Key components of complex trauma therapy:

A therapist who has completed some training in understanding the

condition known as “trauma” (or PTSD and hopefully C-PTSD) is called

a “trauma – informed therapist”. This is absolutely NOT the same as

being a “trauma specialist” or “traumatologist”. The reason for this is

the wide and deep nature of trauma specialist, and simply the range of

issues and therapy types needed to cover it. To be a true traumatologist

you need to be trained in at least the 9 basic areas listed below to a

sufficient degree to expertly refer on a matter if you are unable to

directly treat one of the areas yourself.

A 9 stringed instrument is known as a “nonacorde”. An example is the

portugese 9 stringed guitar:

So if this represents a traumatologist, imagine instead the guitar is missing all

but perhaps one of it’s strings….. that would be a trauma informed counsellor

or therapist. Add a couple of additional relevant skills and you get 3 or 4

strings, but still a few missing. A proper traumatologist has all their strings and

is trained to play them…. for complex trauma specifically!

1. Safety and Stabilization: Creating a safe and supportive therapeutic

environment is paramount. This involves establishing clear boundaries, ensuring

confidentiality, and helping the individual feel secure enough to explore their

experiences. Stabilization techniques, such as grounding exercises and

mindfulness practices, are often used to manage overwhelming emotions and

physical sensations. This requires skills and knowledge from the area of

neurobiology, relaxation therapies, physical based therapies, energetic

therapies. It also requires the ability to coach clients in self regulation methods

from a variety of therapies, and to be able to explain how and why they work.

2. Psychoeducation: Providing education about complex trauma, its effects on the

brain and body, and common reactions is essential. This helps individuals

understand their experiences and reduces feelings of shame or self-blame. This

requires a good sound scientific training in neurobiology, health psychology,

integrative medicine and the “ingredients for health” (including nutrition,

movement, sleep, complementary treatments, medical testing, conversing

with medical professionals etc).

3. Emotional Regulation: Developing skills to manage and regulate emotions is a

crucial aspect of complex trauma therapy. This may involve learning techniques

for identifying and labeling emotions, coping with triggers, and developing

healthy emotional expression. This requires a skillset and knowledge including

neurobiology, relaxation and energy therapies, physical therapies,

wellbeing coaching, self management using diet and exercise and a whole

wide range of other disciplines as well as social psychology / interpersonal

neurobiology. It preferably includes a grounding in polyvagal theory and other

cutting edge physiology.

4. Processing Traumatic Memories: Once the individual is stabilized and has

developed coping skills, they may begin to process traumatic memories. This is

often done gradually and at the individual’s own pace. Different therapeutic

approaches, such as Eye Movement Desensitization and Reprocessing

(EMDR) or Somatic Experiencing, may be used to help process these

memories. Hypnosis, EMDR, brainspotting, sensorimotor psychotherapy,

somatic (mind-body) processing methods, advanced mindfulness methods,

NLP, MEMI and various other therapies are needed if memory reconsolidation

needs to occur, and more importantly a sound understanding of the neurology

and science behind what is being used, and why. Failuire to have proper

specialist knowledge and training can lead to amateur and premature application

of methods, leading to real harm!

5. Attachment and Relationship Repair: Complex trauma often affects an

individual’s ability to form and maintain healthy relationships. Therapy may focus

on exploring past attachment patterns, identifying current relationship challenges,

and developing skills for building and maintaining healthy

connections. Interpersonal psychotherapy, attachment psychology or

social psychology, together with understanding interpersonal

neurobiology is a specialist field and not part of general talking therapy training.

6. Reintegration and Empowerment: The final stage of complex trauma therapy

involves reintegrating the traumatic experiences into the individual’s life narrative

and fostering a sense of empowerment. This may include exploring personal

strengths and resilience, developing a sense of self-worth, and creating a

hopeful vision for the future. Narrative therapy, parts work therapy and other

advanced somatic and narrative based methods are again advanced and

specialist therapy areas not used by general therapists.

7. Behavioural Change: Alongside the above main areas there are often essential

life changes that need to occur in moving from trauma adaptation (survival based

adaptation of behaviour and beliefs during trauma) to re-adaptation (choosing

behaviours and perceptions that work in safe post trauma living). These changes

require specialised knowledge of advanced behavioural change methods and

the neuroligical implications of applying them successfully with trauma survivors.

This means having a combination of knowledge of therapies such as DBT, RO-

DBT, ACT, CBT, CT, CBASP, ABA, and being able to adapt them to the traumasurvivor and their need for patience with neuro-flexibility and trauma based

neuro-diverdence.

8. Socratic Challenge: Before perceptual change can be designed hand in hand

with the client, it is important to take a critical thinking / philisophical approach to

challenging beliefs and ideas. This is done compassionately and without agenda,

teaching the client to challenge their own “trauma think”. This leads to designing

re-adaptation to move on from fear and adaptive behaviours that hold the client

back, as well as uncovering and nurturing hidden qualities and aspects of

identity that may have laid hidden and suppressed. This requires the ability to

understand deeply how perception and behaviour change during trauma, and

frankly is only possible for therapists who have completed their own trauma

recovery journeys. Methods include Compassionate Inquiry (created by Gabor

Mate) and philosophical analysis / therapy. There are some limited

philosophical therapy training courses available, alternatively the route to

knowledge is general knowledge and experience, together with specific study of

philosophy of the mind, or philosophy in therapy context. Both are available from

credible universities.

9. Complex trauma is notorious for co-morbidity. In other words where long

term exposure to traumatic events has occured other diagnosis, both

physiological and psychological are usually present, and therefore the therapist

needs additional knowledge of other integrative and functional medicine, and

mental health areas in order to support these cases. This is reflected in the UK

NICE guidelines for PTSD where other concurrent common conditions are

discussed.