Lessons from the Natural Course of Complex Posttraumatic Disorders

The natural course of complex posttraumatic disorders typically consists of a gradual “social breakdown.” Sufferers and their partners (e.g., parents, siblings, and lifemates) become increasingly avoidant of opportunities for intimacy. The proposed mechanism for the breakdown is the sufferers' method of testing others' trustworthiness. They test unproductively, repetitively, without closure either way. Partners misunderstand it as manipulation for trivial wants or instigation to replicate old betrayals. Patients often suffer social breakdown despite psychotherapy. Tempted to experiment in intimate relationships privately, outside therapy, they become hopeless faster than gains in therapy can generalize. I present a psychotherapy model to avert this breakdown: Clinicians and patients jointly stage experiments with intimacy in the relationships that matter from the beginning of therapy.