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“Beneath the surface of the protective parts of trauma survivors there exists an undamaged essence, a Self that is confident, curious, and calm, a Self that has been sheltered from destruction by the various protectors that have emerged in their efforts to ensure survival. Once those protectors trust that it is safe to separate, the Self will spontaneously emerge, and the parts can be enlisted in the healing process”
― Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

“The happy family is a myth for many.”
― Carolyn Spring

“Eighty two percent of the traumatized children seen in the National Child Traumatic Stress Network do not meet diagnostic criteria for PTSD.15 Because they often are shut down, suspicious, or aggressive they now receive pseudoscientific diagnoses such as “oppositional defiant disorder,â€� meaning “This kid hates my guts and won’t do anything I tell him to do,â€� or “disruptive mood dysregulation disorder,â€� meaning he has temper tantrums. Having as many problems as they do, these kids accumulate numerous diagnoses over time. Before they reach their twenties, many patients have been given four, five, six, or more of these impressive but meaningless labels. If they receive treatment at all, they get whatever is being promulgated as the method of management du jour: medications, behavioral modification, or exposure therapy. These rarely work and often cause more damage.”
― Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

“Many survivors of relational and other forms of early life trauma are deeply troubled and often struggle with feelings of anger, grief, alienation, distrust, confusion, low self-esteem, loneliness, shame, and self-loathing. They seem to be prisoners of their emotions, alternating between being flooded by intense emotional and physiological distress related to the trauma or its consequences and being detached and unable to express or feel any emotion at all - alternations that are the signature posttraumatic pattern. These occur alongside or in conjunction with other common reactions and symptoms (e.g., depression, anxiety, and low self-esteem) and their secondary manifestations. Those with complex trauma histories often have diffuse identity issues and feel like outsiders, different from other people, whom they somehow can't seem to get along with, fit in with, or get close to, even when they try. Moreover, they often feel a sense of personal contamination and that no one understands or can help them. Quite frequently and unfortunately, both they and other people (including the professionals they turn to for help) do misunderstand them, devalue their strengths, or view their survival adaptations through a lens of pathology (e.g., seeing them as "demanding", "overdependent and needy", "aggressive", or as having borderline personality).

Yet, despite all, many individuals with these histories display a remarkable capacity for resilience, a sense of morality and empathy for others, spirituality, and perseverance that are highly admirable under the circumstances and that create a strong capacity for survival. Three broad categories of survivorship, with much overlap between them, can be discerned:

1. Those who have successfully overcome their past and whose lives are healthy and satisfying. Often, individuals in this group have had reparative experiences within relationships that helped them to cope successfully.
2. Those whose lives are interrupted by recurring posttraumatic reactions (often in response to life events and experiences) that periodically hijack them and their functioning for various periods of time.
3. Those whose lives are impaired on an ongoing basis and who live in a condition of posttraumatic decline, even to the point of death, due to compromised medical and mental health status or as victims of suicide of community violence, including homicide.”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“The act of consciously and purposefully paying attention to symptoms and their antecedents and consequences makes the symptoms more an objective target for thoughtful observation than an intolerable source of subjective anxiety, dysphoria, and frustration. In ACT, the act of accepting the symptoms as an expectable feature of a disorder or illness, has been shown to be associated with relief rather than increased distress (Hayes et al., 2006). From a traumatic stress perspective, any symptom can be reframed as an understandable, albeit unpleasant and difficult to cope with, reaction or survival skill (Ford, 2009b, 2009c). In this way, monitoring symptoms and their environmental or experiential/body state "triggers" can enhance client's willingness and ability to reflectively observe them without feeling overwhelmed, terrified, or powerless. This is not only beneficial for personal and life stabilization but is also essential to the successful processing of traumatic events and reactions that occur in the next phase of therapy (Ford & Russo, 2006).”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“I look around and think: Good God, what kind of hell is this?”
― Chil Rajchman, The Last Jew of Treblinka

