What Are Your Internal Dialogues Trying to Protect You From?

By Concentric Therapist Intern Mara Hundrieser-Acosta, B.A. (Clinical Mental Health Counselor M.A.)

I know I am not the only one that has internal conversations with different parts of myself. Just going back and forth with what I should have done, said, or even experienced. I recently lost my mother to cancer. When someone asks me “How are you doing? I answer with “ I am doing ok, just taking it one day at a time.” but on the inside, my brain is struggling. The actual answer in my mind is, “ I miss my mom, I wish I could see her.” and then another part of my mind answers “I have to cook dinner, wash clothes, put them away, and so much more to do, I feel so overwhelmed.” and another part says, “People will think you don’t have a handle on your life if you let them know how you truly feel.” So, I end up giving a generic answer and smile. 

The conversation inside my mind keeps going even though on the outside I am smiling and making small talk. Sometimes when we have been through hard times, we develop a strong voice that keeps us “in check.” When we view this through an Internal Family Systems (IFS) lens, it's called a Manager. We all have these internal conversations. No, there is nothing wrong with us; it’s just part of how we take care of ourselves internally. You might wonder what I mean about how we take care of ourselves internally. We all go back and forth with all of our parts to try to navigate our lives through stress, anxiety, depression, painful situations, and trauma. Through IFS we can learn what these parts need in order to feel at peace in our life. 

“IFS guides us to offer deep understanding and credible help to the critic and the innumerable other parts who populate our clients’ inner worlds, some of whom long to transform but are stuck in extreme, destructive roles.” -Schwartz & Sweezy (2020)

What is IFS?

Internal Family Systems (IFS), a model of therapy and an approach to better understand ourselves, was developed by Dr. Richard Schwartz. He has worked on the development of IFS for over 40 years.  Dr. Schwartz holds a Ph.D. in Marriage and Family Therapy and was trained to view and understand people through a systematic lens.  After years of working with families and individuals, Dr. Schwartz noticed how clients would speak about their different inner parts. Just like I shared my internal dialogue about being asked about me in relation to my mother. 

While in session with clients, Dr. Schwartz’s patients would share how they would go back and forth with different parts of themselves.  Dr. Schwartz noticed those parts also operate within a system similar to how a system of family operates. For example, a family system consists of different family members, roles or parts (e.g. parents, children) that interact with each other.  

If we look at humanity or systems with a very wide lens, we notice a system is always in place, starting with our solar system. Dr. Schwartz was able to recognize there is a system that consists of people’s inner parts.  These parts are called Managers, Firefighters, and Exiles. These parts have developed to protect us from harm, trauma, and difficult experiences that have left a wound inside our psyche. They all have a specific role that falls under a three-group system. All of our parts are good, even though they might seem mean or aggressive at times. 

The goal of IFS is to help people become Self-led, which means that their various parts feel loved by the Self and trust the Self’s leadership. IFS therapy has a gentle way to ease the pain of people’s experiences and parts and to help navigate the internal turmoil one often faces throughout life. 

The Roles of Parts: A Three-Group System

In order to understand further this three-group system we need to understand that each group or also called protective parts (Managers, Exiles, and Firefighters) doesn't have just one personality. There are different kinds of Managers; each one has its own role to play, as well as the Exiles and the Firefighters to protect us internally. These three-group systems work with each other and sometimes what feels like against each other in order to keep us safe internally. 

In other words…

One group tends to be highly protective, strategic, and interested in controlling the internal or external environment to keep things safe. In IFS, we call the members of this group Managers

A second group contains the most sensitive members of the system. When these parts feel injured or outraged, Managers will banish them for their own protection and the good of the whole system. We call them Exiles

A third group tries to stifle, anesthetize, or distract from the feelings of Exiles, reacting powerfully and automatically, without concern for consequences, to their distress as well as to the over-inhibition of Managers. We call these members Firefighters

Trauma & Internal Family Systems 

According to Schwartz & Sweezy (2020), internal systems (parts) that are responding to trauma not only divide into these roles, but the protective parts (Managers and Firefighters) also form alliances and get into conflicts with each other and can be very harsh or smothering with the Exile they are trying to protect or ward off. The sadder, more terrified, ashamed, rageful, or sexually charged an Exile is, the more protectors legitimately fear its release and the more extreme they become in their efforts to suppress and constrain them. In turn, the more an exile is suppressed, the more it tries to break out. In this way all three groups become victims of an escalating cycle of internecine* conflict. 

