Samenvatting

ESCAPING MY PRISON: Trauma-focused therapy for COMPLEX ptsd

Charesca Henriette & Jackie June ter Heide

Despite the fact that treatment guidelines recommend trauma-

focused therapy as treatment of choice for adults who meet the criteria for posttraumatic stress disorder (ptsd), some clinicians still consider ‘complex’ patients the exception to the rule. Patient complexity may be related to traumatic experiences (multiple, prolonged, and childhood experiences) as well as to trauma symptomatology (including the dissociative subtype of ptsd, complex ptsd, and comorbid disorders). In the Netherlands, less than 40% of patients with ptsd are offered trauma-focused therapy, which leads to unnecessarily long and possibly ineffective treatment trajectories. This paper, written by a former patient and a therapist, describes the long road taken to achieve healing, and the scientific evidence that supports the effectiveness of trauma-focused treatment, even in so-called ‘complex’ patients.

 


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Een vroegkinderlijk getraumatiseerde patiënt met een diagnose van complexe posttraumatische stressstoornis (ptss), depressie en persoonlijkheidsproblematiek vraagt in februari 2016 een second opinion aan bij een instelling voor psychotrauma. Een traumagerichte behandeling is haar ontraden: te veel risico op decompensatie. Twee jaar later wordt dezelfde patiënt uitgeschreven bij de instelling. Aan een ptss-diagnose voldoet ze niet meer na een traject van intensieve exposure en emdr-therapie.

Het meemaken van seksueel of lichamelijk geweld in de kindertijd kan leiden tot ernstige vormen van posttraumatische stressstoornis (ptss; American Psychiatric Association, 2013). Traumagerichte therapieën, zoals emdr en traumagerichte cognitieve gedragstherapie, zijn effectief in het verminderen van ptss en zijn daarom in de behandelrichtlijnen opgenomen als behandelingen van eerste keus (GGZ Standaarden, 2020). Ondanks dat behandelaren geacht worden deze richtlijnen te volgen, krijgen de meeste Nederlandse patiënten met ptss deze behandelingen niet aangeboden (Zorginstituut Nederland, 2020), vaak vanuit de gedachte dat complex getraumatiseerde patiënten een traumagerichte behandeling niet aankunnen (zie bijvoorbeeld Bloemink, 2016). Door deze terughoudendheid wordt een groot deel van de Nederlandse patiënten met ptss een effectieve behandeling onthouden en duren de klachten onnodig lang voort.

De discussie over het al dan niet aanbieden van traumagerichte behandeling vindt op allerlei plekken plaats: in artikelen, tijdens congressen, in team-overleggen en op LinkedIn. Zelden is daarin

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