“Trust of others is in short supply for many adult survivors, as complex trauma generally involves major relational betrayal. It is, therefore, expectable (although paradoxical) that clients with these histories are predisposed to be mistrustful at the outset of therapy, precisely because of (and in proportion to) the actual trustworthiness of the therapist. When past experiences have thought hard lessons, namely, that one can least afford to trust the people who should be most trustworthy, it stands to reason that confusion about trust results. The therapist must understand and not take offense either personally or professionally and not react judgmentally or defensively. Practically speaking, this involves the therapist being prepared to patiently and empathically respond to active or passive tests or challenges to trustworthiness as legitimate and meaningful communication that deserves a respectful reply in action as well as in words.”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“... every therapist must develop enough personal maturity, clinical wisdom, and capacity for good judgment to effectively and safely conduct psychotherapy, an imperative that is especially important in the treatment of this population. The emotion dysregulation and insecure and disorganized attachment of complex trauma clients elicit strong emotional reactions from others, even those in their support network, including therapists. Reactions can range from sympathy, sorrow, fear, and guilt to frustration, impatience, anger/rage, hostility, and disgust or contempt.”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“... the silent client may be experienced as withholding, oppositional, and sulking or as holding the therapist "hostage" in ways that elicit resentment and other negative responses. Because it is not unusual that relational and other forms of traumatization began when the client was preverbal, he or she may not have words. The lack of access to emotions or to words to describe them is known as alexithymia and is a common response to trauma. What the client is likely to have instead is somatosensory, behavioral, dissociative, and relational manifestations that therapists must seek to understand and translate into words, a process that involves hard work and intense focus.”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“... as Herman (1992b) cogently noted two decades ago, these personality disorders can be iatrogenic, causing harm to individuals as an inadvertent result of the social stigma they carry and the widespread (but not entirely accurate) belief among professionals and insurers that those with Cluster B personality disorders (especially borderline personality disorder[BPD]) cannot be treated successfully, cannot recover, and are a headache to practitioners. For example, the BPD diagnosis continues to be applied predominantly to women often, but not always, in a negative way, usually signifying that they are irrational and beyond help. Describing posttraumatic symptoms as a personality disorder not only can be demoralizing for the client due to its connotation that something is defective with his or her core self (i.e., personality) but also may misdirect the therapist by implying that the patient's core personality should be the focus of treatment rather than trauma-related adaptations that affect but are distinct from the core self. In this way, both therapists and their clients may overlook personality strengths and capacities that are healthy and sources of resilience that can be a basis for building on and enhancing (rather than "fixing" or remaking) the patient's core self and personality.”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“The overarching principle of a therapeutic relationship is that therapists should be ever mindful of a variant of the Hippocratic oath and, to the degree possible, strive to "do no more harm" (Courtois, 2010). Complex trauma clients have already experienced considerable harm, much of it at the hands of other human beings. As a result of the ubiquitous processes of transference, attachment styles, and IWM [Internal working models], these clients often view the therapist's behavior and their relationship through the lens of their trauma-related negative interpersonal expectancies and unhealed emotional wounds and injuries. Therapists should not be surprised to be "guilty until proven innocent", not because clients with complex trauma histories are "unfair" or "unreasonable" but precisely the opposite - because the most realistic self-protective stance for them (given the fact that betrayal and harm have been more the rule than the exception) is to "distrust first and verify" (or to be hypervigilant) rather than to start with an expectation of safety and trustworthiness.”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“Children who are scapegoated in families are in reality victims of abuse and neglect â€� Yet this is rarely recognized by those working in our Mental Health systems, Family Courts, or Educational systems. Because scapegoating processes can be subtle, many scapegoated adult survivors fail to realize that they have suffered from psycho-emotional abuse growing up, and even their therapist or counselor might miss the signs and symptoms associated with being in this most devastating dysfunctional family role.”
― Rebecca C. Mandeville, Rejected, Shamed, and Blamed: Understanding Family Scapegoating Abuse

“Thus polyvictimization or complex trauma are "developmentally adverse interpersonal traumas" (Ford, 2005) because they place the victim at risk not only for recurrent stress and psychophysiological arousal (e.g., PTSD, other anxiety disorders, depression) but also for interruptions and breakdowns in healthy psychobiological, psychological, and social development. Complex trauma not only involves shock, fear, terror, or powerlessness (either short or long term) but also, more fundamentally, constitutes a violation of the immature self and the challenge to the development of a positive and secure self, as major psychic energy is directed toward survival and defense rather than toward learning and personal development (Ford, 2009b, 2009c). Moreover, it may influence the brain's very development, structure, and functioning in both the short and long term (Lanius et al., 2010; Schore, 2009).