*internecine: destructive to both sides in a conflict.

Example: The more ashamed I feel about a traumatic event that happened to me the more scared the Managers and Firefighters are of me releasing or admitting this shame. So, the Managers and Firefighters will try really hard for me to suppress that shame. Which can mean one can begin to use drugs and alcohol to control that shame, or become very narcissistic in order to push it way down. The Managers and Firefighters believe that if one releases or admits this shame, it (the part) will ultimately fall apart. 

Childhood & Internal Family Systems

The Self can be forceful and protective. Children who have experienced developmental trauma or any abuse of their independence, spontaneity, leadership (or other traits that rely on courage themselves) begin to suppress their courageous side. It takes tremendous courage to go toward terrifying places in the psyche. Many protectors avoid stepping out of their roles because they believe the person would be weak and passive without them. Protectors always have intense fears about allowing clients to open the door to Exiles they locked away years ago in inner dark places. When a client says they are afraid to do something, we know a part in their inner world is speaking. But once the part understands the fearless nature of the Self, its fear (and emotional pain, shame, and rage) surrenders.

IFS Therapy has 4 Goals:

  1. To liberate parts from the roles they have been forced into, freeing them to be who they were designed to be.

  2. To restore faith in The Self and in Self-Leadership.

  3. To re-harmonize the inner system.

  4. To encourage the person or client to become increasingly Self-led in their interactions with the world.

So, What Does This All Mean? 

The intention of IFS is for the client to access, experience, and be Self-led, to feel safe, to learn their inner world, and understand how their parts work together or against each other in order to protect them. The more we learn and understand about our parts and what they are trying to tell us; it then becomes easier to identify when they get activated. Understanding who we are, where we have been, and what has hurt us, is what is going to give us the opportunities to heal ourselves. The end goal is to be able to be our own saviors, but to get there we must be willing to surrender and be open to learning. 

Once a person experiences faith in The Self and in Self-leadership, the IFS therapist seeks to help the client develop the Eight C’s. 

The Eight C’s

Curiosity: The client learns to be inquisitive, and have interest rather than be judgmental or fearful. This is where one comes with no agenda, one just wants to learn, know, and understand. There is a sense of feeling at ease and moving forward with wonder. There is a sense of safety that opens the door to vulnerability. 

Calm: After being in a high alert state, where one’s nervous system is often aroused, Self-leadership does the opposite by creating a sense of calm that is both physical and mental. The client is able to accept life on its own terms and there is a sense of resilience and assertiveness. 

Courage: When a client says they are afraid to do something in the inner world, we know a part is speaking. But once the part understands the fearless nature of The Self, its fear (and emotional pain, shame, and rage) surrenders. 

Confidence: The Self validates and comforts its Exiles bringing about an infectious air of confidence, conveying to protector parts that it is safe to relax instead of trying to “let it go and move on” (the typical protector advice that encourages people to abandon and isolate their burdened young parts), injuries can be healed. When Exiles are unburdened, the system becomes less delicate and less reactive, and protective parts are more inclined to trust Self-leadership

Connectedness: The Self, in its natural state, experiences the sense of connectedness. Instead of trying really hard to obtain a connection with someone, through trauma bonding.  The Self can now move through the world in harmony. Connectedness links with calm and confidence which altogether links up The Divine

The Divine: Through extensive research by Dr. Richard Schwartz this is what he describes as The Divine. “Though they used different words, all the esoteric traditions within the major religions – Buddhism, Hinduism, Christianity, Judaism, Islam – emphasized their same core belief: we are sparks of the eternal flame, manifestations of the absolute ground of being. It turns out that the Divine within – what the Christians call the soul or Christ Consciousness, Buddhists call Buddha Nature, the Hindus Atman, the Taoists Tao, the Sufis the Beloved, the Quakers the Inner Light.” 

Clarity: One can see things more clearly. The distortions are no longer in effect and the extreme beliefs ease as one can see authenticity. Our vision is clear when we see through the eyes of the Self versus when our vision is distorted through the eyes of extreme parts.

Creativity: It’s believed that once the inner turmoil and constant struggle start to quiet down and The Self becomes the leader (aka Self-led), creativity can emerge naturally. This means once the managers start to relax, we can problem-solve with greater ease which becomes second nature. 

