment to effectively and safely conduct psychotherapy, an imperative that is especially important in the treatment of this population. The emotion dysregulation and insecure and disorganized attachment of complex trauma clients elicit strong emotional reactions from others, even those in their support network, including therapists. Reactions can range from sympathy, sorrow, fear, and guilt to frustration, impatience, anger/rage, hostility, and disgust or contempt.”

Therapy Complex Ptsd Complex Trauma Interpersonal Trauma Therapeutic Relationship Therapist Responsibilities Interpersonal Abuse

Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Source: Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“... the silent client may be experienced as withholding, oppositional, and sulking or as holding the therapist "hostage" in ways that elicit resentment and other negative responses. Because it is not unusual that relational and other forms of traumatization began when the client was preverbal, he or she may not have words. The lack of access to emotions or to words to describe them is known as alexithymia and is a common response to trauma. What the client is likely to have instead is somatosensory, behavioral, dissociative, and relational manifestations that therapists must seek to understand and translate into words, a process that involves hard work and intense focus.”

Therapy Childhood Abuse Therapist Complex Trauma Interpersonal Trauma Therapeutic Relationship Early Trauma

Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Source: Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

Christine A. Courtois Biography

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