Complex PTSD: The Invisible Aftermath of Prolonged Trauma
“I’ve been in therapy for years, and I keep hearing that I have ‘trauma responses,’ but I don’t have PTSD. I was never in a war or a car accident. Nothing really bad happened to me. So why do I feel this way?” This is something I hear often from clients who are struggling with the effects of childhood trauma, emotional abuse, neglect, or other forms of prolonged, repeated trauma. They’ve been told—or have convinced themselves—that their experiences don’t “count” as trauma because they don’t fit the traditional picture of Post-Traumatic Stress Disorder (PTSD). What they’re experiencing, though, may be Complex PTSD (C-PTSD)—a form of trauma that comes not from a single traumatic event, but from prolonged, repeated experiences that chip away at a person’s sense of safety, worth, and identity. What Is Complex PTSD? Complex PTSD develops when someone experiences ongoing trauma over months or years, particularly during childhood or in situations where escape feels impossible. This might include: • Childhood emotional, physical, or sexual abuse • Chronic neglect or emotional unavailability from caregivers • Growing up with alcoholic or mentally ill parents • Being in an abusive relationship • Experiences of domestic violence • Being a prisoner of war or held captive • Living in a war zone or refugee situation • Being subjected to torture or ongoing oppression The key difference between PTSD and C-PTSD is that C-PTSD comes from repeated trauma—often within relationships—that fundamentally disrupts a person’s developing sense of self, safety, and ability to trust others. PTSD vs. Complex PTSD: What’s the Difference? While PTSD and C-PTSD share some symptoms, there are important distinctions. Understanding these differences helps explain why traditional treatments for PTSD don’t always fully address the needs of people with C-PTSD. PTSD (Post-Traumatic Stress Disorder) PTSD is recognized in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders) and typically develops after exposure to a single traumatic event or a series of similar events, such as: • Combat or military service • A serious accident • A natural disaster • A single assault or violent attack • Witnessing death or serious injury Symptoms of PTSD include: • Intrusive memories, flashbacks, or nightmares about the traumatic event • Avoidance of reminders of the trauma • Negative changes in thoughts and mood • Heightened reactivity (being easily startled, difficulty sleeping, irritability, hypervigilance) Complex PTSD (C-PTSD) C-PTSD, while not included in the DSM-5, is recognized in the International Classification of Diseases (ICD-11) and by trauma experts worldwide. It includes all the symptoms of PTSD, plus additional difficulties that stem from prolonged trauma: 1. Difficulties with Emotional Regulation People with C-PTSD often struggle to manage their emotions. They might experience: • Intense emotional reactions that seem out of proportion to the situation • Difficulty calming down once upset • Emotional numbness or feeling disconnected from their emotions • Rapid mood swings • Chronic feelings of sadness, anxiety, or rage 2. Negative Self-Concept Prolonged trauma, especially in childhood, deeply affects how we see ourselves. People with C-PTSD often struggle with: • Persistent feelings of shame, guilt, or worthlessness • Believing they are fundamentally damaged or “bad” • Difficulty accepting compliments or recognizing their own worth • A sense of being different from other people • Chronic self-blame, even for things that weren’t their fault 3. Difficulties in Relationships When our earliest relationships are sources of trauma, it fundamentally affects how we relate to others. People with C-PTSD may: • Have difficulty trusting others • Struggle with intimacy or maintaining close relationships • Feel isolated, even when surrounded by people • Experience patterns of codependency or people-pleasing • Oscillate between being overly dependent and pushing people away • Have difficulty setting or maintaining healthy boundaries In essence, while PTSD is about recovering from discrete traumatic events, C-PTSD is about healing from a traumatic way of life—one that shaped your very sense of self and how you relate to the world. Why Isn’t C-PTSD in the DSM? You might be wondering: if C-PTSD is real and recognized by trauma experts, why isn’t it in the DSM-5? The short answer is that the DSM is a living document that evolves as our understanding of mental health conditions grows. C-PTSD was only officially recognized in the ICD-11 (published by the World Health Organization) in 2018. Many clinicians and researchers are advocating for its inclusion in future editions of the DSM. In the meantime, therapists like me diagnose C-PTSD based on the presentation of symptoms, even if we have to use other diagnostic codes for insurance purposes. (While I am not a provider for any insurance plans, I do offer superbills that can be submitted for insurance reimbursement.) What matters most is not the label, but understanding your experience and finding the right treatment approach. Why My Therapeutic Approaches Work Well for C-PTSD C-PTSD requires a different treatment approach than traditional PTSD therapy. Because C-PTSD affects your sense of self, your emotional regulation, and your relationships—not just your memories of specific events—effective treatment must address all of these areas. The therapeutic approaches I use—EMDR, Internal Family Systems (IFS), Brainspotting, and sandtray therapy—are particularly well-suited to treating C-PTSD. Here’s why: EMDR (Eye Movement Desensitization and Reprocessing) EMDR is an evidence-based therapy originally developed for PTSD, but it’s equally powerful for C-PTSD. Here’s how it helps: • It processes trauma at the neurological level. EMDR helps your brain reprocess traumatic memories so they’re stored as “in the past” rather than feeling like they’re still happening. This is crucial for C-PTSD, where early trauma can feel ever-present. • It addresses both “big T” and “little t” traumas. While a single assault or accident is a “big T” trauma, C-PTSD often comes from an accumulation of “little t” traumas—the daily emotional neglect, invalidation, or criticism. EMDR can help process both. • It helps change negative self-beliefs. EMDR specifically targets the negative beliefs that formed during trauma (“I’m worthless,” “I’m not safe,” “I can’t trust anyone”) and helps install more adaptive, positive beliefs. • It
A Gentler Approach to New Year’s Resolutions
“This year I’m going to lose 30 pounds, exercise every single day, completely reorganize my house, stop procrastinating, be more patient with everyone, read 50 books, and finally become the perfect version of myself!” Sound familiar? Every January, so many of us set ourselves up for failure with ambitious, all-or-nothing resolutions. By February (or sometimes even mid-January), we’ve already “failed,” and that familiar sense of shame and disappointment settles in. We tell ourselves we should have tried harder, should have had more willpower, should have been better. But here’s the thing: the problem isn’t you. The problem is the way we’ve been taught to think about resolutions. What if, instead of setting rigid goals that leave no room for being human, we approached the new year with gentleness, flexibility, and self-compassion? The Problem with Traditional Resolutions Traditional New Year’s resolutions are often: • Too rigid and all-or-nothing • Focused on what we’re doing “wrong” rather than what we want to grow toward • Shame-based (“I need to lose weight because I’m not good enough as I am”) • Set up for failure because they don’t account for the messy reality of being human As Dr. Christopher W.T. Miller, an associate professor of psychiatry at the University of Maryland School of Medicine, points out, “There’s something that’s a bit demanding about resolutions. It automatically creates an expectation.” When we inevitably fall short of those expectations, we feel bad about ourselves—which is the exact opposite of what we were hoping to achieve. Enter the “Nudge Word” Instead of setting specific, rigid resolutions, consider choosing a single word to guide you through the year—what some people call a “nudge word.” This is a word that reflects your values, intentions, and hopes for how you want to show up in the world. As Dr. Miller explains, a nudge word “is meant to be harmonizing and centering and help us feel grounded.” It’s more fluid, softer, and gentler than a resolution. Some examples of nudge words: • Peace • Balance • Playful • Gratitude • Vitality • Clarity • Compassion • Courage The beauty of a nudge word is that it’s not pass/fail. You can’t “mess it up.” If you choose “peace” as your word and find yourself stressed and anxious in March, you haven’t failed—you’ve just been given another opportunity to reconnect with your intention. You can ask yourself, “What would peace look like in this moment?” or “What small choice could I make right now that would bring me closer to peace?” How to Choose Your Nudge Word Take some quiet time to reflect on these questions: 1. What made you happy this past year? What felt good? When did you feel most like yourself? 2. What parts of your life could be better? What causes you stress or drains your energy? 3. How is your physical health? Your mental well-being? Your relationships? 4. If you could feel one way more often, what would you want it be? Let yourself sit with these questions without judging your answers. You’re not trying to find what you “should” want or what sounds impressive. You’re listening to what your heart actually needs. Resolutions as Living Intentions If you do want to set some concrete goals for the year, that’s wonderful! Just approach them differently. Think of your resolutions as living intentions that can be re-evaluated and modified as the year goes on. Instead of: “I will exercise for 60 minutes every single day without exception.” Try: “I want to move my body in ways that feel good to me, and I’ll check in with myself each month about what that looks like.” Instead of: “I will never eat sugar again.” Try: “I want to nourish my body with foods that make me feel good, while still allowing myself to enjoy treats without guilt.” Instead of: “I will completely eliminate my anxiety.” Try: “I want to develop better tools for managing my anxiety when it shows up.” Notice how the gentler versions: • Allow for flexibility and adjustment • Focus on moving toward something positive rather than running from something “bad” • Leave room for being human • Can be revisited and modified as you learn more about what works for you Permission to Adjust Life changes. You change. What felt important in January might not feel as relevant in June, and that’s perfectly okay. Give yourself permission to check in with your intentions throughout the year: • Is this still serving me? • What have I learned about myself that might shift this intention? • How can I adjust this to better fit who I’m becoming? Modifying your resolutions isn’t failure—it’s wisdom. It’s listening to yourself and responding with compassion. The Research Backs This Up Setting intentions isn’t just