Compassion:  Once a client finds some separation or healthy distance from their angry or scared part, they can now see these parts from a compassionate lens.  They can express how sad or sorry they are for those parts and are willing to help them heal. This inherent desire to help their suffering parts signifies and taps into compassion. 


I hope that after reading all this information there is a part of you that feels compelled to explore IFS. I want to say to “the part” of you that has that interest, that feels like it has been lost, in pain, or any other unresolved feelings; you are important and you deserve to be seen and heard. If you are wondering which part that might be, I am talking to your Self-led part; the part that might be hiding in the shadows for a while. 

We live in a time where we are overworked, overwhelmed, on the go, not getting enough sleep, expecting to be everything and nothing at all, where we have to walk on eggshells, but make a difference. It’s no wonder that our Self-led part feels so overwhelmed and just lost. This is the time when we need to slow down and rebel; which translates to going inside, getting curious about your parts, and reconnecting to who we truly are meant to be.

I know it might sound like a big ask, yet if you go back and read about The Eight C’s and imagine experiencing them, I think it’s all worth the journey of healing. The idea of feeling liberated is what motivates me through the IFS lens. I wish for you and my clients to feel liberated from whatever has been holding you back from being your most authentic self and be connected to your Divine

So, next time you have those internal conversations bring awareness to what each part is saying, and ask them what they truly need. They are trying to protect you even if they might sound very harsh or act maladaptively; they just haven’t learned a better way, yet, to communicate with you. Even if you don’t think you have the power within you to heal, to reframe those inner dialogues; you actually do, it’s inside you.

Resources for Consideration

Books: IFS online store | IFS Institute 

Videos: Dr. Richard Schwartz explains Internal Family Systems (IFS) Dr. Richard Schwartz Has A Radical Approach To Healing

Podcast: Multiplicity of the Mind: An Approach To Healing the Inner Self | Dr. Richard Schwartz X Rich Roll

The Trap of Anxiety and Trauma

By Concentric Owner Jennifer Larson, LCPC, NCC

This blog post was originally posted on the Anxiety Relief Project’s website as the Founder was asked to be an expert contributor. The Anxiety Relief Project and website are no longer active. Jennifer Larson, LCPC, NCC is the Owner of Concentric Counseling & Consulting, a private practice group in Chicago that specializes in relationship and couples struggles; tween, adolescent and family issues; complex and relational trauma; anxiety, depression and bi-polar disorders; mind-body connection; life transitions and stress; the self and identity; substance abuse; and unresolved family-of-origin issues. Jennifer has experienced complex trauma, anxiety, and post-traumatic growth and is passionate about helping others who have endured similar struggles. Over the past 2 years, Jennifer has started sharing more about her personal struggles and growth in an effort to help de-stigmatize mental health.

Driving my car in my early adult years filled me with freedom and curiosity. Didn’t matter if I was driving by myself, on city streets, highways or traversing the deserts of Arizona, I loved driving. Toggling between radio stations to find the right tune, opening up the windows to feel the fresh air hitting my face and throwing my hair around, hanging out with my thoughts, or being mesmerized by the pink and purple hues of Arizona’s sunsets were met and felt with ease, peace, and freedom. Fast forward several years later, and my experience of driving catapults me into feelings and sensations of feeling trapped and crippled by anxiety, panic attacks, and at times, dissociation.

White-knuckling my steering wheel bound by the perpetual ticking of the clock, shouting at me to be here and there at this time. “Hurry up!” is my internal mantra. Truth be told, my life was definitely more stressful during that time. Let’s face it, chronic stress does not do anyone any favors, much less me who has endured the impact of years of complex trauma and its anxieties that are married to it. 

It started with commuting on I-90 expressway in Chicago as I began to feel a tinge of anxiety and thoughts about possibly becoming trapped in gridlocked traffic with no easy way to escape. The first spider silk strand of anxiety over time grew and grew into an unwieldy, dense web that ended up trapping me. Inching closer as I merged onto the express lane, I experienced frantic and dreadful panic as I imagined being stuck in the express lanes flanked by 4 rows of cars on either side of me where escape was next to impossible. Knowing the gift of extra time – a much coveted commodity - would be more favorable to me if I chose the express lane during my commutes. However, I now found myself avoiding it all together because my anticipatory anxiety of driving in the express lane, even the night prior, crept in and simply took over me. 