Complex trauma often forces the child victim to substitute automatic survival tactics for adaptive self-regulation, starting at the most basic level of physical reactions (e.g., intense states of hyperarousal/agitation or hypoarousal/immobility) and behavioral (e.g., aggressive or passive/avoidant responses) that can become so automatic and habitual that the child's emotional and cognitive development are derailed or distorted. What is more, self-integrity is profoundly shaken, as the child victim incorporates the "lessons of abuse" into a view of him or herself as bad, inadequate, disgusting, contaminated and deserving of mistreatment and neglect. Such misattributions and related schema about self and others are some of the most common and robust cognitive and assumptive consequences of chronic childhood abuse (as well as other forms of interpersonal trauma) and are especially debilitating to healthy development and relationships (Cole & Putnam, 1992; McCann & Pearlman, 1992). Because the violation occurs in an interpersonal context that carries profound significance for personal development, relationships become suspect and a source of threat and fear rather than of safety and nurturance.

In vulnerable children, complex trauma causes compromised attachment security, self-integrity and ultimately self-regulation. Thus it constitutes a threat not only to physical but also to psychological survival - to the development of the self and the capacity to regulate emotions (Arnold & Fisch, 2011). For example, emotional abuse by an adult caregiver that involves systematic disparagement, blame and shame of a child ("You worthless piece of s-t"; "You shouldn't have been born"; "You are the source of all of my problems"; "I should have aborted you"; "If you don't like what I tell you, you can go hang yourself") but does not involve sexual or physical violation or life threat is nevertheless psychologically damaging. Such bullying and antipathy on the part of a primary caregiver or other family members, in addition to maltreatment and role reversals that are found in many dysfunctional families, lead to severe psychobiological dysregulation and reactivity (Teicher, Samson, Polcari, & McGreenery, 2006).”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“...some adolescent survivors describe feeling special, powerful, and sometimes entitled. This is especially true of those for whom excessive attention was part of the abuse relationship by virtue any power they held over the abuser or members of the family - especially their mothers in some cases of father-daughter incest - and of any affection or sexual pleasure they experienced. All of these feelings can coexist with self-loathing and shame or might alternate with them. Some victims experience this power as personally affirming, resulting in feelings of grandiosity, whereas others believe themselves to be malignantly powerful and defective. As children, these victims may have developed the belief that they could willfully manipulate others and "make or break" the family or their peer group (or the broader community setting) with their terrible powers or the secrets they hold. In adolescence these largely implicit ideas no longer manifest mainly or only as the egocentrism associated with early childhood. A more pervasive form of narcissistic entitlement and power and an apparently callous indifference to and contempt for others can lead to conduct disturbances and the victimization of others. Many individuals with apparent sociopathic tendencies and conduct disorders were victimized as children. Such individuals at some point had the capacity for respect, empathy, and genuine social responsibility that was lost and corrupted in the struggle to survive, to make sense of, and to remove themselves from the receiving end of victimization. Identification with the perpetrator and the victimization of others is specifically included as a core feature of complex PTSD.”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“Therapy must begin with empathy - not a patronizing sympathy, but instead one that is unflinching (Marotta, 2003). Empathy of this sort is highly attuned to the client, no matter the circumstance. The therapist strives to "travel in the client's shoes" or to "view the world from the client's perspective" in order to really understand his or her emotions, cognitions, and beliefs - in short, to understand from the perspective of the other (Wilson & Thomas, 2004). Treatment involves understanding that a client's defeatist and apparently helpless, disempowered, or "masochistic" perspectives can be a logical outgrowth of formative traumatic experiences and, further, may be highly creative means of self-protection. The therapist must not attempt to undo or "make up for" past abandonment or betrayals by their client's caregivers or in their close relationships, but instead first understand the client's perspective and approach to the world, while working to provide alternative perspectives on both past and present that promote change.”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“If the therapist understands and does not take mistrust as personal affront, the therapeutic relationship can evolve gradually. The client can begin to recognize that the therapist actually "gets" why he or she is initially skeptical, self-protective, or "realistically paranoid" and does not pressure the client to be a "happy camper" but instead works to earn trust by being honorable, reliable, and consistent. This also implies a view of the client's initial mistrust as expectable in light of the client's history - that is, as a strength rather than as a deficiency or pathology.”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“With regard to complex trauma survivors, self-determination and autonomy require that the therapist treat each client as the "authority" in determining the meaning and interpretation of his or her personal life history, including (but not limited to) traumatic experiences (Harvey, 1996). Therapists can inadvertently misappropriate the client's authority over the meaning and significance of her or his memories (and associated symptoms, such as intrusive reexperiencing or dissociative flashbacks) by suggesting specific "expert" interpretations of the memories or symptoms. Clients who feel profoundly abandoned by key caregivers may appear deeply grateful for such interpretations and pronouncements by their therapists, because they can fulfill a deep longing for a substitute parent who makes sense of the world or takes care of them. However, this delegation of authority to the therapist can backfire if the client cannot, or does not, take ownership of her or his own memories or life story by determining their personal meaning.Moreover, the client can be trapped in a stance of avoidance because trauma memories are never experienced, processed, and put to rest. Helping a client to develop a core sense of relational security and the capacity to regulate (and recover from) extreme hyper- or hypoarousal is essential if the client is to achieve a self-determined and autonomous approach to defining the meaning and impact of trauma memories, a crucial goal of posttraumatic therapy.”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“The development of a working alliance is crucial because it addresses a psychic phobia associated with relationships that is common in complex trauma clients. As we discussed, when primary relationships are sources of profound disillusionment, betrayal, and emotional pain, any subsequent relationship with an authority figure who offers an emotional bond or other assistance might be met with a range of emotions, such as fear, suspicion, anger, or hopelessness on the negative end of the continuum and idealization, hope, overdependence, and entitlement on the positive. Therapy offers a compensatory relationship, albeit within a professional framework, that has differences from and restrictions not found in other relationships. On the one hand, the therapist works within professional and ethical boundaries and limitations in a role of higher status and education and is therefore somewhat unattainable for the client. On the other, the therapist's ethical and professional mandate is the welfare of the client, creating a perception of an obligation to meet the client's needs and solve his or her problems. Furthermore, the therapist is expected to both respect the client's privacy and accept emotional and behavioral difficulties without judgment, while simultaneously being entitled to ask the client about his or her most personal and distressing feelings, thoughts and experiences. Developing a sense of trust in the therapist, therefore, is both expected and fraught with inherent difficulties that are amplified by each client's unique history of betrayal trauma, loss, and relational distress.”
― Christine A. Courtois, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach

