Complex Trauma Podcast Series

What is it?

Part 1

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Sometimes PTSD cannot be traced back to a single event. Rather, for a person with a web of traumatic events in their past and present, PTSD is a state of “normal”. It is the air they breathe. In this episode of Breaking Bread, Kathy Knochel and Brian Sutter teach us what complex PTSD is. For those who want to live well with people, it is a concept that is good for us to understand.

Show notes:

Definition: Some people experience layers of trauma. Trauma on top of trauma produces an unhealthy stress whose root is not easy to isolate. In fact, a singular root does not exist. This is understood to be complex trauma.

Sources: Complex trauma results from living conditions where safety is repeatedly jeopardized.

Results: Complex trauma undermines a person’s sense of present safety. Traumatic living norms have produced in victims a skewed perception of others and themselves. Often relationships pay a heavy price among those who have experienced complex trauma.


It’s easy to move to a place of feeling overwhelmed, but I think really if you can view it through the lens of like, this is the explanation, being able to talk with individuals that have experienced this, like you’ve already lived through this experience and now here’s the explanation as to why these things are difficult. And then like, here’s the hope, like let’s work together and work on these goals and do these interventions to help in this area.

Welcome everyone to Breaking Bread, the podcast brought to you by Apostolic. Christian Counseling and Family Services. Excellent to have you along. Kathy Knochel is with me today and Brian Sutter.

Welcome to the both of you. Always glad to have a conversation. You know, we’re complex beings. I think that’s one thing that a lot of these conversations come back to is the complexity of the human experience and the human heart and the human mind. And all those things run together. And today’s topic is really going to yet expose another facet of that complexity.

We’ve talked about trauma in the past. In fact, we’ve had some, I know I’ve had Ted on and we’ve talked about trauma. We’ve talked about PTSD, which I think is somewhat of a household term. Yeah, certainly today. It wouldn’t have been 20 years ago. Right. Even though it existed in the disciplines, it wasn’t necessarily a household name and we’ve maybe with some resistance come to acquiesce with that term and say, yeah, you know what?

There is something there. Sometimes that happens. Oh, right. In the psych world, isn’t it? Exactly. You start to observe something and you can’t quite wrap your mind around it. You’re like, man, how can this be? But you start to see it more and more, and then you try to wrap your mind around it, putting a label on it, and quantifying different symptoms you’re seeing and stuff, yeah.

And so we name it, and then it helps us understand what it is we’re talking about. Well, we’re going to talk about complex PTSD here today. And I would say that’s certainly not a household term, it hasn’t been for me. In fact, I’m very much a blank slate. So, as we talk about complex PTSD today, I would just like to lay some groundwork for this term, the newness of this term, maybe how this term has come about and how does it educate us as just lay folks in engaging in our world?

That’s my objective. Maybe a starting point. And I would just maybe zoom back and even think through the origins of PTSD really. You know, that starts from men are coming back from war and all of a sudden doctors and mental health professions are seeing these individuals really be impacted by that experience and that reality was something that, okay, something has happened here.

And then that starts to, you know, they start to label that shell shock and then eventually that kind of moves in to be called PTSD and that’s kind of that journey that you see and complex trauma has come about in the same sort of way. And, I don’t know what else, I’d maybe hand it off to you, Kathy.

I think it would be helpful to just define and think about for a minute, what is a trauma? Because then that will kind of help us better understand where the complex part of it comes from. And, you know, a trauma is a significant event that happens in someone’s life. And it really is when there is a sense of safety that is threatened.

And so, this can be something like a car accident, a medical trauma, abuse, of any kind, like you had labeled war or combat, some of those things that happen. All of those are events that are labeled as traumatic. And I think that’s really important to just recognize that. This sense of safety gets lost and basically you’re in an environment or a situation that overwhelms your ability to navigate it or cope with it.

And then that has a really profound impact on you that carries forward into the present or into the future and impacts how you view yourself, how you view the world. And, then you come out impacted and scarred from that experience. And that’s what they were noticing and seeing and what we would call PTSD.

As we interact with this broken world there, it’s brokenness does have shockwave effects on us and we shouldn’t be surprised. It has a shockwave effect on our spiritual life. We’re all fallen and in need of a Savior. It also has a shockwave effect on our psyche, doesn’t it? And maybe that’s a little bit of the niche here that we’re talking about with trauma.

Yeah. And I would say for some people, they can experience some of these events that are labeled as traumatic events and it doesn’t necessarily go on to develop a PTSD diagnosis that happens like so in in the middle of a traumatic event are again that sense of safety is gone and we go into like fight or flight or freeze response.

And then what happens for some people is as life keeps moving down the road. months on end, that same level of fear just in every common day experience, that fight or flight or freeze response happens. And those would be individuals that go on to develop or are diagnosed with PTSD. The core of PTSD then, and complex PTSD as well, is the meaning that gets put to the experiences. What is it? What does this mean about me? What does it mean about the world around me and safety and having the tools and skills to navigate that. And so, we can experience the same person or different people can experience exactly the same experience and come through with very different symptoms.

Some with PTSD and some not. Largely based on what the meaning they make out of those events. Is that what I’m catching here? Exactly. Okay, and sometimes it’s about what resources are available following a traumatic event? And so, if the people that are supposed to be there to provide safety and support are there and do well sometimes individuals are able to avoid more of the long-term PTSD like symptoms but sometimes the very people that are supposed to be keeping you safe and be there to be supportive are the ones causing the trauma and then that really compounds it.

