Treating Complex PTSD
Presenter: Dr. J. Eric Gentry, Ph.D., LMHC, F.A.A.E.T.S.
While the focus of Trauma Competency for the 21st Century was to acquire the basic skills for treating post traumatic stress, the focus of the Complex PTSD training is acquiring skills for effectively treating those challenging clients with complex post traumatic stress, or C-PTSD. C-PTSD can present with a myriad of difficult symptoms including intense abreactions/flashbacks; severe “depression-like” shutdown and avoidance; dissociation; relational difficulties and challenges; chronic emotional and somatic dysregulation; chronic pain; and psychotic symptoms. This course provides comprehensive presentation of clinical skills for screening/assessing, stabilizing, skills-building, and treating complex post traumatic stress in all its challenging presentations. Focusing upon working in a tri-phasic model, the participant will learn how to titrate treatment to minimize discomfort and crises while, at once, accelerating treatment gains in early, mid and latter stages of treatment. The course provides a balance of current evidence/science-based interventions and protocols paired with experiential practice wisdom from clinicians who have successfully worked with population for decades. Participants completing this course will discover a newfound sense of competency and excitement for working with these clients who, in the past, have baffled even seasoned clinicians.
Learning Objectives
1. Articulate the differences between simple and complex PTSD (C-PTSD) and identify the distinct challenges for diagnosis, treatment planning, stabilization and treatment of C-PTSD.
2. Understand the neurobiology of C-PTSD and how chronic exposure to threatening environments can produce the spectrum of symptoms of C-PTSD
3. Appreciate the role that attachment trauma and Adverse Childhood Experiences (ACEs) play in risk for and creation of C-PTSD; and how successfully addressing attachment issues can accelerate treatment for C-PTSD.
4. Articulate the causes of attachment trauma (e.g., relational threat/anxious attachment; avoidant attachment; disorganized attachment) and how these adaptations are easily misunderstood as personality disorders.
5. Articulate the importance of neuroplasticity/pruning and understanding neuronal sequencing (i.e., “neural networks”) in treating C-PTSD and all post traumatic conditions.
6. Understand the important role that conditioned threat response and subsequent ANS dysregulation play in generating and sustaining the symptoms of all post traumatic conditions including C-PTSD.
7. Expanded knowledge of the science and applicability of Porges’ Polyvagal Theory to treatment with C-PTSD; specifically the importance of developing and utilizing healthy attachment relationships to augment treatment.
8. Articulate and explain how dissociation symptoms (e.g., numbing; derealization; depersonalization; hearing “voices”; fractured multiple ego-states; dissociative identity) are adaptations to recurring (usually developmental) trauma.
9. Identify evidence-based pharmacological interventions for stabilization and treatment for clients with C-PTSD.
10. Apply Herman’s Tri-Phasic Model to conceptualization, titration and delivery of treatment for C- PTSD.
11. Identify specific assessment and treatment tasks for each of the three phases of the Tri-Phasic Model.
12. Understand symptoms of C-PTSD as adaptations to ongoing developmental trauma that can include extreme symptoms including self-injury; suicide; dissociation; numbing; addiction (process and substance); eating disordered behavior; chronic & intractable depression; hyper/hypo sexuality; and rage.
13. Articulate the role of crucial non-specific factors of positive expectancy and therapeutic relationship using Feedback Informed Therapy (FIT) as central focus of treatment with C-PTSD.
14. Learn and appreciate the pivotal role of psychoeducation in treating C-PTSD to help survivors to begin to honor their survival, ameliorate shame and move towards self-compassion.
15. Learn and implement the four “common factors/active ingredients” shared by all effective trauma therapies for clients with C-PTSD.
16. Appreciate the ubiquitous role of reciprocal inhibition embedded in all evidence-based trauma therapies
Skills
Preparation/Assessment/Treatment Planning/Relationship-Building
1. Master self-regulation of ANS dysregulation (i.e., anxiety) for clinician resilience and optimization of treatment delivery.
2. Become intentional with maximizing positive expectancy as crucial early treatment intervention for engagement and ongoing intervention to enhance outcomes.
3. Informed Consent for C-PTSD
4. Develop understanding and usage of various assessment tools
5. First-session Interventions to enhance safety, stabilization, positive expectancy and therapeutic relationship
6. Skilled implementation of Feedback Informed Therapy using Miller’s Session Rating Scale
Stage I: Safety & Stabilization
1. Enhance case-management skills to facilitate and co-author safety planning interventions with clients in current danger.
2. Practice psychoeducational skills to help C-PTSD clients discern difference between real vs. perceived threat then coaching skills to avoid “real” danger and confront perceived threats with self-regulation (i.e, in vivo exposure).
3. Develop mastery of psychoeducation/cognitive restructuring skills for reframing symptoms from shame and affliction to “over”-adaptation.
4. Develop mastery for teaching and coaching self-regulation skills for clients to down-regulate negative arousal, achieve stability and begin in vivo exposure in early treatment.
5. Gain generic stabilization skills for all C-PTSD clients
Stage II: Remembrance & Mourning/Trauma Resolution
1. Master skills for Direct Therapeutic Exposure using reciprocal inhibition with in vivo exposure as primary means for resolving symptoms in Criteria B (Intrusion), Criterion C (Avoidance), Criterion D (Negative Alterations of Cognition &Mood) & Criterion E (Arousal & Reactivity) of PTSD.
2. Discover CBT skills to lessen avoidance, arousal, shame, dysphoria, reactivity, and distorted thinking symptoms.
3. Compare evidence-based/evidence-informed treatments currently utilized to address symptoms of C-PTSD
Stage III: Reconnection
1. Identification of specific treatment goals and empirical markers for objectives in this final stage of treatment. This stage requires a new and additional treatment plan.
2. Skills for implementing psychoeducational techniques to help client understand and engage the intention of moving from survival to intentional and deliberate lifestyle.
3. Skills for identifying both cognitive and behavioral impediments to transitioning to optimal lifestyle for C-PTSD survivors.
4. Building and enhancing post traumatic resilience
5. Engaging and optimizing post traumatic growth
6. Implementing Forward-Facing Trauma Therapy as reconnection, resilience and moral healing strategy.
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