I was recently asked to write a blog post for The Couples Institute Counseling Services, an institute that specializes in working with couples with a model called The Developmental Model of Couples Therapy, created by Dr. Ellyn Bader and Dr. Peter Pearson. The topic for the article could be anything of my choice so long as it is helpful for couples reading it. As this was my first blog for their website I decided to write about a topic that is close to my heart, Complex Trauma and Complex Post Traumatic Stress Disorder. After having spent most of my career providing direct service to children, adolescents, and adults who have experienced Complex Trauma, I hope to have done the topic justice and contributed in a way in which Complex Trauma can be better understood within the context of your relationship. This article was adapted from its original version sourced from the website of The Couples Institute Counseling Services Blog. Warmly, Dana
When You Love Someone With Complex PTSD
This article gives a brief overview of some basics about Complex Post Traumatic Stress Disorder (CPTSD) and what you can do to support yourself as well as nurture your relationship when you love someone with Complex PTSD. You may be wondering if reading this article will be helpful to you.
If your partner experienced significant trauma during childhood and you find yourself in awe of all that they are in spite of what they have been through, yet uncertain at times about how to provide the right kind of support, then this article is for you.
If you recognize the wisdom within your partner that is derived from their experiences, but struggle to access your own wisdom when you see your partner suffering then this article is for you.
Lastly, if you sometimes see your partner as someone who would benefit from healing work but, are not sure of the right place to start then this article is for you.
This article is about how to bring your best self to your relationship by forging one that is defined by security, consistency, and honesty as well as understanding the importance of your own self-care in cultivating these bonds.
Complex Post Traumatic Stress Disorder (CPTSD) can occur when a person experiences multiple or prolonged traumatic experiences (Complex Trauma) over the course of a lifetime. Oftentimes, the traumas are relational in nature which means that the events occur within relationships during developmental periods such as childhood. For example, periods of child abuse or neglect and/or multiple ruptures or transitions with primary caregivers; such as multiple foster placements in which attachment bonds are ruptured or substance abuse or dependence by a primary caregiver.
There are two areas of human development that are impacted by Complex Trauma. When these areas are impacted it can result in CPTSD. They are:
1. Attachment: the ways in which a person learns to have relationships with others
2. Self-Regulation: the way in which a person handles self soothing in the face of stress.
Let’s look at both more closely.
In terms of Attachment, a child who experienced multiple adverse experiences such as abuse, domestic violence, neglect or community violence is likely to, as an adult, experience frequent mistrust, fear of abandonment, and difficulty feeling secure in their intimate relationships. The reason for this is that the template that was formed early on about how to have relationships was developed under the pretense that “those who love me either hurt me, or leave.” These recurring experiences often cause the belief that people are not safe to trust; leading to the lived experience of, “I’m hurt when you stay and I’m hurt when you leave:a double edged sword.”
Self-Regulation is a set of skills that are learned by internalizing the soothing actions of our caregivers when we are hurt, scared, hungry, sad etc. The capacity by which we are able to do this for ourselves as adults is largely made possible by the quality and quantity of that which was given to us. The opportunities to learn from and observe adults practicing self regulation in ways that are healthy and nourishing for children with Complex Trauma often are minimal. Instead, the stress response system, the internal regulation system that is in charge of keeping us safe in the face of stressors, becomes overloaded due to a lack of opportunities to return to a calm state. In CPTSD this results in an elevated baseline and a stress response system that is overly sensitive to stressors. Thus the system responds by vacillating between extreme states of hyperarousal to hypoarousal (dissociation) rather than remaining within an ideal, more balanced "window of tolerance.” People who have not experienced trauma typically remain in this window within their normal day to day lives. This might account for why your partner may appear to have seemingly disproportionate reactions to stimuli that doesn’t impact you as severely: their system's degree of sensitivity and reactivity is such that a smaller event can cause them great distress and dysregulation.
The hopeful news is that the medicine for CPTSD can be found within the healing power of relationships and within our brains’ incredible ability to create new templates for relationships by a process called neuroplasticity, our brain’s ability to make new neural connections throughout our lifetime. The incredible healing power of relationships as they relate to Complex Trauma has been well documented by neuroscientists such as Dr. Bruce Perry, who specializes in the impacts of childhood trauma and neglect and its impact on neurodevelopment, and Dr. Daniel Siegel who has also well documented the process of neurodevelopment. What this means is that you and your partner have the ability to form a secure attachment in adulthood EVEN IF your partner has not yet experienced that in their life -VERY EXCITING!!! But where do you begin? It is important to know the following:
You can not erase existing templates but you can create new ones.
Your efforts should be patterned and repetitive, as these templates live in lower, less “plastic” ie. not as easily changed, parts of the brain that are only accessed and changed through doing things over and over again.
