FROM TRAUMA TO RESILIENCE:

NAVIGATING THE EFFECTS OF

RELATIONAL PTSD
 OBJECTIVES
YOU WILL BE ABLE TO…
1. Locate and use additional assessment resources for the assessment and
treatment of PTSD resulting from relational or betrayal trauma.
2. Identify internal and external factors contributing to traumatic responses in
clients who are in relationships with persons struggling with some form of sex
addiction.
3. Develop a treatment plan with grounding strategies and mindfulness techniques
that will help the client be objective and self-regulate.
4. Identify personal beliefs or cognitions that may contribute to or exacerbate the
traumatic response and train clients to challenge those core beliefs.
5. Use these tools at the best time in treatment for the intervention of Relational
PTSD.
SORTING IT OUT Assess Assess for the type of client you are serving and lay a
foundation appropriate for their healing needs.
AND PUTTING THE
PUZZLE TOGETHER
Test and measure emotional tolerance relative to
Test their experience, history and relationships as well as
their ability to work through those issues.

Identify internal and external factors such as personal

Identify beliefs or cognitions, relationships, etc. that may
contribute to or exacerbate the traumatic response.
“CRAZY LAND”: THE EXPERIENCE OF RELATIONAL TRAUMA
Cognitive and Emotional Behavioral and Physical
• Anger • Aggression (Verbal and/or Physical)
• Anxiety • Eating Disorders
• Depression
• Self-harm
• Difficulty making decisions
• Sexual Acting Out
• Disorientation and Confusion
• Dissociation
• Sleep Disturbance/Nightmares/Dreams
• Emotional dysregulation & fluctuation • Substance Abuse (Alcohol, Pills, Stimulants)
• Intrusive thoughts (AKA “Crazy land”) • Suicidal Gestures, Threats or Attempts
• Personality Disorders
• Suicidal thoughts
 ASSESSMENT: STANDARDIZED TESTS/TOOLS
- PTSD Assessments:
1. PTSD Symptom Scale (PSS) & PTSD Symptom Scale Interview (PSSI): Public Domain
2. Post Traumatic Stress Index Revised (PTSI-R): Available through collaboration with a CSAT
- Trauma Assessments:
1. Betrayal Bond Index (BBI): Available for free at www.recoveryzone.com
2. Inventory for Partner Anxiety, Stress, and Trauma (IPAST): Available through CSAT
- Dissociative Assessments: Dissociative Experiences Scale (DES), Dissociative Disorders Interview
Schedule (DDIS), Multidimensional Inventory of Dissociation (MID) – Available by permission/training
- Other Assessments (fee assessed unless otherwise indicated)
1. Partner Sexuality Survey (PSS): Available at www.recoveryzone.com
2. Sex Addiction Assessments (SAST, SARA; ISST - free): Available at www.recoveryzone.com
- PROS (Thorough and Inclusive Perspective, Correlations, Collaboration, Visual Aid for the experience)
- CONS (Permission, Cost, Training, Accessibility, Time)
 PTSI-R CATEGORIES:
INFORMATION TO CONSIDER IN TREATMENT
• General PTSD symptoms
• The tendency to reproduce the same emotional state as the original trauma
• Identifies trends of attachments toward the abusive, dangerous and threatening
• Chronic negative Self-Perception and Shame
• Damaged or Distorted Affect Regulation System from early childhood trauma; Personality Disorders
• Trends toward blocking, calming, escaping, numbing, self-soothing, etc.
• Traits of Avoidant, Disengaged, Dissociative, Fragmented
• Self-Deprivation trends: Avoidant of affirmation, compliments, praise, pleasurable experiences
• Chronic compartmentalization – things to deal with and engage in things to perpetually avoid
• Depression, reduced energy, difficulty shifting thought processes, difficulty with abstraction, ritualistic
• Trauma based drive, energy, hyperactivity…they just can’t stop and actually want more energy or to do more.
IPAST
Severe
Severe