Yes. And it really foils the meaning. And so I think what’s interesting or one of the things that would be important to think about is that situation that you’re describing that actually would have the potential of, of moving on into complex trauma for some, some specific reasons that we can get into.

I think, so, maybe the starting point as we think about PTSD would be the person who’s had a really good, safe, supportive upbringing, and then they’re 45, and they get in a car accident, and that would be like a traumatic experience, but they’re likely to have a lot of helpful resources to help them navigate that. They may even move into the symptoms of PTSD, but how that would be treated or thought about, it’s going to be different than a complex trauma that that is going to have a lot more of a difficult web and have a lot of more profound impact and going to be harder to work through, if you will.

I like that. And I want to further tease this difference out because I’m starting to catch the difference between PTSD and complex PTSD. I mean, just by the way it’s titled, it’s not a completely new phrase, right? That’s interesting enough. So, what we’re saying is, the base is the same, but now we’ve got something more complex on top of it. Say more to that, Kathy.

So, if you think about the word complex, I’m pretty sure the definition is like, there’s many parts and that is what complex PTSD, it generally you see it as the traumas happen throughout childhood. And then an individual goes on to experience the symptoms of complex PTSD throughout adulthood. And, what that boils down to is like ongoing abusive situations that happen in childhood. So, it happens multiple times. There’s no way to escape. It’s not just a single incident of trauma. That would be the things that are behind complex PTSD. In addition to sometimes when caregivers are in a place of struggling with their own mental health or like ongoing domestic violence or situations that just make the environment around somebody unsafe, kind of chronically over a long period of time.

That’s helpful. So, again, kind of for my understanding here, Kathy, based on what you just said here, it seems like one of the complexities of this PTSD is it’s hard to go back to the event. If we’re trying to make meaning of something, it would seem to me the event is kind of important. We need to put that event back in its proper place and pull the right meaning out of it seems like would be the health moving forward, but the complex piece makes that meaning making difficult. Right. And it makes it challenging to name the event. One, because there maybe could be multiple events. Or two, because the events may not be as obvious. They could be a lots of, you know, kind of just the day to day. You know, that you just grow up and, and it’s so normal, you can’t even recognize it. It’s the water you’re swimming. So, you don’t even realize that it’s having an impact or that it’s not the norm or that it is painful. And when that’s the case, then you look at it and say, well, nothing’s really happened or it’s not that been that big a deal, or I can’t even put my finger on it.

And, again, that makes it complicated, right? Can we then say what would be the symptoms if a person is swimming in this water unaware of it, is not coming to you saying, this is what’s happened to me, what symptoms are surfacing that brings them into your counseling room, or what symptoms should we as just wise people in this world be able to see and have a deeper understanding for?

I think two main ones stand out to me, and I would say just that really a lack of ability to feel like there is any control or regulating of emotions. And then also a lot of times someone that is struggling with like the aftermath of complex trauma has a lot of difficulties in relationships forming healthy relationships maintaining relationships. And I think in many ways, some of the factors that play well and those would be things that would be there for PTSD and a lot of other symptoms too or diagnoses as well but certainly to maybe even more of a pervasive or more intense kind of nature.

And that relationship piece could just be like, I don’t think anybody is trustworthy or having a really hard time opening themselves up and just seeing, and you can see how damaging that would be to relational connection. If everybody’s been put in this category of either they’re not safe and they’re going to hurt me. And again, you don’t even know for sure why that’s going to be really difficult to navigate the relational space. And then I think another big part of the symptomology would just be a really negative view of self. And again, that can show up in a lot of different places. And that’s where diagnoses can be difficult because it’s not just one thing. It’s lots of different things all together that have a certain kind of history. So that gets complicated, but just the view of self where you have a really negative view of self, even almost just at times like a hate of self that is so deep and like everything you try to speak into that just seems to bounce right off.

I’m sure you wish you could take a blood sample and have some of these questions answered, to see what the white blood cell count is and that type of thing, trace things backwards and you don’t have that. So, what I really am interested in knowing, like. It’s so complex. How can, how can you narrow down this particular diagnosis?

And I think the reality is, Matt, that is really challenging and oftentimes in the mental health world, I think this would be true in the medical world as well. But a lot of times in the medical world, they have more capacity to draw blood and like, oh yeah, you’ve got this thing. And that’s where sometimes particularly diagnosis like PTSD or complex PTSD or other things take quite a long time to get diagnosed because it’s hard to sort through all the pieces and you have to be around someone or interact with them for long enough that, oh, okay, now this, now I’m, I didn’t see this before, but now I see it.

And you kind of start to piece the puzzles together or, like, okay, here’s this symptom and we’re treating this, but boy, it’s not quite going the way that I anticipated. Maybe there’s something else or more going on than I anticipated. Yeah, and I would say in addition to that, I think we start to look through this lens once we’re like as a clinician, hearing people’s stories and just like hearing the way maybe they talk about certain experiences in their life or talk about the symptoms that they’re experiencing.

So, if we’re really seeing a lot of the fight or flight or freeze or the collapse of emotional capacity and that sort of thing. It starts to tip our minds towards like, I wonder what all we should explore in this area. You know, I think we have a tendency when we hear of a new diagnosis, I think some of us have a tendency to roll our eyes and say, Oh, here’s one more thing. And, others are like, finally, somebody understands me, right? Brian, speak to that concept.

I think that’s such an important thing to acknowledge and I think even just to know where you fall on that, that spectrum, your tendency would be good to think about. I remember in my undergrad going through a class and they’re talking about all the diagnoses in the DSM 5 or the DSM at that time.

