pmonroe@biblical.edu
www.dianelangberg.com
NEW ADVANCES IN TREATING
COMPLEX TRAUMA
Diane M. Langberg, PhD
Diane Langberg PhD & Associates
Philip G. Monroe, PsyD
Biblical Seminary
Session Outline

Defining Complex Trauma
 CPTSD
Review
 Diagnostic Differentials

Interventions: Talking, Tears & Time
 Safety
& Stabilization
 Telling the Story
 Grief & Lament

Self-Care
 Strategies
for Renewal
Trauma turns complex when:
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Terror goes beyond typical PTSD
Stressors are interpersonal, premeditated, planned
and caused by humans
Stressors are repeated and chronic in nature
Victims are exploited by “caregivers”
A new diagnosis?

Complex Trauma
 Judith

Herman, Trauma and Recovery
Type II PTSD
 Lenore

Terr, Too Scared to Cry?
Disorders of Extremes Stress (DES NOS)
 Besel
Van der Kolk, Trauma Center
Complex trauma alters a person’s
1.
2.
3.
4.
5.
6.
7.
Ability to regulate affect and impulses
Attention and consciousness
Self-perception
Perception of the perpetrator
Capacity for relationships
Body and brain responses
Perception of meaning and faith
Differential Diagnostics
Complex PTSD, PTSD, BPD, or Complicated
Grief?
Common trauma experiences
Intense fear, paralysis/helplessness, inability to effect
any change, threat of annihilation, leading to
experience of,
Loss of voice, control, connection, and meaning,
resulting in,
Disorganized physical, cognitive, and emotional
response system thereby increasing,
Relational pain, distrust, self-contempt, overwhelming
anxiety, evidenced as,
Running from the past, afraid of the future
Overlapping diagnoses
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Posttraumatic Stress Disorder (PTSD)
Complex PTSD (C-PTSD or DESNOS)
Borderline Personality Disorder (BPD)
Complicated Grief (CG)
Major Depression
Generalized Anxiety
How do you tell the difference?
Traumatic Symptoms
BPD
(DTD?)
PTSD
Prolonged DESNOS
Grief
C-PTSD
Trauma
Depression
Key differentials
DESNOS
Anxiety
Complicated
Grief
Primary Affect:
Panic and pain
Worry
Intrusive sad or
guilty thinking
Relationships:
Passive,
avoidance, revictimization
Varies; trust
Loss of prerelationships likely existing good
coping skills
Dissociation:
Present
Not likely
Not likely
Cognitive Focus:
Fear
Future dangers
Loss
Self:
Consistent self
loathing
External focus,
Compare/
self in background contrast with self
prior to loss
TIME: Key factor in determining intensity of diagnoses
The biology of trauma?

Amygdala + Hippocampus + Cingulate
 Arousal
+ Evaluate + Decide
 Michael Lyles: accelerator, no brakes, no steering

Hypothalamus + pituitary + adrenal
 Cortisol/stress
feedback loop
 In PTSD: low cortisol but more frequent “radar” results
in overreaction to weak “signals” and no correction
back to norm
Treatment Overview
talking, tears, and time
Safety & stabilization



Foundation for all treatment
Longest phase and vital to positive outcomes
Features
 Alliance
building; support networks
 Coping; grounding
 Education about the nature of trauma
 Avoid forced telling or catharsis
Initial goals
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Increase client self-reflective capacities and
compassion for the struggle
Support appropriate boundaries
Increase positive coping skills and support network
Why talk?
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Truthfully telling of a silenced narrative
At right place, improves client self-efficacy
Tells the whole story
Supports grieving well
Brings faith and experience together
Talking dangers
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Pushing or avoiding the story
Believing that telling the story is what heals
Seeking catharsis alone
Complex Trauma in the Church
Educating the Church, Connecting Victims to God
Educating the Church

What might it mean if CT clients appear to be
resistant, refusing good advice, yet dependant at
the same time?
 Are
they sinfully anxious?
 Are they demon possessed?
 Are they rebellious?
 Are they refusing to forgive or get better?
Caring church leaders may grow weary in well-doing
Educating the Church: key areas

Develop a theology of oppression to explain impact of
trauma

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Failure to love violates the imago dei, true religion
5 facets of oppression (the opposite of love)
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Abuse of power
Deception and false teaching
Failure to lead
Objectification
Forced false worship
See my “The nature of Evil in CSA: Theological considerations of oppression and its
consequences” in the 2012 Schmutzer, A (ed.) The Long Journey Home: Understanding
and Ministering to the Sexually Abused. Wipf & Stock.
Educating the Church: key areas

Develop a larger view of healing
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What constitutes healing?
How do we participate in God’s healing?
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Support? Mercy? Prayer? Listen? Play?
Remember: some healing is immediate, other healing
grows day by day
Educating the Church: key areas

Explore ancillary themes: forgiveness,
reconciliation, restoration, restitution, etc.

What is the rush?
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Why forgiveness now?
Point in time? Attitude?
Why reconciliation now? What bothers us most about
brokenness?
What does repentance look like?

What about restitution?
Lament
An Intervention for Counselors and Clients
What is Lament?
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
Canonized complaints to God
Lamentations includes
 Complaint
against sin and destruction
 Agony over personal/corporate sin (in children of God
and heathen)
 Questioning God
 Waiting expectantly for answers
 Worship
Does lament resolve hurt/anger?
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Answers from Scripture?
Answers from Science?
Counselor Self-Care
Preventing Vicarious Trauma; Some Directions for
Church Leaders
Vicarious trauma

“Trauma is contagious”
 Bearing
witness leads to hopelessness, questions of
faith, and fear in relationships
 Temptation: withdrawal or intrusive action

VT defined: (Saakvitne & Pearlman)
 transformation
of the therapist's inner experience as a
result of empathic engagement with another’s trauma
Transforming the Pain
Tend your garden
To last the long haul without damage, tend to:
 Self-care
 Relationships
 Faith
A temptation to avoid self-care?
I find many therapists feel guilty pursuing beauty and
peace and order in their own lives...
It is as if somehow they should not have good in their
lives while others suffer.
However, the Word of God says that He gives us richly
all good things to enjoy.
To turn from such things is to turn from the gifts in His
hand.
For additional resources

www.dianelangberg.com
 Books,
CDs, bibliographies on related topics
 Opportunities for case consultation

www.wisecounsel.wordpress.com
 Phil’s
personal and professional musings
 Contact information: pmonroe@biblical.edu