Working with Complex Trauma from a Therapist's Perspective

I am a clinical psychologist licensed in Australia with over 20 years of experience.

Throughout my career, I have worked in the area of complex trauma, including working with

children affected by trauma and child protection issues, as well as adults who experienced

severe developmental trauma in childhood. This writing serves as a reflection of my years of

practice. Over time, I have been fortunate to receive training in specialized therapeutic

models, such as Somatic Experiencing Therapy, EMDR, and Structural Dissociation Model

(work with part of self), which greatly complement my work with individuals who have

experienced complex trauma.

When I take on a client, it is not the complexity of their presentation that determines my

decision, but rather whether there is a match between how I work and where the client is in

their therapeutic process. Based on my experience, clients tend to progress better in therapy

and work through their issues when they have the capacity for emotional regulation, strong

external support that preferably involves a felt sense of being attached to someone safe, and a part of them that can function despite the chaos they have experienced.

Research shows that no single therapeutic model—such as CBT, EMDR, somatic therapy, or

IFS—fully addresses complex trauma. Effective treatment often requires a combination of

approaches tailored to the individual. The Blue Knot Foundation recommends integrating

both bottom-up(physiological and somatic) and top-down (cognitive and emotional)

methods. The National Institute for Health and Care Research calls for further research to

determine the most effective therapy combinations, highlighting, that while existing therapies

are helpful, they are not universally effective.

Fundamental skills for therapists working in this area include the ability to process trauma using approaches like EMDR, somatic therapy, and CBT in a titrated, safety-focused manner; maintaining client stability without fragmentation; and working with fragmented parts of the self when necessary. My training as a somatic therapist has helped me stay grounded and support clients in reconnecting with their bodies to process trauma within the nervous system. Trauma impacts the nervous system profoundly, and therapy involves working to heal these effects.

When working with complex trauma, clients may present with a fragmented sense of self,

often requiring skills in Parts-based Therapy model work, such as Internal Family Systems,

Inner child or Structural Dissociation Models. Therapy for complex trauma is not a quick

process and can range from a few sessions to long-term work, depending on the client's goals and readiness for change. Realistic expectations about therapy duration are essential for both therapist and client.

References

• Blue Knot Foundation. (n.d.). Trauma-specific practice when working with complex trauma. Retrieved from: https://professionals.blueknot.org.au/resources/trauma-specific-practice-when-working-with-complex-trauma/

• National Institute for Health and Care Research. (n.d.). Mental health problems and complex trauma: effective therapies identified. Retrieved from: https://evidence.nihr.ac.uk/alert/mental-health-problems-complex-trauma-effective-therapies-identified/