Most effective types of therapy for CPTSD?
February 5, 2023 12:17 AM   Subscribe

That attract the fewest number of quacks, voyeurs, cons, or abusers? My SO needs a therapist. He’s had some strange experiences with therapists in the past. The person needs to be effective and someone he can trust.

CPTSD isn’t in the DSM, so the evidence base really only speaks to PTSD, which relates to single events. The gold standard for that is various forms of CBT and/or exposure therapy. From what I’ve read in peer groups, many people hate this approach and feel worse off after the fact. Many complain that therapists lacking real experience are attempting it and actually harming people. Seems inappropriate for complex childhood trauma tbh.

I have seen mention of psychoanalytic approaches, which also makes sense if key schema are being reworked. However some practitioners in this world make mention of creepy shit like “trance”. Really I mean that is a situation ripe for abuse of power…. My SO experienced this once with a hypnotist he saw for smoking cessation. No to anything close to that.

Have seen EMDR mentioned, how effective is it really? “Parts” therapy? What else?

How do you find GOOD, well trained, TRULY trauma informed therapists who do this? Affordably? In Toronto (or Ontario)?

He’s been burned MANY times by crappy therapists, his trust is floor level, his need is stratospheric. I also have heavy reservations about therapists so maybe as his partner and sometime advocate I’m inclined to suggest more caution than others might. (I did study psychology myself, but had less than zero interest in clinical psych. Saw therapists for GAD/social anxiety, was never helped, by therapy anyway).

Currently he’s compulsively revisiting awful memories and frustrations with me, at length. And can’t resolve being NC with his very confusing family. Is also very committed to “standing up for himself” which sometimes goes a bit too far or in the wrong contexts imo, ultimately alienating him from more people. Just imo. I am certainly out of my depth and he needs actual assistance, urgently.
posted by cotton dress sock to Human Relations (17 answers total) 14 users marked this as a favorite
I don’t Know how you can avoid bad therapists other than trying them and quitting if you don’t like them. It’s also hard to do this in a way that (for me) is affordable. I feel like, you need to buy the main books (like Peter Walker’s) and sign up for an actual yoga (or tai chi/qui gong) course, and find a therapy that works so that the trauma becomes integrated. It takes a long time and for me it feels expensive. I guess the alternative is educating yourself a lot (you’ll have to do this anyway) and trying to do it alone but I think that’s hard with traumatic stress. I can tell you that the program at the hospital near me gave me their weekly inpatient program schedule and it had Nordic walking, qui gong, therapy, group therapy, art therapy, body based psychology, social skills/competence, and a few other things.
posted by pairofshades at 1:45 AM on February 5 [1 favorite]

Interview therapists maybe? I found mine by recommendation, but I was positively impressed by how her profile included work with Adult Children of Alcoholics and Dysfunctional families, treatment of addiction, experience with adolescents (all of which indicate experience with trauma work), and an integrated approach with elements of CBT but not concentrating on it to the exclusion of all else. It allowed her to help me reintegrate my traumatic memories and at the same time learn techniques on how to manage resurgences and panic attacks.
posted by I claim sanctuary at 2:55 AM on February 5 [2 favorites]

I’d say ACT (Acceptance and Commitment Therapy), DBT (Dialectic Behavior Therapy), Internal Family Systems (I think this is what you meant by Parts Work, and yes it can be so deeply helpful), and especially EMDR (yes, it’s real and truly revolutionary. The evidence is clear, you can look up tons of peer-reviewed research. Its as good as it sounds).

I’d avoid straight CBT like my life depended on it.
posted by asimplemouse at 3:16 AM on February 5 [9 favorites]

EMDR and Parts therapies, in my experience, are an excellent and effective modality for C-PTSD. It's what I'm currently doing myself, and I've seen truly dramatic shifts over the past year. I've gone to several other therapy types but this combo seems to work the best.

Finding the right therapist is trial and error, unfortunately. If you can't find any personal referrals, you can start looking at Yelp reviews in your area. Psycholoday Today maintains an online directory of practitioners but I'm not sure they extend into Canada.

Best of luck.
posted by ananci at 5:44 AM on February 5 [5 favorites]

I have been in the same situation for decades. I don't even remember how many unsuitable therapists I have seen.

A few years ago, I was in a garrison town, and for the first time had a therapist who was helpful, and she suggested I seek help for PTSD at a hospital. Now I have been an out-patient at a special clinic for PTSD for a year and a half, where I am treated by a whole team with different specialities, and I am recovering! They are absolutely addressing the C-part, the complexity of my trauma, though it started with the single event.