“Adult survivors of family scapegoating abuse have historically been diagnosed with one or more mental health conditions that ignore the trauma symptoms they are regularly experiencing. Rarely will their most distressing symptoms be recognized as Complex post-traumatic stress disorder (C-PTSD) secondary to growing up in an unstable, non-nurturing, dangerous, rejecting, or abusive family environment.”
― Rebecca C. Mandeville, Rejected, Shamed, and Blamed: Help and Hope for Adults in the Family Scapegoat Role

“How about that. My struggles with C-PTSD made me more empathetic. They made me more attuned to what people needed and uniquely skilled in comforting them.

Even the negative parts of my C-PTSD had a silver lining. It was true that when Joey was angry or upset, I had a hard time sitting with his pain and never let him sulk in peace. Instead, I'd nag and badger him until he told me exactly what was up. Once, fed up with me pawing at him like a squirrel analyzing a nut, he yelled, "Can't you just say, 'Hear you, that sucks' instead of trying to solve all of my problems? Not everything needs solving!"

But days afterward, once he was feeling better, Joey often thanked me. "In the end, because you pester me, I tell you things I don't tell anyone else. And then the talks we have about my feelings change me for the better," he told me. "Nobody makes me feel cared for as much as you do."

I wasn't loved in spite of my C-PTSD--but in part, because of it.”
― Stephanie Foo, What My Bones Know: A Memoir of Healing from Complex Trauma

“As we follow and respond, our people have the opportunity to teach us about the intricacies of our multigenerational inner world and the processes that can heal at such a deep level.”
― Bonnie Badenoch, The Heart of Trauma: Healing the Embodied Brain in the Context of Relationships

“It was not until I did my family genogram as part of my Masters in Counseling Psychology training that I learned of some of the devastating, traumatic events that had impacted my family-of-origin. Many genograms my clients have done as part of their family systems exploration reveal sudden, unexpected deaths (including suicides); illness; stillbirths; divorce; abandonment; 'missing' relatives'; and profound financial setbacks and losses.”
― Rebecca C. Mandeville, Rejected, Shamed, and Blamed: Understanding Family Scapegoating Abuse

“Was it more demoralizing to be belittled or simply ignored?”
― Stephanie Foo, What My Bones Know: A Memoir of Healing from Complex Trauma

“The thing you left doesn't forget.”
― Stephanie Foo, What My Bones Know: A Memoir of Healing from Complex Trauma

“Do you know the difference between pain and suffering?

