Journal of Loss and Trauma, 11:321–335, 2006

Copyright # Taylor & Francis Group, LLC

ISSN: 1532-5024 print/1532-5032 online
DOI: 10.1080/15325020600663078

COMPLEX TRAUMA: APPROACHES TO THEORY

AND TREATMENT

WENDY IDE WILLIAMS

College of St. Rose, Albany, New York, USA

In this article on complex trauma, the author looks at how biology, attachment,
and belatedness form a core of symptoms and fragmentation in individuals who
are victims. The source of the victimization is not limited to family violence and
neglect. Wars, accidents, and disease fall into the enlarged view of ‘‘polytrauma,’’
and the emotional and physical manifestations share commonalities. The naming
and connection to a new story, the healing within the context of the therapeutic
relationship, and the nature of implicit memory are all examined as important to
the victim’s recovery and re-creation of self and soul.

Over a hundred years ago, Pierre Janet became one of the first sys-
tematic investigators of the relationship between traumatic experi-
ence and its effect on the psychopathology of a person. He saw that
a person’s vehement emotions in response to an event were caused by
the state of the person and the cognitive interpretation of the situ-
ation ( Janet, cited in van der Kolk, van der hart, & Marmar, 1996,
p. 309). Throughout the evolution of man, horrific events have
happened. Trauma is the result of people’s adaptability to their
experience of those events. Some people have developed resilience
that enables them to continue living, and some find that their social,
psychological, and biological equilibrium is damaged (van der Kolk
& McFarlane, cited in van der Kolk et al., 1996, p. 199).
The story of trauma is one of suffering that fragments the psy-
che and body’s self-defense mechanisms, leaving an individual
with a variety of difficult symptoms that may include dissociation,
arousal difficulties, anxiety, depression, and numbing (Greenberg,
1998; Herman, 1992). When exposure to a catastrophic or violent
event does not allow a person to resume living an undisrupted life,

Received 10 January 2006; accepted 12 February 2006.

Address correspondence to Wendy Ide Williams, 49 Central Ave. Ravena, NY 12143.
E-mail: wendyidewilliams@aol.com

321
322 W. I. Williams

or if the type of trauma is both repetitive and cumulative, the result

will be persistent complex manifestations that affect psychological,
social, and biological systems. Referred to as complex posttrau-
matic stress disorders, as opposed to acute stress disorders, they
exist independent of the causation situation (Newman, Orsillo,
Herman, Niles, & Litz, 1995; Roth, Newman, van der Kolk, &
Mandel, 1997; Taylor, Gordon, & Carleton; Herman, 1992).
The focus of this article is on the experience of complex
trauma that is caused by multiple factors: Family violence, includ-
ing emotional and physical abuse; witnessing and neglect; disease;
and the experience of war share common threads. Although adult
trauma that includes battering and abuse damages the adult
formed personality, the trauma that a child experiences ‘‘deforms
the personality’’ (Herman, 1992, p. 96). Most of the resources
and research used in the discussion of complex trauma here relate
to ideas and theories surrounding a subjective experience of a
negative and yet life-relearning event. Although it is helpful to clar-
ify appropriate relationships between the kinds of trauma that
cause the most distress, it is clear that anyone who has experienced
any kind of trauma due to violence in the family is at risk for long-
term sequelae. Responses to trauma have more similarities than
differences (Blank, cited in Brett, 1996, p. 130). As Rothschild
says in The Body Remembers (2000), ‘‘Trauma is a psychophysical
experience, even when the traumatic event causes no direct bodily
harm’’ (p. 5).

The Belatedness of Trauma: Symptoms and Affects

A traumatic event, even if repeated, has a place in time (Herman,

1992). There is, however, a quality of timelessness and time
stopped in a victim’s experience of that event (Greenberg, 1998).
If the activated system becomes overwhelmed from the threat
and is not successful at discharging the energy, the moment, the
memory, and the hurt become frozen in time. The bodies and
brains of traumatized people contain blueprints of the attempted
gesture to survive in the face of threat and injury (Freyd, 1994;
Levine, 2004). When faced with danger, the body and mind will
temporarily react to alarm by freezing, numbing, detaching, and
forgetting. When the defense mechanisms have been over-
whelmed, and there is a failure to restore homeostasis, the memory
 Complex Trauma 323