And, they would just say, hey, as we walk through this course, I just want you to know every time that we go through a diagnosis, you are gonna see yourself in it. You’re gonna think that you have it. And that was true. Like everyone that went, oh, there it is. And, the reality is that with each diagnoses, you’re gonna see different parts of it that fit for you.

But the reality is there is like, you have to meet so many of them, and it is pretty complicated to sort through. And so, as you hear something, if you’re like, oh, that’s me. Well, it’s possible. And I don’t want to take that away, but it’s also possible that that they’re just parts of it that show up for all of us.

And then I think the person that maybe rolls their eyes that, oh, another thing. I think that would, my encouragement to you would be is even as I’ve moved into working as a counselor for the number of years I have seen with my own eyes, the impacts of trauma and complex trauma in ways that I can’t deny it anymore.

Whereas I think as most of us as conservative Christians, we want to take responsibility for our actions. We want to encourage other people to take responsibility for their actions. And we see choice is such a big thing, which I agree with all those things. But the reality is when somebody’s walked through really painful experiences like it has such a profound impact below what is consciously known that sometimes what they do or how they view things really isn’t a choice at the same level that if you don’t experience that is, and I think that’s important to acknowledge so that we can express and give compassion to those who’ve walked through hurts, even if they can’t identify exactly what it is.

And I think that puts us in a position to be good learners and express the compassion and really model Christ and how he interacted with those who are hurting. And that’s a challenging thing if this is a world or a diagnosis that you haven’t experienced or maybe even haven’t seen as directly.

I think that’s really helpful, Brian. And really part of the purpose of this podcast is to provide some education to people and to the world we live in. And I think we have vested interest in understanding our world and our communities and our neighbors and our own children so that we can live well and we can love them to Christ, right? So, speak to that reality as well. As a church, we want to be thinking about not only our own, but our communities and the places we serve. How should this conversation help inform that effort?

On a base level, the first thing that comes to mind for me is just understand that everybody has a story and has an experience. And I think that like specifically if we’re reaching out to the community and trying to form healthy relationships with them, being willing to be in a place where you have ears to listen to their story and hear their experiences so that you can understand what Brian was saying that there are reasons that the choices are being made that are being made. And I think that’s such an important point. That’s really hard for us, I think in general to hold on to. But, if that could just be something that we try to remind ourselves. The things that we see or the individuals that we interact with who are maybe challenging for us to interact with, that there’s probably something behind that that’s driving that if we understood or if we had an experience, we’d have a lot more compassion than what naturally comes.

And I think that’s the importance of this topic, whether it’s trauma or complex trauma, just the reality that people have lived through really painful things, some which they may not even be fully aware of or be able to articulate well. But those might be some of the things that are driving some of the things that are hard for us to be around or interact with and see.

This is helpful, Brian and Kathy, maybe Kathy, I’ll put this to you to bring some clarity and summary between, okay, we finally gotten our mind around PTSD, and now we’ve got complex PTSD. Maybe summarize the difference or maybe. how complex PTSD is now on top of and furthers PTSD alone.

So, I would say that the similarity between just PTSD and complex PTSD is that there is, there was, a traumatic experience that happened in both situations. So, when an individual gets the diagnosis of PTSD, that diagnosis comes from the reactions that they have had to what’s considered a single incident trauma. And so, those symptoms are like hypervigilance or feeling like they’re experiencing the trauma over again.

And then how we differentiate that piece with complex PTSD is that it is multiple incidents over a long period of time and so like the chronic trauma piece. And then that individual is also experiencing the PTSD symptoms. The explanation for it is just that it happened, there were more frequent events of traumas that happened more than just a single incident.

In addition to the PTSD symptoms, those three things that we labeled earlier of like the high level of difficulty with regulating emotions, that sense of self, and then also just the high pervasive difficulty in relationships. And I think that is reason enough to provide education on this topic. This impacts relationships. And so, this gives us some level of understanding to the brokenness that we see in communities, in relationships and puts a little bit of a voice to that.

I really appreciate that. I just really appreciate both of you rolling up your sleeves in this area, I think it can seem daunting, even as it’s been described, seems kind of impossible, right? Events that we can’t put our finger on, meaning that’s not true, impacting relations, the emotional regulation, all of that. But yet you guys showed up to work today, so speak to the hope that you see in this work. And I think that the good news in my mind is that a lot of times the path towards healing is relationship.

And, one of the tricky parts there is that’s where there’s been a lot of damage and even can make it difficult. But, where we can see the instruction from the Scriptures of how to interact with each other and to be full of love and compassion and all the different places and even the just beautiful example of Christ, where we can do that and where we can start to give a new experience that starts to create new meaning and actually starts to create a present moment and present day reality that is safe and that they have a new experience of somebody loving and caring. I think that’s really exciting and hopeful, even though the journey towards healing through these things generally takes a lot of time and lots of corrective experiences.

And I think that all of this information here is easy to move to a place of feeling overwhelmed, but I think really, if you can view it through the lens of, this is the explanation, being able to talk with individuals that have experienced this, like, you’ve already lived through this experience, and now here’s the explanation as to why these things are difficult.

And then, here’s the hope, let’s work together and work on these goals and do these interventions to help in this area. Thank you. And you see that positive motion and movement in lives. Oh, yeah, for sure. And I think, to Kathy’s point there, just being able to name it, there’s something that’s really powerful about that.

Like, oh, I’m not alone. Or, oh, I’m not losing my mind here. That gives a sense of hope, and in that, there is an opportunity to think about what can be helpful or pinpoint, okay, here’s the action point, and yeah, by God’s grace, and I think that’s one of the favorite parts of my job is being able to just watch people, you know, some of the lights come on, and some of that healing occur is just really amazing.

