If you’re working through your trauma wounds with the help of psychotherapy, there’s a chance you’re going to be told at some point that “exposure” is part of the process.
For a long time, various exposure-based treatments were a centerpiece of working with PTSD.
The reason for that is, PTSD was originally thought of as primarily a “disorder” of avoidance: we were hurt or terrified by a thing, so our nervous system got in the habit of avoiding that thing.
The solution, it was thought, was to teach trauma survivors how to re-engage with the thing they were so hurt by, the thing they learned to avoid. That is to say: to expose them to it.
To this day, “prolonged exposure” is a centerpiece of the Veterans Administration PTSD treatment protocol.
Here’s the thing about “exposure” as a tool for working with trauma: it relies, in my opinion, on a very one dimensional view of how trauma impacts survivors.
And exposure based treatments definitely were not designed with COMPLEX trauma or dissociation in mind— in fact, in my experience “exposure” can make CPTSD or dissociative disorders exponentially worse.
Yes, it’s true that one of the common symptoms of PTSD is avoidance.
But the trauma responses associated with CPTSD go much deeper than old-school formulations of PTSD acknowledge.
Whereas PTSD tends to evoke reactions to what traumatized us, CPTSD tends to f*ck with our thoughts, feelings, and beliefs— about the world, about other people, but most notably, about ourselves.
One of the most frustrating things ABOUT CPTSD is the fact that many of our trauma responses may not seem to have ANYTHING to do with what traumatized us— which, by the way, we may not even remember, due to how CPTSD tends to “Swiss cheese” our memory.
You don’t change important beliefs through exposure.
And if a survivor is dissociative— as almost all CPTSD survivors are, either a little or a lot— exposure based treatments are highly likely to just kick on those dissociative defenses.
Oh, you may get a “part” out front that can pretend the exposure therapy was a great success.
But what’s actually happened is, the complex trauma wound has been deepened.
I’ve told you all that to tell you this: there IS no one-size-fits-all, “gold standard” treatment for trauma, especially CPTSD.
Your trauma recovery blueprint has to be integrative and individualized.
And before you proceed with ANY modality of treatment from ANY provider, look it up. Know the assumptions that modality makes, the theory of change that modality embraces— and the risks associated with that modality.
I want the telltale sign that a trauma survivor has read my blog or page to be the fact that they are HELLA informed about their options and tools.
Even if that annoys some providers. (Sorry, not sorry.)
Use Your Damn Skills 