Treating complex trauma: critical interventions with adults who experienced ongoing trauma in childhood

Complex trauma (CT) most often results from exposure to severe stressors that begin in childhood or adolescence, occur repeatedly, and take place within the caregiver system. Typically, CT involves repeated incidence of maltreatment over an extended period of time (i.e., months or years) that includes emotional abuse, physical abuse, sexual abuse, neglect, and witnessing family violence. These individuals experience lifelong difficulties related to self-regulation, relationships, psychological symptoms, alterations in attention and consciousness, self-injury, identity, and cognitive distortions. This article focuses on a limited number of interventions related to three clinical issues that are central in treating individuals exposed to CT: alliance repair, developing reflective functioning, and motivational enhancement. Each clinical issue and accompanying interventions includes (a) theoretical foundation and mechanism of change, (b) example verbatim clinical interchanges, and (c) supportive research.