What is complex trauma and how does it relate to complex forgiveness?

cropped-shutterstock_84358198_Sad_White_Woman.jpgNote from Author: Below is an excerpt from an unpublished manuscript (Coleman, 2013) that argues for the designation “complex forgiveness” to describe the unique challenges faced by those who have experienced what is being coined “complex trauma” or “complex PTSD” and are sincerely seeking to work through their forgiveness issues. It is being posted on both the web site and referenced as a hyperlink on the web site, since it pertains to both domains.

The term “complex trauma” (J. Briere & Lanktree, 2008) (D’Andrea & Pole, 2012) (Lanktree & Briere, 2008) (Aideuis, 2007) (J. N. Briere & Lanktree, 2012) (Arvidson et al., 2011) or “complex post-traumatic stress disorder” (Herman, 1997) (Resick, Nishith, & Griffin, 2003) (Dyer et al., 2009) is a term that is being used by a growing number of clinicians to describe those instances where a person’s experience of trauma and the resulting symptoms do not fit the traditional diagnosis of “post-traumatic stress disorder” (PTSD). Lanktree and Briere (2008), for example, described complex trauma in terms of “multiple, and sometimes highly invasive traumatic events, usually of an ongoing, interpersonal nature” (p. 8) which are often accompanied by harmful social environments, experiences of emotional neglect, and repeated exposure to physical, psychological, or sexual abuse and/or family violence.

Proponents of a diagnostic category of complex trauma or complex PTSD argue for such a diagnosis primarily because the existing diagnostic criteria for PTSD was derived primarily from studies of survivors who were exposed to a relatively limited or circumscribed experience of trauma such as combat, rape, or a disaster (Herman, 1997). However, for survivors who have been exposed to severe and prolonged trauma such as repetitive childhood physical, psychological, and/or sexual abuse, (Lanktree & Briere, 2008) and/or continuing experiences of domestic violence or attachment trauma (Courtois, 2004) (Lanktree & Briere, 2008), or for those who have been subjected to totalitarian control over a period of months or years, such as is often true of prisoners of war, hostages, concentration-camp survivors, or survivors of organized sexual exploitation (Herman, 1997); or even for persons who have suffered with an acute or chronic illness that has required intensive, often painful, ongoing medical interventions; the diagnosis of PTSD seems insufficient (Herman, 1997).

Why is this important? Because current research is indicating that that those who meet the criteria for a diagnosis of complex trauma (as compared to those who meet the criteria for PTSD) are more likely to suffer lifelong problems that can put them at greater risk for addictive disorders, psychiatric disorders, chronic medical illness, family, legal and vocational problems and additional trauma exposure which naturally can make the journey toward healing more challenging (Cook et al., 2005).

These and other factors make any attempt at forgiveness for those who have suffered complex trauma especially challenging, complex, and subject to misunderstanding. This is because the examples of forgiveness that most often make the Christian talk shows and readily form the basis for books on forgiveness are rarely representative of those who have suffered complex trauma.

It is for this reason that I am suggesting the term “complex forgiveness” as a way to frame the unique journey faced by those who continue to suffer in the aftermath of having experienced complex trauma, persons who may truly desire to forgive those responsible for their suffering and who may have sincerely experimented with a number of different methods of forgiving prescribed by well-meaning authors and speakers, and yet, who continue to suffer in inexplicable ways that, from a simplistic and misinformed point of view, appear to put into question the sincerity of their decision(s) to forgive.

It is my hope that this book will become a valuable resource for you, as you seek to help others who are experiencing difficulty working through their forgiveness issues, or as you seek to work through your own trauma history, whether the trauma suffered happens to fall closer on the spectrum to that of a relatively circumscribed experience of trauma or whether it falls closer on the continuum to what is being coined complex trauma. (Coleman, 2013)

Aideuis, D. (2007). Promoting Attachment and Emotional Regulation of Children with Complex Trauma Disorder. [Article]. International Journal of Behavioral Consultation & Therapy, 3(4), 546-554.

Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., . . . Blaustein, M. E. (2011). Treatment of Complex Trauma in Young Children: Developmental and Cultural Considerations in Application of the ARC Intervention Model. [Article]. Journal of Child & Adolescent Trauma, 4(1), 34-51. doi: 10.1080/19361521.2011.545046

Briere, J., & Lanktree, C. (2008). Integrative treatment of complex trauma for adolescents (ITCT-A): A guide for the treatment of multiply-traumatized youth. Long Beach, CA: MCAVIC-USC, National Child Traumatic Stress Network, US Department of Substance Abuse and Mental Health Services Administration.

Briere, J. N., & Lanktree, C. B. (2012). Treating complex trauma in adolescents and young adults. Los Angeles, CA: Sage.

Coleman, S. A. (2013). The forgiveness clinic: A Christ-centered counseling approach for those who continue to suffer with unwanted anger, bitterness, or hurt associated with traumatic events of the past. The Forgiveness Clinic. Chattanooga, TN.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., . . . van der Kolk, B. (2005). Complex Trauma in Children and Adolescents. Psychiatric Annals, 35(5), 390-398.

Courtois, C. A. (2004). Complex Trauma, Complex Reactions: Assessment and Treatment. Psychotherapy: Theory, Research, Practice, Training, 41(4), 412-425. doi: 10.1037/0033-3204.41.4.412

D’Andrea, W., & Pole, N. (2012). A naturalistic study of the relation of psychotherapy process to changes in symptoms, information processing, and physiological activity in complex trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 4(4), 438-446. doi: 10.1037/a0025067

Dyer, K. F. W., Dorahy, M. J., Hamilton, G., Corry, M., Shannon, M., MacSherry, A., . . . McElhill, B. (2009). Anger, aggression, and self-harm in PTSD and complex PTSD. Journal of Clinical Psychology, 65(10), 1099-1114. doi: 10.1002/jclp.20619

Herman, J. (1997). Trauma and recovery: The aftermath of violence – from domestic abuse to political terror. New York, NY: Basic Books.

Lanktree, C., & Briere, J. (2008). Integrative Treatment of Complex Trauma for Children (ITCT-C): A Guide for the Treatment of Multiply Traumatized Children Aged Eight to Twelve Years. Unpublished treatment manual. Long Beach, CA: MCAVIC-USC Child and Adolescent Trauma Program, National Child Traumatic Stress Network.

Resick, P. A., Nishith, P., & Griffin, M. G. (2003). How well does cognitive-behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial. CNS Spectr, 8(5), 340-355.