Avoiding the express lane did mitigate my anxiety, but it was a temporary solution at best. The same level of anxiety and panic now started to emerge when driving on the regular lanes on the highway. My heart-racing, tingling sensations in my lower legs, sweating hands and unfriendly thoughts befriended me. Panic attacks started to fuse into a strange hybrid of disconnect and escape sensations. I wish I were describing a feel-good, daydream-state of imagining being in a beautiful place that evokes happiness and ease, but this type of disconnect and escape experience that later emerged is called dissociation. 

When dissociation occurred, I would experience a sense of not feeling attached or even inside of me, but rather sucked into a vast abysmal, ominous space from above me. This experience was the most terrifying of them all. Other times, I would experience my surroundings as a surreal place, almost as though the cars and buildings were toy-like, not real. These experiences felt like transactional moments as if I was holding onto a roll of processed film looking at each frame-by-frame. During these times, I was not embodied, but rather detached from myself as I experienced both de-personalization and de- realization which are dissociative states.  These were all very new experiences for me.

Drifting in and out of anxiety, panic, and dissociation soon became more commonplace. Perpetual thoughts and sensations of being revved up, anxious, scared, wanting to escape, and seeking a place of refuge became a part of my lived experiences. 

This Is The Trap of Anxiety and Trauma

Learning about the connection of anxiety and trauma from a neurobiological or neuroscience perspective greatly helped to illuminate and normalize my experiences of anxiety and traumatic stress, and allowed me to move from being the driver to a driving instructor. I started to understand how my own past complex trauma coupled with chronic stress impacted my health. This knowledge also helped me in my own therapy journey as well as with helping my client’s. To better understand the neuroscience of anxiety and trauma, let’s first begin with a basic understanding of human’s nervous system and the brain. 

anxious while driving in traffic.jpg

The Triune Brain 

There is some debate around this; some people believe in the triune or 3-part brain model, while others believe this is too simplistic. For brevity sake, let’s look at the different parts of the triune brain and its respective functions: 

• Brain stem: This is often referred to the reptilian or primal part of the brain which is responsible for instincts, survival and autonomic body processes, such as breathing, eating, blood pressure, sleep, and regulating the central nervous system. 

• Mid-brain: This is where the limbic system is housed and is often referred to the mammalian or emotional part of the brain. The limbic system is largely responsible for processing emotions and feelings, implicit memory, sensory somatic experiences, and hormonal secretions. The amygdala plays a role in autonomic responses to fear. The hippocampus plays a role in memory. 

• Fore-brain: This is where the neocortex is located and is often considered the Homo Sapiens, modern or highly evolved part of the brain. This part is responsible for processing intellectual, language, abstraction, and executive functioning, such as decision-making. The dorsolateral prefrontal cortex is the time-keeping part of the brain. 

The Nervous System 

The nervous system has 2 parts - the limbic system and the autonomic nervous system. The limbic system is a portion of the brain that deals with the functions of our emotions, memory formation, and arousal. The limbic system consists of the hypothalamus, the hippocampus, the amygdala, and several other structures. The hippocampus helps to regulate our autonomic nervous systems by regulating our breathing, blood pressure, pulse, and arousal in response to emotional circumstances. The amygdala plays a role in autonomic responses to fear and the hippocampus plays a role in memory, such as converting short-term memory into long-term memory. 

The autonomic nervous system is composed of 2 opposing parts: the sympathetic nervous system (arousing) and parasympathetic nervous system (calming). When both systems our in sync, we feel 

balanced and centered. The sympathetic part our system is highly involved when we face a threat or something dangerous as it enables us to go into “fight or flight” mode. Eventually, the opposing parasympathetic system helps bring our nervous system back to a state of calm and relaxation. For people who feel too much sympathetic arousal, the parasympathetic system can take over causing a person to go into “freeze of collapse” mode, otherwise known as shutdown. In the shutdown mode, the dorsal vagal, parasympathetic system is activated causing a person to dissociate, faint, or become immobile. This survival mechanism is similar to an animal that lies completely still, feigning its death hoping for the predator to go away. 

