It's Not You, It's What Happened to You: Complex Trauma and Treatment

Probably the most useful and succinct book on trauma I've read in the last year. Just because it is short, does not mean it doesn't have impact. Major impact. So much is clarified and my self-knowledge greatly deepened.Just be aware that, depending on your current emotional/psychological state, a bit of the material may be trigger-y. That being said, the vast majority of this short, detailed, yet concise book is extremely validating and illuminating.That's where my book review begins and ends, and from here out, I muse on the impact of the book on my self-perception and my perception of mental health professions and professionals... so you may want to bail on the rest of this.Mainly I wonder why not a single mental health services professionals of the many I encountered in adolescence and my 20s and 30s ever spelled out for me what I was clearly struggling with my entire life, in the way that this book has.The book's extremely validating and illuminating, yet succinct, breakdown of how a genetic predisposition combined with early trauma sets you up for lifelong mental (and *physical*, as if the two are separable, thanks, Descartes, NOT) health problems paradoxically made me really, really sad.I've been living with this/like this my entire life, since early childhood. But I did not get "help" until age 15 after my parents' violent breakup/divorce/police removal/orders of protection and multiple siblings' suicide attempts &/or substance abuse rehabilitation. And I did not get meds until age 20. After which I made more progress in one year than I had in the preceding five. Big surprise. Not.Not one of my preceding 4 therapists (all LCSWs, as opposed to the LCPC I currently see...whether that is a factor, or not, I'm really not sure) ever said the words "trauma," "dissociation," or "PTSD" to me. Or ADHD for that matter.Only on the cusp of 50 years of age did I finally hear these terms (early 40s for the ADHD diagnosis). Unfortunately, if I had not dissociated in my current therapist's office (why, I can not recall -- a feature of dissocation, it turns out)... and if I had not figured out my BPD on my own via research (trying to look up more handouts like those he gave me, wishfully thinking that if I worked harder, did *more*, I would get better faster; it doesn't work that way, unfortunately), I am not sure he would have told me his diagnoses (C-PTSD in addition to severe MDD, with many features of BPD). I do not understand this.*I thought I had been living with MDD for my entire life; that's what I was diagnosed with at age 20 (so were 2 older siblings; the other siblings have been diagnosed with anxiety/panic disorder &/or specific phobias) and that's what I was treated for, once I finally got on meds at age 20 (been on meds x 30 years).Unfortunately, the duration of response, development of habituation, and necessity of changing AD meds have shortened and occurred with more frequency over the last decade.Luckily my flexible psychiatrist was willing to do a fuller, if brief, assessment (hey, managed care only gives him 15 minutes with me, and I'm extremely lucky he stretches it sometimes based on need, so I never complain when I wait for a long time in his waiting room because I figure he's doing the same for some other similarly troubled soul). This resulted in a new diagnosis (ADHD) which, when I read the diagnostic criteria, hit me like a ton of bricks, because it explains SO MUCH of my childhood and adolescence, and my professional/occupational difficulties. That was my first experience of deep "if only I'd known this back then" sadness, since that diagnoses came my early 40s.Currently I am on 3 ADs and considering, as of my doctor's assessment of the diminishing returns I have experienced over the last year at my last apopintment, either TMS or adjunct antipsychotic mediction. Neither of which seem like a preferable option. I am thinking maybe I will suggest we go back to the drawing board, and try to treat all the OTHER comorbidities, since theoretically my neurotransmitter receptors would be naive to at least some of those medications, as opposed to every class of AD that exists, from which I've already taken 2-3 medications over the last 3 decades.My psych MD pointed out that MDD and ADHD symptomology do overlap in areas and that the known (and correct) MDD diagosis likely obscured the ADHD diagnosis. But it is also true that you often find only what you are looking for... and he's my 4th psychiatrist d/t changing jobs, careers, and insurances over a lifetime. And I'm aware that diagnoses can be comorbid, eg. MDD and ADHD, or MDD and anxiety disorder. Also that, as my therapist pointed out, some diagnoses aren't apparent to a therapist until perhaps months (or years...) into therapy because the symptomology -- how the person *truly* lives, and what they disclose about it -- isn't apparent until a certain level of trust and a therapeutic bond are established.Fair enough; I never felt that bond was established with the last LCSW, which I of course attributed to my own dysfunction rather than what I look back and see now as poor rapport. But insurance or self-pay, you get what you get and you have to try to make it work.* With my first therapist, it's understandable she said nothing about trauma/PTSD, because much less was known about it back then and much work has been done in only the last 15 years; van der Kolk, Courtois, etc research wasn't even available then &/or was in preliminary stages and therefore not part of mental health educational/training curricula).Also the presenting symptoms, all meeting MDD diagnostic criteria, were very severe and intractable -- until I got on meds (what a surprise).But why the other three therapists over the decades (and two psychiatrists) -- all of whom were informed of the large gaps in my memories of childhood (a hallmark of dissociation, I now know, btw) as well as the abuse, and who could clearly see my motor-mouth, scatter-brained, chronically late tendencies in session -- never informed me of these diagnoses/comorbidities (C-PTSD, ADHD, BPD, rejection sensitive dysphoria, etc), I simply do not understand.When I asked my current therapist why none of the previous ever told me my diagnosis/es, I was told therapists treat people, not diagnoses. Also that they do not want to predispose a client to any particular psychological response (learned helplessness... as if my violent childhood hadn't beaten fight and flight out of me, and left me with only freeze...) &/or to a self-fulfilling/limiting prophecy based on a given diagnosis a therapist shared with me.OK, fair enough, I suppose. But no other health care providers are allowed to withhold a diagnosis from