of that event also becomes encoded in a way that impairs cognitive

consolidation. When an organized adaptation response is not poss-
ible, mental recall also becomes persistently both intrusive and
disjointed (Siegel, 2003; van der Kolk et al., 1996).
Thus, the timelessness and frozen aspect of trauma can be
seen in ‘‘rememory’’ (Morrison, 1987, p. 36). Rememory refers
to a memory that refuses to disappear, possesses the survivor,
and at the same time reassembles outside the boundaries of time
in a confused way. When the memory reappears later, confusing
the present reality and the past as well, it becomes difficult for
the person to describe. It is this belated response to the original
experience and the subsequent return that keeps a person’s
relationship to time both fixed and fixated (Greenberg, 1998;
van der Kolk, 1994). Memories that cannot be retrieved con-
sciously, return in fragmented form at a later time, and resist inte-
gration into existing cognitive structures are traumatic memories.
(Janet, cited in van der Kolk, Hopper, & Osterman, 2001).
The ability to integrate violence, abuse, and horror in one’s
life will determine mental, functional, and behavioral outcomes.
Studies show that early social support and secure attachment
may predict these outcomes. The tragedy of trauma occurs when
these resources aren’t available (Kagan & Schlosberg, cited in
Kagan, 2004; Kinniburgh, Blaustein, & Spinnazola, 2005; van
der Kolk et al., 1996).

The Power of Attachment

To lose a symbol of attachment is to lose a part of oneself. The

irony lies in the need to attach, even if the attachment figure is per-
petrating an atmosphere of violence and abuse. The pathological
environment of childhood dysfunction and threat is not the place
of healthy development. To lose that attachment, however bleak,
is to live a life of isolation. Children who grow up in an unpredict-
able place of violence and threat live with fear and anguish, and
adapt by becoming attuned to the abuser’s inner states. Realizing
that the powerful adult figure is dangerous and unavailable, they
are in a frozen or hyperaroused state, unable to engage in social
activities that might be able to soothe them. These profoundly dis-
rupted relationships cause the child developmental nightmares as
well as alterations in his or her neurobiology (Kagan, 2004; Schore,
324 W. I. Williams

2001; Muller, Sicoli, & Lemieux, 2000). His or her preservation

depends on keeping hope and meaning as well as faith in signifi-
cant figureheads. All of the child’s adaptations serve one purpose,
and that is to preserve attachment to his or her caregivers at all
costs (Herman, 1992; van der Kolk and Cole & Putnam, cited in
van der Kolk, 2001).
A child’s emotional security and safety are impacted by the
parent’s level of distress (Papp, Cummings, & Schermerhorn,
2004). The result is severe fragmentation of self, an inability to
trust, and an altered sense of autonomy. Abused and neglected
children suffer from a diminished sense of self. Cole and Putnam
(1992) have proposed that without a complete sense of self, a per-
son cannot regulate internal states and, therefore, stress (Freyd,
1994; Levine, 2004). The sudden loss of secure attachment can
lead a child to seek any attachment. This reinforces the victim’s
attachment to the victimizer (Johnson, 1987). Many children who
are deprived of secure attachment find other figures, such as a neigh-
bor, a teacher, or a friend, who can provide a healing bond to com-
pensate for what they were missing as a younger child or infant.
Some find a bond with a psychotherapist.
Although brain maturation and regulation are affected by lack of
attachment, there are other variables that determine adaptation to
complex traumas (Rothschild, 2000). Children internalize interac-
tions with caregivers that inform the nature of their future relation-
ships. Representations of the self, known as the ‘‘working model of
the self ’’ and the ‘‘working model of the world’’ (Bowlby, 1973;
Muller, Sicoli, & Lemieux, 2000, p. 322), act as a map for interpreting
the behavior of others. The working model of the world refers to one’s
view of the other person and the ability to trust that the attachment fig-
ure can be relied on; the working model of the self reflects one’s ability
to see oneself as a loveable figure to the attachment figure. These inter-
nalizations affect future relationships. The insecure pattern of attach-
ment learned by a victim of trauma also shows problems in affect
regulation. Alternately, negative traumatic events can impact a
person’s self-concept, which can affect future relationships (Bowlby,
1980; Crittenden, 1997; cited in Muller et al., 2000, p. 39).
Profound psychological trauma in the developing child causes
a form of amnesia that manifests itself in numbing and blocking of
information and intrusive cognitions. To survive, children must not
lose their attachment to their caregiver. To do so would threaten
 Complex Trauma 325