Anxiety 

Anxiety is a psychological and physiological response to fear, danger, or threat. When we are faced with a threat – a real or perceived threat - or memory that reminds us of former threat, our nervous system swiftly responds through an intricate and interconnected network by going into fight-flight-freeze-or collapse mode. The amygdala gets activated, certain hormones are secreted pouring into the body, and the body is primed to behaviorally respond in either fight-flight-freeze-or collapse mode. This amygdala activation is akin to a smoke detector going off when there is an excess of smoke that is trapped in a home. The alarm system goes off to warn and signal people to get out of a dangerous situation. As in the case with anxiety or trauma, actual smoke or perceived smoke trip the smoke detectors to go off. 

Many studies have shown there is a link between what happens in one’s nervous system and those who suffer from anxiety. For instance, when a person is faced with a fear or even a conditioned fear (such as arachnophobia or any other type of phobia), the amygdala is activated, signaling to the person’s body that they are in danger. Neuroscience explains what occurs within the brain and autonomic nervous system. Therapy can help people understand how anxiety impacts 4 areas: cognitions (or thoughts), emotions, physical sensations, and behaviors. To illustrate, a person who has social anxiety (or fear of public speaking) may think others will judge or criticize them, feel insecure and embarrassed, have physical sensations of heart racing, dry mouth, shallow breathing, and behaviorally may pace back-and-forth when speaking. A person who suffers from panic attacks might think they are going crazy, feel overwhelmed and anxious, experience intense and overwhelming physical sensations, and may behaviorally try to escape their environment. All of these examples of anxiety involve the nervous system. Similarly, those who suffer from traumatic stress experience thoughts, emotions, behaviors, and sensations as those with anxiety. 

Trauma 

Trauma involves a loss of choice in which a person faces a single dangerous event, series of overwhelming threats (or neglect) or when a person recalls threatening memories in which that person feels unsafe or trapped. Not everyone who faces a threat or something dangerous will experience traumatic stress, but for those who do, their autonomic nervous system continues to be in a longer-term state of dysregulation. People who have a traumatic response may find daily life as threatening even if there is no actual or rational threat present. Studies* have shown the dorsolateral prefrontal cortex or the time-keeping part of the brain goes offline and shuts down, consequently, the traumatic memory 

and internal experience feels like it is perpetually present (*nicamb, National Institute for the Clinical Application of Behavioral Medicine, Treating Trauma Master Series). People who suffer from Post Traumatic Stress Disorder (PTSD) or Complex Trauma (C-PTSD) share feeling unsafe, trapped, crippled, or limited. 

In addition to feeling anxious, people with traumatic response can also become disembodied and detached from oneself by route of dissociation. When someone dissociates, the dorsal vagal nerve shuts down and immobilizes the body. As people have described (and I surely can attest), it feels like one has been hijacked or assaulted from within. 

For me, I found driving on the highway with limited ability to escape as threatening. It didn’t matter if it was a real or perceived because my mind and body responded as though it was a real threat. It is critical that our built in alarm systems in the brain and body respond when faced with real threats so we can find a way to escape them and ultimately survive in the end. But as you may suspect, it’s not so good when our alarm systems are going off constantly when there are no or minimal threats. 

Once the threat retreats or we are able to thwart off the threat, for some people, their body discharges the excess energy caused by hormonal secretions that had been initially resourced and ignited to return back to a state of balance and integration. This is a healthy response as people can function well and go back to business as usual with a sense of ease, mobility, curiosity, and even play. However, for some other people, as in the case with me, people who face anxiety, chronic stress, or trauma, this discharge of energy does not occur, but rather the brain and body are stuck in a recycling and dysregulation mode. In these occurrences, people walk through life seeing, feeling, or sensing threats around them as though they are walking in a minefield, which in turn, constantly pulls on those internal alarm systems, secreting and overloading the system with hormones, and maintaining dysregulation. 

Free Yourself from The Trap of Anxiety and Trauma 

Knowledge and research provides concrete explanations as to what happens to people when faced with anxiety, chronic stress, and trauma. And, research has demonstrated what can help people manage and overcome its impact. Knowledge is power. There are a number of respectable and beneficial treatment options, both traditional and non-traditional. I do not believe in a one-size-fits-all approach. Medications, supplements, and a healthy diet are important considerations. Mental health therapy, both top-down and bottom-up approaches are helpful remedies, such as Cognitive Behavioral Therapy (CBT), Somatic Experiencing (SE), Prolonged Exposure Therapy (PE), and Sensorimotor Psychotherapy. Learning how to practice being in the here-and-now with mindfulness, meditation, and grounding techniques is useful. Good sleep and exercise are essential. And, of course, surrounding yourself with healthy, safe people and spending time in nature and spirituality are key. I can personally attest to the power and effectiveness of an integrated approach to escaping the trap of anxiety and trauma. Your options are limitless and there is hope for healing. 

