Complex Posttraumatic Stress Disorder

Two common misconceptions about working with survivors who suffer from posttraumatic stress disorder (PTSD) are that the disorder always stems from a single event and that effective treatment consists solely of a set of exposure-based interventions that address that one event.

However, individuals who have survived prolonged or repeated trauma often develop complex PTSD, a disorder consisting of forms of impairment much more extensive than in PTSD. Often, when trauma-focused exposure-based interventions are launched into prematurely, they are highly likely to cause deterioration rather than improvement.

In this video, Dr. Steven N. Gold demonstrates an approach to working with clients experiencing complex PTSD that focuses initially on helping them improve their quality of life in the present. By coaching clients on various facets of adult living, such as mastering effective coping skills, maintaining steady employment, and building a social support network, therapists can help them experience marked improvement in the present and form a stable base from which to address the lingering impact of traumatic experiences.

Contextual trauma therapy (CTT) is a form of treatment developed specifically for survivors of prolonged or repeated trauma, especially of prolonged child abuse (PCA).

It is grounded in the clinical observation corroborated by empirical research that PCA often occurs in the context of growing up in an interpersonally deficient household that fails to adequately foster development, promote socialization, and transmit the practical daily living skills required for effective adult functioning. Consequently, PCA survivors' difficulties are often attributable not only to the impact of the overt trauma, but also to the gaps and warps in adaptive capacities attributable to having been reared in deficient family environments.

Without these competencies, trauma-focused exposure-based interventions are highly likely to trigger flashbacks and dissociative episodes and foster deterioration rather than improvement in functioning. The initial focus of CTT, therefore, is to help survivors improve their quality of life in the present by mastering the facets of adult living that were not sufficiently transmitted to them during their formative years, including the capacity for self-soothing and other adaptive coping skills.

Once this has been achieved, processing of past traumatic experiences can be productively engaged in without appreciable risk of decompensation. With the resolution of trauma-related difficulties, treatment can more intensely focus on helping survivors develop the components of a productive and gratifying life structure — such as maintaining steady employment, establishing a network of social support, and participating in a stable intimate relationship — that previously eluded them.

Steven N Gold, PhD, has been a professor in the doctoral psychology programs at Nova Southeastern University (NSU) since 1982. In 1990, he founded NSU's Trauma Resolution & Integration Program (TRIP), a trauma psychology clinic entirely staffed by doctoral student therapists that has earned a national reputation for quality service, clinical research and training.

In 2004, he served as president of the International Society for the Study of Trauma and Dissociation. He was president of APA Division 56 (Trauma Psychology) in 2009, inaugural editor of the Division's scientific journal, Psychological Trauma: Theory, Research, Practice and Policy, from 2008 through 2014, and in 2014 received the Division's Award for Outstanding Service to the Field of Trauma Psychology.

Recruited by APA's Office of Publications as Editor-in-Chief of the two volume APA Handbook of Trauma Psychology, Dr. Gold has published extensively on trauma-related topics, including the book Not Trauma Alone, which details a model for treating adult survivors of prolonged child abuse.

His passionate, enthusiastic, and humane approach to working collaboratively with traumatized people has garnered him invitations as a speaker throughout the United States and in Canada, Colombia, Argentina, Spain, and Austria.

Dr. Gold maintains an independent psychology practice in Plantation, Florida and in recent years he has regularly been retained as an expert witness in legal cases in which trauma and dissociation appeared to be relevant issues.

• Gold, S. N. (2000). Not Trauma Alone: Therapy for Child Abuse Survivors in Family and Social Context. New York, NY: Routledge.
• Gold, S. N. (2009). Contextual Therapy: A Treatment Designed for Complex Trauma Survivors. In C.A. Courtois & J. D. Ford (Eds.), Complex Trauma Disorders: An Evidence-Based Clinician's Guide. New York, NY: Guilford Press.
• Gold, S. N. (2016). Growing Together: A Contextual Perspective on Counter Trauma, Counter Resilience, And Counter Growth. In R. B. Gartner (Ed.) Trauma and Counter Trauma, Resilience and Counter Resilience: Insights from Psychoanalysts and Trauma Experts. London, England: Routledge.
• Gold, S. N., & Seibel, S. L. (2009). Treating Dissociation: A Contextual Approach. In P. F. Dell & J. O'Neill (Eds.), Dissociation and The Dissociative Disorders: DSM-V and Beyond. New York, NY: Routledge.

APA Videos

• Behavioral Emergencies
  Phillip M. Kleespies
• Cognitive Behavioral Interventions for Posttraumatic Stress Disorder
  Candice M. Monson
• EMDR for Trauma: Eye Movement Desensitization and Reprocessing
  Francine Shapiro
• Emotion-Focused Therapy for Trauma
  Sandra C. Paivio
• Working With Men Survivors of Trauma and Abuse
  Laura S. Brown
• Working With Women Survivors of Trauma and Abuse
  Laura S. Brown

APA Books

• Building Psychological Resilience in Military Personnel: Theory and Practice
  Edited by Robert R. Sinclair and Thomas W. Britt
• A Practical Guide to PTSD Treatment: Pharmacological and Psychotherapeutic Approaches
  Edited by Nancy C. Bernardy and Matthew J. Friedman
• The Suicidal Patient: Clinical and Legal Standards of Care, Third Edition
  Bruce Bongar and Glenn R. Sullivan
• Treating PTSD With Cognitive-Behavioral Therapies: Interventions That Work
  Candice M. Monson and Philippe Shnaider