The Difficulty of Finding a Therapist for Complex Post-Traumatic Stress Disorder.

For those of us who have sought treatment for the symptoms of complex post-traumatic stress disorder, here at CPTSD Foundation, know how difficult it is to find a therapist trained to treat us. In fact, in the United States, finding a therapist specifically for CPTSD is exceedingly arduous.

This set of articles will explore the mental health disparities displayed in finding help for one of the nation’s most significant and fastest-growing mental health disorders.

Attempting to Find Treatment

We have already discussed the futility of searching Google to find a specialist in CPSD, what about the other resources out there to find a therapist.

There are dozens of websites, including the site for the Substance Abuse and Mental Health Service Administration (SAMHSA). However, most, if not all, of these sites do not search for complex post-traumatic stress disorder. Instead, they may search for therapists who are trauma-informed or treat post-traumatic stress disorder instead.

Finding a therapist who is trauma-informed or treats PTSD is enormously easier than searching for someone who treats CPTSD specifically. Psychology Today has its own search program to help one find a therapist that treats PTSD and is trauma-informed.

Trauma-informed care (TIFC) done by a trained therapist offers an approach to understanding the entire person who is seeking treatment. Since trauma affects one’s sense of self and their beliefs about the world, TIFC serves to directly challenge the assumptions that a trauma victim may have about themselves and others.

The therapist who is trained in trauma-informed care will strive to aid their client in recognizing how the events changed how they see themselves but also fights not to retraumatize the person seeking treatment.

The Differences in Treatment

So far, the treatment for complex post-traumatic stress disorder and post-traumatic stress disorder are strikingly the same.

The treatment options commonly adopted for the care of post-traumatic stress disorder include trauma-focused psychotherapies, including cognitive processing therapy (CPT) and prolonged exposure (PE).

Cognitive processing therapy teaches trauma victims to reframe their negative thoughts about what happened during the traumatic event. CPT involves victims talking with a therapist about their negative thoughts and doing short writing assignments to change the story of what happened to them.

Prolonged exposure therapy (PE) teaches victims of trauma living with PTSD to gain control by talking about the trauma in treatment. During therapy, the client will be encouraged to go ahead and do the things they have avoided. This intentional exposure to triggers will desensitize the brain of victims, calming the fight/flight/freeze response.

To treat complex post-traumatic stress disorder, therapists often take a drastically different approach. They may use cognitive behavioral therapy (CBT) or eye movement desensitization and reprocessing therapy (EMDR).

Cognitive-behavioral therapy involves talking to a therapist who will help steer one away from the traumatic events in the past. They will then replace those memories with new methods of thinking to help the client navigate their way through the trauma to health.

EMDR is a treatment option that is available for both CPTSD and PTSD. Eye movement desensitization and reprocessing therapy help people who live with the diagnosis of CPTSD by using the movements of their eyes to process and deal with the emotions and flashbacks that occur during treatment.

Using EMDR involves remembering the trauma while paying close attention to a back and forth movement of fingers or a repetitive sound. This combination of remembering and movement somehow has been found to desensitize the brain to the trauma of the past.

Doing a Google Search

Like many of us who live with the effects of CPTSD on our lives, you have probably conducted a search on Google to try and find a therapist. When you do carry out a search for a CPTSD trained therapist, one is met with a long list of ads for therapists with treatment options for post-traumatic stress disorder.

There are distinct differences between complex post-traumatic stress disorder and post-traumatic stress disorder, such as the following.

Post-traumatic stress disorder is caused by a single event such as a natural disaster, a terrorist attack, or a rape.

Unlike PTSD, Complex post-traumatic stress disorder is caused by a series of brutal, traumatic events that may last decades. These traumatic events may include:

• Emotional abuse
• Neglect
• Sexual abuse
• Mental abuse
• Human trafficking
• Physical abuse
• Domestic violence
• Being a prisoner of war
• Surviving a concentration or internment camp
• Living in a war zone

The symptomology of each of these chronic mental health disorders is also different. While some do overlap, the difference between the two disorders is striking.

A few of the host of symptoms of PTSD:

• Intrusive and distressing memories of the traumatic event
• Intense distress when triggered by a similar event to the traumatic event
• Persistent and exaggerated negative expectations about oneself or the world
• Have distorted blame of self or others for the consequences or cause of a traumatic event
• Persistent anger, shame, horror, and guilt

A few of the host of symptoms of CPTSD:

• Difficulty regulating emotions especially rage
• Losing memories of the trauma
• Depression
• Suicidal thoughts or actions
• Feeling ashamed
• Having difficulty forming or maintaining relationships

The list above contains only a few of the myriad of symptoms of both post-traumatic stress disorder and complex post-traumatic stress disorder.

As one can see, many of the symptoms of post-traumatic stress disorder are more outwardly focused while the symptoms of complex post-traumatic stress disorder are focused inward.

Follow the Money

The reason behind this difficulty in even finding a listing for a therapist in the United States who treat complex post-traumatic stress disorder is that it is not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

The DSM-5 is the bible, published by the American Psychological Association, that all therapists follow to diagnose and treat mental health disorders. It is also, unfortunately, where therapists get their diagnosis codes for payment from insurance companies, Medicare, and Medicaid.

This lack of listing in this crucial reference for therapists means that therapists will not get paid by insurances if they treat CPTSD. All the more reason to lobby the American Psychological Association to include complex post-traumatic stress disorder under its own heading.

References:

Harris, M. & Fallot, R. D. (Eds.) (2001). Using Trauma Theory to Design Service Systems. New Directions for Mental Health Services. San Francisco: Jossey-Bass.

Substance Abuse and Mental Health Services Administration (2014). A Treatment Improvement Protocol: Trauma-Informed Care in Behavioral Health Services, Tip 57. U.S. Department of Health and Human Services, 14–4816.

Originally published at https://cptsdfoundation.org.