I would like to acknowledge the following professionals as my blog post draws from the expertise, work, and writings of Bessel van der Kolk, MD, Stephen Porges, Ph.D., Pat Odgen, Ph.D., Peter Levine, Ph.D., Dan Siegel, MD, Ruth Lanius, MD, Ph.D, Paul Maclean, MD, David Carbonell, Ph.D., C. George Boeree, Ph.D., David Puder, MD, and nicamb, National Institute for the Clinical Application of Behavioral Medicine, Treating Trauma Master Series.

Let's Talk About Complex Trauma

By Concentric Counselor Jordan Perlman, LPC, NCC

I imagine many people have heard of Post-Traumatic Stress Disorder (PTSD) but not nearly as many are familiar with Complex Post-Traumatic Stress Disorder (C-PTSD) which is lesser-known and unfortunately, not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). And while an individual with a PTSD diagnosis, which is often the result of an isolated incident, a person who experienced complex or repeated traumas requires different considerations.

But first, it’s important to understand the differences between each:

PTSD

According to the DSM-V, PTSD is diagnosed when an individual meets the following criteria that create distress or functional impairment last more than one month, which is not a result of medication, substance use, or other illness. The individual was exposed to one of the following: 

  • Death or threatened death 

  • Actual or threatened serious injury

  • Actual or threatened sexual violence 

  • Witnessing trauma

  • Learning that a relative or close friend was exposed to trauma 

Indirect exposure to aversive details of the trauma (usually in the course of professional duties), the individual must have at least one intrusive symptom that causes the persistent re-experience of the trauma in the following ways:

  • Nightmares

  • Flashbacks

  • Emotional distress after exposure to traumatic reminders

  • Physical reactivity after exposure to traumatic reminders

The individual must also experience avoidance of trauma-related stimuli after trauma either by trauma-related thoughts or feelings, or trauma-related external reminders.

Two negative alterations in cognitions and mood must be present where the negative thoughts or feelings began or worsened after trauma in the following ways:

  • Inability to recall key features of the trauma

  • Overly negative thoughts and assumptions about oneself or the world

  • Exaggerated blame of self or others for causing trauma

  • Negative affect

  • Decreased interest in activities

  • Feeling isolated

  • Difficulty experiencing positive affect

 Lastly, there must be alterations in trauma-related arousal and reactivity that began or worsened after trauma in the following ways: 

  • Irritability or aggression

  • Risky or destructive behavior

  • Hypervigilance

  • Heightened startle reaction

  • Difficulty concentrating

  • Difficulty sleeping

ComplexPTSDtrauma.jpg

 C-PTSD

Trauma typically associated with C-PTSD tends to be long-term, where the individual is generally held in a state of captivity, physically or emotionally. In these situations, the victim under the control of the perpetrator has little or no chance to get away or escape from the danger. Some examples might include:

  • Long-term domestic violence

  • Long-term child physical and/or sexual abuse

  • Neglect

  • Organized exploitation rings

  • Concentration/Prisoner-of-War Camps

  • Prostitution brothels

  • Recruitment into armed conflict as a child

  • Sex trafficking or slave trade

  • Experiencing torture

  • Exposure to genocide campaigns

  • Other forms of organized violence

Some might be wondering, why is this difference important then? This is because of exposure to long-term or prolonged or repeated trauma results in a broad range of symptoms that go beyond the diagnostic criteria of PTSD, a.k.a “simple” PTSD.  As such, the basic symptoms of C-PTSD are:

  • Somatization (physical problems, associated pain, and functional limitations)

  • Dissociation (a division of the personality into one component that attempts to function in the everyday world and another that regresses and is fixed in the trauma, spacing out, daydreaming, or feeling strong sensations of being disconnected from one self or the world)

  • Affect Dysregulation (difficulty with emotions, such as experiencing and/or expressing them, alteration in impulse control, attention and consciousness

  • Self-Perception (experience of their own perspective tends to be drastically different from how others perceive them)

  • Interpersonal Relationships (tend to be a struggle, difficulty with engaging with others, feeling distrustful of others)

  • Perception of Perpetrators (can be skewed, or longing to be loved by their abuser)

  • Systems of Meaning (doubt there is any goodness in the world, outlook on life can be dark)

Further, a 2018 study by Karatzias et al. found the most important factor in the diagnosis of C-PTSD was negative cognitions about the self, characterized by a “generalized negative view about the self and one’s trauma symptoms; attachment anxiety which is defined as involving a fear of interpersonal rejection or abandonment and/or distress if one’s partner is unresponsive or unavailable; and expressive suppression, conveyed by efforts to hide, inhibit, or reduce emotional expression.”

