Complex PTSD is what happens when the trauma was not one event.
It develops out of harm that was ongoing, that happened inside a relationship you could not leave, or that started when you were too young to have anywhere to put it. The nervous system adapts to it, and those adaptations are still running long after the danger has gone.
I am Craig Coventry, a BACP accredited psychotherapist. Most of my work is with complex trauma, online across the UK and in person in Woking and Guildford.
What complex PTSD actually is
Complex PTSD was formally recognised by the World Health Organization in ICD-11, the current international classification of diseases, as a condition distinct from PTSD.
It carries the core PTSD symptoms: re-experiencing, avoidance, and a persistent sense of threat. On top of those sit three more that define it.
Difficulty regulating emotion, so feelings arrive at full volume or not at all. A persistently negative sense of self, usually involving shame rather than fear. And ongoing difficulty in relationships, whether that shows up as distance, intensity, or both in turn.
How is complex PTSD different from PTSD?
PTSD usually traces to an identifiable event. There is a before and an after, and the work is largely about processing what happened.
Complex PTSD often has no clear before. When the trauma was your childhood, or a marriage, or a decade of something, there is no untraumatised version of yourself to return to. What developed instead is a whole set of adaptations that were once necessary and are now costly.
That changes what therapy is for. It is less about processing an event and more about building something that was never able to develop in the first place.
Signs you might recognise
- Feeling permanently braced, even when nothing is wrong
- Emotions that arrive at full intensity with no warning, or a flatness where feelings should be
- A deep sense that something is fundamentally wrong with you rather than something happened to you
- Relationships that follow the same shape every time
- Losing time, feeling foggy, or watching yourself from outside
- Understanding your history perfectly well and finding that it changes nothing
- Being told you are “too much” or “too sensitive” often enough that you believe it
None of that is a diagnosis, and I am not a diagnosing clinician. It is a description of what people tend to describe to me.
Why understanding it is not enough
This is the thing that brings most people to me, usually after other therapy.
Insight lives in one part of the brain. The threat response lives somewhere older and faster, and it does not consult the part of you that knows better. You can hold a completely accurate account of your childhood and still have your body react as though it is 1997.
So the work has to reach the response, not just the story. That is why I use approaches that work with the nervous system alongside the talking.
How I work with complex trauma
In three broad phases, though they overlap rather than running in a neat line.
Stabilisation first. Grounding, resourcing, and understanding your own patterns well enough to notice them arriving. Nothing gets processed until this is solid. With complex trauma this phase can take months, and skipping it is the single most common way this work goes wrong.
Then processing. Working through what is underneath, using EMDR, attachment-focused EMDR, or Deep Brain Reorienting depending on what suits your system. This happens in pieces rather than all at once.
Then integration. Rebuilding a sense of self that is not organised around threat, and working out what relationships look like when you are not managing them.
Which approaches I use, and why
EMDR helps the brain reprocess stuck memories. For complex trauma I use the attachment-focused adaptation, which puts more weight on the relationship and on resourcing before any processing.
Deep Brain Reorienting works with the brainstem sequence that fires in the fraction of a second after a shock, before emotion arrives. It is slower and more contained than EMDR, which often makes it the better fit where EMDR has felt overwhelming.
Parts work and structural dissociation theory treat the mind as having different aspects that developed to handle different things. With ongoing childhood trauma those parts often end up separated, and the work is about cooperation between them rather than getting rid of any of them.
How long does complex PTSD therapy take?
Longer than most people want to hear, and I would rather say that than have you find out four months in.
Adaptations built over years do not unwind in weeks. Many people notice things settling within the first few months, particularly around managing intensity and recognising patterns as they happen. The deeper relational work takes considerably longer.
I work open-ended rather than to a fixed number of sessions, and we review together as we go.
Frequently asked questions
Do I need a diagnosis of complex PTSD to work with you?
No. Many of the people I see have never had it named by anyone, and recognised themselves only when they read a description. You do not need a diagnosis, a referral, or a label to start.
Can complex PTSD therapy be done online?
Yes. Most of my complex trauma work is online, including EMDR and DBR, and I see clients across the UK. Some people find their own space easier for this work. We build in grounding and agree signals before starting, because I cannot read the room the way I can in person.
Is complex PTSD the same as BPD or EUPD?
They overlap enormously, and in my view the patterns labelled as BPD are usually far better explained as a trauma and attachment response. That reframe changes what the work is trying to do. There is more on my BPD and EUPD page.
Will therapy make things worse before they get better?
It can stir things up, which is exactly why stabilisation comes first. We do not begin processing until you have somewhere to put what surfaces. If things become too much we slow down, which is a normal part of the work rather than a failure.
I have had therapy before and it did not help. Why would this be different?
It might not be, and I will not promise otherwise. What I would ask on the free call is what kind of therapy it was and what happened. Where talking therapy has not reached it, an approach that works with the nervous system sometimes does. Where the fit with the therapist was the problem, that is a different conversation.
Do you work with dissociation as part of this?
Yes, and it comes up often with complex trauma. Dissociation is one of the more common adaptations and it needs working with directly rather than around. There is a page on it here.
What does it cost?
Online sessions are £65 to £75 for 50 minutes, in person is £75 to £90 depending on location, and I work on a sliding scale by income. Full details on the fees page, and I am recognised by seven major health insurers.
Start with a conversation
If any of this sounds like your experience, get in touch and we will arrange a free 20-minute call. No charge, and no expectation that you book anything afterwards. You can also call me on 07470 514551.