I really appreciate that and thanks both of you for stepping into this work and I know you’re not the only ones stepping into this work. Certainly in the larger community, there’s lots of people stepping into this work, but even in our church community, in our Apostolic Christian denomination, we’ve got a number of brothers and sisters that are stepping into this particular topic in just some really beautiful ways and we’re really benefiting from that as well.

And one of the things I would just encourage anybody that’s listening in that is that you can have a profound impact in these places, even if you don’t know what complex trauma is, you don’t know what PTSD is. You don’t know what the path forward, like being able to just be a safe person and come alongside as just a follower of Jesus with them or, pointing them towards Jesus.

That is a really powerful thing to do. And I just encourage people in that. It helps with that, creating new experiences for them, which is powerful. That’s neat. And I think that’s a great way to close and really send us all off here from this podcast, just thinking about that. Can I be that person that doesn’t so quickly write a person off for their poor thinking, but just to have the ability to maybe hold their complexities and love them as Jesus did. Thanks for being an example to that end and exposing this concept of complex PTSD. Really appreciate it. And to our listeners, I hope that you as I, have found some direction, some clarity here in this conversation about people and how to better love them.

Thanks for being here.


What does help look like?

Part 2

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God asks us to participate in the life-giving care of people. Untangling the web trauma spins for those who have complex PTSD is one of those rewarding opportunities. In this episode of Breaking Bread, Kathy Knochel and Brian Sutter take the discussion of complex trauma to the next level. They help us see what help looks like and gives us all a role to play.

Show notes:

Help for those with complex trauma can be understood in three phases:

  • Phase 1: Safety and Stabilization
    • Stabilize the victim and ensure their safety. Receive them on an emotional level. Help create for them a new safe experience that will over time help them construct a healthy meaning of their world.
  • Phase 2: Processing Trauma
    • Professionals in this phase can help create healthy meaning to old memories.
  • Phase 3: Meaning Making and Reconnecting
    • Help a victim engage in the world in a healthy way. Their difficult past does not bind them; rather it equips and provides value to their present.


Definitely, all healing and glory goes to God throughout this whole process. The body and brain can heal from the experiences that happen in a fallen world.

Welcome, everyone, to Breaking Bread, the podcast brought to you by Apostolic Christian Counseling and Family Services. It’s wonderful to have you along, Brian and Kathy are with me again today.

We’re picking up with a conversation in our last episode. We talked about complex PTSD, really, honestly, to the both of you, this is a fresh concept for me. Okay. You’ve piqued my interest enough that I am in agreement that, whoa, this is a big deal and there’s a lot more to this than at first thought.

So Brian, I’d like you to really pick this up a little bit to say, yeah, why is it important for us to have this understanding of complex PTSD? How does it impact my view of the world?

So, one of the things that comes to mind, Matt, is a study that came out, it’s been a while now, but it’s called the ACEs study. And basically, what they looked at is early experiences in life and how profound of an impact those had on individuals as they grew up. So, for example, if you grew up and you’ve had somebody in your home who’d been incarcerated or somebody who is addicted, or somebody who was going through severe mental health issues or there’s neglect or abuse and so on and so forth. If you have so many of those experiences, which are called ACEs, adverse childhood experiences, the more likely you have a really challenging adulthood experience. And I think, so that’s kind of the lens we’re talking about.

Complex trauma a lot prior, has been called developmental trauma, for example, would be another lens now. It doesn’t have to happen early in life. So that’s where they’ve kind of shifted into complex trauma. But I think knowing there’s been a lot of experience, maybe early in life and the more of those that you have that have been hurtful, that’s going to have an impact. And, that may be something I should be thoughtful of in my own life, but also as I interact with others. And this gives me maybe a more honest view of the world that I live in. Doesn’t it?

Yes. Kathy, speak to the prevalence then of those matters that, that, that Brian just articulated in our at large culture. If you think about this piece of like, what is the prevalence of this? I think that it’s good to have this frame of like we do. live in a fallen world, which means that there are hard things that happen in a lot of people’s life. I think that we run the risk when we’re thinking about trauma and like adverse experiences because we all face them.

It’s easy to start to see, well, is everything trauma? And that is actually an unhelpful lens to have. Not everything is trauma, but what does happen is there are just a lot of really difficult experiences that people walk through. And then what can happen is, when they have walked through it and when they’re struggling with it, it can actually start to impact the next generations when parents are bringing that with them in their parenting.

And then all of that continues on of these like adverse experiences that Brian talked through. And so I can see this. I’m not that surprised then. I’m not surprised then that the fallenness of the world bends us up in ways, right? And that gives us, I think, a context to engage the world, which we’re called to do, engage our families, engage our congregations, engage our communities, engage our neighborhoods, engage the world.

In a way that I think brings some understanding that when A plus B equals C in my head, A plus B equals D in another person’s head. And there’s actually a reason for that. Yeah. And then that helps bring, I mean, a lot of dots get connected when you start to think about, oh, maybe their conclusions or their behaviors or my own thoughts and behaviors my perspective is shaped because of those hurtful experiences rather than something else. I think it just gives us a very different lens. And I think one of the challenges for us as a group of believers, that’s going to be primarily our audience here is that we need to be able to be honest about the difficulties and the reality is that sometimes we would prefer to just not think about them because it is so scary, but then sometimes we get freaked out and we get too focused on them.

And so, there’s this kind of delicate balance of being able to be honest about what is, without getting overwhelmed, seeing it underneath, and, the Lord knows about these things and he cares and he’s got these things in his hands. But what’s it look like to be his hands and feet in the midst of it all?