feel-good fluff—it’s backed by research. Studies show that our intentions, which are essentially guiding principles on how to show up in the world, can play a key role in determining how we behave, including in pursuit of our health goals. Setting intentions can be a potent way to shift our behaviors. And here’s something that might help if you do “slip up”: In the recovery community, some people reframe relapse as “doing more research.” Instead of seeing a setback as proof that you’ve failed, you can see it as gathering more information about what works and what doesn’t. “I tried that approach and learned it doesn’t work for me, so now I’m going to try something else.” A Therapist’s Perspective In my 20+ years as a therapist, I’ve seen countless clients beat themselves up for not living up to impossible standards they’ve set for themselves. Many of them grew up in families where they learned that their worth was tied to their achievements, or where they had to be perfect to feel safe. Traditional, rigid resolutions just reinforce that old, painful pattern. Choosing a gentler approach to the new year—whether through a nudge word or flexible intentions—can actually be an act of healing. You’re telling that
Understanding Sandtray Therapy: How Sand and Symbols Support Healing
When people think of therapy, they generally picture sitting in chairs talking through problems. While talk therapy is incredibly valuable, sometimes our deepest experiences and emotions exist beyond words. This is where sandtray therapy offers a unique and powerful pathway to healing—one that speaks to parts of us that may have been silent for years. Sandtray therapy is a form of expressive therapy that uses a tray full of sand and miniature objects to help people explore their inner world. Developed by Margaret Lowenfeld in the first half of the twentieth century, this approach recognizes that our psyche naturally seeks healing and wholeness, and sometimes the path to that healing runs through our hands rather than our words. The tactile experience of the sand itself is soothing and grounding. Many clients find that simply running their hands through the sand helps them feel more present and connected to their body—an important foundation for healing work. My collection of sandtray miniatures includes people, animals, buildings, vehicles, natural objects, and symbols. During a sandtray session, you’ll choose objects that resonate with you, then place them in the sandtray. There’s no right or wrong way to create a sandtray—the process itself is what matters. While sandtray therapy is powerful by itself, it also integrates beautifully with Internal Family Systems (IFS) therapy and EMDR (Eye Movement Desensitization and Reprocessing) therapy, creating a comprehensive healing experience. IFS recognizes that we all have different parts within us. Sometimes these parts have been silenced, exiled, or are difficult to access through conversation alone. Sandtray work provides a safe way for these parts to express themselves: Clients often discover parts of themselves they weren’t consciously aware of through their sandtray creations. The process allows for a dialogue between your conscious Self and these various parts without the pressure of finding the “right” words. While EMDR helps reprocess traumatic memories, sometimes those memories contain elements that are pre-verbal or exist as bodily sensations, images, or emotions. Sandtray can help: What Happens in a Sandtray Session? A typical sandtray session in my office might unfold like this: Preparation: We begin with a brief check-in about how you’re feeling and what’s present for you today. I might invite you to take a few deep breaths and simply notice what draws your attention. Creation: You’ll start by selecting miniatures from my collection that speak to you. There’s no need to have a plan—trust your instincts. Some people create detailed scenes that tell a story, while others arrange objects more abstractly. Exploration: Once your sandtray feels complete, we’ll explore it together. I might ask questions like: Integration: We’ll discuss what emerged during the process and what it might mean for your healing journey. Sometimes insights arise immediately; other times, understanding unfolds over days or weeks. Sandtray therapy can be helpful for anyone, but it’s particularly valuable for: One of the most remarkable aspects of sandtray therapy is how it reveals the wisdom of our unconscious mind. Clients often choose objects that perfectly represent aspects of their experience, even when they can’t initially explain why. While sandtray therapy can certainly help process difficult experiences, it’s not just about addressing problems. This approach recognizes your innate wisdom and capacity for healing. Your sandtray creations often reveal not just where you’re struggling, but also your strengths, resources, and natural healing impulses. In our achievement-oriented world, we don’t often have permission to simply be present with our inner experience without judgment or the pressure to figure things out. Sandtray therapy offers that rare opportunity. You don’t need to be artistic or creative in the traditional sense. You don’t need to know what your sandtray “means.” You just need to be willing to let your hands and your intuition guide you into deeper relationship with yourself. If you’re interested in exploring how sandtray therapy might support your healing journey, I invite you to reach out. Sometimes the most profound healing happens not through talking about our experiences, but through giving them form and witnessing them with compassion.
