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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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“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.”

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

EmpathyTherapyChildhood AbuseTherapistComplex TraumaDevelopmental 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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“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).”

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

RelationshipsTherapyComplex TraumaRelational Trauma
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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“... 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.”

TherapyChildhood AbuseTherapistComplex TraumaInterpersonal TraumaTherapeutic RelationshipEarly Trauma
Book:Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach
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