Understanding Patterns Shaped by Trauma
Complex trauma often develops through experiences that occurred repeatedly or over long periods of time, particularly during childhood or within important relationships.
Years later, you may find yourself becoming highly anxious during conflict, worrying about disappointing people, struggling to know what you need, or shutting down when emotions become intense.
These responses can be confusing, particularly when you understand intellectually that the circumstances of your life are now different.
Often, they make more sense when we understand how you learned to adapt to what was happening at the time.
Complex PTSD therapy can help you understand these patterns and develop greater flexibility in how you respond to yourself and others.
I provide in-person therapy in Washington, DC, as well as secure online therapy throughout Washington, DC, Maryland, Virginia, and Florida.
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What Is Complex PTSD?
Complex PTSD (C-PTSD) can develop following prolonged, repeated, or difficult-to-escape traumatic experiences, particularly when those experiences occurred within important relationships.
It shares the core symptoms of PTSD but can also involve persistent difficulties with emotional regulation, relationships, and sense of self.
For a more detailed discussion, read What Is Complex PTSD?
How Is Complex PTSD Different From PTSD?
PTSD and Complex PTSD share many features. Complex PTSD also involves broader difficulties with emotional regulation, relationships, and how a person experiences themselves.
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PTSD |
Complex PTSD |
|---|---|
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May follow a single event or repeated traumatic experiences |
More commonly associated with prolonged, repeated, or difficult-to-escape trauma |
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May involve intrusive memories, nightmares, avoidance, or feeling persistently on guard |
Includes core PTSD symptoms alongside broader emotional and relational difficulties |
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Changes in mood, beliefs, and relationships can occur |
Persistent shame, negative self-perception, and relationship difficulties may be more pervasive |
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Treatment may focus more directly on particular traumatic experiences |
Treatment may also need to address longstanding patterns involving relationships, emotions, and sense of self |
The distinction is not simply about how many traumatic experiences someone has had. It is also about the broader ways prolonged trauma can shape how someone experiences themselves and relationships.
What Complex PTSD Therapy Looks Like
We usually begin with what is happening in your life now.
Perhaps you become overwhelmed during conflict, agree to things you do not want to do, become highly self-critical after making a mistake, or withdraw when you feel hurt.
Rather than immediately trying to change the response, we become curious about it.
What tends to activate this response? What happens when it appears? And when might responding this way have made sense?
Someone who grew up around unpredictable emotions may have learned to monitor other people’s moods closely. Someone who experienced frequent criticism may have learned that making mistakes was dangerous. Someone whose needs repeatedly led to conflict may have learned to minimize those needs.
The circumstances may now be different while the response remains.
Understanding why a pattern developed does not mean that every response remains useful or that we avoid responsibility for how our behavior affects other people.
Understanding and accountability can exist alongside one another.
The work involves recognizing when an earlier way of responding has been activated and developing more choice about how you want to respond now.
The Therapeutic Relationship
When difficult experiences occurred within important relationships, some of those patterns can also appear in therapy.
You may worry about disappointing me, wonder whether you are saying the right thing, agree when you actually disagree, or want to withdraw when something feels uncomfortable.
Rather than viewing these moments as problems with therapy, we can become curious about them together.
Therapy provides an opportunity not only to talk about relationship patterns, but also to notice them as they emerge in the present.
Working at a Manageable Pace
Complex trauma therapy does not require immediately revisiting painful experiences or telling your entire story.
Sometimes the work begins with recognizing what happens when you become overwhelmed, shut down, or disconnected and developing a greater ability to remain present.
Working more directly with traumatic memories may eventually be useful, but it is not always necessary or the place to begin.
There is no predetermined timetable. The method is less important than understanding what your nervous system can tolerate and working within that capacity.
How I Work
There is no single approach to complex trauma that works for everyone.
Depending on what we are working on, I may draw from EMDR, Somatic Experiencing®, Parts Work (Ego State Therapy), DBT skills, mindfulness-based approaches, and relational psychotherapy.
At different points, we may focus on managing emotions, noticing what is happening physically, understanding a recurring pattern, exploring what happens in relationships, or working more directly with a distressing memory.
We begin by understanding what is happening and consider together what kind of work may be useful.
Complex PTSD and Dissociation
Dissociation can sometimes accompany complex trauma and may involve feeling numb, disconnected, or having difficulty remaining present when emotions become intense.
When significant dissociation is present, the pace and approach to therapy may need to be adjusted accordingly.
Learn more about Dissociation Therapy.
Frequently Asked Questions
Do I need a diagnosis of Complex PTSD?
No. We can begin with what you are experiencing rather than with a particular diagnosis.
Will I have to talk about my childhood?
Not necessarily. Often we begin with something happening in your life now and consider whether earlier experiences help us understand why it feels particularly difficult.
Will I need to process traumatic memories?
Not necessarily. Working with memories can be useful, but complex trauma therapy may also involve relationships, emotions, boundaries, dissociation, self-criticism, and how you relate to yourself.
How long does Complex PTSD therapy take?
There is no standard length of treatment. We can periodically consider what is changing, what remains difficult, and whether the therapy continues to be useful.
Getting Started
You do not need to know whether Complex PTSD is the right way to describe what you are experiencing.
We can begin with what is happening in your life now and what you would like help understanding or changing.
From there, we can consider together whether earlier experiences may be relevant and what kind of therapeutic approach might be useful.
