Complex PTSD – the missing piece for many Third Culture Kids

As a follow up to my previous interview with PTSD practioners (read more here) I was prompted to seek out a therapist who could shed some light on Complex PTSD (or C-PTSD). And Mary-Clare de Echevarria very kindly stepped into the breach. In this post, she outlines the diagnostic and experiential differences between PTSD and C-PTSD and her clients’ treatment experiences.

Though I do not work directly with PTSD, I have gained a growing appreciation for the number of Third Culture Kids who have experiences of trauma featuring strongly throughout their life stories. And I am deeply grateful for therapists such as Mary-Clare who can so expertly support those battling both PTSD and C-PTSD.

Mary-Clare de Echevarria is a UKCP-registered psychotherapist, supervisor and training supervisor with over 20 years’ experience. She is a staff member at The Centre for Counselling and Psychotherapy Education, London, and teaches her own series of workshops on complex trauma, The Missing Piece™. Her website can be found at Primary Light.

What’s the difference between PTSD and Complex PTSD, or C-PTSD?

Trauma is an overwhelming experience that’s bigger than our capacity to integrate it. ‘Big T trauma’ is usually a one-off experience such as a car accident or 9/11, which can lead to PTSD.

C-PTSD comes from ongoing trauma in childhood and adolescence. This may be abuse, or may be less obvious trauma (sometimes called ‘small t trauma’), such as not being understood or listened to; not being allowed to have feelings or needs, or not expressing them because your parents/caregivers can’t deal with them; not being safe, not having anyone to go to for comfort or protection; or constantly having to break attachments, eg through frequent moves or being sent to boarding school. C-PTSD is also known as complex or developmental trauma.

What draws you to working with clients with C-PTSD?

It’s the realisation that complex trauma underpins everything, and yet this is often not recognised. For so many people, an understanding of C-PTSD and dissociation is the missing piece that allows them to make sense of what they feel and the ways in which their past has shaped them. When you know how to recognise and work with it, the changes that come about can seem magical as they are so real and tangible. My students and clients who have C-PTSD are among the strongest, most creative and inspiring people I’ve met. It’s a privilege to work with them and help them to reconnect with parts of themselves that they had to ‘put away’, or dissociate, in order to survive. They learn to be kinder and gentler towards themselves, and are no longer overshadowed by constant background pain, anxiety or self-doubt. They start to feel powerful, competent and grounded in the present, in touch with themselves and able to stand up for themselves quite naturally and spontaneously. They say things like ‘I feel that I’m really living for the first time’.

What are the common presenting symptoms of C-PTSD that you identify in your clients?

As a therapist you have to learn to look for ‘intrusions into day-to-day functioning’: thoughts, feelings and behaviours that come from the past. They’re very real in the present and affect people’s ability to function in their lives, but they’re memories: emotional and physical memories of what you once felt. They can include critical voices in your head; persistent feelings of helplessness, emptiness, aloneness, or not being good enough; hypervigilance – waiting for something bad to happen; feeling that you have to be the strong one all the time, or that good things are for other people; intense reactions that seem out of proportion to the present situation; anxiety, depression or strange moods that seem to come from nowhere, then they vanish just as suddenly and you may feel ‘what was all that about?’. You may find it hard to have intimate relationships, to trust others or let them come close; you may be drawn to unavailable people, or find that you can’t always parent your children as you would want to.

Are there ‘mental blocks’ that interfere or complicate treatment and recovery from C-PTSD, that are shared by your clients?

Sometimes people are (understandably) afraid that they’ll have to ‘go back into the past’ and feel terrible. That isn’t the case: the aim of trauma therapy now is to help people to process traumatic experiences without becoming overwhelmed. It isn’t about going back into the past, but working with and resolving memories of the past that are coming into the person’s present. It’s essential that clients learn to feel painful feelings just for a moment, long enough to acknowledge them, then immediately bring themselves back to a place of feeling strong, safe, grounded and connected in the present.

What factors seem to be the most helpful in your clients’ recovery?

Psychoeducation – helping clients to understand what happened to them and how to recover, then therapy isn’t a mysterious process that they have to go along with: they know what’s going on and what to do to make themselves feel better. Having a therapist who is a real, attuned person. Above all, having a therapist who knows how to recognise and work with complex trauma and dissociation, is not at all afraid of it and understands that it’s a set of totally natural survival strategies.

Are there specific processes or treatments that you’d recommend in the treatment of C-PTSD, that your clients find especially effective?

A therapy that recognises dissociated states, sometimes known as ‘ego state therapy’. EMDR and interventions from sensorimotor psychotherapy or Somatic Experiencing, woven into an integrative, relational ego-state therapy. It’s essential to work with the body in trauma therapy, and I can’t recommend yoga highly enough as a way of connecting with yourself and your body and learning to feel strong, powerful, centred and relaxed in the present moment. Many of the interventions that I use regularly in my practice are drawn from yoga therapy.

Thank you so much Mary-Clare, for your work and for your insight.

