Complex Trauma: About & Outcomes

Complex Post Traumatic Stress Disorder (cPTSD)

Complex Post Traumatic Stress Disorder (cPTSD) is similar to Post Traumatic Stress Disorder in that we can be triggered into re-experiencing traumatic event(s), reminders of the event(s) are avoided and or lead to upset. However, Complex PTSD arises from repeated exposure to many traumatic events, often over many years, and can include traumatic events experienced in childhood, physical abuse, sexual abuse and emotional abuse/ neglect. See for example the NHS description of cPTSD

Healing from Complex Trauma: a Guide to Recovery

If you are reading this, perhaps it is because you are (or someone you know is) having problems with Complex PTSD. The problems caused by experiencing cPTSD can be helped by counselling and psychotherapy.

Dr Tony Weston’s BACP award winning research showed how clients improved through counselling in terms of their anxiety, depression and general distress caused by a number of problems such as abuse, addiction, anger, bereavement and relationship difficulties. Dr Weston’s private practice is located in the South Cambridgeshire village of Horseheath from where he offers in person and online appointments. He enjoys working with individuals, couples and family groups (e.g. parent and child).

Contact him now at tony.weston5@btinternet.com to make an initial appointment.

The rest of this page gives you some more information about the nature of Complex PTSD, some of the problems this can lead to and some of the outcomes experienced by clients working with Dr Tony Weston.

With permission, the assessment measure used by Dr Tony Weston to assess clients for Complex Trauma is the Early Trauma Inventory Self Report Short Form (ETI-SR-SF, (c) J Douglas Bremner 2007). This self report questionnaire asks clients about traumatic experiences in childhood, including:

• General Traumas e.g. death of a parent or sibling, serious accidents, illnesses or injuries, etc.
• Physical Punishment e.g. being slapped in the face, burned, punched, kicked, etc.
• Emotional Abuse/ Neglect e.g. being ridiculed, ignored, unloved, failure to meet needs, etc.
• Sexual Abuse e.g. being forced or coerced into sexual acts as a child.

Of 114 clients who had completed the ETI-SR-SF questionnaire as at January 2025, 101 clients (89%) met the criteria for cPTSD (a score of 7 or over):

Complex PTSD is associated with a wide range of difficulties throughout the life course. These may include the following:

• Difficulties arising in childhood e.g. anxiety, depression, PTSD, failure to thrive, failure to achieve developmental milestones, etc.
• Difficulties arising/ identified in early adulthood, e.g. substance abuse, addictions, bipolar disorder, schizophrenia, etc.
• Physical health problems arising/ identified in later adulthood e.g. arthritis, cancer, diabetes, heart disease, irritable bowel syndrome, multiple sclerosis, etc.

NOTE: The information provided on this website is for general information only and not intended as a substitute for diagnosis or treatment; if you are concerned about your health please contact an appropriate practitioner.

cPTSD and Generalised Anxiety

The following graph shows outcomes for clients presenting at this counselling service with both Complex Trauma and symptoms of anxiety measured using the Beck Anxiety Inventory, (BAI²). The BAI measures symptoms associated with anxiety disorders, particularly panic and generalised anxiety disorders. As at January 2025 there were 15 clients who had started with cPTSD, clinical anxiety and a subsequent measurement of their anxiety. Average scores are illustrated in the graph below, where the average start score was equivalent to a severe level of anxiety and the average subsequent score was equivalent to being not clinically anxious. This was a ‘large’ effect size (ES = 2.21) and statistically significant at better then 99.9% confidence.

Using the methodology described by Elliott, et al (2013) these average outcomes compare well with the published literature for anxiety outcomes in clinical trials and practice-based studies. On average clients had eighteen sessions (range nine to thirty-four sessions).

Clinical trials typically exclude clients who have more than one presenting problem e.g. include clients who only have anxiety. This practice-based research included clients who are usually excluded from clinical trials and included clients who had Complex Trauma, were at risk to themselves and/or others, and/or were also suffering with depression and other problems, and/or had a so-called ‘personality disorder’ and/or had problems with addiction (e.g. drink, drugs, gambling, pornography, etc.), in addition to their anxiety.

cPTSD and Panic

Outcomes for 10 clients seen at this service with Complex PTSD and symptoms of panic to January 2025 are shown in the following graph. Symptoms of panic included heart pounding or racing, feelings of choking, fear of dying and or difficulty breathing. These clients had cPTSD and scored 3 or greater on the BAI panic subscale out of a maximum of 12. At the start, on average, they were describing symptoms of panic in the past week being ‘very unpleasant’ and or ‘I could barely stand it’ and subsequently had had ‘no symptoms at all’ or ‘it did not bother me much’. These clients had on average 19 sessions, range 2 to 34 sessions.

