Attachment-based Phase-oriented Intervention Framework for Complex Trauma: A Psychotherapy Case Study and Reflections

Early exposure to multiple trauma has a cumulative and pervasive effect, often resulting in complex symptomatology that includes Post Traumatic Stress Disorder (PTSD), as well as a variable group of symptoms, including self-regulatory disturbances, dissociative experiences, negative view of self, and difficulties in the relational context referred to as complex-PTSD. The complex presentation calls for a nuanced understanding of the interdependent impact of trauma on neurobiology and healthy development to formulate and implement specific psychotherapeutic interventions. Here, we describe the case of a 14-year-old girl adopted at age 8, presented with severe affective dysregulation, dissociation, aggression toward her mother, and a range of self-harm behaviors, with temperamental difficulties and multiple adverse childhood experiences (ACEs) since early childhood. This case study describes the complex interactions of ACEs and their impact on child development, with key considerations for attachment-focused trauma work. The practical aspects and implications of the therapy processes that hold relevance for the management of children with complex trauma and therapist reflections are discussed.