Occupational Therapy with
individuals suffering from
Complex Psychological Trauma.
Geraldine Hamilton
Clinical Specialist Occupational
Therapist
Complex PTSD

Severity of complex PTSD symptoms (i.e.,
complex trauma symptoms) were related to:
– Childhood abuse and neglect
– Posttraumatic avoidance
– Feeling emotionally disconnected from other people
(complex problems impact on relationships)
– Perceived psychological impact of troubles-related
traumatic events
Trauma Events (e.g.,)
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Sectarian Murders
Sectarian
beatings/shootings
Feud murders
Paramilitary attacks
Death threat
Intimidation
Displacement
Witness to Suicide
Kidnapping, tortures
State violence
Phase-oriented treatment

Janet (1919/1925); Herman (1992); Van der Hart,
Nijenhuis & Steele (2005)
– Establishing Safety (Stabilisation & symptom reduction)
– Remembrance and Mourning (memory/trauma work)
– Reconnection (rehabilitation & reintegration)
NB: Not linear progression; like ‘a spiral’
Phase 1: Stabilisation
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Establishing Safety – Therapeutic Alliance,
stabilisation; symptom reduction
Education, Affirmation, Normalisation
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Impact of Trauma on daily routine,
ADL,
symptom control for anxiety/depression,
building coping strategies to assist alcohol/ drug reduction,
goal setting,
activity planning,
impact on role in family, community,
advocacy re: financial situation, housing, childcare etc
Phase 2: memory/trauma work
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Remembrance and Mourning/memory work
–
–
–
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maintain stabilisation,
introduce physical activity
facilitate expression using creative activities
ongoing avoidance and safety behaviour
interventions (graded exposure & motivational
interviewing),
– commence reintegration,
– create new narrative
Phase 3:
Habilitation/Rehab/reintegration
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Reconnection, rehabilitation, reintegration
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Assessing & focusing on strengths, interests, goals;
building pathways to education;
vocational/educational activities; work; hobbies;
fostering & maintaining good knowledge of and
relationships with services in community, support
networks, leisure facilities;
skills development (e.g., social skills, assertiveness
skills), group work
Core – Functioning
3
2.5
2
OT +
Counselling
Counselling only
1.5
1
0.5
0
1st Phase
2nd Phase
SYMPTOM REDUCTION - FUNCTIONING
Client: OT Only Input
1.4
1.2
all
1
all minus risk
0.8
functioning
0.6
problems
risk
0.4
well being
0.2
0
1
2
Focus of treatment by
discipline
Past
Psychological
Therapy
Present
Physiotherapy
Future
Occupational
Therapy