Getting Back in Through Others: Patient Views on Psychotherapy for Complex PTSD

Abstract

People who have been subjected to human mistreatment, such as torture or sexual abuse, may develop mental health problems for which they seek psychotherapy from the NHS. In the past, many were diagnosed as having Post-traumatic Stress Disorder, PTSD, and offered psychotherapy for this, although such treatment did not address all their symptoms. A new diagnosis has now been drawn up by the World Health Organisation (2012), which describes complex symptoms more comprehensively: Complex PTSD. It is set to be approved by WHO member countries in 2019. There is little research on what patients with the new diagnosis might find helpful and this study set out to explore patient views on psychotherapy for Complex PTSD in a community setting in south London. While patients did not formally have the diagnosis, they had the symptoms of Complex PTSD at assessment. The study was innovative in that it took a collaborative, participatory approach where researchers, who had formerly been patients, were trained to carry out interviews (n=24) with each other, as well as contributing to the analysis. The findings were that the key factor in recovery was enabling patients to rebuild relationships with others, beginning with the psychotherapist. Establishing trust in the relationship with the therapist, followed by other people, was identified as crucial, because trauma had been caused by human mistreatment. Although this may be considered a non-specific element of treatment, the participants considered it to be an active mechanism of change. They also emphasised that sufficient time, at least one year, had to be provided for therapy. These findings are explained by a psychoanalytic theoretical framework based on the concepts of attachment and object relations. The findings come at an opportune time because the UK government through the National Institute of Health and Care Excellence (NICE), will need to recommend treatment guidelines for the new diagnosis based on the evidence of scientific studies, as well as clinician expertise and patient views.