For those who may wonder why people affected by a long-term trauma “can’t just get over it,” the answer lies in the fact that even after a person is removed from the event, their brain may be permanently affected by that intense and prolonged trauma. And since a person’s nervous system is shaped by his or her experiences, stress and trauma over time, can lead to changes in the parts of the brain that control and manage feelings and the long-term effects are found on a physical and emotional level.  

Symptoms may manifest as:

  • Eating disorders

  • Substance abuse

  • Alcoholism

  • Promiscuity

  • Chronic pain

  • Cardiovascular and gastrointestinal problems

  • Migraines

  • Rage displayed through violence, destruction of property, or theft

  • Depression, denial, fear of abandonment, thoughts of suicide, anger issues

  • Flashbacks, memory repression, dissociation

  • Shame, guilt, focusing on wanting revenge

  • Low self-esteem, panic attacks, self-loathing

  • Perfectionism, blaming others instead of dealing with the situation, selective memory

  • Loss of faith in humanity, distrust, isolation, inability to form close personal relationships

Special Considerations for Survivors of C-PTSD from Childhood 

Many survivors of C-PTSD also experience Attachment Disorder which is a huge consequence of individuals who suffered complex trauma as children. Attachment Disorder is the result of a person growing up with primary caregivers who were regularly dangerous. Recurring abuse and neglect habituate children living in fear and sympathetic nervous system arousal, which over time creates them an easily triggerable abandonment mélange of overwhelming fear, shame, and depression. 

Because a child’s main attachment (to their primary caregiver) helps them learn to control their emotions and thoughts, when a caregiver’s responses are in tune with a child’s needs, the child feels secure. The child then uses this relationship pattern as a practice to build coping skills.

However, children who receive prolonged confusing or inconsistent responses from their primary caregiver are prone to be fussy, have a hard time calming down, may often withdraw from others and may have frequent tantrums. Unlike adults who have more tools to understand what is happening to them, children often do not possess these skills or have the ability to separate themselves from another’s unconscionable actions. Consequently, the resulting psychological and developmental implications become complexly woven and spun into who that child believes themselves to be, thereby creating a messy web of core beliefs that are harder to untangle than the flashbacks, nightmares and other posttraumatic symptoms that may surface later. Further, these disorganized attachments and mixed messages from those who are supposed to provide love, comfort, and safety - all in the periphery of extreme trauma - can create even more unique struggles that PTSD-sufferers alone don't always face.

Treatment Considerations 

While the symptoms can be daunting and the future seems bleak for someone who appears to be suffering from C-PTSD regardless of whether an individual has been diagnosed with a trauma-related disorder or not, there is help out there and there are ways to manage and help the individual cope. 

Treatment challenges include, Survivors:

  • Avoiding thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming

  • Relying on alcohol or other substances as a way to avoid and numb feelings and thoughts related to trauma

  • Engaging in self-mutilation and other forms of self-harm

  • Who have been abused repeatedly are sometimes mistaken as having a “weak character” or unjustly blamed for the symptoms they experience as a result of victimization and often have comorbid disorders such as dissociative identity disorder (DID), other specified dissociative disorder (OSDD), borderline personality disorder (BPD), depressive or bipolar disorders, anxiety disorders, obsessive-compulsive disorders, eating disorders, and substance abuse

Since many trauma specialists see Attachment Disorder as one of the key symptoms of C-PTSD, a relational, individual, approach will often be most beneficial for many of these clients. For many survivors, therapy is the first opportunity to have a safe and nurturing relationship.  Therefore, the therapist must be especially skilled to create the degree of safety that is needed to build trust or risk adding to the attachment trauma. Working with these clients is essential to the development of trust and relational healing and the four key qualities are empathy, authentic vulnerability, dialogically (when two people move fluidly and interchangeable between speaking and listening) and collaborative relationship repair. This makes therapy a teamwork approach where there is mutual brainstorming and problem-solving in a respectful way implying mutuality. All of these steps will provide the client with a “good enough secure attachment” to serve as a model for other relationships. 

