Introducing a Revolutionary Diagnosis:
Complex PTSD is Now Recognized!
Brad Kammer, NARM Faculty Trainer
In June 2018, nearly 40 years after the APA controversially yet officially recognized Post-Traumatic Stress Disorder (PTSD) as a mental disorder that required clinical treatment, the World Health Organization released the ICD-11 including a new diagnosis: Complex Post-Traumatic Stress Disorder (C-PTSD).
This diagnosis has the potential to completely revolutionize the world of mental health.
Understanding the long-term impact of unresolved early trauma is indeed a world health issue. Attachment, relational and developmental trauma - which crosses all cultures, religions and communities - impacts the neurobiological development of children and creates life-long patterns of disorganization within the body, mind and relationships. Perhaps a greater understanding of Complex Trauma can help us understand the underlying causes of the disorders our clients are struggling with, in addition to the increasing social challenges like substance abuse, systemic injustice and violence. A trauma-responsive perspective brings great hope.
While PTSD evolved the field of psychology in a major way nearly 40 years ago, those of us who have worked in this field know that there are limitations to the diagnosis and the treatments addressing it. C-PTSD helps us evolve our understanding of trauma. Now that C-PSTD has been officially recognized, the next step is to finding treatments that are specifically geared to addressing Complex Trauma.
Many of us have experienced frustration with clients dealing with complex trauma due to their lack of progress in therapy, as well as those clients who make good progress only to regress back to old, stuck patterns of self-sabotage, hopelessness and despair. These are usually the clients that therapists bring to consultation.
The question we as NARM consultants get asked repeatedly - how can I most effectively help my client?
To answer this, let's review The ACEs Study (Adverse Childhood Experiences). The ACEs Study has a fascinating origin. Originally, it was designed as a weight-loss program until the head of the program, Dr. Vincent Felitti, observed that despite making successful gains toward their weight-loss goals, nearly 50% of the participants were dropping out. This did not make sense to Dr. Felitti at the time: why participants would leave the program as they were losing weight and coming close to meeting their weight-loss goals. He created a questionnaire to understand this phenomenon and discovered that a majority of those who dropped-out had experienced childhood trauma. Thus began the monumental research project we now refer to as the ACEs Study.
One fascinating aspect here is the underlying mechanism of self-sabotage. One would think that the closer a participant got to their goals the more motivated they would be to complete their program. But whether it's weight loss, or a student dropping out their senior year of college just a few credits shy of graduating, or someone who has been sober and returns to their substance use, we see so many examples of people getting closer to health, wellness and success turn to behaviors that are self-sabotaging and self-destructive.
We are now unwinding this puzzle through recognizing the “survival” function of shame and self-hatred. As young children, everything revolves around staying connected to our caregivers via attachment - this is essential for our basic survival and well-being. When there has been failure, whether from our caregivers or from the environment, our basic survival is threatened. A child is unable to experience themselves as being a good person in a bad situation. Therefore, unconsciously, psychobiological mechanisms turn on to assure our basic survival. A main survival strategy is what we might refer to as shame and self-hatred; that children experience themselves as bad as a way to protect themselves from their failures of their caregivers and / or environment.
One of the things we have observed in consulting many somatic-oriented therapists internationally is that despite very effective and powerful somatic work, therapeutic process still gets thwarted without recognizing and working directly with the survival-based developmental strategies. Clients begin to get better and then repeatedly have set-backs or sabotage it in a number of ways. Going back to the original weight-loss program, something is threatening about moving forward in life toward greater health and well-being. That something is the way we learned to protect our early caregivers and environment through foreclosing fundamental aspects of ourselves, even if those fundamental aspects are positive like growth, healing and aliveness.
So what does this have to do with somatic therapy? What happens when a client is moving toward greater embodiment, self-regulation and empowerment ("bottom-up"), but we fail to recognize the underlying shame-based wounds that have led to the dysfunctional strategies, behaviors and symptoms? Or for traditional, talk-based therapists, what happens when we work with the psychodynamics of shame, self-hatred and self-sabotage ("top-down") without shifting the physiological and emotional patterns that are fueling the self-limiting beliefs and behaviors? And, what happens when we are working with early attachment wounds and do not recognize our own countertransference (our own unresolved trauma patterns and triggers) and how this impacts the therapeutic process?
The NeuroAffective Relational Model (NARM) is a therapeutic approach designed to work with unresolved wounds and leftover patterns from early trauma. This integrated “top-down” (psychodynamic-based) and “bottom-up” (somatic-based) approach works with the psychobiological patterns of shame and self-hatred within a deeply mindful, relational context. With a framework that identifies the developmental wounds from early trauma, our clients have a possibility of moving forward unencumbered by these unconscious survival strategies that have come to dominate their lives. Freedom from childhood trauma is possible
While research on this is still in its infancy, we at the NARM Training Institute are buoyed by clinical reports and early research demonstrating how effective the NeuroAffective Relational Model (NARM) is in resolving attachment, relational and developmental trauma. We have trained thousands of mental health clinicians throughout North America and Europe, and are rapidly expanding our NARM training programs throughout the world and online.
If you have clients that are struggling from unresolved early trauma and would like more information on how to provide more effective therapeutic support for your clients, we invite you to learn more about the NeuroAffective Relational Model in our online or live training formats.
To learn more about this revolutionary method to treat this paradigm-shifting diagnosis: