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Matthew Sexton, LCSW, NATC — Telehealth: New York · Maine · Delaware · Florida

Complex PTSD therapy — a structural approach to a structural injury.

Complex PTSD is not PTSD with extra steps. The ICD-11 (code 6B41) distinguishes it from PTSD by three additional disturbances: affect dysregulation, persistently negative self-concept, and profound interpersonal difficulties. Matthew Sexton, LCSW provides structured telehealth therapy for complex PTSD in New York, Maine, Delaware, and Florida.

What is complex PTSD and how is it different from PTSD?
PTSD follows identifiable traumatic events. Complex PTSD follows prolonged, repeated trauma — typically interpersonal and often beginning in childhood or in long-term coercive relationships. The additional ICD-11 criteria (affect dysregulation, negative self-concept, relational difficulties) require a different clinical approach than standard PTSD protocols.
What are the symptoms of complex PTSD?
Beyond standard PTSD symptoms (intrusion, avoidance, hyperarousal), complex PTSD includes: difficulty regulating emotions, chronic shame and self-blame, a persistently negative sense of self, difficulty trusting others, feeling permanently damaged, and dissociation. Many people are misdiagnosed with personality disorders before an accurate CPTSD formulation is made.
What does treatment for complex PTSD look like?
Treatment is phased: stabilization and safety first, then trauma processing, then integration. Modalities include Internal Family Systems (IFS), EMDR where appropriate, and polyvagal-informed somatic work. The therapeutic relationship itself is a primary repair vehicle — consistent rupture-and-repair sequences provide a reference experience for secure attachment.

Complex PTSD therapy — a structural approach to a structural injury.

Complex PTSD is not PTSD with extra steps. The ICD-11 (code 6B41) distinguishes it from PTSD by three additional Disturbances in Self-Organization: affect dysregulation, persistently negative self-concept, and profound interpersonal difficulties. It typically develops from prolonged, repeated trauma — childhood abuse, coercive relationships, captivity — rather than a single incident. It is treatable with a phased clinical approach.

Matthew Sexton, LCSW, NATC is a licensed clinical social worker in New York, Maine, Delaware, and Florida, and a credentialed Narcissistic Abuse Treatment Clinician. He has spent fourteen years in clinical practice and healthcare systems, and writes for the people who hold everyone else together.

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