Background: A history of complex trauma alters basic self-structure, attachment system and core areas of interpersonal functioning and relationships. There is increasing recognition of the high proportions of complex trauma histories within substance misusers and limited research into the sequelae of complex trauma, particularly in relation to comorbid complex trauma and substance misuse. There is a distinct lack of adequate theory and guidelines for treatment. Research Aim: to explore psychologist’s experiences of and perspectives about their work with substance misusers with a history of complex trauma. Complex trauma is a term used to describe experience’s which arise from severe, prolonged and repeated trauma which is often interpersonal in nature. Courtois & Ford (2009) have defined complex trauma as “involving stressors that: are repetitive or prolonged, involve direct harm and/or neglect and abandonment by ostensibly responsible adults, occur at developmentally vulnerable times in the victim’s life, such as early childhood, have great potential to compromise severely a child’s development.” (p1). The prototype trauma that was first described under the term complex trauma was child abuse and neglect. Method: Semi-structured interviews were conducted with eleven clinical and counselling substance misuse psychologists working across four health boards in Central Scotland. The data was analysed using Interpretative Phenomenological Analysis (IPA). Results: Six main superordinate themes emerged from the data: 1. Challenges in negotiating therapeutic relationship; 2. Balancing relational forces; 3. Walking the tightrope of comorbidity; 4. Conceptual dearth (surrounding complex trauma); 5. Emotional impact of Work, and, 6. Core role of therapeutic relationship (in treatment and recovery). Discussion: Participants accounts suggest there are many risks to balance as well as paradoxes inherent in this type of work. The nature of a history of complex trauma means that often clients have difficulties with attachment and relational aspects in their lives, which in turn affect their engagement in the therapeutic relationship. The findings of this study suggest that it is precisely because relationships seem so threatening and challenging for these clients, that the therapeutic relationship appears to form such a vital role in the therapeutic treatment and recovery process for these client.

The research on pastoral counseling of persons struggling with complex trauma was undertaken with the aim of designing a practice-orientated model for pastoral counseling in order to guide such persons to emotional healing, stability and spiritual growth. An exegetical study throws light on the role of prayer and trust in God. One can entrust to God one's problems and one's supplication for help in the firm belief that He will provide a way out. An investigation into counseling perspectives in the Scriptures and in the literature on Christian counseling brought to light that pastoral counseling, which is a mandate given to believers, affords a unique opportunity for lovingly encouraging and consoling people with complex trauma. Contributions by psychiatry and psychology emphasise the phase approach. They stress security and stability, the processing of the traumatic memory and mourning, as well as a renewed commitment to new relationships. The core of the findings is that persons with complex trauma - which is an intricate syndrome relating to a spectrum of post-traumatic disturbances following intense, protracted and repeated trauma - can be guided by pastoral counseling to emotional healing, stability and spiritual growth. Specific reference is made to victims of prolonged family violence and/or physical and/or emotional and/or sexual abuse and/or protracted physical and/or emotional neglect in family context. The empirical research confirmed that the children of the Abraham Krielkinderhuis, Potchefstroom, who were subjected to these traumatic experiences in their parental homes exhibit the typical symptomatology of complex trauma. These entail emotional disturbances like anger and self-injury, disturbances of consciousness like dissociation, disturbances of self-image like stigma, guilt and shame, disturbances in the image of the perpetrator, like unrealistic expectations and finally disturbances in relationships like distrust and loss of faith. The principles and outcome of the empirical research are eventually applicable to all persons struggling with complex trauma. A practice-orientated counseling model was designed which focuses on stabilisation and security, the processing of the traumatic memory and mourning, as well as a renewed commitment to life in abundance and new relationships. In this therapeutic relationship of faith the distress narrative and the narrative of the past are central. God allows everything to turn out for the best for those who trust in Him. In Christ people are more than victors through God's will for their lives. / Thesis (Ph.D. (Pastoral))--North-West University, Potchefstroom Campus, 2006.

This dissertation explores the education of foster care children through the perspectives of classroom teachers. Numerous studies have found that foster youth experience depressed educational outcomes relative to their peers. A meta-analysis of such studies reported depressed educational outcomes in terms of standardized test scores, grade averages, retention rates, and suspension and expulsion rates (Scherr, 2007). Foster care is most often associated with maltreatment, which in turn has been linked to depressed educational outcomes (Runyan, 1985) and to insecure attachment (Howe, 1999). Attachment theory, which emphasizes the impact of relationships in early childhood on future relationships, informed this study. Purposeful sampling was used to identify classroom teachers in a rural Vermont high school that serves a large number of foster youth relative to its size. Participants were selected based on their high degree of experience with and perceived success in supporting students in foster care. In interviews, teachers were asked to describe distinguishing characteristics of foster youth as well as their relationships with peers and adults while at school. Teachers described several characteristics of foster youth, including the perceived impact of trauma on foster youth‟s ability to attend to school and school related tasks. Teachers also characterized intense relationships between foster youth and their peers, and between foster youth and adults at school. Participants also identified several strategies they believed to be effective in supporting this population, each of which emphasized the development of caring relationships between teachers and foster youth. Teachers shared concerns about the impact of frequent placement changes on the educational experiences of foster youth. Interviewees also noted that their support of foster youth was hampered by insufficient information about changes in students‟ status. Intersections between the characteristics of foster youth and selected literature on attachment theory and traumatic stress are explored in the interpretation of the findings. Finally, this study utilizes a feminist ethic of care to contextualize relationships between foster youth in schools and effective teacher strategies.