Okay. So, I like that. And, my brain goes three different ways with what you’ve just said there, Brian. Number one is, yes, how do we understand this with an understanding of the gospel and understanding of grace and understanding of God, Christ making all things new. So, I’d like to hold that out there.

Another one then is I would like to talk a little bit about how do you move forward in a healthy way in two different ways. One is as we just engage our cultures, right? When we go down as a work team, for example, or as we go onto the mission field, for example, we can expect to encounter this even in our own neighborhoods, as we want to bring the community into our church and in a saving type of way.

And then, so there is a lay response that I think I would like to hear, and then I would like to hear the clinical response too. I would say that ultimately it is God’s grace is sufficient. We do need to be sensitive to the Spirit working and the role that’s there. And so, definitely all healing and glory goes to God throughout this whole process.

There is that natural, like, using parts of the body, like the church, to help come alongside and support and help people be in a place where they have the ability to be open to how the Spirit’s working in them, and then also being able to utilize the tools that are out there also so that the body and brain can heal from the experiences that happen in a fallen world.

And these are things that have been wrestled with, I think, since, you know, we see them in the authors of the Scriptures. So, it’s not new things, but the reality is that there is a lot of suffering and how to make sense out of that is a real challenge. I think that the hope or the Scriptures are very honest about that.

It doesn’t try to run from that reality, but really just says the remedy is in Jesus that there is a remedy. It’s not that boy, this shouldn’t have, well, you know, maybe it shouldn’t happen. It wasn’t designed that originally, but now it is here. And the remedy is the gospel and I think that’s so important to hold on to that.

Those trauma inducing situations are not the last say. There’s an incredible amount of hope. And that’s what we have in the gospel. I think too, just coming from this perspective as a lay person in it, I think one of the biggest things to think about with trauma is that the person’s perception of safety has gotten altered.

And so, with what you said earlier, A plus B should equal C. And that’s true for the individual who has not had that threatened safety. But for the person that has maybe not had their emotional needs taken care of in the way that was needed, or maybe there was scarcity of food or exposure to a lot of violence, A plus B definitely does not equal C in their life.

And so being able to have eyes for how or what am I doing to help create a sense of safety in these interactions with this person and just being able to understand things through that lens is important too. So, give us some helps on that. What should we as folks that want to be helpful? How can we be most helpful? I guess, is really my question. And I think I’d maybe even back up a bit from that. But I think so in trauma work, the first phase of it is called safety and stabilization. And so even just to give those words, it’s like, oh, what could I maybe do in that space of providing some sense of safety or providing some sense of stability?

And sometimes that’s in just basic needs, to make sure do they have shelter and food and that level of safety is a really important thing to at least consider that sometimes isn’t being met. And if we can do something in that or relational, just having somebody present can be a big part of it.

Now, I think if we look at maybe the brain and behind it, I think that can help give us some insights as well. So, part of the way the brain is designed in the inner part is what’s called the amygdala and the hippocampus. And those, you can think of the amygdala as like the alarm bell. So when something happens that’s scary, that fires up and it tells you danger, danger, danger. And then you go into trying to pursue safety as an individual. And that’s how God’s created it and it’s helpful. Now the hippocampus is really in charge of memory and helpful memories are memories that have a beginning, a middle and an end and it makes sense and you can recall it when you want, but what happens when the amygdala fires up, it kind of scrambles the hippocampus and therefore memory isn’t coded the same way and therefore you don’t have as much authority over and it can come and go when it wants. And all of those things combined make for why that perception is so off in the individual because of something that’s going on in the brain.

I think that’s helpful because then we can see it through like oh, this isn’t maybe rebellion or this isn’t them making just a really poor choice There’s something in their brain that’s leading to that perception that their conclusion of A plus B is D instead of C.

And, I would say, I think that words that come up for the person, like how do we be present in these people’s lives? I think that the phrase is being intentional and consistent because that helps with those systems that Brian just talked about of like they may be in alarm mode that somebody might be in fight, flight, freeze mode, but our ability to just stay consistent in what we’re saying, what we’re doing and how we’re interacting with them starts to help slow down that scramble effect that Brian was talking about.

Yeah. And, therefore when you’re trying to be consistent, say, hey, I really care about you, Kathy. But if I’m speaking to a brain where there’s trauma involved, that amygdala fires up and it says, I don’t think that’s true. I’ve heard that before and that wasn’t accurate. And so, for me to be able to expect that she may not believe that, or she might even act in ways that are pushing against that to show, oh, he doesn’t care.

But, it’s really her own protection rather than like a conscious thing that she’s likely doing. Well, it sounds to me like what we can perhaps offer other people is a new experience. Absolutely. It sounds to me that at the experience level, now I quickly want to go to the A plus B equals C, right? And let’s try to work this out at the rational level.

But what I hear you saying is there’s not a lot of gain at the rational level, but there’s something more at the subconscious. You want to speak to that? Yeah. So, I think you’re exactly right, Matt. I think it’s really helping them experience that even though they’ve heard from me that I care about them, they’re also experiencing in my posture, in my tone, in my body language that I’m with you. And in counseling what we would say is you’re trying to go from the bottom up to help bring healing rather than the top down. And so, the top down is really thinking you engage the logic and the reason of somebody’s mind, and then you’re hoping and that filters down into the emotion and into their actions.