Average scores are illustrated in the graph above, this was a ‘large’ effect size (ES = 4.07) and statistically significant at better then 99.9% confidence.

cPTSD and Trauma (PTSD, post-traumatic stress disorder)

Following is a graph of average changes in symptoms of trauma experienced by 36 clients at this service to January 2025 who had cPTSD (from childhood) and were showing symptoms of trauma as an adult (e.g. subsequent traumatic experiences). Using the CORE-OM (clinical outcomes routine evaluation – outcome measure) trauma subscale for 36 clients scoring at least 4 out of a maximum possible score of 8 on the trauma sub-scale, meaning clients were distressed and or disturbed by unwanted thoughts, feelings, images or memories ‘sometimes’, ‘often’ and or ‘most or all of the time’. Subsequently, on average, these clients had two of these symptoms ‘only occasionally’ or one symptom ‘sometimes’.

The average number of sessions was ten (range 2 to 43 sessions). This was a ‘large’ effect (ES = 2.58) and statistically significant at better than 99.9% confidence.

A more detailed exploration of the experiences of clients with complex trauma and recovery from trauma is shown by before and after scores on the PCL-5 PTSD questionnaire. This is based upon the diagnostic criteria for PTSD in DSM-5 (the Diagnostic and Statistical Manual of the American Psychiatric Association, 5th Edition). As at January 2025, for 9 clients with cPTSD and PTSD who met the diagnostic criteria for all four symptom groups of PTSD, after an average of 24 sessions on average they met the diagnostic criteria for 1.3 symptom groups, so had on average recovered from PTSD.

This was a ‘large’ improvement (ES r = .90) at better than 99.9% confidence and a recovery from PTSD.

These changes are also illustrated by the average changes in total scores on PCL-5. As at January 2025 for these 9 clients, on average they started with a score of 48.9, equivalent to a ‘severe’ level of PTSD and after 24 sessions on average they had a score of 13.6, equivalent to no longer having PTSD.

This was a ‘large’ improvement (ES d = 4.21) at better than 99.9% confidence.

Clients with complex trauma can and do recover from trauma.

cPTSD and Problems with Social Relationships

Following is a graph for average changes experienced at this counselling service by 21 clients to January 2025 who had cPTSD and were struggling to function in social relationships (e.g. talking to people felt too much, feeling humiliated, shamed or criticised by other people). These clients scored 9 or more out of a maximum 16 on the Problems with Social Relationships scale of CORE-OM at the start of counselling, average score around 10 and a subsequent average score of around 2.5:

This was a ‘large’ effect size (ES = 5.00) at better than 99.9% statistical significance. The average number of sessions was twelve, range 2 – 43 sessions.

cPTSD and Blushing when with other people

Following is a graph for average changes experienced at this counselling service by 6 clients who had cPTSD and problems with blushing (face flushing), to January 2025. This is an anxiety problem with no conscious control. The average score at the start of counselling was around 2 and the average score at the end was less than one quarter:

These were clients who had experienced blushing in the past week to a moderate level (‘it was very unpleasant but I could stand it’) or a severe level (‘I could barely stand it’). By the end of counselling on average they described themselves as having experienced blushing in the past week to a mild level (‘it did not bother me much’ or not at all. Average client age was around forty years of age, age range late teens to sixties, around three-quarters were female and over three-quarters were in relationships and/or had a child(ren). The average number of counselling sessions was eleven, range 3 – 34 sessions. This was a ‘large’ effect size (ES = 4.15) at better than 99.9% statistical significance.

Clinical trials typically exclude clients who have more than one presenting problem e.g. include clients who only have anxiety. This practice-based research included clients who are usually excluded from clinical trials and included clients who had cPTSD, were at risk to themselves and/or others, and/or were also suffering with depression and other problems, and/or had a so-called ‘personality disorder’ and/or had problems with addiction (e.g. drink, drugs, gambling, pornography, etc.), in addition to their anxiety.

