Working with

Complex PTSD
Including Issues Around Child Abuse
and Adult Domestic Violence

Garry Rollins
Housekeeping
Welcome
Trigger Warning
Keeping ourselves safe
Respect
Adulting
Confidentiality
Feelings and OK’ness

Safety Safety Safety

 Book List

The Body Remembers (Babette Rothschild)

The Body Keeps The Score (Bessel van der Kolk)
Unshame (Carolyn Spring)
Interpersonal Neurobiology (Dan Seigel)
Working with the Trauma of Rape and Sexual
Violence (Sue Daniels)
Polyvagal Exercises for Safety and Connection
(Deb Dana)
 Book List

The Post Traumatic Stress Disorder Sourcebook

(Glenn Schiraldi)
Complex PTSD, From Surviving to Thriving (Pete
Walker)
Recovery of Your Inner Child (Lucia Capachione)
Attached (Levine and Heller)
(And Bowlby’s stuff)
Healing the Shame That Binds You (John
Bradshaw)
 Book List (TA)

TA Today (Ian Stewart and Vann Joines)

Anything by Richard Erskine
What Do You Say After You Say Hello (Berne)
Scripts People Live (Claude Steiner)
Into TA (Cornell et al)
Transactional Analysis 100 Key Points (Mark
Widdowson)
Counselling for Toads (Robert de Board)
Born To Win (Jongewaard and James)
 Book List (TA)

Transactional Analysis Counselling in Action (Ian

Stewart)
Transactional Analysis, A Relational Approach
(Hargadden and Sills)
Opening Thought
Do you know what this is?

--------------------------

It’s a Eucalyptus

Eucalyptus literally means

WELL-HIDDEN

Trauma remains hidden

Until it doesn’t …
Personal Story
Pre Birth
Infancy
Broken Bones
Torture and Vicarious Torture
Emotional Abuse and Toxicity
Rape
Suicide
Surviving
Therapy
Thriving
Impact
 Physis
And the day came
When the risk to remain
Closed tightly in a bud
Became more painful
Than the risk it took
To blossom

(Anais Nin)

Lemonade Bottles and Airbeds !

 Physis
When the inward tenderness
Finds the secret hurt
Pain itself will crack the rock
And ah, let the soul emerge

(Rumi)
PTSD : What is it?
An event, usually sudden and
unplanned (but not always) which
happens to us personally and
causes us pain, discomfort or
trauma which is beyond our ability
to process or deal with at that time.

And because we have not processed

or dealt with it, the trauma stays
with us and continues to impact us
in our thoughts, feelings and bodies,
until we are able to process and
deal with it
Vicarious PTSD
An event which we witness happening to
others, which causes us pain, discomfort
and trauma as a consequence of witnessing
it, and which we feel unable to deal with or
process at that time or soon after

And so it stays with us until we can process

it or deal with it

Eg. Soldiers witnessing the consequences

of war
Eg. Ambulance personnel witnessing
devastating accidents
Eg. Watching the news at times …
Complex PTSD
Continuous or many cases of traumatic
events which happen to us as children or
adults and which we are unable to deal
with, make sense of or process at the time

Long term child abuse

Short term child abuse
Domestic violence (all kinds)
Ongoing sexual violence
War, Conflict and Destruction
Watching family,community and country being
destroyed
Medium or Long Term Illness or Disability (and
its treatment)
 Examples
• Combat, Civil War, Combat Zones
• Abuse (All types) and/or ongoing sexual violence
• Torture
• Criminal Assault or Other Activity
• Imprisonment, fairly or unfairly
• Hijack, threats of harm or death
• Cult membership with oppression and abuse
• Terrorist acts or constant threats
• Ongoing vicarious trauma not delt with
• Participation in atrocities by force or by choice
• Living with long term addiction in family
• Natural Disasters and their consequences
• Long term illness, disability or conditions
• Repeating of any single trauma over time

What do they all have in common? Powerlessness and Despair

How Complex PTSD Affects Children and Adults 1

• Acting Out, Anger, Powerlessness, Self Harm

• Continuing Toxic Generational Script Patterns

• Parentification : growing up too quickly

• Lack of Self Care, But Cares For Others

• Insomnia, Nightmares, Sweats, Sleep Paralysis,

monsters

• Fear of socialising, groups, going out. Don’t Belong.

• Body Image, hating, Body dysmorphia,

How Complex PTSD Affects Children and Adults 2

• Anxiety, Flashbacks, Triggers, Panic attacks

• Eating Disorders as coping or safety or control

• Relationship, Sexuality and Attachment Issues

• Secrecy, Shame, Guilt, Blame, Self Criticism

• Fear, Hyper-vigilance, Anxiety, OCD/

• Rituals as Magic Coping
How Complex PTSD Affects Children and Adults 3

• Denial and Discounting of the Events or Issues

• Dissociation as a survival coping mechanism

• Dissociative Identity Disorder

• Sensory or emotional inhibition, numbness

• Fantasies. What did happen?

• What could have happened?

• Fragmented or denied memories, confusion

Issues In Treatment Planning (1)
• Safety Safety Safety

• Building A Safe Therapeutic Relationship

• Time, Clear Boundaries, Empathy, Space

• Respecting and holding the Silence

• Defences are there for a reason. Trust/Encourage Them

• Give Permissions Over Time. You Exist. You are OK. Etc

• Believe them and tell them you believe them.