their life, physically and mentally. Freyd (1994) suggests that in

order for these conditions to continue, a child must create a
betrayal amnesia based on the social need to continue with the
attachment. Betrayal amnesia produces conflict between social
dependence and an external reality. Loyalty to the betrayer or
caregiver requires the child to selectively admit information into
consciousness, creating an unconscious selective memory of the
event. Therefore, these selected coded thoughts and feelings are
repressed temporarily. Therein lies the concept of delayed memor-
ies (Freyd, 1994). Traumatic events may be processed through
both implicit and explicit memory systems. Since implicit memory
bypasses words, and because it is often difficult for a person to con-
struct a logical sequence of events, it is likely that traumatic mem-
ory is implicit (Rothschild, 2000). Healthy attachment to a
caregiver promotes self-regulation toward negative and positive
stimuli and mediation of stress throughout one’s life.
At all ages, secure attachment can create resiliency and help
buffer an individual against the worst effects of trauma (Herman,
1992; Kagan, 2004). People who have not had a proper mirroring
by another experience self-fragmentation and a lack of resiliency
for processing a traumatic event. In an environment that is too
unpredictable and harsh, the traumatized individual splits;
rearrangement of the self to survive the abuse results in an incohe-
sive self, an incohesive other, and an incohesive relationship with
others (Layton, 1995). Without the relationship or attachment
that comes to symbolize mutual relatedness, a person’s ability to
develop resilience is challenged. The origins of fragmentation
and traumatic stress lie in a lack of relatedness and therefore a
lack of meaning making (Widderschoven, 1999; van der Kolk,
2005). Resiliency refers to being capable of returning to an original
form.
Without relationship and mirroring, the self has no other
option than to fragment, as it cannot find its original form. Disso-
ciation and fragmentation are defenses against a world that has
been perceived as a place that offers little pleasure or integration
(Haaken, 1994). The ability to mobilize help and support, to
re-create relatedness and attachment to others and the self after a
trauma, is essential. McFarlane and Yehuda (1996) discuss the
incapacity that the victim with posttraumatic stress disorder experi-
ences. Although the ability to forge renewed relationships at this
326 W. I. Williams

time is threatened due to belatedly occurring secondary symptoms,

Layton argues that it is the trauma victim who is most likely able to
reinvent the self (1995). The paradox is that the return of the
trauma in its fragmented form will grant victims the recognition,
the witness, and the attachment that have been missing from their
experience (Greenberg, 1998).
In ending the discussion on attachment and its power, it will
be interesting to look at the slim but present concept of hope that
is implied in the reinvention of the self. In this case, a cancer sur-
vivor uses hope to transform her personal agony by relating that
trauma to the larger context of a global relationship to pain. By
doing so, she re-creates attachment to others. Kaethe Weingarten,
a Harvard University–affiliated psychologist who experienced the
trauma of three cancer diagnoses and multiple surgeries, trans-
formed her private pain by dedicating her treatments to victims
of torture. She systematically researched people and organizations
globally that were the victims of violence and abuse. Her frozen
and fragmented self was redefined with each radiation session.
During each session, she dedicated her treatments by focusing
intently on the people and organizations she had chosen to honor.
The underlying message to people who are traumatized comes
back to the power of attachment. As she says in her essay ‘‘Cancer,
Meaning Making, and Hope’’:

I have written a lot about hope (Weingarten, 2000, 2004, in press). Hope
may be a feeling, but expecting people who are sick and scared to feel
hopeful may be expecting too much. I prefer to think of hope as the
responsibility of the community. Hope is something we do together. The
latest research makes it clear that hope is essential to health (for a review,
see Groopman, 2004). This makes it even more crucial that hope be avail-
able to all, not just those few robust people who can summon hope . . . or
cockneyed optimism under the most challenging circumstances. (p. 159)

The implication is that the interlocking of integrity and trust in

caretaking relationships revives the sense of human bonding that
trauma destroys. It also suggests that in renewed connections with
people, the trauma survivor re-creates connection with others
(Herman, 1992). It also paves the way for consideration of a
rebuilding of the fragmented memory by a reattachment with
the wordless inner world that waits to be ‘‘retold.’’ ‘‘Being a
‘survivor’ has come to represent a positive, even heroic stance in
 Complex Trauma 327

surviving pernicious assaults on one’s spirit as well as one’s body’’

(Haaken, 1994, p. 139).

