Skip to main content

Advertisement

Log in

Treating Complex Trauma: An Evidence-Based Case Example of Severe Childhood Abuse

  • Case Study
  • Published:
Journal of Child & Adolescent Trauma Aims and scope Submit manuscript

Abstract

Complex trauma (CT) results from exposure to severe stressors that occur within the caregiver system, are chronic, and largely begin in childhood or adolescence. This article describes the evidence-informed treatment of a 9-year-old female with chronic CT symptoms, resulting from long-term sexual, physical, and psychological abuse within her family. Treatment lasted 17 months and followed an assessment-driven, phase-based process. This process was flexibly implemented based on the unique circumstances of the case, while remaining consistent with the intent of the treatment models. Pre- to post-treatment data indicated significant reductions in trauma-related symptoms. Verbatim clinical vignettes illustrate specific interactions between family members and therapists, as well as interventions related to the treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Achenbach, T. M. (1991). Manual for the child behavior checklist and revised child behavior profile. Burlington: University of Vermont.

    Google Scholar 

  • Amaya-Jackson, L., & DeRosa, R. (2007). Treatment considerations for clinicians in applying evidence based practice to complex presentations of child trauma. Journal of Traumatic Stress, 20, 379–390.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.

    Google Scholar 

  • Arvidson, J., Kinniburgh, K. M., Howard, K., Spinazzola, J., Strothers, H., Evans, M., … Blaustein, M. E. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the ARC intervention model. Journal of Child & Adolescent Trauma, 4, 34–51.

  • Blaustein, M. E., & Kinniburgh, K. M. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. New York: Guilford.

    Google Scholar 

  • Briere, J. (1996). Trauma symptom checklist for children. Odessa: Psychological Assessment Resources.

    Google Scholar 

  • Briere, J. (2001). Detailed assessment of posttraumatic stress. Odessa: Psychological Assessment Resources.

    Google Scholar 

  • Briere, J., & Lanktree, C. B. (2012). Treating complex trauma in adolescents and young adults. Thousand Oaks: Sage.

    Google Scholar 

  • Briere, J., & Scott, C. (2013). Principles of trauma therapy (2nd ed.). Los Angeles: Sage.

    Google Scholar 

  • Cloitre, M., Stolbach, B. C., Herman, J. L., van der Kolk, B., Pynoos, R., Wang, J., & Petkova, E. (2009). A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22, 399–408.

    Article  PubMed  Google Scholar 

  • Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford.

    Google Scholar 

  • Cohen, J. A., Mannarino, A. P., Kliethermes, M., & Murray, L. A. (2012). Trauma focused CBT for youth with complex trauma. Child Abuse & Neglect, 36, 528–541.

    Article  Google Scholar 

  • Collins, S., Griffiths, S., & Kumalo, M. (2005). Patterns of disclosure in child sexual abuse. South Africa Journal Psychology, 35, 270–285.

    Article  Google Scholar 

  • Cook, A., Blaustein, M., Soinazzola, J., & van der Kolk, B. A. (Eds.). (2003). Complex trauma in children and adolescents. Retrieved from www.nctsn.org.

  • Cook, A., Spinazzola, J., Ford, J. D., Lanktree, C., Blaustein, M., Cloitre, M., & van der Kolk, B. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.

    Google Scholar 

  • Eyberg, S. M., & Pincus, D. (1999). Eyberg child behavior inventory Sutter student behavior inventory revised professional manual. Odessa: Psychological Assessment Resources.

    Google Scholar 

  • Ford, J. D. (2009). Neurobiological and developmental research: clinical implications. In C. A. Courtois & J. D. Ford (Eds.), Treating complex traumatic stress disorders: an evidence-based guide (pp. 31–58). New York: Guilford.

    Google Scholar 

  • Ford, J. D., & Cloitre, M. (2009). Best practices in psychotherapy for children and adolescents. In C. A. Courtois & J. D. Ford (Eds.), Treating complex traumatic stress disorders: an evidence-based guide (pp. 59–81). New York: Guilford.

    Google Scholar 

  • Ford, J. D., & Courtois, C. A. (2009). Defining and understanding complex trauma and complex trauma disorders. In C. A. Courtois & J. D. Ford (Eds.), Treating complex traumatic stress disorders: an evidence- based guide (pp. 13–30). New York: Guilford.

    Google Scholar 

  • Grasso, D., Greene, C., & Ford, J. D. (2013). Cumulative trauma in childhood. In J. D. Ford & C. A. Courtois (Eds.), Treating complex traumatic stress disorders in children and adolescents (pp. 79–99). New York: Guilford.

    Google Scholar 

  • Hodgdon, H. B., Kinniburgh, K., Gabowitz, D., Blaustein, M. E., & Spinazzola, J. (2013). Development and implementation of trauma-informed programming in youth residential treatment centers using the ARC framework. Journal of Family Violence, 28, 679–692.

    Article  Google Scholar 

  • Kisiel, C., Fehrenbach, T., Small, L., & Lyons, J. S. (2009). Assessment of complex trauma exposure, responses, and service needs among children and adolescents in child welfare. Journal of Child & Adolescent Trauma, 2, 143–160.

