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“Trust of others is in short supply for many adult survivors, as complex trauma generally involves major relational betrayal. It is, therefore, expectable (although paradoxical) that clients with these histories are predisposed to be mistrustful at the outset of therapy, precisely because of (and in proportion to) the actual trustworthiness of the therapist. When past experiences have thought hard lessons, namely, that one can least afford to trust the people who should be most trustworthy, it stands to reason that confusion about trust results. The therapist must understand and not take offense either personally or professionally and not react judgmentally or defensively. Practically speaking, this involves the therapist being prepared to patiently and empathically respond to active or passive tests or challenges to trustworthiness as legitimate and meaningful communication that deserves a respectful reply in action as well as in words.”

TrustAbuseBetrayalTherapyChildhood AbuseComplex PtsdComplex TraumaDevelopmental TraumaInterpersonal Trauma
Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach
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“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.”

TrustSafetyTherapyChildhood AbuseComplex PtsdTherapistComplex Trauma
Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach
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“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.”

AuthorityTherapySelf DeterminationAutonomyComplex PtsdComplex TraumaDevelopmental TraumaInterpersonal Trauma
Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach
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“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.”

AbuseComplex PtsdTrauma Bonding
Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach
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“... 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.”

TherapyComplex PtsdComplex TraumaInterpersonal TraumaTherapeutic RelationshipTherapist ResponsibilitiesInterpersonal Abuse
Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach
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