Finding the Meaning: The Body’s Clues, the Haunted

Mind, a New Language

In the myth of Dionysus, his body is dismembered and scattered

all over the earth. The rituals that celebrate his reunification and
re-membering in the sowing of seeds, harvest festivals, and com-
munion in drink and song tell a story of existential thought and mean-
ing making (Levine, 1999, p. 10). Trauma victims whether from
abuse or violence, will need to find rituals and narratives that can help
them navigate out of the isolation by ‘‘facing the reflecting pool that
mirrors and witnesses the event’’ (Greenberg, 1998, p. 341). Their
threatened body and mind have survived, and the story of coming
out of trauma will require safely experiencing sensations and emo-
tions, identifying with those experiences, and learning to use emo-
tions as signals (van der Kolk et al., 1996; Kinniburgh et al., 2005).
Experience is processed on three levels which are mutually
dependent. The sensory, autonomic, and somatic systems, all parts
of the nervous system, help transmit sensations from the environ-
ment that are then stored either implicitly or explicitly (Rothschild,
2000). As van der Kolk says in The Psychobiology of PTSD, ‘‘Brain,
body, and mind are inextricably linked . . . . Alterations on any
one of these will ultimately affect the other two’’ (p. 216). The
brainstem, thalamus, limbic system, cerebellum, neocortex, and
sensory association cortices mediate sensory input and motor
ouput. People with posttraumatic and complex stress disorder have
brains with altered responses that involve a sensitization of these
systems to threats and alarm. In children, if violence and trauma
are chronic and repeated, the actual development of the brain
may be altered. This impacts both behavioral and emotional func-
tioning (Perry, 2001). Adolescents and adults tend to process inter-
nal and external stimuli in a maladaptive way; emotions become
triggers of past trauma that are no longer clearly perceived. The
result is a similar physiological reaction to a very different situ-
ation. The memory that caused the original reaction to threat is
fixed in a part of the brain that has frozen its ability to access
(van der Kolk, 1994). The body’s response to that original threat
is replayed. The memory of the traumatic event is encoded, but
328 W. I. Williams

the individual is missing the ability to make sense of the somatic

sensations that are really implicitly felt memories of the event.
In order to begin processing the ‘‘lost’’ memories, individuals
must feel and identify the body sensations (Rothschild, 2000).
Then they can start to narrate a meaningful passage that both inte-
grates and moves beyond. Moving the victim out of the role of vic-
tim means positioning the past in relationship with the present:
Cues and triggers of past memories are revisited, evaluated, and
taken out of storage (Spring, 1993). The unresolved and often
unreachable memories are often found in body sensations that
cue awareness of the emotion (Damasio, cited in Rothschild,
2000). The lack of recovery from the traumatic moment may be
related to the body’s frozen response to the original event. The
response of being helpless and immobile has created an inhibitory
influence on neocortical centers that process memory (Scaer,
2001). The somatic and sensory reactions that have kept the person
frozen in time have also contributed to the disruption of the
emotional and cognitive processes (van der Kolk et al., 1996).
Resolution and retrieval of memories that are essentially implicit
processes have to occur through the feeling states in the body in
connection with the cognitive states. The ‘‘wordless’’ state and
the inability to describe or locate a memory stem from a coding
process based on that original biological survival reaction (Levine,
2004). Freud also considered the fixation of the trauma to be
biologically based (Freud, cited in van der Kolk, 1994). Because
the flight, fright, and freeze response that helped the person survive
has deactivated some of the important functions of explicit
memory processing, cues that are reminders of the event and
still unavailable cause a sense of danger and disorganization
(Kinniburgh et al., 2005).
The disorganized sensations and patterns of activity that result
from the experience of helplessness and being frozen are at the
core of trauma. People need to identify with their bodily sensations
in order to access implicit memories (van der Kolk, cited in Wylie,
2004). As Herman says, ‘‘Chronically traumatized people no
longer have any baseline state of physical calm or comfort’’
(1992, p. 86). The beginning of the road out of trauma is to name
and tolerate sensations in the body. Finding words to explain a
feeling is a step toward a personal narrative that will begin
empowerment for the victim (Herman, 1992). Recovery and the
 Complex Trauma 329