But with trauma that usually isn’t a route that goes very well because the cognitive is so strongly blocked by the limbic or the emotional underneath of it. So, you try to figure out how to connect with the bottom of the body and the emotion. And then hopefully those start to help shift the thinking. And then you can use the logic and reason over time, but that’s not usually the starting place. Really? Because like that logical brain or that, my words, that part can kind of go offline basically when someone is feeling triggered or overwhelmed in their emotions. Yeah. Cause that amygdala turns on it.

All it says is you got to get out of here. Danger, danger, danger. And it’s not thinking anymore. It’s just reacting. And so, until we get that calmed down, the brain is offline. And what we say, even if it’s really good, is unlikely to have a profound impact. Now, that doesn’t mean we shouldn’t say the things that still can be helpful, but I think our expectations should shift on how impactful that’s going to be.

Yeah, and I think that an important thing to know just as someone walking beside another individual that might be struggling with effects of trauma is your job is not to regulate for them or try to be the person to solve that. But again, I think just that presence of I’m here, I’m here with you again, that consistency piece in like, if you say you’re going to do this, you’re going to do this.

I think all of that is just really important to know that. The healing has to take place on their terms, but you can be there to be consistent in different areas. And, I don’t know if it’s helpful or not even just cuz our A plus B equals C, but I think so an example of that, let’s say somebody’s in a relationship that’s supposed to be loving and caring, a parent figure and in that they consistently tell them, hey, I care about you, Johnny. But then, they’re maybe, let’s say, physically abusive to them. So, what the brain starts to do with that is that somebody says they care about me, but they actually hurt me. So, A plus B equals D. Whereas somebody else, when their experience has been, you know, Dad says he cares about me, and he treats me good, then our conclusion is C.

If somebody says they care about me, then they treat me well. They’re taking care of me and you can see then you start to see how experience starts to impact the conclusions you come from and how those impact the present day conclusions even if the present day is different and but that’s part of what we want them to tap into is maybe right here right now is different without denying that back here, it was painful. And so, through experience healthy experience over time we create new meaning because a lot of it’s tied up in meaning, right? It’s been made and that’s where the long-term gain is made and perhaps as lay folks, that’s our role in healthy care for individuals with CPTSD. And so that kind of takes us into continuing the treatment process.

If phase one is safety and stabilization, we start to try to be safe people. And then that moves into phase two of trauma treatment, which is really around processing the trauma and helping really shift the meaning around those trauma through processing the past hurt. So that’s probably going to be moved into the clinical realm. But the safety and stabilization of a relational person who’s consistent and caring and giving a new experience is really helpful then in that phase two.

Alright, so let’s go to phase two because I did ask, that was the third one, right? What does this look like in terms of professional help? I think one of the pieces that I would just be quick to label here is maybe just some advice that you are encouraging people to step into more specific counseling or treatment for their trauma. I think what can happen really easily is we as people don’t want to have to think through and talk through the hard experiences we’ve had, which actually leads to this piece of avoidance. And it’s, yeah. We can develop this idea. If I just don’t think about it or I just don’t bring it up, I will be okay. But that’s not true because as Brian has laid out the reactions that we’re having and the way trauma impacts us is really on a brain level. And so, committing to getting involved in some specific trauma focused counseling can be helpful in processing that so your brain can heal in a way that it’s not reacting in these fight flight freeze modes in seemingly safe situations.

And one of the things that comes to mind with that, we do this in so many areas of life and we don’t really realize it. So, I think it maybe would be helpful even just to point that out. But I think you’re right. It’s so important to not engage the avoidance, which is so natural, because avoidance really reduces the opportunity to learn, right?

So, for example, if a child is walking through the kitchen and they put their hand on the stove when it’s hot, That’s gonna hurt, right? That’s gonna burn them. And if the conclusion is you just stay out of the kitchen, well, you might not get your hand burnt anymore, but you’ve actually come to the wrong conclusion.

You’ve come to the conclusion. If I just stay out of the kitchen, I’ll be safe. And so, what actually happens for a child is they don’t avoid the kitchen. Generally, they keep walking through the kitchen. Actually, there’s a lot of times I walk through and nothing bad happens, and actually if I touch the stove, there’s a lot of times that nothing bad happens and it starts to give competing information. And then that actually helps them come to the right conclusion that it’s not actually the kitchen. It’s not even the stove. But when the stove is on and it’s hot, then I’ve got to be really careful and that’s an accurate conclusion.

You know, something that occurs to me as you give that example, the important impact that a child is creating the correct meaning now with touching the stove. I think we can all get there that a young child of nine or five can perhaps process that and not avoid the kitchen. But there are other things that happen being processed at a young age. I can see where they might not be mature enough, they might not be mature enough to construct the correct meaning. Isn’t that part of what’s being tied up here?

A hundred percent. Exactly. And so therefore, part of that phase two treatment is hopefully, well, I shouldn’t say hopefully, but one of the things is we’re interacting with them maybe as they develop and time has passed, but let’s say you’re interacting with an adult, and we’re talking about trauma that happened early in life. Now you’ve got the adult brain, the adult self with a lot of other experiences that we can draw on to then help kind of, we go back into the hurt. We process that. And if we can bring the adult self into that they’re going to have a lot more information and a lot more just emotional and relational maturity to like, hmm, maybe that wasn’t quite right.

I can see how I came to that conclusion then, but now I’ve got all these other experiences that are competing that, and that can be really helpful. And the connection piece that has to be made, because again, what’s happening on a brain level with trauma is some, like on our own, we can’t always make those connections because again, the fire alarm is going off.

This is dangerous. It’s always been dangerous. So through the process of healing and understanding, I can reach safety and stabilization with my emotions so I can calm that down so that I can make meaning and new experiences and learn things. And then that happens really through that processing piece in a counseling session.

