New Advances in Treating Complex Trauma

1. pmonroe@biblical.edu www.dianelangberg.com New Advances in Treating Complex Trauma Diane M. Langberg, PhD Diane Langberg PhD & Associates Philip G. Monroe, PsyD Biblical Seminary

2. Session Outline • Defining Complex Trauma • CPTSD Review • Diagnostic Differentials • Interventions: Talking, Tears & Time • Safety & Stabilization • Telling the Story • Grief & Lament • Self-Care • Strategies for Renewal

3. Trauma turns complex when: • Terror goes beyond typical PTSD • Stressors are interpersonal, premeditated, planned and caused by humans • Stressors are repeated and chronic in nature • Victims are exploited by “caregivers”

4. A new diagnosis? • Complex Trauma • Judith Herman, Trauma and Recovery • Type II PTSD • Lenore Terr, Too Scared to Cry? • Disorders of Extremes Stress (DES NOS) • Besel Van der Kolk, Trauma Center

5. Complex traumaalters a person’s • Ability to regulate affect and impulses • Attention and consciousness • Self-perception • Perception of the perpetrator • Capacity for relationships • Body and brain responses • Perception of meaning and faith

6. Differential Diagnostics Complex PTSD, PTSD, BPD, or Complicated Grief?

7. Common trauma experiences Intense fear, paralysis/helplessness, inability to effect any change, threat of annihilation, leading toexperience of, Loss of voice, control, connection, and meaning, resulting in, Disorganized physical, cognitive, and emotional response systemthereby increasing, Relational pain, distrust, self-contempt, overwhelming anxiety, evidenced as, Running from the past, afraid of the future

8. Overlapping diagnoses • Posttraumatic Stress Disorder (PTSD) • Complex PTSD (C-PTSD or DESNOS) • Borderline Personality Disorder (BPD) • Complicated Grief (CG) • Major Depression • Generalized Anxiety

9. How do you tell the difference?

10. Anxiety Depression Trauma

11. Key differentials TIME: Key factor in determining intensity of diagnoses

12. The biology of trauma? • Amygdala + Hippocampus + Cingulate • Arousal + Evaluate + Decide • Michael Lyles: accelerator, no brakes, no steering • Hypothalamus + pituitary + adrenal • Cortisol/stress feedback loop • In PTSD: low cortisol but more frequent “radar” results in overreaction to weak “signals” and no correction back to norm

13. Treatment Overview talking, tears, and time

14. Safety & stabilization • Foundation for all treatment • Longest phase and vital to positive outcomes • Features • Alliance building; support networks • Coping; grounding • Education about the nature of trauma • Avoid forced telling or catharsis

15. Initial goals • Increase client self-reflective capacities and compassion for the struggle • Support appropriate boundaries • Increase positive coping skills and support network

16. Why talk? • Truthfully telling of a silenced narrative • At right place, improves client self-efficacy • Tells the whole story • Supports grieving well • Brings faith and experience together

17. Talking dangers • Pushing or avoiding the story • Believing that telling the story is what heals • Seeking catharsis alone

18. Complex Trauma in the Church Educating the Church, Connecting Victims to God

19. Educating the Church • What might it mean if CT clients appear to be resistant, refusing good advice, yet dependant at the same time? • Are they sinfully anxious? • Are they demon possessed? • Are they rebellious? • Are they refusing to forgive or get better? Caring church leaders may grow weary in well-doing

20. Educating the Church: key areas • Develop a theology of oppression to explain impact of trauma • Failure to love violates the imago dei, true religion • 5 facets of oppression (the opposite of love) • Abuse of power • Deception and false teaching • Failure to lead • Objectification • Forced false worship See my “The nature of Evil in CSA: Theological considerations of oppression and its consequences” in the 2012 Schmutzer, A (ed.) The Long Journey Home: Understanding and Ministering to the Sexually Abused. Wipf & Stock.

21. Educating the Church: key areas • Develop a larger view of healing • What constitutes healing? • How do we participate in God’s healing? • Support? Mercy? Prayer? Listen? Play? • Remember: some healing is immediate, other healing grows day by day

22. Educating the Church: key areas • Explore ancillary themes: forgiveness, reconciliation, restoration, restitution, etc. • What is the rush? • Why forgiveness now? • Point in time? Attitude? • Why reconciliation now? What bothers us most about brokenness? • What does repentance look like? • What about restitution?

23. Lament An Intervention for Counselors and Clients

24. What is Lament? • Canonized complaints to God • Lamentations includes • Complaint against sin and destruction • Agony over personal/corporate sin (in children of God and heathen) • Questioning God • Waiting expectantly for answers • Worship

25. Does lament resolve hurt/anger? • Answers from Scripture? • Answers from Science?

26. Counselor Self-Care Preventing Vicarious Trauma; Some Directions for Church Leaders

27. Vicarious trauma • “Trauma is contagious” • Bearing witness leads to hopelessness, questions of faith, and fear in relationships • Temptation: withdrawal or intrusive action • VT defined: (Saakvitne & Pearlman) • transformation of the therapist's inner experience as a result of empathic engagement with another’s trauma Transforming the Pain

28. Tend your garden To last the long haul without damage, tend to: • Self-care • Relationships • Faith

29. A temptation to avoid self-care? I find many therapists feel guilty pursuing beauty and peace and order in their own lives... It is as if somehow they should not have good in their lives while others suffer. However, the Word of God says that He gives us richly all good things to enjoy. To turn from such things is to turn from the gifts in His hand.

30. For additional resources • www.dianelangberg.com • Books, CDs, bibliographies on related topics • Opportunities for case consultation • www.wisecounsel.wordpress.com • Phil’s personal and professional musings • Contact information: pmonroe@biblical.edu