rebuilding of trust can begin. The therapist becomes a crucial

part of the road back, enabling the client=patient to develop a
narrative that is meaningful, transformed, shared, and rewoven
(Widderschoven, 1999).
Energy and information flowing through the brain can affect
neuronal firing patterns. Because the mind is more than a physical
entity, we can look at the psyche as more than a functional entity
based on physical processes alone: It is also the soul and intellect of
a human being (Siegel, 2003). ‘‘Phobia of memory’’ ( Janet, cited in
van der Kolk et al., 1996, p. 309) is a function of the halted percep-
tion of the meaning behind the event, not the event itself. It will be
the location and processing of a personal narrative that will bridge
the gaps (van der Kolk et al., 1996). ‘‘If the past is an irreparable
fact, the present can be a revisable fiction’’ (Schweizer, 1998, p. 52).
The road out of or back from the isolation and suffering of
trauma involves the re-creation of empowerment and trust through
relationships (Herman, 1992); the safety and homeostasis of the cli-
ent is the most important ingredient (van der Kolk, McFarlane, &
van der Hart, 1996). There is an intense need to assign meaning
(Peterson, Bull, Propst, Dettinger, & Detwiler, 2005) and to seek
recognition through the creation of mutual engagement and trust
(Widderschoven, 1999). The trauma victim surrenders his or her
story to the right audience. ‘‘Once the password that lies within
narrative has been heard and recognized in a therapeutic context,
the listener becomes a witness’’ (Hepburn, 1998). Witnessing and
being witnessed link safety and facilitate a sense of ‘‘universality’’
(Yalom as cited in Meekums, 1999, p. 254) that also encourages
cognitive connection (Meekums, 1999).
Posttraumatic victims and storytellers have a story to tell that
oscillates between the ‘‘unbearable nature of an event and the story
of the unbearable nature of its survival’’ (Caruth, cited in
Greenberg, 1998, p. 325). ‘‘Pain is the most powerful aid to mne-
monics’’ (Nietzche, cited in Schweizer, 1998, p. 191). The returning
traumatic memories will be different and fragmented: Even though
there has been a delay and incompletion of the recall of the mem-
ory, the experience is true for that moment and must be honored
by the witness=therapist. Reconstruction of events and creation of
meaning is a feature of human intelligence, regardless of how
haunted one is, and may be more difficult in emotional neglect
and abandonment than it is with abuse (Haaken, 1994). Words
330 W. I. Williams

alone are not enough to contain and locate suffering (Hepburn,

1998). Because unconscious mental representations may be
recorded in sensorimotor form, relying on the verbal alone to
access the unconscious may interfere. Narration of traumatic
memories requires a creative process. Creativity is equated with
new solutions and new possibilities (Madden & Bloom, 2004). As
in any creative process, it is common for there to be more than
one insight before the final form is reached (Meekums, 1999). It
is also important to find a way to connect, relive, and re-member
a memory that is not explicit in the creative process. This brings
to life inner and outer reality that occur in the space between the
therapist and client (Winnicott, cited in Meekums, 1999).
A point of departure for all healing and creative processes is
found in the transformation of metaphor, symbols, and patterns
in words and visualizations. The creative process of meaning mak-
ing comes from a perceptual shift. Telling the story through new
perspectives provides the chance to assign meaning, integrate the
experience, find recognition, and relive (Peterson et al., 2005).
The healing role in the therapeutic relationship may in part be
about the ‘‘shareability’’ factor: It may be that the sensory infor-
mation that was stored implicitly can, within the context of
therapy, be rendered categorical and therefore more likely to
be integrated into a new narrative (Freyd, 1994).
In trauma, the left hemisphere of the brain that is responsible
for explicit memories is less active than the right hemisphere
(van der Kolk, 2001). Most of the implicit memories that are
experienced as emotional sensations are mediated by the right
hemisphere. Information processing in the right brain is not ana-
lytical or reasoned. The modes of communication are nonverbal
(van der Kolk, cited in Korn, 2001). It makes sense that any thera-
peutic efforts involving the unknown fragments of sensation
located within the right hemisphere be creative in regard to
retrieval. Because the information is not stored explicitly, why try
to translate it as such (Meekums, 1999; Mitchell, 1998)?
Imagination and ritual have played an important part in con-
temporary psychotherapies and healing practices, as have the shar-
ing of those experiences (Levine & Levine, 1998). The co-creative
action of locating the haunted fragmented images and words and
acting on the discovery requires great care. Both participants can
change within this context. Taking action means using all of the
 Complex Trauma 331