This naturalistic research showed on average a large improvement for clients with cPTSD plus a wide range of anxiety problems, including generalised and severe anxiety, panic, trauma, difficulties with social relationships and blushing when with others, even if there were other co-occuring symptoms.

cPTSD and Depression

Outcomes for clients presenting at this counselling service with cPTSD and symptoms of depression are shown below. To January 2025 there were 37 clients who had started with some level of clinical depression and who had a subsequent measurement of their depression, measured using the Beck Depression Inventory, Second Edition (BDI-II²). Client average age was around forty years (range 18 to 66 years), two-thirds were female, a quarter were single and two-thirds were themselves parents.

The average start score was 29.2, equivalent to a severe level of depression, and the average subsequent score was 7.7, equivalent to no longer being depressed. In this case the effect of counselling (ES = 2.11) was a ‘large’ effect after an average of fourteen counselling sessions. These average scores are illustrated in the graph below:

Using the methodology described by Elliott, et al. (2013) these average outcomes compare well with the published literature for depression outcomes in clinical trials and practice-based studies which typically exclude clients with cPTSD.

cPTSD and Distress

Outcomes for clients presenting at this counselling service with cPTSD and general distress are shown below. To January 2025 there were 51 clients who had started with cPTSD and some level of clinical distress and who had a subsequent measurement of their distress, measured using the Clinical Outcomes Routine Evaluation Outcome Measure (CORE-OM). Client average age was around 40 years (ranging from 18 to 66 years), just over half were female, around a third were single and two thirds were parents. The average number of sessions was nine, (range 2-25 sessions). Client average scores are illustrated in the graph below:

On average clients started with a moderate-severe level of distress (average score 69 out of a maximum possible score of 136) and were subsequently no longer distressed (26/136), this was a ‘large’ effect size (ES = 2.79) at better than 99.9% confidence. Using the methodology described by Elliott, et al. (2013) these average outcomes compare well with the published literature for distress outcomes in clinical trials and practice-based studies which typically exclude clients with cPTSD.

cPTSD and Constructive Personality Change/ “Personality Disorders”

One way of measuring ‘constructive personality change’ is to consider changes in so-called ‘personality disorders’, an ‘enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture’ (APA 2000) that can be manifest in cognition (perceptions and interpretations of self, others and events), affectivity (emotional responses), interpersonal functioning and impulse control. A preferable phrase is ‘personality process’ to indicate an habitual way of processing information resulting in actions and behaviours that may cause difficulties. Therapy to understand the nature and origin of these ‘habits’ and how they can be changed tends to span a number of sessions spread out over a period of several months.

There are a number of ‘personality disorders’ and some of these are described below briefly, together with some outcome data from this service. The Personality Beliefs Questionnaire (PBQ, Beck & Beck 1991) measures the extent to which people endorse beliefs associated with personality disorders (Beck et al 2007) and has been empirically validated (Beck et al 2001, Butler et al 2002). With Aaron Beck’s permission the PBQ has been adapted for use by UK English-speaking clients at this service.

The Avoidant personality is characterised by ‘a pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation’ (APA 2000). In my clinical experience often this is an adaptive response in childhood to experiences of being mistreated by adults, such as being ignored, lack of recognition, affirmation & validation and on the contrary being criticised, blamed and abused; resulting in fearfulness and wariness around others. This avoidant process is adaptive in childhood as an attempt to avoid further attachment injuries, however in adulthood this becomes maladaptive, as a fear-based inability to create close relationships & friendships with other adults. The following graph shows outcomes for 25 clients to January 2025 at this service with cPTSD. The average number of sessions was 23 sessions. Average client age was around forty years (range 15-60 years), around three-quarters were female, one quarter were single and two-thirds were parents.

On average clients improved from clinical to non-clinical scores for avoidant process and at better than 99.9% confidence these are ‘large’ improvements in avoidant process (ES = 2.07).

The Dependent personality is characterised by ‘a pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation’ (APA 2000). In my clinical experience this arises in childhood as an adaptive attempt to turn a disinterested and neglectful caregiver into an engaged and caring parent figure. This becomes maladaptive in adulthood when similar strategies of submissiveness and clinging are used as attempts to manage fears of rejection and lack of secure attachment from childhood in adulthood, these behaviours are typically disliked by peers and unfortunately, creates the feared scenario. The following graph shows outcomes for 9 clients with cPTSD seen at this service to January 2025 (average 30 sessions):

On average clients improved from clinical to non-clinical scores for Dependent process and at better than 99.9% confidence these are ‘large’ improvements in dependent process (ES = 2.36).

