Living Legends Webinar: Trauma is Only Half the Story: Contextual Trauma Therapy for Complex PTSD
Contextual Trauma Therapy (CTT) is a form of therapy specifically developed to treat Complex PTSD (C-PTSD). Unlike other approaches to trauma treatment, the CTT model is not grounded in specific, predetermined interventions, but rather is guided by a conceptual model consistent with research on the nature of C- PTSD that has emerged in recent years. At the core of this conceptual framework is the principle that C-PTSD is comprised of two distinct sets of difficulties attributable to two divergent forces in childhood: the presence of damaging occurrences (prolonged or recurrent abuse trauma), and the absence of adequate favorable conditions (developmental deprivation).
Empirical findings that have helped to formulate the criteria for diagnosing C-PTSD as it appears in the current version of the International Classification of Diseases (ICD-11) are consistent with this conceptual framework. These criteria are organized into two discrete categories: PTSD symptoms (essentially identical to those comprising the DSM-5 posttraumatic stress disorder diagnosis) and disturbances of self-organization (DSO). DSO consists of three components: difficulty modulating emotions and impulses; unsatisfactory interpersonal functioning; and a pervasively negative self-image. Analogously, studies have identified that adverse childhood experiences (ACEs) can be divided into two separate types with divergent impacts:
- "experiences of threat,” various forms of child maltreatment (i.e., verbal, physical, and/or sexual abuse) which promote an enduring pattern of scanning for and over-reactivity to perceived instances of potential danger that corresponds to PTSD symptoms; and
- “experiences of deprivation,” emotional and physical neglect, which have been found to be related to compromised emotional and social development, difficulties consistent with the features of DSO, the “other half” of the C-PTSD story.
What is crucial about the two-pronged CTT conceptual model is its clinical implications. Ever since the introduction of the C-PTSD diagnostic construct in the early 1990s, it has commonly been viewed as exclusively resulting from “prolonged, repeated trauma.” This perspective is too often taken to imply that effective treatment is solely accomplished via trauma processing. Recognition of the role of developmental deprivation in the genesis of the DSO constituent of C-PTSD illuminates that these difficulties require a decidedly different treatment approach. Trauma-related PTSD symptoms of C-PTSD are performance deficits, difficulties acting on capacities that the individual possesses but that are disrupted by traumatization. DSO, in distinction, are skills deficits, gaps in functioning that, due to developmental deprivation, were never mastered. Consequently, CTT emphasizes the need to work to remediate developmental gaps and warps both for its own sake and to foster the capacities required to benefit from rather than be debilitated by intensive trauma work. In fact, thorough developmental remediation may resolve C-PTSD symptoms sufficiently to reduce or even eliminate the need for extensive trauma processing. The presenter will provide an overview of how CTT is implemented to accomplish this objective.
Potential to Distress
This presentation was originally presented as a live webinar in July 2022.
At the conclusion of this webinar participants will be able to:
- Identify the two distinct forces which, according to Contextual Trauma Therapy, contribute to the difficulties of individuals with Complex PTSD
- Describe the two main components of the Complex PTSD diagnostic criteria in the Eleventh Edition of the International Classification of diseases
- Discuss the three main spheres comprising the treatment model of Contextual Trauma Therapy for Complex PTSD
Presenter: Steve Gold
Presenter Bio: Steve Gold received his PhD in clinical psychology from Michigan State University in 1981. He taught at Central Michigan University for two years before joining the doctoral faculty at Nova Southeastern University (NSU) in Fort Lauderdale, Florida in 1982. From 1990 until 2020 he was director of NSU’s Trauma Resolution and Integration Program (TRIP), a trauma training clinic and research center. He is currently Professor Emeritus at NSU. In 2004 served as President of ISSTD and was President of the APA Division of Trauma Psychology in 2009. He also was inaugural editor of the APA Trauma Division’s scientific journal, Psychological Trauma, from 2008 through 2014. He received the 2014 APA Trauma Division Award for Outstanding Service to the Field of Trauma Psychology, and ISSTD’s Cornelia B Wilbur Award for outstanding clinical contributions to the treatment of dissociative disorders in 2020. He authored over 100 articles and chapters in on topics including trauma, dissociation, and hypnotherapy, and two books on his approach to treating Complex PTSD, Not Trauma Alone (2000) and Contextual Trauma Therapy (2020). He was editor-in-chief of the APA Handbook of Trauma Psychology and is a co-editor of the upcoming second edition of Dissociation and the Dissociative Disorders. He has conducted numerous presentations and workshops throughout the US, and has been an invited speaker in Argentina, Austria, Canada, Columbia and Spain. Dr. Gold has maintained an independent psychology practice since 1983, and is an expert witness on trauma and dissociation in legal cases. He is a Certified Traumatologist with the Traumatology Institute, a Certified Consultant in Clinical Hypnosis with the American Society of Clinical Hypnosis, sits on the Board of Directors of the Sidran Institute for Traumatic Stress Education and Advocacy, and on the Advisory Board of the Leadership Council on Child Abuse & Interpersonal Violence.
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