available imagination and resources within the context of a joint

practice (Widderschoven, 1999). Imagination allows flexibility in
the bridge between the inner and outer world (Winnicott, cited
in Levine & Levine, 1998). The therapist may find many modalities
that can help the client bridge the sensations, feel comfortable in his
or her body, build trust, and integrate memory. Wordless testimony
may require the assistance of imagery work, movement, film, and
drawing, as well as play and drama and learning to still the body
(Levine & Levine, 1998; van der Kolk, cited in Wylie, 2004). Poetry
and writing may help in reconstruction and narrative processes.
Eye movement desensitization reprocessing, hypnosis, group, cog-
nitive, behavioral, and pharmacological interventions are available
to assist co-creational recovery (Chard & Widiger, 2005; Courtois,
2004; Falasca & Caulfield, 1999; Kinniburgh et al., 2005, Ogden &
Minton, 2000; Olff, Langeland, & Gersons, 2005).

Conclusion

The shared transformed story is a testimony of dignity that replaces

shame and secrecy. With the help of therapies and the therapist, a
trauma victim becomes more than a survivor. The research is
clear. Trauma assaults the body and mind. It is difficult to treat.
Knowledge, creativity, and empathy can only help this process.
Everyone has a spirit that responds to care and hope, even if it
is tiny. The gift of the therapeutic response to trauma is its com-
plexity and its ability to co-create and find that thread of hope.
As Linsey Blair, a young woman from Belfast, Ireland, said in
regard her to experience as a sexually abused child:

For this, I thank my demons, with the knowledge that the darkness that
they walk in is still more hideous than that which I was lost in. I hope that
they find the light. . . . I will fight to overcome the legacy of my abuse, how-
ever complex and subtle that might be and I shall try to be happy and
peaceful. It’s strange, but I feel almost as if my past selves died to give
me life and I cannot let my child’s suffering have been for nothing. I cannot
insult my adolescent’s rebellions and courage by forgetting the fight now. I
just hope that maybe they can hear me now, so that they can know I love
them and that I love myself, every part of me. For there is nothing about
my self I would change, if I had the choice there is nothing about my past
I would change either. I am far from perfect, you—reader, friend—should
know that by now, but there is beauty within me and I have absolutely
nothing . . . to be ashamed of. (Blair, 2002, p. 19)
332 W. I. Williams

Blair reclaimed and created her history in the ‘‘action of tell-

ing a story’’ (Herman, 1992, p. 135). She understands that she has
increased her sense of empowerment and that her victimization no
longer paralyzes her. As Widderschoven (1999) says: ‘‘The change
in worldview is not a theoretical endeavor achieved by an individ-
ual as it is in cognitive psychology, but a practical process that
comes about through interaction and dialogue’’ (p. 248).
In this dynamic process of interaction, we, as listeners and
readers, establish a relatedness and recognition of the other. The
story is as much a journey as an arrival, wherein the listening
becomes an active and resourceful opportunity to become forever
changed (Braid, 1996; Widderschoven, 1999). Linsey Blair obliges
us to hear her story. In the process, we create a connection that had
been destroyed by trauma and memory (Hepburn, 1998).