Moderate

At Risk

Within Normal Limits

ATTACHMENT
STYLES

• Secure
• Preoccupied
• Fearful Avoidant
• Dismissive
PARTNER SEXUALITY
SURVEY
 ASSESSMENT: THE CLINICAL INTERVIEW
• Still the most helpful, reliable, cost effective and can always be improved
• Presentation & Recognition of Problem: Experience vs. Knowledge Base – Where do gaps need to be filled?
• Biological/Health Background: How much of their experiences, responses or reactions have a potential or
correlated health issue? What is the baseline for their self-care? Any other unaddressed or concurrent
trauma?
• Psychological/Emotional/Cognitive Info.: What is their overall emotional and mental healthy picture?
• Social/Relationship Information: How healthy is their family of origin? Friends? Past relationships?
• Willingness to change/heal: What are they willing to commit to for peace of mind and healthy relationships?
• Treatment and Relapse history: What have they been treated for? Is this a recurring problem? Is there a
pattern of breakdown in treatment?
• History of Sexual education and experiences: Addressing the abused, uneducated and taboo factors and
preventing its continuance in the existing or future relationships or repeating the cycle with children.
• Collaborative information will be crucial – if you’re given permission to obtain it.
 TRADITIONAL APPROACHES
Co-Dependent
• Clients are labeled as “co-dependent” or “co-
addicts” and treated within the 12 step
framework.
• Early in treatment clients are asked to explore
“their part” of the dysfunctional relationship.
• Symptoms of PTSD may have been pathologized
instead of validated and normalized.
• Clients asked to participate in Addiction
Recovery Program (ARP), COSA (historically co-
dependent of a sex addict) or Sexaholics
Anonymous (S-Anon) support groups.
TAKING A BROADER APPROACH WITH MORE EDUCATION…
Traumatized
• The model first addresses the relational trauma
that occurred in the relationship with the Sex
Addict.
• It acknowledges the PTSD symptoms a partner
experiences following discovery and disclosure.
• Specific trauma experiences are addressed.
• Clients are asked to participate in Addiction
Recovery Program (ARP) or Partners of Sex
Addicts (POSA) support groups.
CLIENT Blindsided
PRESENTATION:
Co-Dependent
DISTINGUISH AND
DETERMINE THE
MOST EFFECTIVE Addicted
TREATMENT
APPROACH Affect Dysregulated and
Personality Disorder
CLIENT TYPE DEFINED
• Blindsided: Just experienced discovery or forced disclosure. They may have had no idea that their
partner was a sex addict. They may say, “My marriage was great before this.” Naïve or in denial
about relational problems. They will be in a trauma reaction at intake and may present as
unregulated, raging, crying uncontrollably, appear paranoid, depressed, extremely anxious, numb,
incongruent.
• Co-dependent: This client may have known for years that “something was wrong” within the
relationship either through discovery or staggered disclosures from the addict. They may have
adapted to the addict's behaviors in an attempt to cope with overwhelming emotions. This client
may have engaged in behaviors they are ashamed about and resistant to discussing in the beginning
of treatment (ex. increasing sexual contact with addict). May present as calm, minimizing and/or
overwhelmed.
• Co-addicted: Relationships, sex, love, alcohol, drugs, food…may present as detached and ambivalent at
intake, numb with a flat affect or no emotion regarding acting-out behaviors.
• Affect Dysregulated/Personality Disorder: Present as super agreeable, make you feel like you’re the
best therapist ever, hyper-focused on addict, seem contained but exhibit incongruence.
 PLANNING TREATMENT:
INGREDIENTS FOR RESILIENCE

1 2 3 4
Identifying, Grounding Challenging
A Moldable Task developing and strategies, negative core
Approach applying positive mindfulness and beliefs
resources self-regulation

TALK LESS – EXPERIENCE MORE!