So, it sounds to me. Check my understanding here that some of the work that you do in a professional sense with individuals with CPTSD would be to go back into those where that meaning has been created and to rewrite that meaning with the adult brain now to basically be able to employ that adult brain to get good healthy meaning out of it.

Am I right about that? Yeah, for sure. And I think, too, I’d also want to just say that you can do that with a child as well, so it doesn’t necessarily have to be an adult. And the good news about a child is that they’re, while they don’t have the adult experience, they’re moldable. Exactly. They’re very moldable.

So, there’s actually a lot of hope there, too, because those early experiences that were painful aren’t quite set in concrete yet. So, there’s a lot of opportunity to mold them. One of the things that I would add to what Brian just said is I think that it is really important and healthy that we’re engaging kids in trauma counseling when they have experienced some sort of trauma in their life.

Really, you’re setting them up as they go through their teenage years and as their brain continues to develop, to not have as many difficulties with trauma as an adult. Here’s an important disclaimer though, with that is that once the trauma is passed, then the trauma processing can happen for an individual.

When we’re talking about this complex trauma, if we think about a child that has experienced complex trauma, they have experienced repeated traumas ongoing. And so, if the trauma continues to happen, the processing can’t happen because they have not yet reached a place of safety. And so, I think it’s important to know that there is processing that can happen once the trauma is over. And I think it’s important to just acknowledge this comparison between PTSD and complex trauma is just the expectation of what that journey of healing is going to look like and the time and there’s going to be some differences there because those are different experiences.

Yes. Okay. So, if I’m counting right, we’ve had two phases. Is there another phase? So, yes, there are three phases in trauma counseling work. And so, the first one would be safety and stabilization. Then you move into phase two, which is the trauma processing. And then phase three, the last one would be the meaning making and the reconnecting and so certainly there’s pieces in each of those that go across the board but then the third phase is really after the memory’s been processed and then that helps the meaning. What does this look like moving forward?

So, the memory doesn’t like it’s not present day and kind of ruling the moment, but now what does meaning look like for me moving forward? And, now that maybe I don’t view relationships through this lens, or I don’t view myself through this lens, or whatever that shift would happen, now the reconnection, what does it look like? What do I want life to be like? And how do I step into that with this new meaning and this freedom that’s come? Reengaging with goals and reengaging in relationships and with values, the things that are important and make life meaningful.

So, would you say it’s one thing to get correct meaning of the memory and say, okay, that’s what it meant. And this is what it doesn’t mean. So, we do that. Is this connection piece now, how is this a part of me in a helpful way? Right? Yes. And how do I live in this newfound understanding or realization? Yeah. This process of trauma counseling or trauma therapy piece of it is there’s this important piece of it doesn’t take the memory away, it doesn’t take away the fact that it was hard or that you might have reactions to it but really the going through this process and working. It really helps focus on those core three things that we talked about in the last episode of emotional regulation skills, that sense of self, and then the interpersonal relationships. Really you give them the ability to have a more healthy structure around them.

And I think it’s really exciting, even as we talk through these phases, you can just see the church has a place in each of them. You know, especially phase one and phase three now, like, there’s just a lot of opportunity. What does it look like to come alongside and give opportunity for these things to be played out in a helpful way for folks?

I like that. You know, Christ has done all the heavy lifting. He’s done all the things that we could not do in saving the soul and dispatching his Holy Spirit in the lives of people that bring about a conversion and a born again experience. But he does, in his wisdom, leave some redeeming work up to us to do, doesn’t he?

To come alongside people with his hands and feet and voice and he invites us to be part of the story, which is amazing. Yeah. And I think that’s exciting. I’d like maybe our listeners to catch that part, that the gospel is alive and well and doing well and doing incredible things and participating in that work in the lives of others is rewarding. You’ve brought that out. Thanks for sharing that to us and thanks each one for being on. I hope this has been helpful. I hope it’s been educational. I hope it’s been hopeful to at least help us see the complexity of the world that we live in and the struggles that we all have, but also the beautiful hope that we have as well as just good, thoughtful techniques and steps to move forward with people.

Some of our listeners might be interested to know that Brian and Kathy have unpacked some of the more clinical methods that they use as they deal with trauma, cognitive behavior therapy as well as EMDR. But for sake of time and space, we decided to put that 10-minute audio clip that explains those things in further detail for those who are interested on our website, where you will find these two podcasts as well.

Search trauma on our website and you’ll find some work on that if that interests you. And I hope you’ve been blessed. Goodbye.


What are the professional tools for treatment?

Part 3

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Cognitive behavior therapy and EMDR are helpful tools in the clinical toolbox for treating complex trauma. In this audio recording, Kathy Knochel and Brian Sutter provide some wherewithal to what these are and other methods.


Do you want to say something a little bit about techniques? I mean, you mentioned this is where the professional might have some techniques at hand, right? What would be some of those tools in the toolbox? And, that’s one of those things that I’m, it’s exciting to live in the day and age that we do because there are so many different options, which is really exciting.

And it also speaks to the reality. That it is a really challenging thing to bring healing into, so I think there’s both sides of that, but probably historically, a lot of CBT or cognitive behavioral therapy has been used, and that’s still very effective, but that again is probably going to be more effective with a single PTSD trauma experience where you’re trying to think about engaging the mind and the beliefs and trying to rewrite or reshape those beliefs.

And there’s certainly value in that. And so that would be one of the techniques for sure that technique that Brian is talking about. A lot of that is when you’re walking with a person through more of a trauma focused CBT therapy, you are doing that piece of making sure that they have skills for regulation and understanding unhelpful thinking styles for what they are.

