Abstract
Contextual Trauma Therapy (CTT) was specifically developed to help people resolve complex traumatization and complex dissociation. It differs from other approaches in that it is not grounded in prescribed interventions. Instead, it is conceptually driven. The central guiding premise of CTT is that the range of difficulties extending from complex PTSD through complex dissociation are not just attributable to the harmful things that happened (trauma), but also to the lack of sufficient beneficial resources early in life (developmental deprivation). Recognition of the distinction between these two factors is critical to comprehensive, effective treatment for these conditions, because they not only point to two divergent spheres of impairment but also require two markedly different modes of intervention. Treatment approaches designed to resolve traumatization are highly unlikely to instill absent or incomplete developmental capacities. 

CTT purports that the divergent effects of traumatization and developmental deprivation are encapsulated in the bimodal structure of the diagnostic criteria for Complex PTSD found in the ICD-11. The symptoms of PTSD, by definition, are the consequences of exposure to traumatic events. In contrast, the additional constellation of impairments collectively referred to as disturbances of self-organization – negative self-concept, inadequate ability to effectively manage emotions, and impaired capacities for effectively engaging in sustained and sustaining interpersonal relationships – are deficits primarily attributable to developmental deprivation, not traumatization. 

The term “context” in CTT refers to the proposition that extensive childhood trauma almost invariably occurs in an interpersonal environment (i.e., context) that is appreciably lacking in the qualities needed to foster adequate psychological development. This factor approximates what is commonly referred to as neglect. However, the term neglect is often construed as intentional negligence, a failure to provide adequate care when one could do otherwise. CTT avoids that assumption in favor of the term developmental deprivation in acknowledgement that adequate developmental resources can be lacking in a child’s background due to a variety of factors that are beyond caretakers’ control. These circumstances may include, for example, parental figures’ own developmental limitations, debilitating illness, or the need to work long hours to provide a subsistence existence. CTT suggests that developmental deficits, such as hunger for affection, low self-esteem, and limitations in accurately reading social situations may render children especially vulnerable to manipulation and domination by predators.

Key aspects of CTT intervention are individualized conceptualization, attentiveness to fostering a collaborative therapeutic relationship as essential for nurturing development and reducing disturbances of self-organization, and adhering to tripartite phase-oriented treatment. The major departure from standard phase-oriented trauma therapy is that the first (stabilization) and third (integration) phases are strongly focused on remediating developmental deficits in addition to being trauma-responsive. Although CTT proposes its own set of treatment techniques, interventions such as those for stress-reduction in phase 1, trauma processing in phase 2, and integration of processed trauma and assimilation into effective daily living in phase 3 can be appropriated from other forms of treatment when case conceptualization indicates that they are suitable for a particular client.  

Potential to Distress: No