Pain is about feeling real, appropriate, and valid hurt when something bad happens. Suffering is when you add extra dollops to that pain. You're feeling bad about feeling bad.

So getting rid of suffering means you're not adding to the pain. You appropriately felt awkward and uncomfortable and regretful that that dinner party didn't go well. You appropriately feel annoyed and angry at one of your friends who is being prissy. You're just accepting of it all. And if the feeling stays, you ask, okay, why is this feeling still in me? And then, assume that there's incredible wisdom in your intuitions and just start listening to them. What is this? What is this thing in my body right now? What are you trying to teach me?”
― Stephanie Foo, What My Bones Know: A Memoir of Healing from Complex Trauma

“Love is not a finite resource, something you have to mete out carefully like a package of Oreos. Instead, providing love begets more love, which begets more and more love.

To my friends: Even in my loneliest, most painful moments, it was your love that shone through the dark. Your love kept me alive. Your love raised me. When I let your love in, it made me better. It taught me how to slowly become kinder and gentler, and then, as love tends to do, it multiplied and blossomed and taught me how to love myself, and how to love others.”
― Stephanie Foo, What My Bones Know: A Memoir of Healing from Complex Trauma

“Most people would feel bad about this. But your C-PTSD means that you especially value stability and reliability. It's okay to have these needs. They're not out of control. They are a part of you and it's okay for you to make them known. If he can adapt to meet your needs, then he's a decent dude! If it freaks him out, good riddance to him.”
― Stephanie Foo, What My Bones Know: A Memoir of Healing from Complex Trauma

“ACEs research has shown that more than 66% of the population, regardless of income, have experienced at least one ACEs, and nearly 25% have experienced three or more. I had eight ACEs by the time I was twelve.”
― Demarra West, Me Too: A Therapist's Journey to Heal, Find Liberation, & Joy

“Her smile was brittle. "Well, I know Kieran's achieving something if someone like you is willing to be in a relationship with him."
"Someone like me?"
She gestured to me from head to toe. "Respectable. Elegantly dressed, if a little flamboyant with color. Beautiful manners, well-spoken. Clearly you listened to your parents when they told you how to behave."
I choked back a snort at the thought of my biological father being Mr. Manners. The sheer audacity of it.
"Kieran probably hasn't told you about all the times we had to get him out of trouble," she continued.
I blinked, confused. "No."
She ticked off on her fingers as she spoke. "He skipped classes, he stole money out of my wallet, he crashed our cars more than once. Not to mention the drinking, my God. He couldn't hold his liquor at all. We were so ashamed."
I held back my eye roll. It was like having a conversation with a steamroller. As she continued to list Kieran's crimes, I realized that she relished this monologue, all the ways he'd done them wrong. Like she never wanted him to grow up because then she'd have to stop being a martyr.
"But anyway, that's all in the past. Finally, he's become who we always wanted him to be, and we can hold our heads up."
The thought of being a source of pride to these snobby, plastic people made me want to drink ten flutes of prosecco, climb onto their dining room table, and do Amy Winehouse karaoke, Diane's advice about polish and presentation be damned. But all I needed to shock them was the truth.
"I haven't seen my father in over twenty years," I began. "As far as I know he's still the lead singer of the second-best hair metal band in Spokane. My mother's salary was for keeping herself in clothes and boyfriends. Sometimes I had to break into my piggy bank so that I could by Cup O' Noodles at 7-Eleven for my brother and me. I've made a good life in spite of my parents, not because of them. It's one of the reasons I fell in love with your son. I knew he was a survivor, too. But thank you for the compliments. Now, if you'll excuse me.”
― Sarah Chamberlain, The Slowest Burn

“I've been on the very top. I've been as happy as a man can be. I've had the greatest joys. The greatest friends. I've had victories and I've had....love. And then...something happens. You lose something or...someone or...and there it is again. I'm there again. Mother's tangled. Father's yelling. I'm ten and I'm on my damn knees. And I'm scared out of my damn mind. And feeling that, I say...I become...something, I do things....I'm not...I am myself. But I'm not what I want to be or what I should be. I'm scared. And I'll do anything to get out of the fright.”
― Tom King, Batman, Vol. 8: Cold Days