What is IFS-Informed EMDR Therapy and How Does It Work?
If you’ve been researching trauma therapy options, you’ve probably come across EMDR (Eye Movement Desensitization and Reprocessing) and IFS (Internal Family Systems) therapy. But what happens when these two powerful therapeutic approaches work together? As a therapist who specializes in IFS-informed EMDR, I’d like to help you understand how this integrated approach can support your healing journey. Eye Movement Desensitization and Reprocessing (EMDR) is a well-researched therapy specifically designed to help people heal from trauma and distressing life experiences. During EMDR sessions, you’ll recall troubling memories while engaging in bilateral stimulation, such as holding pulsators or watching a light move back and forth on a light bar. This process helps your brain reprocess traumatic memories, after which they’re no longer emotionally charged in the way they were before. Internal Family Systems therapy recognizes that we all have different parts within us that have taken on roles to help us navigate life’s challenges. For example, you might have a part that works hard to please others, another part that protects you by staying vigilant, and yet another that constantly criticizes you to try to keep you from being criticized by others. In IFS, we also work with what’s called your “Self”—your core essence that is naturally curious, compassionate, and capable of healing. When your Self is in the lead, you can relate to your various parts with understanding and care, rather than being overwhelmed or controlled by them. When I practice IFS-informed EMDR, I’m drawing on the strengths of both approaches to create a more comprehensive healing experience. It starts in the preparation phase when we “install” resources that will help us during EMDR processing. In addition to the calm/safe/peaceful place and the container resources that are pretty standard for EMDR, I install what are called attachment resources: a nurturer, a protector, and a wise figure. These can be people, animals, trees, spiritual beings, fictional characters…whatever makes sense for you. These attachment resources represent aspects of your Self. An important component of IFS-informed EMDR is dealing with what IFS calls “protector” parts. These parts may protect vulnerable parts of you, usually child parts; they may also protect your internal system against parts that feel dangerous. Not surprisingly, when we begin to use EMDR to process disturbing memories, these protectors often step in. When this happens, we work with the protectors to help them to feel safe enough to allow the processing to happen. Unless the protectors say it’s ok, EMDR processing won’t get anywhere! Often, when we’re processing a memory, one of your child parts will show up. When that happens, it’s important to help that part to feel safe enough to not overwhelm you and keep you from being able to do the work. (In IFS terms, when a part takes over, you’re “blended” with that part; this makes EMDR processing more difficult.) At the end of an IFS-informed EMDR session, we check in to see how your parts are doing. If we’ve been working with child parts, we help them to find somewhere comfortable to stay until the next session. (My child parts have a room they like to stay in that has a tree growing up through the floor (!), a woman in a rocking chair who represents my Self, and a bunch of puppies to play with.) What does IFS-informed EMDR look like in practice? Let’s say you’re working on a childhood experience where you felt abandoned. In traditional EMDR, we would focus primarily on the memory itself. In IFS-informed EMDR, we might also explore: This integrated approach often leads to deeper, more lasting healing because we’re not just processing the memory—we’re also helping your internal system reorganize in a healthier way. Healing from trauma isn’t just about making bad memories less painful—it’s about reclaiming your wholeness and developing a loving relationship with all parts of yourself. IFS-informed EMDR recognizes that you are naturally equipped for this healing, and that with the right support, your Self can lead this process. Both EMDR and IFS are evidence-based approaches with strong research support. When combined thoughtfully, they offer a path toward not just symptom relief, but genuine post- traumatic growth and self-discovery. If you’re interested in learning more about how IFS-informed EMDR might support your healing journey, I invite you to reach out. Every person’s path to healing is unique, and I’m here to help you discover what approach feels right for you.
