Complex trauma histories

In this chapter we discuss some of the issues therapists face when working with patients who have complicated and chronic trauma histories. We differentiate complex trauma from complex posttraumatic stress disorder and address common concerns therapists might have when considering a trauma-focused therapy such as cognitive processing therapy (CPT) for such patients. This includes questions about the suitability of a relatively short-term approach such as CPT, risk of retraumatization and exacerbation of problems, and therapeutic alliance. We provide guidance on how CPT accommodates patients who have multiple and extensive traumatic experiences, how to manage the breadth of negative cognitions patients can present with, and how to keep on track when the turmoil of a patient’s circumstances threatens to derail therapy. We also make suggestions about managing patients’ out-of-session contact with the therapist.