References

Blair, L. (2002). Into the light. Journal of Loss and Trauma, 7, 1–19.
Bowlby, J. (1980). Attachment and loss. 3rd vol New York: Basic Books.
Braid, D. (1996). Personal narrative and experiential meaning. Journal of American
Folklore, 109, 5–30.
Brett, E. A. (1996). The classification of posttraumatic stress disorder. In B. A. van
der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress (pp. 129–
155). New York: Guilford Press.
Chard, K. M. & Widiger, T. A. (2005). Abuse, coping, and treatment. Journal of
Psychotherapy Integration, 15, 74–78.
Cole, P. & Putnam, F. (1992). Effect of incest on self and social functioning: A
developmental psychopathology perspective. Journal of Consulting Clinical
Psychology, 60(2), 174–184.
Courtois, C. (2004). Complex trauma, complex reactions: Assessment and treat-
ment. Psychotherapy: Theory, Research, Practice, Training, 41(4), 412–425.
Crittenden, P. (1997). Truth, error omission, distortion, & deception: The appli-
cation of attachment theory to the assessment and treatment of psychological
disorders. In S. C. Dollinger’s & L. F. Di Lalla (Eds.), Assessment and inter-
vention: Issues across the life span (pp. 35–76). Hillsdale, New Jersey: Lawrence
Erlbaum Associates.
Falasca, T. & Caulfield, T. (1999). Childhood trauma. Journal of Humanistic Coun-
seling, 37, 212–214.
Freyd, J. (1994). Betrayal trauma. Journal of Humanistic Counseling, 37, 207–329.
Greenberg, J. (1998). The echo of trauma and the trauma of echo. American Imago,
55, 319–347.
Groopman, J. (2004). The anatomy of hope: How people prevail in the face of illness.
New York: Random House.
 Complex Trauma 333

Haaken, J. (1994). Sexual abuse, recovered memory and therapeutic practice.

Social Text, 40, 115–145.
Hepburn, A. (1998). Lost time: Trauma and belatedness in Louis Begley’s ‘‘The
man who was late.’’ Contemporary Literature, 39, 380–404.
Herman, J. (1992). Trauma and recovery. New York: Basic Books.
Johnson, D. R. (1987). The role of the creative arts therapies in the diagnosis and
treatment of psychological trauma. The Arts in Psychotherapy, 145, 7–13.
Kagan, R. (2004). Rebuilding attachments with traumatized children. New York:
Haworth Press.
Kinniburgh, K. J., Blaustein, M., & Spinnazola, J. (2005). Attachment, self regu-
lation, and competency. Psychiatric Annals, 35, 424–430.
Korn, M. (2001). Trauma and PTSD: Aftermaths of the WTC disaster; An inter-
view with Bessel A. van der Kolk, MD. Medscape Mental health, 6(5), 2001.
Layton, L. (1995). Trauma, gender identity, and sexuality: Discourses on frag-
mentation. American Imago, 52, 107–125.
Levine, P. A. (2004). Memory, trauma and healing. Retrieved from www.
traumahealing.com.
Levine, S. & Levine, A. (1999). Foundations of expressive arts therapy: Theoretical and
clinical perspective. London: Jessica Kingsley.
Madden, C. & Bloom, T. (2004). Creativity, health and arts advocacy. Inter-
national Journal of Cultural Policy, 10, 133–156.
Meekums, B. (1999). A creative model for recovery from child sexual abuse.
The Arts in Psychotherapy, 26, 247–259.
Mitchell, J. (1998). Trauma, recognition, and the place of language. Diacritics, 28,
121–133.
Morrison, T. (1987). Beloved. New York: Knopf.
Muller, R., Sicoli, L., & Limieux, K. (2000). Relationship between attachment
style and posttraumatic stress symptomatology among adults who report
the experience of childhood abuse. Journal of Traumatic Stress, 13(2), 321–332.
Newman, E., Orsillo, S., Herman, D., Niles, B., & Litz, B. (1995). The clinical
presentation of disorders of extreme stress in combat veterans. Journal of Ner-
vous and Mental Disease, 183, 664–668.
Ogden, P. & Minton, K. (2000). Sensorimotor psychotherapy. Traumatology, 6.
Olff, M., Langeland, W., & Gersons, B. (2005). The psychobiology of PTSD: Cop-
ing with trauma. Psychoneuroendocrinology, 30, 974–982.
Papp, L. M., Cummings, E. M., & Schermerhorn, A. C. (2004). Pathways among
marital distress, parental symptomatology, and child adjustment. Journal of
Marriage and the Family, 66, 368–384.
Perry, B. D. (2001). The neurodevelopmental impact of violence in children. In
D. Schetsky & E. Benedek (Eds.), Textbook of child and adolescent forensic
psychology. Washington, DC: American Psychiatric Press.
Perry, B. D., Peterson, S., Bull, C., Propst, O., Dettinger, S., & Detwiler, L. (2005).
Narrative therapy to prevent illness related stress disorders. Journal of Counsel-
ing and Development, 83, 41–47.
Peterson, S., Bull, C., Propst, O., Dettinger, S., & Detwiler, L. (2005). Narrative
therapy to prevent illness-related stress disorder. Journal of Counseling and
Development, 83, 41–47.
334 W. I. Williams

Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. (1997). Com-
plex PTSD in victims exposed to sexual and physical abuse: Results from the
DSM-IV field trial for posttraumatic stress disorder. Journal of Traumatic
Stress, 10, 539–555.
Rothschild, B. (2000). The body remembers. New York: Norton.
Scaer, R. (2001). The neurophysiology of dissociation and chronic disease. Applied
Psychophysiology and Biofeedback, 26, 73–91.
Schore, A. (2001). The effects of a secure attachment on right brain development,
affect regulation, and infant mental health. Infant Mental Health Journal, 22,
7–66.
Schweizer, H. (1998). History and memory: Suffering and art. Lewisburg, PA:
Bucknell University Press.
Siegel, D. (2003). An interpersonal neurobiology of psychotherapy: The develop-
ing mind and the resolution of trauma. In D. Siegel & M. Solomon (Eds.),
Healing trauma. New York: Norton.
Spring, D. (1993). Shattered images: Phenomenological language of sexual trauma.
Chicago, Illinois: Magnolia Street Publishers.
Taylor, S., Gordon, J., Asmundson, G., & Carleton, R. (2005). Simple versus com-
plex PTSD: A cluster analysis investigation. Journal of Anxiety Disorders. Arti-
cle in press.
van der Kolk, B. A. (1994). The body keeps the score. Harvard Review of Psychiatry,
1, 253–265.
van der Kolk, B. A. (2001). The assessment and treatment of complex PTSD. In
R. Yehuda (Ed.), Traumatic stress. Washington, DC: American Psychiatric
Press.
van der Kolk, B. A., Hopper, J., & Osterman, J. (2001). Exploring the nature of
traumatic memory. Journal of Aggression, Maltreatment, and Trauma, 4, 9–31.
van der Kolk, B. A., van der hart, O., & Marmar, G. (1996). Dissociation and
information processing in posttraumatic stress disorder. In B. A. van der Kolk,
A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress (pp. 303–327).
New York: Guilford Press.
van der Kolk, B., McFarlane, A., & Van der Hart, O. (1996). A general approach
to treatment of posttraumatic stress disorder. In B. A. van der Kolk, A. C.
McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming
experience in mind, body and society (pp. 417–440). New York: Guilford Press.
van der Kolk, B. A. (2005). Cited in appendix for the video (summary article)
Treating complex PTSD. Nevada City, Nevada: Calvacade Productions.
Weingarten, K. (2000). Cancer, meaning-making, and hope: The treatment dedi-
cation project. Families, Systems and Health, 23, 55–60.
Weingarten, K. (2000). Witnessing, wonder, and hope. Family Process, 39,
389–402.
Weingarten, K. (2005). Common shock- Witnessing violence everyday: How we are
harmed, how we can heal (2nd ed). New York: New American Library.
Widderschoven, G. A. (1999). Cognitive psychology and hermeunetics: Two
approaches to meaning and mental disorder. Philosophy, Psychiatry &
Psychology, 6, 245–253.
Wylie, M. J. (2004). The limits of talk. Psychotherapy Networker, 28, 30–41.
 Complex Trauma 335

Yehuda, R. & McFarlane, A. (1996). Conflict between current knowledge about

posttraumatic stress disorder and its original conceptual basis. American Jour-
nal of Psychiatry, 152(12), 1705–1713.

Wendy Ide Williams is in the Graduate Program for Mental Health

Counseling at the College of St. Rose in Albany, New York. She is also a
visual artist, receiving a BFA in illustration from the Rhode Island School
of Design in 1979 and an MFA in studio art from the University at Albany
in 1986.