Abstract

Since 2009, the presenters have co-authored and co-edited four books on the treatment of complex traumatic stress disorders in children, adolescents, and adults. They are currently revising their co-authored text,Treatment of Complex Trauma: A Sequenced, Relationship Based Approach, published in 2013. In the decade since the book's publication, the understanding of what constitutes complex trauma has grown quite rapidly as society has struggled with the ongoing COVID crisis, polarized political discourse and unrest, and increasing numbers of climate disasters and their consequences. Complex forms of trauma (i.e., those that occur repeatedly to the point of becoming chronic and that impact the victim's development or ability to regain life equilibrium) are now understood as likely the most common type of trauma. When such trauma occurs repeatedly from early childhood in the form of abuse, neglect, and other forms of violence, it is especially deleterious to a child's healthy development and commonly results in developmental psycho-physiological disruptions. The child copes by adapting to the ongoing traumatization; these adaptations can later become symptoms of PTSD and other personal, relational, medical, and mental health difficulties that can derail the individual's entire life course, at the time and later. 

Due to these complex adaptations, treatment itself is complex. Challenges and crises abound i. We have developed a treatment meta-model to supplement the recommended sequence of treatment for complex trauma in an attempt to assist therapists and address some of these complexities. We will provide a description of the PRISM model which stands for Personalized, Relational, Integrative, Sequenced, and Multi-dimensional/Multi-component. We will then address a number of the challenges and crises that can emerge from a variety of perspectives ranging from ethical, legal, and professional, traumatic transference, (re-)enactments, and dissociative process. We will further discuss issues of countertransference, secondary traumatic stress, and vicarious trauma in the therapist who must contends with all in the course of treatment. 

In the many evidence-based and supported practices and psychotherapy modalities available to clinicians, there are general guidelines for handling crises but no systematic practical guide for what to say and do in the moment of crisis. This presentation will illustrate, through several excerpts from filmed simulated psychotherapy sessions (archived on the Center for the Treatment of Developmental Trauma Disorders Identifying Critical Moments and Healing Complex Trauma webinar series available at no cost on learn.nctsn.org), a range of approaches taken when crises occur in session. The scenarios were filmed with real therapists and with actors portraying the clients. They demonstrate different ways that a variety of therapists guide clients through critical moments of trauma reenactment and dissociative fragmentation. These critical moments rely on and can strengthen the therapeutic alliance as they assist clients in restoring self-awareness and developing greater self-esteem and integration. The presentation will provide a moment-to-moment commentary and linkage with PRISM dimensions with each film excerpt, highlighting how the different therapists summon the presence of mind to be able to think clearly and respond reassuringly and empathically with severely distressed, physically and emotionally dysregulated, dissociated, or detached clients. The key phrase is “presence of mind”—being able to stop, think clearly, and act decisively and therapeutically while in the midst of a crisis.

This session was originally presented as a live conference session in April 2022.