However, and as expected, there is no “one size fits all” approach to working with individuals who have survived trauma, but one thing is for certain: recovery from Complex PTSD requires restoration of control and power for the traumatized person. Survivors can become empowered by healing relationships which create safety, allow for remembrance and mourning, and promote reconnection with everyday life. 

If you feel as though you have experienced complex trauma, it is important to know what happened to you was not your fault. While it is undeniable trauma changes the way we experience the world, I strongly believe like a phoenix, a person who suffered from trauma can arise from the ashes, stronger than ever before. This “stronger than ever before” is also known as “Post-Traumatic Growth.” Post-Traumatic Growth identifies a shift in personal strength and worldview as a consequence of trauma. Although you can’t change it, you can change what your life looks like going forward. One step you can take towards recovery is calling to schedule an appointment with a therapist who can help guide and support you on your healing journey. 

Sexual Trauma, Triggers, & The 24-Hour News Cycle

By Concentric Counselor Katie Ho, LPC, NCC

You can hardly escape today’s current social and political climate - it’s on the news, in your social media, overheard at lunch, and even for therapists, themes in session. For those who have experienced trauma in their lifetime, past or ongoing, navigating topics like sexual assault can be overwhelming, scary, complicated and sometimes even powerful. How we take care of ourselves and the people around us who may be struggling with the complexity of their emotions has to be part of the larger conversation. It’s clear that avoiding or minimizing discussions on sexual violence and quieting the stories of survivors is not the path to atonement and reconciliation. But as we create space and lift up the voices of those who have suffered, we must also take inventory of what comes up in us and tend to those parts with kindness, care and nurturing.

The #MeToo movement, local and national advocacy groups and social justice organizations have been and continue to create a platform for those who have been victim to sexual harassment and assault. While the stories and accounts of these traumas seem to be daunting all of the sudden for those who have been unaware, statistics and experts have known for some time of these experiences. The National Sexual Violence Resource Center (NSVRC) estimates that 1 in 5 women will be raped in the United States in their lifetime, and that 1 in 3 women will experience some form of sexual violence. The majority of these acts are committed by acquaintances, partners or people who are known by the victim, and according to the Rape, Abuse & Incest National Network (RAINN), the majority of these events occur at or near the victim’s home. These of course are statistics, data and research gathered through reports from multidisciplinary agencies. There is undeniable value in knowing these numbers. And just as much, there is value in hearing the experiences and seeing the faces of survivors who have chosen to come forward.

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As allegations and reports of sexual assault make the news, we are bombarded with information, opinions, commentary and even jokes on the matter. Survivors are subject to their own re-traumatization, which has an impact on psychological and physical health, triggered by both the details of these publicized allegations of assaults and non-believers who dismiss them.

In knowing that a trigger is a psychological stimulus that can be evoked through anything from sights, smells or sounds, it’s no wonder that the 24-hour news cycle is affecting so many people. Survivors are not alone in their strong reactions to the constant replaying and subsequent criticism, shaming or dismissing of survivor stories. Those who feel a connection or calling to the cause, whether it be through their empathic attunement or knowing a survivor, may also experience the distress and burnout that comes with the current climate.

So how do we take care? How do we balance the righteous anger and complexity of our other emotions, promote advocacy and change, all while healing and taking gentle care of ourselves? In doing this, one of the most important things to know is nothing can replace the support of others. So find someone, or a group of someones, who can help to support, validate and foster a safe environment for processing.

Find a tribe, or maybe even create one. Pay attention to your body, as our physical being can often tell us when stress is increasing and it’s time for tending and healing. Maybe that means physical exercise, movement, touch or a practice of progressive muscle relaxation (a quick YouTube search is all you need!). Set boundaries. Limit your intake of news and dialogue on the topic by knowing how much mental and emotional labor you’re able to give without overextending yourself. And if you find yourself overwhelmed, triggered or lost, use mindful grounding techniques to bring yourself back into your here and now. Feel your feet on the floor, describe and notice something around you, use your five senses to bring a consciousness into your physical environment and current moment in time and add in a quick reminder - “I am safe. I am in control. I am okay.”