a mentally competent patient anymore; that is considered unethical now. I don't know why it isn't the same for therapists/LCSWs/LCPCs. By definition, I must be competent: I was informed by a previous LCSW therapist that I was "too functional" to ever qualify for SSI disability (which I wasn't even asking for; she just completely misunderstood my question because not listening because poor rapport, sigh) -- because I'd held down a job too long, and I'd finished an undergrad degree.This was within the last ten (actually six) years... So, wait -- I was competent enough to never qualify for any kind of disability assistance, no matter how badly I was failing to keep my head above water, maintain a long term relationship, or in fact do anything more than sleep, eat, wake, work, and sleep (according to her)... yet I was not competent enough to be informed of my comorbid disganoses (as evidence by her not sharing the diagnoses with me)...? Really?My current therapist explained that many therapists also don't like to submit specific diagnoses to insurance companies, because 1) the diagnoses tend to follow patients around like a label, and can be used by insurance companies (at least until Obamacare made refusing care for pre-existing conditions illegal, which doesn't mean I love Obamacare, because I don't) to deny coverage. ...and also d/t 2) the diagnosis is actually a moving target.Fair enough... but they don't have to put it in your insurance paperwork in order to inform you in the confidential setting of the therapy appointments... and the exigencies of diagnosing a moving target, and regularly re-assessing can surely be explained to the more functional clients... one would think.This all makes me incredibly sad. Because I could have saved myself so much anguish and pointless repeated effort (with attendant failure, self-blame, and shame, on top of all the pre-existing lifelong self-blame and shame I had from abuse, from my parents' woefully unrealistic expectations/demands, and for all I had already failed to do and blamed myself for)......had I been informed what was really wrong with me, and that the neurobiology was a huge determinant in not just the trajectory of the mental illness, but also in its remitting/relapsing pattern. The very strong likelihood of a lifelong need for and consumption of psychiatric and psychological services (as well as medication management), would at least have let me know what I was in for, and would have explained my neurological differences from others and the decreased likelihood of a traditional life trajectory for me......and I might have let myself off the hook for so many perceived failures, and felt so much better about the accomplishments and successes I *did* achieve, instead of beating myself up further for failing to achieve *more* and failing to achieve the levels of personal and professional success that repeated achievement/academic and intelligence testing indicated I *should* have been capable of.If I had a dollar bill for every written and verbal academic "not performing to potential" from childhood on, I'd have a mountain of money piled up to my chin (to steal a favorite lyric from Eurythmics).And still no one has been able to explain to me why Borderline Personality Disorder seems to be diagnostically the same as the emotional dysregulation and intense emotional overreaction (including rejection sensitive dysphoria &/or severe social anxiety) of ADHD.What IS the difference between BPD and ADHD's emotional hyperreactivity? They certainly have the same comorbidities (OCD, anxiety disorders, depression, rejection sensitivity/social anxiety). Could they actually be the same thing?If the difference is solely the training and background of the assessor, then Houston, we've got a problem. Because one can supposedly only be treated by DBT (the evidence base for which has methodological study design issues, based on my readings, including the fact that much of the early research evidence was pioneered by the creator, whose financial interest in the intellectual property copyright and manualization of DBT is both obvious *and* a conflict of interest)......whereas the other is treatable with medication (therapy/DBT is an adjunct, not primary, treatment to help sufferers cope; it seems no one would suggest ADHD can be *treated* successfully with DBT alone).And I disagree with the so-called "given" that in evidence-based research on efficacy of therapy of any kind (manualized or not), there can be no blinding or placebo.The placebo "sugar pill" of therapy modalities would simply be assigning the research subject another human being to talk to -- someone sworn to confidentiality and trained as a lay listener, not a *therapist* -- for the same frequency and duration as a therapist trained in the modality being tested.Blinding can be accomplished by excluding from the subject pool those for whom BPD or ADHD is a prior diagnosis and who have prior experience with any kind of talk therapy -- and/or by comparing the tested treatment modality to a self-help modality such as 12 step programs (Emotions Anonymous, Al-Anon, Ala-teen, etc.). In other words, include only treatment-naive (therapy-naive) subjects, and provide a 100% layperson-based self-help modality as one of the comparators. By their treatment-naive status, such subjects are already "blinded." Is that really so difficult?I am so weary of a profit-driven healthcare system, which encourages the proprietary copyrighting and IP protection of treatment modalities by their originators, instead of open scientific sharing of treatments and consequent truly double-blinded or at least blinded randomized controlled trials over LONG periods of times, not the weeks or months (or 2 years at most) most research seems to consider "longitudinal" and the consequent efforts and duplication of results.Considering how much and how long (decades... if not 100+ years) clients/patients have been blamed for "therapy interfering" behaviors and "resistance" for disorders we now know are neurobiological in origin whose first-line treatments are (or should be) psychopharmacology......it is curious how resistant some researchers and supposed pioneers of treatment modalities are to truly empirical evidence based research of sound methodological design, and how dismissive they are of the ways in which that could be accomplished. I don't know... like the responses I got from my current therapist, it smacks a little of an elite group reluctant to police itself (much like state boards of medicine), and a lot of *ss-covering. But what do I know. I'm only the lifelong sufferer of a disorder or disorders whose diagnostic criteria keep shifting and depend on the education, background, and training of the assessor...