Currently, only the TSI assesses complex traumatic reactions and patient response styles. However, its feigning scale, ATR, uses a flawed detection strategy and is potentially confounded by experiences of complex PTSD. As a consequence, clinicians using the TSI to evaluate severely traumatized patients have no useful method for discriminating genuine and feigned responding. Several detection strategies have demonstrated utility within evaluations of feigned trauma including the assessment of rare symptoms, symptom combinations, symptom selectivity, and symptom severity. The current study created scales on the TSI according to these strategies using a development sample of 107 severely traumatized patients. Validation of all TSI feigning scales was then performed with a second independent sample of 71 severely traumatized patients using a mixed simulation design. Results found support for each scale's convergent validity with SIRS primary scales (M rs = .52) and discriminant validity with measures of defensiveness on the SIRS (M rs = -.07) and TSI (M rs = -.19). Each scale also produced expectedly mild to moderate relationships with SADS-C clinical scales (M rs = .32) and the SCID-IV PTSD module (M rs = -.02). Support for their criterion validity was only moderate (M ds = .69) when comparing the scores of genuine patients to those simulating disability. Potential explanations for this trend were reviewed, including (a) the impact of comorbidity, (b) the restrictions associated with creating embedded feigning scales, and (c) the influence of simulator knowledge in analogue designs. Limitations of the study and future avenues of research were discussed.

The research on pastoral counseling of persons struggling with complex trauma was undertaken with the aim of designing a practice-orientated model for pastoral counseling in order to guide such persons to emotional healing, stability and spiritual growth. An exegetical study throws light on the role of prayer and trust in God. One can entrust to God one's problems and one's supplication for help in the firm belief that He will provide a way out. An investigation into counseling perspectives in the Scriptures and in the literature on Christian counseling brought to light that pastoral counseling, which is a mandate given to believers, affords a unique opportunity for lovingly encouraging and consoling people with complex trauma. Contributions by psychiatry and psychology emphasise the phase approach. They stress security and stability, the processing of the traumatic memory and mourning, as well as a renewed commitment to new relationships. The core of the findings is that persons with complex trauma - which is an intricate syndrome relating to a spectrum of post-traumatic disturbances following intense, protracted and repeated trauma - can be guided by pastoral counseling to emotional healing, stability and spiritual growth. Specific reference is made to victims of prolonged family violence and/or physical and/or emotional and/or sexual abuse and/or protracted physical and/or emotional neglect in family context. The empirical research confirmed that the children of the Abraham Krielkinderhuis, Potchefstroom, who were subjected to these traumatic experiences in their parental homes exhibit the typical symptomatology of complex trauma. These entail emotional disturbances like anger and self-injury, disturbances of consciousness like dissociation, disturbances of self-image like stigma, guilt and shame, disturbances in the image of the perpetrator, like unrealistic expectations and finally disturbances in relationships like distrust and loss of faith. The principles and outcome of the empirical research are eventually applicable to all persons struggling with complex trauma. A practice-orientated counseling model was designed which focuses on stabilisation and security, the processing of the traumatic memory and mourning, as well as a renewed commitment to life in abundance and new relationships. In this therapeutic relationship of faith the distress narrative and the narrative of the past are central. God allows everything to turn out for the best for those who trust in Him. In Christ people are more than victors through God's will for their lives. / Thesis (Ph.D. (Pastoral))--North-West University, Potchefstroom Campus, 2006.