If you have any questions for Mary-Clare, do contact her on the link above.

Failure: my greatest fear & my greatest gift

"So my name is Rachel Cason, and I'm a failure". This was how I felt like introducing myself yesterday. Complete with aggressive self-loathing and topped with misery and embarrassment. I had failed my driving test. Halfway through it I failed to see and respond to the actions of the driver ahead of me, and probably frightened my examiner half to death. I somehow managed to complete the rest of the test competently, but my ultimate failure was made worse by the fact that my examiner was convinced due to my otherwise tolerable driving, that I had seen the danger ahead and simply taken a chance. So I had failed. AND I had been misunderstood. This is such a 'double-whammy'. I am a Third Culture Kid, and have grown up working frantically to try to work out the rules of every new cultural environment I found myself in.

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Life Story - Adults TCKs

What is a Third Culture Kid?

The chances are, if you have landed on this blog, you already know something about Third Culture Kids. Maybe you are one, and are looking for resources to better understand or support your experiences. Maybe you are a parent of a TCK? Maybe you have just started realising there is a whole community our there who share your experiences... and you are excited to find you have a name! Or maybe TCK feels more of a label than a community, and you are feeling ambivalent about it all. Whoever you are, welcome!

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Why I hated ‘Resilience’

I've been delaying writing this post. So much has already been written about Resilience, how to foster resilience in our children, how it's a good thing, and a predictor of success. And I would cringe at the sound of it. As much as my rational brain knew that the science behind resilience made sense, I recoiled. Odd because, after all, who would want the alternative? Who would want to NOT be resilient? Who wants to crumble under adversity? Resilience is a particularly popular buzz word for Third Culture Kids, those children raised abroad due to parental employment, and their expatriate communities. For anyone who has loss or transition built into the structure and fabric of their lives, resilience can be an attractive concept.

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Language Imperialism: how identities get negotiated, and suppressed

I came across language imperialism before I had a name for it. If you have spent time in a multi-cultural, multi-lingual setting, you will have experienced the negotiation that occurs to try and establish the common denominator, the language most commonly spoken and understood. You will have witnessed a group dynamic writhe under the effort to incorporate such individual Individuals and lend accessible expression to all their tongues. Language imperialism, however, is when this negotiation does not occur.

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PTSD: interviews with two specialists

In light of my previous posts on this topic, PTSD and Cultural Variance: Implications for Third Culture Kids and TCKs and PTSD continued: West African culture-bound syndromes, I wanted to speak to some therapists who are more experienced than I in this field. My hope is that my interviews with them will both inform and encourage any Third Culture Kids to feel better equipped in understanding their stress responses, and actively seek help if needed. There are wonderful practioners out there - and it's an important investment in our mental health to reach out to them.

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Terror, Fear… and Victory

I've never been frightened of the world around me. I grew up on airplanes, alongside scorpions and malaria. I grew up as a member of a minority group in my host country; a speck of White in a Black landscape. I grew up without fear. I knew nothing of hijacking; I had relatively good access to medical supplies and treatment, and I was a privileged and tolerated, if not welcomed, minority. Protection nurtures Fearlessness.

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Living at the Edge of our Competencies

Many of us are living in a culture other than the one (or 'ones'!) in which we were raised. We are called Cross Cultural Kids, Third Culture Kids, Expats, Immigrants, Global Nomads, and many other things besides. We are competence tight-rope walkers. We are familiar with borderlands, with the edges of our Selves. We are marginals, drawn to the edges of our competencies. We seek out new challenges, excited by the novelty, the stretch we feel in our characters and abilities. Yet as stimulating as these spaces are, we can easily tip from thrill to spill as we dance on the edge of situations that we feel ill-equipped to handle with grace.

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Courage & Relationships: A TCK Challenge?

How many of us find relationships utterly terrifying? My hand is up.

Third Culture Kids have grown up in flux, travelling around different identities as much as different countries and cultures. Raised by parents in a culture other than the one represented by their passport, and often embedded in an organisational context (mission, military, business), we TCKs are hard to pin down. We become cultural chameleons, adept mimickers (or perhaps rejectors of?) of localised belonging.

Some of us, of course, are drawn to relationships like magnets, for they signal 'home' and 'belonging' in a way that soothes the weary nomad soul. But this doesn't make them easy to navigate, drawn as we are to their promises of love, and of rest. Hence the terror.

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Be You-tiful

In the last week, a lot has changed in my life. I'm entering new roles and responsabilities, negotiating changing relationships and managing the ripple effect this has. It's tiring stuff! And I've found it very easy to slip into feelings of inadequacy, worrying that I'll never be enough for all the people in my life. As TCKs we can grow so adaptable it's as though we get caught spinning in circles holding tightly onto our mirror, reflecting all the demands that come whirling towards us. With practise, we learn to reflect back what is expected; just one expert flick of the wrist and we can juggle competing demands on our identities. But the stage shifts too, and the dance can become frantic as we whirl to keep up with the identity demands around us.

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