The Passive-Aggressive (negativistic) personality is characterised by ‘a pervasive pattern of negativistic and passive resistance to demands for adequate performance in social and occupational situations’ (APA 2000). In my clinical experience this arises from childhood experiences with angry and aggressive caregivers who refuse to listen, understand or accept legitimate attempts at self-assertion by the child, who has little option other than to develop what at that time were adaptive ways to resist coercive control and demands from adults. This becomes maladaptive in adulthood when the similar strategies of passive resistance are utilised, rather than more adaptive attempts to discuss, negotiate and develop mutually agreeable ways forward. These strategies could not be learned in childhood because of the failures of the adults around the child. Results for 10 clients with cPTSD to January 2025 are shown below (average 23 sessions):

On average clients improved from clinical to non-clinical scores for Passive-Aggressive process and at better than 99% confidence these are ‘large’ improvements in passive-aggressive process (ES = 3.62).

The Obsessive-Compulsive personality is characterised by ‘a preoccupation with orderliness, perfectionism and mental and interpersonal control, at the expense of flexibility, openness and efficiency’ (APA 2000). In my clinical experience this arises from childhood attempts to negotiate interpersonally dangerous and chaotic environments wherein it is adaptive for the child to attempt to create order and maintain self-control to stay out of trouble and try to build a safe environment. These fear-based habitual ways of being and behaving become maladaptive in adulthood when they are no longer required and consume time, energy and other resources at the expense of more adaptive ways of simply responding to cues from the environment. Following are outcomes for 11 clients with cPTSD seen at this service to January 2025 for an average of 20 sessions:

On average clients improved from clinical to non-clinical scores for Obsessive-Compulsive process and at better than 99.9% confidence these are ‘large’ improvements in obsessive-compulsive process (ES = 2.22).

The Anti-Social personality is characterised by ‘a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adulthood and continues into adulthood. This pattern has also been referred to as psychopathy, sociopathy or dyssocial personality disorder’ (APA 2000). In my clinical experience this arises from adaptive responses in childhood to dangerous home and social environments when extreme measures were required to survive. These can become maladaptive in adulthood when such extreme measures may no longer be required for survival, or the choices to inhabit hostile environments may necessitate the perpetuation and further refinement of extreme survival measures. Following are outcomes for 6 clients with cPTSD seen at this service to January 2025 for an average of 21 sessions:

On average clients improved from clinical to non-clinical scores for Anti-Social process and at better than 98.6% confidence these are ‘large’ improvements in anti-social process (ES = 1.07), although small sample size, see also main section on Anti-Social personality.

The Narcissistic personality is characterised by ‘a pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy [for other people]’ (APA 2000). In my clinical experience this is an adaptive strategy arising in childhood from a caregiver failure to recognise, validate and affirm the child. Lack of recognition, validation and affirmation feels so awful to the child that they desperately attempt to create ‘pseudo self esteem'(grandiosity, larger then life, admiration), irrespective of the feelings of others, such are their desperate attempts to survive. This can become maladaptive in adulthood when unempathic demands for admiration from others may be rejected, creating the feared scenario of feeling abandoned and alone. Following are outcomes for 5 clients seen at this service to January 2025 for an average of 13 sessions:

On average clients improved from clinical to non-clinical scores for Narcissistic process and at better than 99.3% confidence these are ‘large’ improvements in anti-social process (ES = 2.55), although small sample size, see also main section on Narcissistic personality.

The Histrionic personality is characterised by ‘a pervasive and excessive emotionality and attention-seeking behaviour’ (APA 2000). In my clinical experience this adaptive strategy in childhood often arises from disinterested caregivers who only give an emotional child attention; the child learns that in order to gain caregiver attention they have to behave in excessively emotional ways. This becomes maladaptive in adulthood when attention-seeking behaviour may result in rejection by peers or only work with particular people in particular settings. Outcomes for clients with cPTSD to January 2025 are shown below after an average of 9 sessions:

On average clients improved from clinical to non-clinical scores for histrionic process and at better than 99.7% confidence these are ‘large’ improvements in histrionic process (ES = 1.76).

The Schizoid personality is characterised by ‘a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings’ (APA 2000). In my clinical experience this strategy is adaptive in childhood when the caregivers are hostile and threatening; keeping distant and emotionally shut down is self-protective for the child. This can become maladaptive in adulthood when the person is perceived as distant, emotionless and difficult to reach; so others keep away and this creates the feared scenario of isolation from a world perceived as hostile. Outcomes for 6 clients with cPTSD to January 2025 are shown below after an average of 17 sessions:

On average clients improved from clinical to non-clinical scores for schizoid process and at better than 97.3% confidence these are ‘large’ improvements in schizoid process (ES = 1.61).