This study deals with the pastoral counselling of elderly persons after the loss of a mature child by unnatural death. Such a traumatic event leaves a significant void in a person's life, who is already experiencing other losses, and is in the eve of their lives. With the death of a mature child, the natural order of life is turned around: the child who is supposed to live and financially and emotionally support the elderly, is no more, while they who's own passing away is imminent, are alive. Elderly parents in this position experience this situation as an existential conflict, because it is to them as if they are burying the future with their child. Because the death is one of a mature child, the elderly parent does not necessarily receive the appropriate recognition from society for the trauma they experience. To further complicate the issue is the fact that they are not usually the primary care receivers being guided along the path of mourning and acceptance - the focus, on the contrary, is usually upon the spouse and children of the deceased. In the section dealing with basis-theoretical research, it is evident that the exceptional empathy and sympathy of God for the parent who lost a child, is repeatedly stressed by Scripture. Because of Jesus Christ's victory on the cross and also His victory over death, there is the assurance of hope for eventual healing for the traumatized parent finding himself/herself in such a situation. From the section dealing with meta-theoretical research, it is evident that the death of a mature child is one of the most alarming and traumatic experiences any parent can go through. The process of mourning is however a natural reaction and differs from parent to parent, according to circumstances. Specific phases have been identified through which parents will go under these circumstances and it is therefore very important that both the pastoral counselor, as well as the parents, are aware of the pertinent aspects. In the section dealing with empirical research, use has been made of both qualitative and quantitative research methods. In the quantitative section, the results obtained from questionnaires handed to a significant number of elderly parents who have lost mature children, were processed. Thereafter, in the qualitative section of the research, in depth interviews were conducted with two sets of parents from the original group. It became evident that this process of discussion had a significant healing and therapeutic effect on parents dealing with the loss of a mature child. In the section dealing with the practice theoretical research, a model has been formulated by which pastoral counsellors and ministers can generally assist elderly parents after the death of a mature child. / Thesis (Ph.D. (Pastoral))--North-West University, Potchefstroom Campus, 2009.

This study deals with the pastoral counselling of elderly persons after the loss of a mature child by unnatural death. Such a traumatic event leaves a significant void in a person's life, who is already experiencing other losses, and is in the eve of their lives. With the death of a mature child, the natural order of life is turned around: the child who is supposed to live and financially and emotionally support the elderly, is no more, while they who's own passing away is imminent, are alive. Elderly parents in this position experience this situation as an existential conflict, because it is to them as if they are burying the future with their child. Because the death is one of a mature child, the elderly parent does not necessarily receive the appropriate recognition from society for the trauma they experience. To further complicate the issue is the fact that they are not usually the primary care receivers being guided along the path of mourning and acceptance - the focus, on the contrary, is usually upon the spouse and children of the deceased. In the section dealing with basis-theoretical research, it is evident that the exceptional empathy and sympathy of God for the parent who lost a child, is repeatedly stressed by Scripture. Because of Jesus Christ's victory on the cross and also His victory over death, there is the assurance of hope for eventual healing for the traumatized parent finding himself/herself in such a situation. From the section dealing with meta-theoretical research, it is evident that the death of a mature child is one of the most alarming and traumatic experiences any parent can go through. The process of mourning is however a natural reaction and differs from parent to parent, according to circumstances. Specific phases have been identified through which parents will go under these circumstances and it is therefore very important that both the pastoral counselor, as well as the parents, are aware of the pertinent aspects. In the section dealing with empirical research, use has been made of both qualitative and quantitative research methods. In the quantitative section, the results obtained from questionnaires handed to a significant number of elderly parents who have lost mature children, were processed. Thereafter, in the qualitative section of the research, in depth interviews were conducted with two sets of parents from the original group. It became evident that this process of discussion had a significant healing and therapeutic effect on parents dealing with the loss of a mature child. In the section dealing with the practice theoretical research, a model has been formulated by which pastoral counsellors and ministers can generally assist elderly parents after the death of a mature child. / Thesis (Ph.D. (Pastoral))--North-West University, Potchefstroom Campus, 2009.

The work group in charge of editing the trauma disorders in the upcoming edition of the International Classification of Diseases (ICD-11) made several changes to the trauma criteria. Specifically, they simplified the criteria for posttraumatic stress disorder (PTSD) and added a new trauma disorder called complex PTSD (CPTSD). To assess the new and newly defined trauma disorders, Litvin, Kaminski and Riggs developed a self-report trauma measure called the Complex Trauma Inventory (CTI). Although the reliability and validity of the CTI has been supported, no empirically-derived cutoff scores exist. We determined the optimal CTI cutoff scores using receiver operating characteristic (ROC) analyses in a diverse sample of 82 participants who experienced trauma and were recruited from an inpatient trauma unit, student veteran organizations, and university classrooms. We used the Clinician-Administered Interview for Trauma Disorders (CAIT) to diagnose the presence of an ICD-11 trauma disorder, and we correlated the results of the CAIT with the Clinician-Administered PTSD Scale for the DSM-5 to establish the convergent validity of the CAIT, r = .945, p < .001. For the ROC analyses, the CTI was used as the index test and the CAIT was used as the criterion test. The area under the curve (AUC) analyses indicated good to excellent effect sizes, AUC = .879 to .904. We identified two sets of cutoff scores for the CTI: the first set prioritized the sensitivity of the CTI scores and ranged from .884 to .962; the second set prioritized the specificity of the CTI scores and the false-positive scores (1-specificity) ranged from .054 to .143. Our study enhanced the utility of the CTI and addressed another need in the trauma field by developing a structured clinical interview (CAIT) that can be used to diagnose the ICD-11 trauma disorders.

