Benefits of a Contextual Approach to Understanding and Treating Complex Trauma

Abstract

The conceptual framework and treatment rationale of contextual therapy are described. Contextual therapy was specifically fashioned for survivors of prolonged child abuse (PCA). It is grounded in the observation that contexts beyond abuse trauma, especially restrictions in psychological development stemming from growing up in an ineffective family environment, appreciably impact the adjustment of many PCA survivors. Contextual therapy proposes that remediation of developmental gaps commonly manifested by PCA survivors is essential to equip them to (a) benefit from rather than be debilitated by trauma processing and (b) move beyond symptom reduction to the attainment of adequate social and occupational functioning.

Physiological Monitoring and Biofeedback-Assisted Relaxation Training for Panic Disorder in a Case of Complex Developmental Trauma

“…While exposure-based interventions are typically effective in the treatment of uncomplicated PTSD cases (e.g., posttraumatic stress reactions to single-incident trauma), they can often make symptoms worse for adult survivors of childhood maltreatment if used too early in therapy. Trauma experts argue that adult clients with a history of CDT often need to learn how to regulate affect first before they can safely engage in exploration of trauma content in therapy (Gold, 2008). Many report a history of panic attacks, lack confidence in their ability to regulate their emotions, and have symptoms that meet criteria for panic disorder, which is the case for Laura.…”

“…While not a formal diagnosis in the DSM , Developmental Trauma Disorder (or Complex PTSD) is a good framework for understanding the relationship between the multiple clusters of symptoms that are present in this case (Van der Kolk & Courtois, 2005). This framework recognizes that chronic interpersonal trauma in childhood (i.e., abuse and other forms of maltreatment) often leads to deficits in multiple areas of development (e.g., attachment, affect regulation, interpersonal effectiveness, self-esteem, self-efficacy, and personality), resulting in multiple seemingly unrelated disorders during the life span, which may or may not include PTSD (Gold, 2008). Laura seemed to have multiple socio-emotional deficits associated with interpersonal trauma history in childhood, and they appeared to underline the more acute symptoms of anxiety and depression that were triggered by her brother’s suicide and brought her to treatment.…”

“…Complex developmental trauma (CDT) is characterized by repeated incidents of interpersonal trauma occurring at early stages of development (e.g., witnessing domestic and/or community violence, being direct target of abuse, suffering severe neglect) and is a risk factor for panic and other anxiety disorders, as well as several other diagnosable conditions, including mood, substance use, eating, personality, and posttraumatic disorders (Ford, 2005). CDT experts argue that while some forms of trauma typically lead to PTSD, such as combat and disaster trauma, interpersonal trauma in childhood (i.e., other forms of maltreatment) often leads to complex symptom presentations, which may or may not meet full criteria for PTSD but almost invariably results in affect dysregulation and other affective, somatic, behavioral, and characterological problems (Gold, 2008; Van der Kolk & Courtois, 2005).…”

“…The long-lasting impact of child maltreatment is attributed not only to trauma but also to the cumulative effects of being raised in home environments that are ill-equipped to meet the developmental needs of children. Research findings and clinical experience documented in the trauma literature suggest that growing up in abusive, chaotic, and unpredictable homes typically leads to deficits in multiple areas of development, including emotional/self-awareness, affect regulation, self-esteem, self-efficacy, and other socio-cognitive and emotional skills that are important for successful adult living (Gold, 2008; Lanius, Bluhm, & Frewen, 2011; Van der Kolk & Courtois, 2005). Laura reported a significant family history of substance abuse and interpersonal violence and displayed anxiety and other symptoms consistent with those expected in cases of complex developmental trauma.…”

Supervising trauma treatment: The contextual trauma treatment model applied to supervision.

“…In addition to child sexual abuse, the trainees at TRIP now work with a full and ever-growing range of trauma types, among them combat and military trauma, criminal assault, political terrorism and torture, life-threatening accidents and illnesses, refugees and immigrants, and domestic violence. Moreover, the majority of clinic clients report having experienced or been exposed to several varieties of traumatic experiences during their lifetimes, usually beginning with an extensive history of child maltreatment (Gold, 2000(Gold, , 2008Gold et al, 2001). They frequently meet criteria for multiple psychiatric diagnoses (e.g., posttraumatic stress disorder [PTSD], depressive and anxiety disorders, dissociative disorders, personality disorders, etc.…”