It was really difficult to get the diagnosis and the treatment, and its probably the same in Canada, but I wrote to a psychiatry helpline, and they helped me.
posted by mumimor at 6:17 AM on February 5 [2 favorites]

Parts/IFS depends on his tolerance for people saying things like "let me talk to your defender part." (I may have the language wrong because I find IFS culty and baffling.)
posted by less-of-course at 6:27 AM on February 5 [4 favorites]

I interview them. Education, preferred methods, how active/passive are they, etc. I ask if they're a feminist and the answers are revealing, because some people have never asked themselves this, or get very rattled. I am not looking for feminist therapy, if that's still a thing, but I want to work with someone who grasps feminism and identifies. To some extent, the specific answers are important, but the person will reveal themselves if you have a few non-standard probing questions.

I'd look for a PhD Psychologist.

In the US, there's a shortage of therapists. Many don't even return phone calls or emails. It's appalling. It's great that he has you to help make calls, etc.
posted by theora55 at 7:24 AM on February 5 [1 favorite]

Try the Centre for Psychotherapy and Training:

I used them several years ago to find a therapist. That was my first time in therapy. I had an intake session with a faculty member then was "matched" with a student therapist. If I didn't like that therapist, I could ask to be matched again. I ended up working with my therapist for a few years.

A friend sees this therapist and says she's very good: (not very affordable though...)
posted by foxjacket at 9:10 AM on February 5 [2 favorites]

EMDR. Really does work well for many, many people.
posted by saucysault at 9:25 AM on February 5 [4 favorites]

nthing EMDR. I can't say enough good things about it. Took a few sessions to work through what took years in talk therapy (not knocking talk therapy in the least, it's all important) Feel free to DM me for more information.
posted by Sreiny at 10:31 AM on February 5 [4 favorites]

Response by poster: Thank you, everyone. So much.

Just wanted to add that it’s apparent that he also just needs to make sense of what happened and his relationships with his family members today, in addition to addressing intrusive thoughts and rumination. (Plus, trust with non family members, just regular people, and standing up for yourself vs being assertive and preserving friendships, that kind of thing. and grief.)
posted by cotton dress sock at 11:47 AM on February 5

As I've heard it explained by the People at the Top, CBT is the gold standard because the gatekeepers for research funding tend to be CBT faithful. So, it is very hard to get major research for other methodologies (besides imaging/genetics) at the federal level. CBT is also the primary methodology taught at the master's level, so that inexperienced schmo that your partner probably got at a public clinic was probably thrown in way over their depth with a little CBT and "good luck!"

IAAT. IANYT. EMDR, IFS (culty AND good), ego state, polyvagal, psychoanalytic, and hypnosis are all good interventions for trauma. There is the ongoing discussion of whether EMDR is good for chronic trauma, etc. I have to say that, given the state of the art, don't be picky. I've heard good things about ACT and CPT, but both of them are systematized like CBT, so not my cup of tea.

For what you are describing, I would strongly recommend psychoanalytic or heavily psychodynamic therapy, maybe group therapy to warm up to building trust among peers.
posted by executive_dysfuncti0n at 12:19 PM on February 5 [4 favorites]

I'd also like to put in a word for the trite but convincing truism that the fit matters a lot more than the school. This is not the MOST wonderful advice because it's much harder to find a good fit than it is to find someone who does a particular kind of therapy.
posted by less-of-course at 2:11 PM on February 5 [1 favorite]

anecdotal, but a year of regular "parts" therapy (IFS) did not work at all for my CPTSD
posted by CancerSucks at 3:03 PM on February 5 [1 favorite]

EMDR is really remarkable for cptsd. I think in terms of steering clear of woo, honestly you will get that with any modality. You just have to interview people and see if you click. EMDR is very nice also for the understanding of what happened part, because it somehow lets you work through things in a way that allows for sudden insight.
posted by Bottlecap at 4:46 PM on February 5 [1 favorite]

Nthing EMDR and will add, as a bonus, that EMDR requires that therapists undergo significant training/many hours of practice which means that any certified EMDR therapist is someone with more training (and the discipline to seek additional training) than a “standard” therapist.

Will also put in a plug for trauma-informed yoga and other somatic and bodywork techniques - definitely interview practitioners and check credentials but many providers offer a combo of talk therapy and bodywork/somatic/yoga and these combos can be very effective for CPTSD.

Best of luck to your partner!
posted by sleepingwithcats at 8:28 AM on February 6 [1 favorite]

How do you find GOOD, well trained, TRULY trauma informed therapists who do this? Affordably? In Toronto (or Ontario)?

Disclaimer: I am not a Canadian, but the approach I used in my country was to find a professional organisation dedicated to training/certifying therapists, then contact their members. Make sure you ask them if they know other therapists who have vacancies and would be suited to helping you, even if they themselves have no more room for another client. That's how I found my current therapist and it sped up my search a lot.

A quick Google search found this association, EMDR Canada:

EMDR is likely the most accessible form of trauma therapy you can find; a lot of large research bodies support its effectiveness and more and more people are training in it. Anecdotally, it has had much, much better results than talk therapy for my CPTSD.
posted by wandering zinnia at 12:37 PM on February 7 [1 favorite]

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