Lesbian, gay, bisexual, transgender, questioning, intersex, and queer (LGBTQIQ) adults are more likely to report experiences of complex trauma, and have detrimental mental health effects as a result, when compared to cisgender, heterosexual adults. However, LGBTQIQ adults have excellent capacity for resilience. In this phenomenological investigation, I explored the lived experiences of resilient LGBTQIQ emerging adults (N = 11) who have histories of complex trauma. Five themes emerged as a result of this study, including (a) abuse and neglect, (b) emotional experiences during and after trauma, (c) connections are essential, (d) getting through hard times, and (e) struggles in the counseling process. The results indicated implications for counselors and counselor educators to better address the experiences of complex trauma and identify resilience in LGBTQIQ emerging adults. Recommendations are provided to counselors and counselor educators for integrating knowledge and actions into their counseling, teaching, and supervision practices, as well as for parents and caregivers, teachers and school personnel, and policymakers.

Ce travail a été entrepris dans deux pays vivant des catastrophes naturelles et humaines à long terme. Il porte sur les processus créateurs, les traumas complexes et les processus psychiques des adolescents : en Haïti, pour se rétablir à la suite du séisme de janvier 2010 qui a ravagé plusieurs villes du pays et tué environ 2,5% de la population ; en Israël, après la deuxième guerre du Liban en 2006 et les attentats terroristes ayant touché tout le pays. La présente recherche avait pour objectif d'étudier les processus créatifs exprimés après les conséquences traumatiques du séisme, de la guerre et des attentats, parmi les adolescents haïtiens et israéliens, ainsi que les stratégies mises en place pour y faire face et se rétablir. Elle était basée sur des approches multidisciplinaires et des méthodes qualitatives et narratives, tout en tenant compte des particularités culturelles du processus créateur. Nous avons examiné deux groupes, l'un composé de 60 adolescents israéliens âgés de 11-12 ans, l'autre composé de 45 adolescents haïtiens entre 10 et 18 ans, à l'aide d'outils d'analyse non verbaux, de la symbolisation d'événements marquants de la vie, de la manifestation traumatique et de la résilience. Nous avons ensuite recueilli des données grâce à des entretiens cliniques et des dispositifs groupaux de médiation malléable, auprès de 30 adolescents. Nous présentons dans ce travail 6 études de cas que nous avons sélectionnées pour leurs particularités. Les résultats indiquant que le soutien social constitue le meilleur facteur manifeste de la résilience ont pu être constatés au travers des survivants qui s'appuyaient sur un ensemble de tuteurs de résilience et sur leurs réseaux personnels. Ils montrent également que l'influence du risque, les facteurs de protection et la résilience coexistent dans le continuum de la vie de l'adolescent exposé à des situations traumatiques. L'ensemble des résultats souligne la nécessité d'établir des cadres de médiation thérapeutique et créative avec la culture comme levier thérapeutique, pour accompagner à long terme les adolescents en situation de danger et de détresse. / This cross-cultural study has been researched in two countries exposed to natural and human disasters in the long-term. It focuses on the creative processes, complex traumas and mental processes of adolescents: in Haiti, following the January 2010 earthquake, which devastated several towns and killed about 2.5% of the Haitian population ; in Israel after the Second Lebanon War of 2006 and terrorist attacks that devastated the country and affected 4-5% of the Israeli population. This research aimed to study the creative process after the traumatic consequences of an earthquake, war and terrorists attacks among Haitian and Israeli adolescents and the strategies they implement for coping and recovering. It was based on multidisciplinary approaches, as well as, qualitative and narrative methods, taking into account the cultural aspects of the creative process of the adolescents in each country. We examined two groups. In first group there were 60 Israeli adolescents aged 11-12 years. In the second group, 45 Haitian adolescents aged 10-18 years. We collected data from clinical interviews and expressive art groups of 30 adolescents. We used nonverbal methods to analyze the adolescent significant life and traumatic events and resilient experiences. In this study we present six case studies that were selected because of their special features. The results indicate that social support is the highest factor of resilience in adolescents’ survivors of complex trauma situations. We found that the adolescents used resilient tutors and individual resources to survive. The results also show that the influences of risk, protective factors and resilience co-exist in the adolescent`s life continuum in the long-term coping with traumatic events.The overall results emphasize the need for on-going therapeutic and creative process groups to support youth living in dangers and distress situations.