 Issues In Treatment Planning (2)

• Consciously give them power and

choices in sessions

• Normalise what they had to do to

survive

• Decontamination of memories

• Feelings Work, Confusion, Numbness

• Anxiety, Mindfulness and Grounding

Issues In Treatment Planning (3)

• Working with Shame

• Talking and Processing

• Dealing with Issues one at a time

• Creativity and the Damaged Inner Child

• Managing the clients affect

• Dealing with Self Harm as Coping

• Building New Skills (eg. Assertivenenss)

• Transference and Counter Transference

Issues In Treatment Planning (4)

• Grieving for the lost child/adult

• Rubber Banding to the Past

• Dependence on the Therapist

• Learning to Trust Again

• Making Meaning from Pain

• And so many other issues …

 The Compass of Shame (Nathanson)

Withdrawal
Rejected, Distanced, Isolated, Embarrassed
Withdraws from connection/Attachment
Emotionally not present
Withdraw into self. Depression.

Blame Other Blame Self

Hyper alert. Critical Powerful Internal Critic
(To stay safe) Unworthy, Useless,
Lack of trust. On Guard. Not good enough
Very strong defences Didn’t fight back

Addictions and Self Harming Behaviours

Avoiding Bad Feelings (Shame)
Acting Out/Sexual or Physical Negative Relationships
Care for Others But Not Self
Over do, Over give, Over Strive
Distraction
Dissociation
Feelings Issues
 Feelings Work

Denial / Numbness/ Confusion

Teaching Feelings

Naming Feelings (Charts)

Speaking Out Feelings

Reflecting on Feelings

Feeling Feelings Safely

Naming traumatic Feelings

Dissociation, Mindfulness and
Grounding

Grounding in the present

(Senses Work)
Body Scanning
Progressive Muscle Relaxation
Holding the Inner Child
Breathing
Box Breathing
Safe Place Visualisation
The Body Keeps The Score …
• Fibromyalgia

• ME (MyalgicEncephaloMyalitis)

• CFS (Chronic Fatigue Syndrome

• Long Term (Script) Illness or

Disability

• BODY WORK
 Body Work
Getting Back In Touch With Our Bodies

Senses/Sensory Awareness
Mindfulness Breathing
Showers/Baths
Exercise
Interoception
Safety/Boundaries
Body Scanning
Progressive Muscle Relaxation
Coccoons
Accounting What We Feel
Movement Awareness
 Other Options

Mindfulness

EMDR

Rewind Therapy

Pharmacology

Progressive Safe Exposure

 TA
Theoryand
Practice
 TA Tools

Ego States Passivity

Discounting Appetite Pathways
Positive Strokes Stamp Collecting
Relational Needs OK Corral
Injunctions and Drivers
Drama Triangle Permissions
Physis Discounting

Working Relationally / Relational Needs …

Treatment Planning (Berne)

Social Control

Symptomatic Relief

Transference Cure

Script Cure
Treatment Planning (Petrusk Clarkson)

• Establish a safe therapeutic alliance

• Contract for the work to be done from Adult
• Decontaminate Introjected CP Beliefs using Adult
• Deconfuse Magical Child-Like Beliefs
• Establish an Internal Nurturing Parent
• Support to develop Emotional Literacy in FC/A
• Redecision Work (Making new decisions from A)
• Giving Permissions, Protection and Potency
• Working with Generational Script Issues
• Getting used to and reinforcing new beliefs
• Incorporating new beliefs into new behaviours
• Termination with a realistic view of self/others
Stages of Treatment (Erskine)
Defence and resistance to change from
CP/AC

Anger Being Expressed At Last

Hurt and Sadness (Repressed Feelings from

FC)

Hopelessness and Sense Of Self as Shame

Taking Responsibility From A

Putting a New Show on The Road

Ten Key Therapeutic Tasks (Mark Widdowson)
Create an OK/OK Safe Relationship
Replace a Self Critical Ego Voice with Self
Compassion
Identify and Challenge Script Beliefs
Support the Client to recognise and Challenge
Their Own Limiting Beliefs
Support the client to change their Stroking
patterns
Identify and Challenge ways the client maintains
their own Frame of Reference
Help the client to re-evaluate life experiences
that have contributed to the presenting issue
Support the client to make new decisions from
Adult
Support the client to identify, express and
process repressed emotions (Deconfusion)
Support the client to find new ways of relating
to themselves, others and the world
Ego States
Ego States (2)
The Drowning Man (Adrienne Lee)
Erskine’s Keyhole
Erskine’s Relational Needs
Security
Validation
Acceptance
Confirmation
Self Definition
Impact
Initiation
Love

(and Others)
Script (Racket) System
 Discounting

Discounting The Issue Itself

Discounting The Significance of The Issue

Discounting The Possibility of Change

Discounting The Options For Change

Discounting Personal Power To Change

ACCOUNTING …
Working with the Damaged Child Ego
State

The child in the client

Safety
Space
Story Telling
Fears/Confusion
Inconsistencies
Permissions
Being Believed
Vulnerability
 Permissions
It is ok for you to exist
It is ok for you to laugh, cry, be angry,
scared
It is ok for you to trust and be vulnerable
It is ok for you to ask for your needs to be
met
It is ok for you to get your sexual needs met
It is ok for you to belong, to be close
It is ok to be who you really are
It is ok for you to think clearly
It is ok for you to succeed
It is ok to be nurtured and loved
It is ok to look after yourself
It is ok to find new meaning in life