Abstract
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:

1. "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
2. “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
No

This presentation was originally presented as a live webinar in July 2022.