The Paranoid personality is characterised by ‘a pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent’ (APA 2000). In my clinical experience this adaptive strategy in childhood arises from threatening and untrustworthy caregivers and then it is helpful to keep away from ill-intentioned caregivers. This can become maladaptive in adulthood when all others are perceived as hostile and untrustworthy and kept away from; others don’t like to be perceived in this way and so keep their distance too, creating the feared scenario. Outcomes for 15 clients with cPTSD to January 2025 are shown after an average of 27 sessions:

On average clients improved from clinical to non-clinical scores for paranoid process and at better than 99.9% confidence these are ‘large’ improvements in paranoid process (ES = 1.55).

The Borderline personality is characterised by ‘a pervasive pattern of instability of interpersonal relationships, self image and affects, and marked impulsivity’ (APA 2000). In my clinical experience this is a complicated series of adaptive strategies from childhood as a response to abuse (physical, emotional, psychological & sexual) and neglect (physical, emotional & psychological) wherein the child is desperately trying to survive. Such desperate strategies are continued into adulthood when they become maladaptive and create further interpersonal difficulties as an adult. Outcomes for 9 clients with cPTSD to January 2025 are shown below after an average of 36 sessions:

On average clients improved from clinical to non-clinical scores for borderline process and at better than 99.9% confidence these are ‘large’ improvements in borderline process (ES = 2.16).

These kinds of personality processes usually begin by early adulthood and are often what seem like ‘adaptive’ ways of coping with adverse situations that continue into adulthood, when the coping mechanisms are no longer appropriate for the situation and can create problems for the person and others around them. These effects can be particularly pernicious when a person finds themselves ‘stuck’ in situations where they are rewarded for continuing to act out these out-dated coping mechanisms e.g. the histrionic actor, the obsessive-compulsive manager, the dependent partner, etc. Changing the way one habitually behaves (constructive personality change), can be challenging, time consuming and ultimately rewarding, to ‘master oneself’.

cPTSD and Satisfaction in Couple Relationships

Improvements in the satisfaction that clients with cPTSD can experience in their couple relationship (CSI 16) have been found at this service. Research to January 2025 showed for 5 clients, change from couple relationships that were on average described as ‘dissatisfied’ to ‘satisfied’ after an average of 21 sessions:

This was a ‘large’ improvement (ES = 2.58) from dissatisfied to satisfied with the couple relationship and was statistically significant at better than 99.6% confidence.

cPTSD and Attachment Styles

(See Page on Attachment Styles)

The experiences and events leading to Complex PTSD can lead to attachment difficulties, in particular to a rarer attachment style that combines both anxious and avoidant styles. About three to five people in one hundred have an anxious-avoidant attachment style and this can be a key mechanism in issues such as borderline process; perhaps better understood as an understandable response to childhood trauma, abuse and/or neglect. One effect of this can be an internal conflict about interpersonal relationships, oscillating between anxiety about abandonment/ rejection and wanting to avoid closeness/ intimacy. This can lead to intense new friendships/ relationships, characterised initially by idealisation and then by devaluation ‘the best person I’ve ever met turns out to be the worst person I’ve ever met’.

As at January 2025 for 1 clients with Complex PTSD the following diagram shows ‘average’ experiences for these 91 clients of key relationships: with mum as a child and with dad as a child. Arising from these experiences are subsequent average experiences for these 91 clients with their romantic partner and their perceptions of close relationships in general. In addition their initial experience of their attachment with Dr Tony Weston after their first counselling session.

Attachment styles are considered to be ‘stable and plastic’, meaning they tend to remain as they were in early childhood and they can change over time, for example through personal development activity, counselling, etc. Following are some examples, for illustrative purposes of real-life changes in attachment styles with general relationships some clients have experienced through work with Dr Tony Weston:

Changes between attachment styles may be considered along both axes, to the extent that clients have reduced their level of attachment anxiety from higher to lower anxiety and to the extent that clients have reduced their level of attachment avoidance from higher to lower avoidance. Research at this service shows the following changes in both anxious and avoidance dimensions. Firstly, as at January 2025 for 9 clients starting with cPTSD and an anxious attachment and after an average of 16 sessions experiencing a more secure attachment to specific personal relationships in their lives:

This is a large (ES = 3.41) change from an anxious to a secure attachment style for clients with cPTSD and statistically significant at 99.9% confidence.