EMDR and Brainspotting: Two Powerful Approaches to Trauma Healing
As a therapist specializing in trauma treatment, I’m sometimes asked about the different modalities I use in my practice. Two of the most effective approaches I offer are Eye Movement Desensitization and Reprocessing (EMDR) and Brainspotting. While both are brain-based therapies that help process trauma and distressing experiences, they each have unique qualities that make them powerful tools for healing. What They Have in Common Both EMDR and Brainspotting work with the brain’s natural capacity to heal from psychological wounds. They share several important similarities: Brain-Based Processing: Both modalities access the deeper, subcortical parts of the brain where trauma is stored, bypassing the limitations of traditional talk therapy that primarily engages the thinking brain. Bilateral Stimulation: Each approach uses some form of bilateral engagement, though in different ways, to help the brain process stuck material. Minimal Verbalization Required: Neither therapy requires you to talk extensively about your trauma. This makes them particularly helpful for people who find it difficult to put their experiences into words or who feel re-traumatized by detailed recounting. Faster Results: Compared to traditional talk therapy, both approaches can often produce significant shifts in fewer sessions, though the exact timeline varies for each person. Focus on Body Awareness: Both recognize that trauma lives in the body, not just the mind, and incorporate somatic (body-based) experiencing into the healing process. How EMDR Works EMDR, developed by Francine Shapiro in the late 1980s, is one of the most researched and validated trauma therapies available. It uses bilateral stimulation—alternating activation of both sides of the body—while you recall distressing experiences. In my practice, most clients prefer using handheld pulsators (affectionately called “buzzies”) that vibrate alternately, though I also offer a lightbar for those who prefer eye movements. The process follows a structured approach that includes: The bilateral stimulation (either through eye movements or with “buzzies”) helps your brain reprocess the memory in a way that reduces its emotional charge and helps you develop more adaptive perspectives. How Brainspotting Works Brainspotting, developed by Dr. David Grand in 2003, is a newer approach that emerged from EMDR but takes a different path. Instead of moving the eyes back and forth, Brainspotting identifies specific eye positions (brainspots) that correlate with the activation of traumatic material in the brain. The core principle: “Where you look affects how you feel.” In a Brainspotting session, we work together to find the eye position that most strongly connects to your issue or trauma. Once we locate this “brainspot,” you maintain your gaze in that position while staying present to whatever arises : sensations, emotions, memories, or insights. This sustained focus allows your brain to process the material at its own pace. Brainspotting is more open-ended and client-directed than EMDR’s structured protocol, relying heavily on the brain’s innate capacity to heal itself when given the right conditions. Key Differences Structure vs. Flexibility: EMDR follows a specific protocol with clear phases, while Brainspotting is more fluid and follows the client’s process moment to moment. Eye Movement Pattern: EMDR uses bilateral eye movements, while Brainspotting uses a fixed eye position. Therapist Role: In EMDR, I’m more directive, guiding you through specific steps. In Brainspotting, I maintain an attuned presence while you lead your own process. Accessing Material: EMDR often starts with identified target memories, while Brainspotting may start with material that is outside of conscious awareness. Which Approach Is Right for You? The good news is that you don’t necessarily have to choose. In my practice, I often use both modalities, sometimes within the same treatment plan. The choice depends on several factors. EMDR may be particularly helpful if you: Brainspotting may be particularly helpful if you: My Integrative Approach When combined with Internal Family Systems (IFS) principles, both EMDR and Brainspotting become even more powerful. IFS helps us work respectfully with the different parts of you that may be protecting you from the pain of trauma, ensuring that we move at a pace that feels safe for your entire system. I also integrate sandtray therapy when appropriate, which can provide a tangible, creative way to externalize and process material that emerges during EMDR or Brainspotting sessions. The Bottom Line Both EMDR and Brainspotting are evidence-based, effective approaches to healing trauma. Neither is universally “better”—they’re different tools that can be matched to your unique needs, preferences, and healing style. During our initial sessions, we’ll explore which approach feels right for you, and we can always adjust as we go. Some clients start with one modality and later try the other, while some benefit from alternating between them depending on what we’re working on. The most important factor in healing isn’t which specific technique we use—it’s the safety and trust we build together, your own innate capacity for healing, and finding the approach that allows your nervous system to feel safe enough to process and release what it’s been holding. If you’re struggling with trauma, anxiety, depression, or other challenges and are curious about whether EMDR or Brainspotting might be right for you, I invite you to reach out. Together, we can find the path that best supports your healing journey.