Trauma

Why It Gets Missed

Classic PTSD has a recognizable shape beginning with a single terrible event that may be followed by vivid memories of it, nightmares, and flashbacks that return to the same scene.

In complex PTSD, the harm may have occurred on many ordinary days, so there is often no single event to point to. The past still intrudes, but it may arrive as a wave of fear, shame, or feeling small, so it does not always get recognized as a distinct memory. The body can stay on alert, with poor sleep and a quick startle, and no obvious reason why. Alongside all of that is a set of adaptations that were once necessary and have now become problematic.

Those adaptations can look a great deal like depression, anxiety, or a personality problem. That is often what gets treated first, and the relief is often partial.

Where It Can Come From

C-PTSD may be due to a parent who was unpredictable, critical, or simply not there. It may be due to a household organized around someone else's illness or moods, years of being the responsible one, neglect that nobody ever named, or a relationship in adulthood that slowly rearranged one's identity. If none of those quite describes your life and the list below still does, that is worth a conversation.

How It Tends to Show Up

• You have difficulty saying no, and you agree to things you did not want.
• You are taken advantage of, and the anger about it tends to arrive later, sometimes long after the moment has passed.
• You have accomplished real things, and none of them changed how you feel about yourself.
• You are not always sure what you want, or even what you like.
• You feel like you are performing a version of yourself that other people would accept, and that they would think less of you if they saw the rest.
• You feel empty a good deal of the time, and you have never found a way to describe that to anyone.
• You have been told that you could be doing more, and you have run yourself into the ground trying.
• Your body stays on alert. You startle easily, sleep poorly, or feel anxious much of the time without being able to say why.

Where Identity Comes Into It

If a great deal of your attention went into tracking someone else's mood, it was not going into working out what you think, what you enjoy, and creating healthy boundaries. Those things are built through practice, and the practice did not happen.

This is not a character flaw, and it is not a memory problem. It is what happens when a person has to prioritize watching other people over developing themselves.

This work is not only about understanding what happened to you, but also about building the self that never got built.

Trauma-Related Conditions Treated

The conditions treated here include complex PTSD (C-PTSD), developmental trauma, and relational trauma. Not all trauma is complex trauma, so this practice also treats post-traumatic stress disorder following a single event, adjustment disorders following a major loss or upheaval, and the anxiety and depression that frequently accompany all of these. Some people carry both: a history of prolonged or repeated trauma, and a separate traumatic event later in life that brought it to the surface.

What Treatment Looks Like Here

Whatever brought you here, treatment starts with being listened to carefully and without judgment. Nothing you tell me about your past or present changes how I see you as a person. The ways you learned to cope made sense at the time, and we treat them with respect even as we work on changing them.

I offer both psychotherapy and medication management, and I use them together. Therapy is where the deeper work happens. Medication, used thoughtfully, can ease depression, anxiety, poor sleep, and the constant sense of being on alert, which often makes the therapy easier to do. We decide together what combination fits you, and we revisit it as you change.

What the work involves depends on you. Often it includes making sense of what happened and what it cost, learning to notice what you actually feel and want, setting appropriate limits with the people in your life, and working out what you want to be true of you going forward. We go at a pace you set.

If you already have a therapist you trust, that work can continue. My sessions combine medication management and therapy. Many of my patients also have their own therapist, and I work closely with that therapist, coordinating directly so care stays aligned. My role is to support that relationship, not replace it.

Insight, Integration, and Individuation

Scope

This is outpatient care, and it is not right for everyone. If you are in acute crisis, if you need a higher level of care, or if what you are dealing with calls for a more structured setting than a private practice can provide, we will talk about what would serve you better.