Secondly, as at January 2025 for 9 clients starting with cPTSD and an avoidant attachment and after an average of 18 sessions experiencing a more secure (in this case transparent as opposed to avoidant) attachment to specific personal relationships in their lives:

This is a large (ES = 1.76) change from an avoidant to a secure attachment style for clients with cPTSD and statistically significant at better than 99.9% confidence.

In the development process for the ECR-RS questionnaire researchers found the notion of ‘trust’ in a relationship was unhelpful for discriminating between relationship anxiety and avoidance (‘trust’ maps onto both concepts). However, in a naturalistic counselling setting the idea of trust is perhaps helpful for illustrating changes in relationships. As at January 2025 for 7 clients with cPTSD and low levels of trust in specific relationships after an average of 20 counselling sessions higher levels of trust were observed in the same specific relationships, leading clients to feel more emotionally secure and to have a greater sense of the secure base that Bowlby wrote about as being essential to human wellbeing:

This is a large (ES = 2.40) change from an insecure/ untrusting attachment style to a secure/ trusting attachment style for clients with cPTSD and statistically significant at better than 99.9% confidence.

This naturalistic research suggests changes in attachment styles are possible through therapy for clients with Complex Post Traumatic Stress Disorder (cPTSD).

cPTSD and Rejection Sensitivity

Individuals often develop a sensitivity to rejection from others through childhood experience (even in the uterus). Bowlby (1969) is credited with recognising that infants require a secure attachment with a caregiver. The absence of a secure attachment can give rise to fears about being ignored, rejected or even abandoned.

There is some evidence that childhood emotional neglect may be key in the development of long-term rejection sensitivity (Bungert et al., 2015). A lack of confidence in one’s own identity and a stable sense of self-identity, ideally acquired through childhood, are both linked to rejection sensitivity, see Norona and Welsh, 2016. These authors suggested hostility and criticism from caregivers encourages children to develop rejection sensitivity as an adaptive self-protection mechanism that can subsequently cause difficulty in later life. Traumatic experiences may also lead to fears about rejection (e.g. actual rejection, experiences of bullying, abuse, etc.).

Rejection sensitive individuals expect, readily perceive, and often overreact to rejection. Their means of processing these fearful expectations, perceptions, and experiences may in themselves make rejection more likely. Individuals may thus generate ‘self-fulfilling prophecies’ which harm their experience of relationships, and the experiences of intimate others. Ironically, this makes the feared scenarios more likely.

Rejection Sensitivity can be measured using the Rejection Sensitivity Questionnaire developed for use with Adults (A-RSQ). Average scores above 10.25 on the nine scenarios provided on this questionnaire were considered ‘clinical’, indicating ‘high rejection sensitivity’. Research at this service showed the following changes for clients presenting with ‘high rejection sensitivity’. As at January 2025 for 10 clients with cPTSD starting with high rejection sensitivity after an average of 19 sessions these clients were experiencing on average a non-clinical level of rejection sensitivity:

On average clients improved from clinical to non-clinical scores for rejection sensitivity process and at better than 99.9% confidence these are ‘large’ improvements in rejection sensitivity process (ES = 1.70).

Anger Management

It is understandable that children who were repeatedly traumatised in childhood would feel angry about their experiences. Often children living through such experiences are not taught by their parents how to regulate and manage their feelings, including anger. This can lead to problems in adulthood at home, in relationships, at work and in the community. For clients with cPTSD, improvements in their ability to manage their anger have been experienced at this service. Anger was defined as threats, intimidation or physical violence to another person in the week preceding the start of counselling compared with the week preceding the subsequent measure. As at January 2025 there were 15 clients with both complex trauma and anger problems, as defined. On average these clients scored around 2 on this anger scale at the start of counselling and around one quarter of one point on the same scale.

Average number of counselling sessions was eight. One third of clients were female, half of all clients were married and half of all clients had children. Average age was 40 years with range 14 to 79 years. The effect size was ES(d) 1.81, a large effect, statistically significant at better than 99.9% confidence. Please note there are no guarantees in therapy and ‘past performance is no guide to the future’.

Whilst Complex Post Traumatic Stress Disorder (cPTSD) can lead to difficulties throughout the life course it is possible to improve the effects of this and research at this counselling service has shown that clients can improve in terms of their experience of lived symptoms (e.g. distress, depression and anxiety) plus more developmentally important aspects such as personality processes and rejection sensitivity, that in turn can lead to a wide range of interpersonal difficulties.

You can contact Dr Tony Weston by email at tony.weston5@btinternet.com to make an initial appointment.

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