A Sequenced, Relationship-Based Approach to the Treatment of Complex Posttraumatic Stress Disorder (CPTSD): The Hybrid Case Study of “Chloe”

Chronic and repeated exposure to relational and developmental trauma can result in a presentation that differs from posttraumatic stress disorder (PTSD), with a unique cluster of complicated symptoms, and has thus been labeled as complex PTSD (CPTSD). Many such individuals meet criteria for PTSD while also exhibiting additional symptomology not accounted for in a traditional PTSD diagnosis. This case study provides an overview of the differences between PTSD and CPTSD, using empirical evidence to illustrate the necessity of distinguishing between these two differing diagnoses and subsequently the need for differing treatment approaches. The purpose of this case study is to examine the benefits of using a three-phase, integrative model for an individual with CPTSD. Specifically, it explores the delivery of Courtois and Ford’s (2013) sequenced, relationship-based approach to the treatment of complex trauma. This model was chosen due to the emphasis on attachment and because it allows for clinicians to tailor interventions to the unique individual while also providing an overarching structure to treatment. This treatment analysis is demonstrated via the hybrid case of “Chloe,” who serves as a meaningful representation of a psychotherapy patient with a history of chronic relational and developmental trauma who presents to treatment with symptoms concurrent with a CPTSD diagnosis. Chloe’s composite case example is based on the author’s actual, de-identified psychotherapy cases in addition to clinical examples in the relevant literature. Using the format of a pragmatic case study (Fishman, 1999, 2013), Chloe’s case is analyzed through qualitative processes and quantitative measures. An in-depth illustration of this hybrid patient’s course of treatment provides an avenue for describing key clinical issues related to the treatment of CPTSD and the utility of an integrative treatment approach. Chloe’s case study is intended to be a resource for clinicians seeking more knowledge and understanding of the impact of chronic developmental and relational trauma and the implications this has for effective treatment.