Trauma and Complex Trauma Therapy

When the past makes it difficult to be present

A difficult event does not remain only in the past. It may return through intrusive memories, nightmares, physical hyperarousal, a sense of danger, avoidance, disconnection, shame, or guilt. Even when you know intellectually that the event is over, body and mind may continue to respond as though the danger were still present.

Post-traumatic stress disorder (PTSD) is not expressed only in the intensity of memory or fear. Life often becomes organized around trying not to remember, not to feel, not to approach certain situations, or to remain constantly in control. These responses are intended to protect, and they may indeed bring short-term relief. Over time, however, they can narrow life, reinforce the sense of danger, and prevent the experience from becoming a memory that belongs to the past.

How does trauma continue to create suffering?

In therapy, we will try to understand how traumatic distress appears in your life today: what happens in your thoughts, emotions, and body, which situations or experiences you have come to avoid, and what meanings have become connected to what happened. Traumatic events sometimes unsettle basic assumptions about safety, trust, responsibility, and identity.

In other cases, the main difficulty is physical: hyperarousal, sensitivity to noise, fear of emotions, bodily sensations, or trauma-related triggers, difficulty sleeping, or a persistent bodily sense of danger. Developing a shared understanding helps us choose the focus, pace, and interventions that fit the work.

The therapeutic work

The therapy I offer is active, collaborative, and trauma-focused. Depending on what is needed, it may include gradual and direct exposure to the traumatic memory, returning to safe situations that have come to feel threatening, examining beliefs that developed following the traumatic event or events, attending to bodily sensations and survival responses, and re-engaging with meaningful areas of life.

I draw on therapies that have been researched and found effective, including Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), trauma-focused Acceptance and Commitment Therapy (ACT), EMDR, and tools from body-oriented psychotherapy. These approaches offer maps and methods, but the work itself is shaped according to the nature of your difficulties, needs, pace, and goals.

Regulation and exposure

The ability to regulate physical and emotional arousal is an important resource. At the same time, efforts to control anxiety or other emotions can sometimes intensify the difficulty. A prolonged attempt to calm, suppress, or control internal responses may itself become part of avoidance.

To create a safe therapeutic setting, we will develop a shared understanding of the aims of therapy and how to work toward them. Therapeutic tasks are undertaken deliberately and by agreement, with attention to what can be learned from the experience rather than only to the intensity of distress. The aim is to gradually expand the capacity to remember, feel, and act without allowing trauma to continue defining the boundaries of life.

Complex post-traumatic stress disorder (CPTSD)

When harm was prolonged, occurred in childhood, or developed within a close and significant relationship, its effects may be broader. In addition to PTSD symptoms, there may be difficulties with emotional regulation, deep feelings of shame or defectiveness, a negative sense of self, difficulty identifying needs and boundaries, and an impaired capacity to experience safety and closeness in relationships.

In these situations, the work does not focus only on a particular memory. It may also include understanding patterns that developed in order to survive within relationships, developing the capacity to recognize and express needs, working with self-criticism and guilt, and gradually building relationships that allow for more choice, boundaries, and trust. Here too, it is important to create conditions that make it possible to encounter the trauma, reduce avoidance, and return to engagement with life.

What can change?

Memories do not have to disappear for therapy to be effective. Change may include reduced intrusiveness and hyperarousal, but also a greater capacity to do things you have avoided, to be closer to other people, to experience emotions and bodily sensations without becoming alarmed by them, and to develop a broader view of yourself that is not reduced to what happened to you.