As a professional this material was all very familiar but packed into a dense but easy to read and concise format. I would definitely recommend to anyone who wants a crash course into basic information about trauma.

Concise.I read it in 30 minutes and plan to re-read many times as reference.I'm so grateful to have found this book!I feel empowered and just a bit more motivated to move forward with this journey of healing.I have so much praise for the author's ability to reach me with his style of writing and apparent knowledge. Many Thanks.This is just a starting point book for me and I really found it so helpful with it's simple format.You won't regret purchasing this book.

This book is absolutely incredible. It’s very simply and clearing explains the basic ins and outs of complex trauma. It will help anyone who has been through trauma better understand themselves and maybe even help guide steps if healing is needed. Highly recommend.

Five-star work designed for lay readers (including family members) from the esteemed author or co-author of Guidelines for the Treatment of Adults Abused or Possibly Abused as Children (1997), Treatment of Complex Traumatic: A Sequenced, Relationship-Based Approach (2012), and Treating Complex Post-Traumatic Stress Disorder in Children and Adolescents (2013). (Courtois is also the Treatment Director at six of the top residential clinics for complex post-traumatic stress disorder in the US.) Her grasp of ALL the issues is thorough and understandable. As of early 2018, it is hard to think that anyone else -- including Briere, Ogden, van der Kolk or Walker -- has boiled it all down to anything like this, though once finished with this easy-to-read, 112-pager, one will do well to look into them all.

This book helped me so much to understand and work through my early (childhood) and later (boyfriends, husbands, lovers and friends) traumas. One thing she said that repeats often in my mind. I am one of the lucky ones. The unlucky ones are mentally ill, hospitalized, alcoholics / addicts, in jail or prison, or dead. I have come out the other side (mostly) to the point at which I can write a self-help book of my own (Catherine, Karma and Complex PTSD. I highly recommend this book to those who still suffer.

I am a Therapist and I give this to my Clients to educate them and help them understand that their suffering is normal and their behavior makes sense. It is a segway into deeper work. I have bought several copies. I love this book. It simplifies Complex PTSD.

Well written, not overly technical.informative. Breaks down concepts in a way a layperson can understand. Gives an overview of current treatments available.

I found the book to be easy to navigate. The manner of the content made each subject transparent, for even a lay person.

A well written summary and backed up by research but too simple and a bit repetitive. If you want more detail and greater explanation, I would recommend Courtois and Ford "Complex Trauma"

This is a very thorough, yet easy, read on the issues facing trauma survivors. Bravo! I have now ordered other books about treating complex trauma written by Christine Courtois because this was such a great reference tool.

Very useful book. I have read many books on the subject and this one is very comprehensive. I recommend it certainly.

Amazing book. A God sent.