TASK APPROACH: MOLDABLE AND INTERCHANGEABLE
1. Cope with the trauma of Discovery and/or Disclosure (Separate truth from lies; identify trauma)
2. Establish Safety (Setting healthy Boundaries, Perspective and Intention)
3. Deal with the Emotional Aftershock (Get in tune with emotion, Be aware of Negative Beliefs,
Recognize Hope)
4. Understand the Nature of Addiction (Getting Educated about the Addiction, the Illogical, and the
Confusing)
5. Communicate Feelings (Develop healthy, grounded communication skills)
6. Develop a Plan for Support and Self-Care (Create and Enhance a Support System, Locate and work
with a Therapist, Develop and practice Grounding Techniques & Tools)
7. Create a Recovery Plan (Learn to Affirm self, work through Personal Craziness, Balance self &
develop the ability to Forgive)
 DEVELOPING POSITIVE RESOURCES

1. Learn to Identify Healthy People.

2. Determine what is necessary to
Who should share.
Who can help?
know? 3. Get a therapist.
4. Gather collections of supportive
traits, objects, people, places,
locations, activities.
Who can What additional 5. If struggling with addiction or
support & resources are personality disorders, consider other
treatment alternatives first (Substance
validate me? there? abuse treatment, DBT groups)
 GETTING GROUNDED
Establishing Healthy Boundaries
• Recognize Reality
• Identify Needs & Consider Options
• Visualize the Outcome (Peace)
• Empowering the Self
• Action Steps (Specific & Time Sensitive)
• Evaluate (Boundaries vs. Self-
Regulation)
• Revise (if necessary)
Reconstructing Self Regulation
• Clinging to the 5 senses (real data)
• Separating Stories from Experience
• Identifying Emotions & Sensations
• Separating Self from Others
• Recognizing Patterns & Triggers
• Creating and/or Asking for Help
• Putting it into perspective and words
• Self-care (Meditation, Exercise,
Nutrition, Talents, Friends, Affirmation)
 OLDIES BUT GOODIES:
EXPERIENTIAL GROUNDING AND MINDFULNESS TECHNIQUES
• Dialog inside out: Get in tune with the most distressed part of yourself and interact with it as if it
were your child, friend or other close person in need of comfort, nurturing and validation
• Drawing the experience (Anger, Sadness, Betrayal, etc.)
• Exercise/Nutrition
• Fragmentation Exercise: Facts, Emotions and Awareness in a Mosaic
• Hobbies, Interests & Talents
• Journaling
• Meditation – Just basic awareness of breath and thought
• Yoga
TRANSFORMING BELIEFS
• Knowing the difference between Healthy and Unhealthy
beliefs.
• Developing awareness of the physical effects of beliefs.
• Recognizing where beliefs come from & how they are
reinforced.
• Having a clear vision of the possibilities – to challenge and
transform unhealthy beliefs.
• Identifying supportive people for clarification and
reflection.
• Give the Self: Affirmation, Compassion, Forgiveness, Love,
Mercy, etc.
 • Presentation (Body language, Emotional tolerance,
Separation of Self from Spouse).
EMILY: A WALK IN • Assessment (DES, IPAST, PTSI-R; Body language, Emotional
HER FOOT STEPS tolerance, Separation of Self from Spouse)
• Homework: Identify assets/resources, fears, questions in the
context of Online Assessments.
A case study from
• Follow up: Begin to establish awareness between reality and
beginning to end with story, fact and belief, emotions; Teach about Boundaries.
healthy doses of • Homework: Boundary steps, Self-Regulation practice, Support
acceptance, affirmation, System Acquisition.
normalizing, regulating, • Follow up: Identify Patterns over lifespan (Beliefs,
reflecting, inviting, etc. Communication, Coping vs. Reaction, etc.), Develop lists of
unhealthy beliefs and trauma experiences to address.
• Continue to Enhance Awareness, Boundaries, Emotional
tolerance, Self-care.
• Utilize EMDR, Ego State work, CBT
Contact Information
Ryan Christiansen, LCSW, CSAT-S
www.southernutahtherapy.com
achievecontrol@gmail.com
Phone: 435-674-6650
Fax: 435-359-2843