Relational Therapy - Dr. C. Courtois

[Kizzie]

Four stages to treating CPTSD in Relational Therapy:

By Dr. C. Courtois - http://giftfromwithin.org/html/cptsd-understanding-treatment.html

1.   The pre-treatment assessment should be comprehensive, with attention to diagnosis within the posttraumatic/dissociative spectrum, posttraumatic and other symptoms, safety, and comorbidity (particularly substance abuse, medical illness, eating disorders, and affective disorders).

2.   The early stage focuses on safety, stabilization, and establishing the treatment frame and the therapeutic alliance. Measured by mastery of the necessary skills and not by duration, this stage of treatment may be the most important since it is directly related to the clients' capacity to function. Education in complex trauma and elements of the human response to trauma provide a foundation for skill-building. Skills to be developed include healthy boundaries, safety planning, assertiveness, self-nurturing and self-soothing, emotional modulation, and strategies to contain trauma symptoms such as spontaneous flashbacks and dissociative episodes. Additionally, attention to wellness, stress management and any medical/ somatic concerns is needed. Medications such as antidepressants and anti-anxiety drugs are often helpful and should be considered to target posttraumatic symptoms and those associated with depression, anxiety, and sleep disorders.

3.   The middle stage of treatment begins only after stabilization skills have been developed and are utilized as needed. This stage involves revisiting and reworking the trauma with careful processing to integrate traumatic material along with its associated but often avoided emotion. This stage typically involves the expression of pain and profound grief but with the support and witnessing of the therapist. The re-working of trauma is always destabilizing, so the skills learned in the early stage of treatment provide the frame and skill-set needed to face and integrate the previously avoided traumatic material. A wide variety of techniques have been developed for processing trauma that are applicable to this treatment stage including prolonged or graduated exposure, cognitive processing therapy, cognitive restructuring, narrative exposure, and reprocessing, testimony, and Eye Movement Desensitization and Reprocessing, to name the most common.

4.   The late stage of treatment involves identity and self-esteem development and concurrent development of improved relational skills and relationships. The important issues of intimacy, sexuality, and current life choices, including whether to continue certain relationships and vocational choices typically occurs in this stage, if they have not been addressed earlier. Additionally, clients at this stage often encounter an existential crisis associated with a new sense of self and must struggle with the meaning of the now integrated trauma memories and with the losses they have endured. Survivors at this stage often struggle to embrace life with renewed energy and hope for the future.