And then it’s helping them walk through the very specifics of what was a trauma and being able to write about it or process it verbally in order to organize it a little bit more in the memory and then move on to making meaning out of it, of what we’ve talked about, which again, just to what Brian had said, that works well with a trauma that has a clear start and a clear end.

And so a lot of what you’re talking about there is really helping bring the hippocampus on board so that it can help create a memory around it so that has the right meaning, that has the beginning, that has the middle, has the end, and it’s coherent would be one of the things that we would say in counseling and where that kind of memory is there. It’s still painful, but it starts to be a memory instead of something that rewrites the whole story.

And that actually makes sense to me because PTSD is really the past hurt bringing itself out in the present, right? Right. Which ii all comes via memory, doesn’t it? So, being able to rewrite memory and setting memory free in a sense is at the crux of the matter.

It seems to make sense. Exactly. And, it’s really helping it be a full and accurate memory that you have some degree of mastery over. And then so other techniques that we would use as well. And so, this would fit into what Kathy is talking about there would be exposure and kind of reducing the avoidance would be a part of that.

And then things that maybe people have heard about, but maybe let’s not race along too quickly. Exposure. Say a little bit about what you mean by that. Yeah. So, exposure would just be the reality of like, okay, this is what happened. Let’s sit and talk about what happened in a really kind of slow.

So, you’re letting the experience hit, but you’ve worked enough on that safety and stabilization that you’ve got tools to stay with and what we would call as the therapeutic window. So, it’s not overwhelming your system, but you’ve got tools to help, there’s certainly a lot of emotional charge around it, but you’re able to sit with a memory and process it.

And so going back to your example, bringing the child into the kitchen is not the threat, right? So, the first level of exposure might just be standing on the very edge and like, oh, okay, yeah, I can handle this and nothing happened. Okay. And then you get a little bit closer and you get a bit closer and eventually you touch the stove.

That would be the example of what exposure would look like in that kind of scenario. Yes. I think it’s important just to mention from an exposure perspective that what some of the things that you have in play there is you have the therapeutic relationship with the counselor. And so, there’s that sense of safety that’s already built.

And then also just, Brian said this already, but kind of the scaffolding in place of, we’ve already worked on stabilizing emotions and you have the distress that comes along. And I think that I wouldn’t want this to lead to everybody like, okay, well, let’s just, expose. That’s not the idea because there needs to be a lot of things in place. And the other person needs to be in agreement with that because a big part of trauma is a lot of times their voice doesn’t get accounted for.

And so that’s a big part of the trauma work is making sure that their voice is heard and has an impact on the present so that they can’t force it. Exactly. You can’t just force it because that would unwind. That would unwind the meaning. Exactly. It reinforces the wrong meaning that’s already in place.

Brian used the word the therapeutic window of tolerance or distress and that’s a really important thing that maybe as a trained counselor we have our eye on as we’re walking through these experiences and unpacking trauma with people. Meaning that there’s enough emotional arousal that you can see that, okay, we’re in the right vicinity, but it’s not too much that’s overwhelming the system and then reinforcing what we’re trying to de-enforce.

So, another one that comes to mind that maybe people have heard of or like, what in the world is that would be called EMDR. So EMDR is short for Eye Movement Desensitization and Reprocessing, truly a mouthful. And even the author or the originator of it, which they would have renamed at this point because they’ve learned so much.

But EMDR has really been found to be very helpful in trauma work partially because the theory behind it at least is that it’s able to do the bottom up approach where it’s able to impact the body and the limbic system or the emotion and get underneath the logic and the defenses that come with the logic because a lot of the defenses are really around the meaning that’s been put to stuff that we’re trying to shift.

And so, if you can get behind those and under those, then that can help shift things. So, there is a very close tie with our experience in our bodies and how we feel in our bodies, our memories. Things are much more integrated than perhaps what we had formerly thought. And so EMDR really works, you mentioned, from the bottom up.

Really paying close attention to the body and allowing that to give clues to the memory. One of the unique things with EMDR is it uses something that is called bilateral stimulation, which means we are working with the person in therapy to stimulate both sides of the brain. And what happens really through the process of EMDR is the similar thing that happens in the REM cycle of sleep.

So, how God designed our body to reprocess things as we’re sleeping. That same process is happening through that EMDR process. And it’s really just trying to access a traumatic memory. And, then trying to basically help do the work of the hippocampus of turning it into more of like a normal or a helpful memory.

Not in the sense that it’s good or that it’s pleasant, but it’s just been processed in a helpful way that it’s a memory rather than something that just dominates. A present reality. Right. It’s something that’s what PTSD is. It’s a present reality when it should be a memory, right? Because that’s part of what happens with traumatic memory is it doesn’t get stamped with time.

So therefore you can’t tell, is it happening now or did it happen then? And that’s a big part of the work of like, nope, that was back then. And what are things right now in connecting with the now? Sure. So I mean, there certainly would be a lot of other approaches, but I think those would maybe just help give a few categories for folks, and even just to think about that there are some top down approaches, there are some bottom up approaches, and generally speaking, especially with complex trauma, you’re going to be trying lots of different things, and sometimes somebody might be in phase one and then you move into the processing and then, that stirs things up so then you got to move back into phase one and the safety and stabilization. And it’s just back and forth journey and just encourage just lots of patience. But there’s also a lot of hope in it. I think that’s a really important point because that. Certainly see it a lot in the counseling room. It’s not a failure if you’re moving back towards, we just need some time to ground and restabilize. It really is all part of the healing process.


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