Academic journal article Journal of Counseling and Development : JCD

Treating Adults with Complex Trauma: An Evidence-Based Case Study

Academic journal article Journal of Counseling and Development : JCD

Treating Adults with Complex Trauma: An Evidence-Based Case Study

Article excerpt

Adults with histories of exposure to complex trauma (CT) present daunting challenges for counselors working with this population (Courtois & Ford, 2013). These clients may dramatically shift their opinion of the counselor from very positive (idealization) to negative (disillusionment) in a brief period of time; exhibit sudden, extreme swings in mood; and / or anxiously anticipate abandonment by significant others (Briere & Scott, 2013). The etiology of these behaviors is often linked to childhood abuse and forms the substrate for negative intrapersonal and interpersonal relationships, survival-based coping skills, and a general view of the world and others as unsafe and untrustworthy. The resulting symptoms continue in various forms into these individuals' current adult lives. The consequences associated with exposure to CT highlight the importance for counselors who work with these clients to be well grounded in the etiology, development, and treatment of CT. This article provides an overview of CT and a case study describing the evidence-informed treatment of a 25-year-old woman with chronic CT symptoms resulting from childhood sexual, physical, and psychological abuse from caregivers.


Defining CT

The International Society for Traumatic Stress Studies (Cloitre et al., 2012) task force's definition of CT in adults includes the core symptoms of posttraumatic stress disorder (PTSD; reexperiencing, avoidance and numbing, alterations in cognitions and mood, and hyperarousal) and disruptions in self-regulatory capacities grouped into five domains: (a) emotion regulation, (b) self/relational capacities, (c) alterations in attention and consciousness, (d) belief systems, and (e) somatic symptoms and/or medical problems. These symptoms most often result from prolonged exposure to multiple forms of interpersonal trauma, typically during childhood, by caregivers who are expected to provide a safe, predictable, and secure environment (Courtois & Ford, 2013). Typically, there is no escape from the abuse. This disruption in the caregiver-child bond compromises the development of a secure attachment and a coherent, stable sense of self (Courtois & Ford, 2013). As a result of early invalidating messages from caregivers and self-referent thinking, these individuals often develop personal schemas of self-blame for the abuse and view themselves as bad, deserving mistreatment, and undeserving of acceptance (Courtois & Ford, 2013). They may seek validation and yet anticipate and even facilitate their own rejection, or they may avoid relationships altogether.

It is more often the rule than the exception that adults exposed to CT experienced multiple types of interpersonal trauma (i.e., polyvictimization) beginning in childhood (Anda & Brown, 2010; Turner, Finkelhor, & Ormrod, 2010). For example, a study of a national sample of 4,053 children and adolescents (ages 2-17) noted that 66% had experienced more than one type of abuse, 30% experienced five or more types, and 10% experienced 11 or more types (e.g., sexual, physical, assault, community violence, bullying; Turner et al., 2010). In another study of 4,272 youth from the Illinois child welfare system, 34.5% had been exposed to multiple, chronic trauma by a caregiver (Kisiel, Fehrenbach, Small, & Lyons, 2009). In both studies, children who experienced multiple types of abuse by caregivers had more chronic psychological symptoms and fewer overall strengths than youth with single, noncaregiver trauma. Exposure to multiple childhood adversities increases the risk for health risk behaviors (smoking, obesity, alcoholism, drug abuse, exposure to sexually transmitted diseases, and suicide attempts) and health problems (heart disease, cancer, stroke, diabetes, and hepatitis) in adulthood (Anda & Brown, 2010).

In addition, research indicates that child victims of CT have a greater risk of interpersonal revictimization across their life span (Duckworth & Follette, 2011). …

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