    Article  Google Scholar 

  • Kisiel, C., Lyons, J. S., Blaustein, M., Fehrenbach, T., Griffin, G., Germain, J., Saxe, G., Ellis, H., & Praed Foundation & National Child Traumatic Stress Network. (2010). Child and adolescent needs and strengths (CANS) manual: The NCTSN CANS Comprehensive Trauma Version: A comprehensive information integration tool for children and adolescents exposed to traumatic events. Chicago: Praed Foundation/Los Angeles, CA & Durham, NC: NCTSN.

    Google Scholar 

  • Kliethermes, M., Nanney, R. W., Cohen, J. A., & Mannarino, A. P. (2013). Trauma-focused cognitive-behavioral therapy. In J. D. Ford & C. A. Courtois (Eds.), Treating complex traumatic stress disorders in children and adolescents: scientific foundations and therapeutic models (pp. 184–202). New York: Guilford.

    Google Scholar 

  • Kluft, R. P. (2011). Ramifications of incest. Psychiatric Times, 27 (12).

  • Lambert, M. J., Lunnen, K., Umphress, V., Hansen, N., & Burlingame, G. M. (1996). Administration and scoring manual for the outcome questionnaire (OQ-45.1). Salt Lake City: IHC Center for Behavioral Healthcare Efficacy.

    Google Scholar 

  • Lanktree, C.B., & Briere, J. (2008). Integrative Treatment of Complex Trauma for Children (ITCT- C): A Guide for the Treatment of Multiply-Traumatized Youth. Unpublished treatment manual. Long Beach, CA: MCAVIC-USC, NCTSN (http://www.johnbriere.com)

  • Lanktree, C., Briere, J., Godbout, N., Hodges, M., Chen, K., Trimm, L., & Freed, W. (2012). Treating multi-traumatized, socially-marginalized children: results of a naturalistic treatment outcome study. Journal of Aggression, Maltreatment & Trauma, 21, 813–828.

    Article  Google Scholar 

  • Lawson, D. M., & Quinn, J. (2013). Complex trauma in children and adolescents: evidence based practice in clinical settings. Clinical Journal of Psychology: In session, 69(5), 497–509.

    Article  PubMed  Google Scholar 

  • Maker, A. H., Kemmelmeir, M., & Peterson, C. (2001). Child sexual abuse, peer sexual abuse, and sexual assault in adulthood: a multi-risk model of revictimization. Journal of Traumatic Stress, 14, 351–368.

    Article  PubMed  Google Scholar 

  • McCloskey, L., & Bailey, J. (2000). The intergenerational transmission risk for child sexual abuse. Journal of Interpersonal Violence, 15, 1019–1035.

    Article  Google Scholar 

  • McDonald, R., Jouriles, E. N., Ramisetty-Mikler, S., Caetano, R., & Green, C. E. (2006). Estimating the number of American children living in partner-violent families. Journal of Family Psychology, 20, 137–142.

    Article  PubMed  Google Scholar 

  • McLeod, B. D. (2001). The therapy process observational coding system for child psychotherapy. Los Angeles: University of California, Los Angeles.

    Google Scholar 

  • Newman, L., & Stevenson, C. (2008). Issues in infant-parent psychotherapy for mothers with borderline personality disorder. Clinical Child Psychology and Psychiatry, 13, 505–514.

    Article  PubMed  Google Scholar 

  • Pinsof, W. M. (2005). Integrative psychotherapy alliance scales revised-short form: individual. Evanston: The Family Institute at Northwestern University.

    Google Scholar 

  • Russell, D. E. H. (1986). The secret trauma: incest in the lives of girls and women. New York: Basic.

    Google Scholar 

  • Sedlak, A. J., Mettenberg, J., Basena, M., Petta, I., McPherson, K., Greene, A., et al. (2010). Fourth national incidence study of child abuse and neglect (NIS-4): report to congress, executive summary. Washington: U.S. Department of Health & Human Services.

    Google Scholar 

  • Silverman, W. K., Ortiz, C. D., Viswesvaran, C., Burns, B. J., Kolko, D. J., Putnam, F. W., & Lisa Amaya-Jackson, L. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology, 37, 156–183.

    Article  Google Scholar 

  • Steinberg, A. M., Brymer, M., Decker, K., & Pynoos, R. S. (2004). University of California Los Angeles posttraumatic stress disorder reaction index: DSM-IV. Psychiatric Assessment, 6, 96–100.

    Google Scholar 

  • Stroebel, S. S., O’Keefe, S. L., Beard, K. W., Kuo, S. Y., Swindell, S. V., & Kommor, M. J. (2012). Father–daughter incest: data from an anonymous computerized survey. Journal of Child Sexual Abuse, 21(2), 176–199.

    Article  PubMed  Google Scholar 

  • Turner, H. A., Finkelhor, D., & Ormrod, R. (2010). Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine, 38, 323–330.

    Article  PubMed  Google Scholar 

  • Weiner, D., Schneider, A., & Lyons, J. A. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: treatment retention and outcomes. Child and Youth Services Review, 31, 1199–12.

    Article  Google Scholar 

  • Wells, M. G., Burlingame, G. M., & Rose, P. M. (1999). Administration and Scoring Manual for the Youth Outcome Questionnaire-Self-Report, 2.0.Orem, UT: American Professional Credentialling.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David M. Lawson.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lawson, D.M., Hight, S.M. Treating Complex Trauma: An Evidence-Based Case Example of Severe Childhood Abuse. Journ Child Adol Trauma 8, 211–225 (2015). https://doi.org/10.1007/s40653-015-0054-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40653-015-0054-z

Keywords

Navigation