You don’t need to figure this out on your own. Finding a couples therapist educated about Complex Trauma is recommended and can help facilitate the healing process.
Here are some other ideas you’ll want to consider:
Be Consistent, be predictable: Repetition is the key to building a secure attachment. It also facilitates the ability to trust. For example, calling your partner every night before bed to say goodnight, this may seem simple, but it can have a profound effect on shaping a new, loving, and secure template of what a relationship can be in your partner’s brain.
Know your boundaries: This is a big one and related back again to being consistent and predictable. What is and what is not in your control? If your partner is struggling with mood symptoms including anxiety or depression and struggling with self regulation, it is not your job to fix that, but you can encourage your partner to establish a relationship with a therapist or make an appointment with an existing one. It can be powerful to validate your partner's suffering while simultaneously acknowledging that you do not have the power to make it all better. In all relationships it is important for each partner to own their own struggles and work on them independently from the relationship.
Establish and keep up with your own self care plan: When we fall in love it is so easy to give and give and then one day we wake up and we realize, “Oops! I have given to everyone except me!” You have got to fill your own bucket. Keeping up with a routine that nourishes you and keeps you connected to yourself and those in your support system is crucial. You are modeling for your partner that it is okay to practice self care and encouraging the process called differentiation (an ongoing process of self-defining within the context of the relationship that is a key developmental milestone within relationship and is that which sets the stage for further development and deeper intimacy as your relationship progresses).
Don’t try to explain, instead “connect and redirect”: Emotions are not logical, yet it is our tendency to try to explain our way through them. When your partner is in an emotional state of activation, remember, first connect by reflecting back what you hear them say, including their feelings. Listen and mirror without the intention of problem solving. Once your partner has expressed to you that they are feeling heard, ask them if they want support in problem solving (re-direct). Once you check for their interest, you may find that you have already helped enough!
Do find out what is soothing to your partner: People who have experienced complex trauma are often well aware of what they do and do not like. Ask them their preferences, you may find out that your partner can not tolerate massage but loves a warm bath. If so, draw them a bath and draw it often! Remember: repetition, consistency, predictability.
Practice consent in intimacy and beyond: Trauma is defined as an extreme loss of control to a perceived threat or life threatening situation. Healing for trauma survivors always includes establishing a sense of safety. A way to safety is though experienced control-- practicing consent is a powerful vessel for this. This means asking permission before and during intimate encounters as well as throughout your day-to-day interactions, for example, “Is it okay if I move your things while I clean this room?”
Anticipate events that could cause anxiety for your partner: Work together to create a safety plan. For example, if your partner feels anxious in social settings like big events such as a wedding, decide ahead of time where to sit during the ceremony and have a signal that you can give to one another if your partner needs a break. This can be a good opportunity to step outside and get a breather, check in about how you are both doing, and make adjustments to your plan as necessary.
Don’t take it personally: Your partner has been through a lot. It is likely that if your partner has a reaction to something that you do or say that it has less to do with you than you think and more to do with what that thing reminds them of. When this happens take a deep breath and do your own physiological self soothing, then when you feel regulated check back in, try to think of these moments as opportunities to learn more about what your partner’s triggers are so that you can work with them in a thoughtful and meaningful way.
Remember, it all goes back to the incredible healing power of relationships and the bonds that are formed when we are present and available for one another. Even as therapists we can get stuck in the trap of thinking that we should be able to fix it all right then and there and we jump too quickly to problem solving. Yet it is always meaningful to take a step back and remember that the key to building a secure relationship is not in your ability to offer a quick fix. Rather, it lies within your ability to take your time, be consistent, and show your commitment to being there again and again. If past trauma is impacting you or your relationships and you need help, reach out to us, establishing a relationship with a therapist can be the first step in creating a path to healing that can seem overwhelming and uncertain, more clear, manageable, and supportive.
References
1. Perry, Bruce Duncan, and Maia Szalavitz. The Boy Who Was Raised as a Dog: and Other Stories from a Child Psychiatrists Notebook: What Traumatized Children Can Teach Us about Loss, Love, and Healing. Basic Books, 2017.
2. Siegel, Daniel J., and Tina Payne. Bryson. The Whole-Brain Child. Constable & Robinson, 2012.
3. Wallin, David J. Attachment in Psychotherapy. Guildford Press, 2015.
4. Bader, Ellyn, and Peter T. Pearson. In Quest of the Mythical Mate: a Developmental Approach to Diagnosis and Treatment in Couples Therapy. Routledge, 2014.
5. Siegel, Daniel J., and Tina Payne. Bryson. The Whole-Brain Child. Constable & Robinson, 2012.