Survivors of childhood trauma are at increased risk of complex post-traumatic stress disorder (CPTSD). The Recovering from Child Abuse Programme (RCAP) is a cognitive behavioural therapy (CBT) group promoting adaptive coping strategies which may help overcome CPTSD symptoms in adult survivors of childhood trauma. We sought to explore patient experiences of factors influencing treatment acceptability and potential mechanisms of therapeutic change in a sample of participants in the RCAP programme. As the group was delivered during the COVID-19 pandemic, necessitating a transition to remote therapy, we further aimed to capture experiences of the transition to telehealth delivery of the programme. A naturalistic sample of 10 women with CPTSD attending a specialist out-patient psychological trauma service participated in the study. Therapy sessions were recorded, transcribed verbatim and group members completed written feedback forms following each session. Reflexive thematic analysis was used to analyse the written feedback and transcripts. The RCAP was acceptable to group members and several themes were identified related to the experience of change in the group. Key themes centred on group solidarity; safety in the psychotherapeutic process; schema changes related to the self, others and future catalysed by the shifting of self-blame; increased emotional regulation to feel safer in the present; and increased future optimism. Therapeutic progress continued following the transition to telehealth, although face-to-face delivery was generally preferred. The programme was acceptable and led to cognitive change, enabling increased emotional regulation in the present and improved self-concept, thereby addressing key symptoms of CPTSD.

Background: Group schema therapy is an emerging treatment for personality and other psychiatric disorders. It may be particularly suited to individuals with complex trauma given that early abuse is likely to create maladaptive schemas. Aims: This pilot study explored the feasibility and effectiveness of a 4-week in-patient group schema therapy programme for adults with complex trauma in a psychiatric hospital setting. Method: Thirty-six participants with complex trauma syndrome participated in this open trial. Treatment consisted of 60 hours of group schema therapy and 4 hours of individual schema therapy administered over 4 weeks. Feasibility measures included drop-out rates, qualitative interviews with participants to determine programme acceptability and measures of psychiatric symptoms, self-esteem, quality of life and schema modes pre-, post- and 3 months following the intervention. Results: Drop-out rate for the 4-week program was 11%. Thematic analysis of interview transcripts revealed four major themes: connection, mode language explained emotional states, identifying the origin of the problem and the emotional activation of the programme. Measures of psychiatric symptoms, self-esteem and quality of life showed improvement post-treatment and at 3 months post-treatment. There was a reduction in most maladaptive schema modes pre-/post-treatment. Conclusions: A group schema therapy approach for complex trauma is feasible and demonstrates positive effects on psychiatric symptoms and maladaptive schemas.

This paper is based on a presentation I gave to the Childhood Trauma Conference in Melbourne, Australia, August 2014.

Children traumatised within their biological families are described as children who have experienced complex trauma, also called developmental trauma because of the profound impact it has on their development. These children present a range of challenging behaviours within their foster or adoptive families. They respond less well to traditional behavioural management and benefit more from regulatory and relationship-based parenting. This is parenting that focuses on helping the children to regulate their emotional experience through the emotional connection between parent and child before attention is given to the behaviour. Developmentally traumatised children have a foundation of mistrust of parents and thus experience management of behaviour as signs that they are going to be hurt or rejected again. These children need parents who can connect with the child's experience before, or when appropriate instead of, discipline. This is described here as ‘connection before correction’. Correction in this context means helping children to develop pro-social behaviours and to find safe ways to express intense emotional experience. This paper explores the difficulties that the children can experience living in families; how this is expressed through behaviours, and how parents can connect in ways that promote the building of trust and allows successful management of their behaviour.