Judith Herman believes that recovery from C-PTSD occurs in three stages. These are: Establishing safety, remembrance and mourning for what was lost and reconnecting with community and more broadly society. Herman believes that recovery can only occur within a healing relationship and only if the survivor is empowered by that relationship. This healing relationships need not be romantic or sexual in the coloquial sense of relationship however and can also include relationships with friends co workers, ones relatives or children and the therapeutic relationship. Complex trauma means complex reactions and this leads to complex treatments. Hence treatment for C-PTSD requires a multi modal approach. It has been suggested that treatment for C-PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional deregulation, dissociation and interpersonal problems. Six suggested core components of complex trauma treatment include: 1. safety 2. self-regulation 3. Self reflective information processing 4. traumatic experience integration 5. relational engagement 6. positive affect enhancement.
The utility of PTSD derived psychotherapies for assisting children with C-PTSD is uncertain. This area of diagnosis and treatment calls for caution in use of the category of C-PTSD.
Ford and Van Der Kolk have suggested that C-PTSD may not be as useful a category for diagnosis and treatment of children as a proposed category of developmental trauma disorder DTD. For DTD to be diagnosed it requires a ” history of exposure to early life developmentally adverse interpersonal trauma such as sexual abuse, physical abuse, violence, traumatic losses of other significant disruption or betrayal of the child’s relationships with primary caregivers, which has been postulated as an etiological basis for complex traumatic stress disorders. Diagnosis treatment planning and outcome are always relational”.
Since C-PTSD or DTD in children is often causes by chronic maltreatment, neglect or abuse in a caregiving relationship the first element of the biopsychosiocial system to address is that relationship. This involves some sort of child protection agency. This both widens the range of support that can be given to the child but also the complexity of the situation since the agency’s statutory legal obligations many then need to be enforced.
A number of practical therapeutic and ethical principles for assessment and intervention have been developed and explored in the field.
1. Identifying and addressing threats to the child’s or family’s safety and stability are the frist priority
2. A relational bridge must be developed to engage retain and maximize the benefit for the child and caregiver.
3. Diagnosis treatment planning and outcome monitoring are always relational and strengths based.
4. All phases of treatment should aim to enhance self-regulation competencies
5. Determining with whom, when and how to address traumatic memories
6. Preventing and managing relational discontinuities and psychosocial crisis.