Psychological Treatments for Complex PTSD: A Commentary on the Clinical and Empirical Impasse Dividing Unimodal and Phase-Oriented Therapy Positions

Objectives: With the acceptance of Complex Post-Traumatic Stress Disorder (Complex PTSD) as a recognized diagnosis, supporters of unimodal approaches to traditional PTSD (e.g., trauma-focused cognitive behavioral therapies) claim that these modalities should be extended to Complex PTSD, whereas other practitioners stress the need for more gradual phase-oriented treatment plans within this population. This article examines the extant literature base and arguments for each position. Method: A critical literature review and commentary on the clinical area. Findings: Both therapy perspectives appear to share more commonalities than differences in routine clinical practice. Several issues raised by each therapeutic approach (e.g., lack of evidence base, destabilizing effects on complex clients) may be artifacts of clinician identity and examples of a "straw man" fallacy rather than legitimate concerns. Conclusions: An alternative synthesized view may be more helpful in advancing the area of Complex PTSD rather than a perpetuation of long-held polarized opinions. Adopting this stance, the present article makes a number of research recommendations to increase understanding of both unimodal and phased interventions. Suggestions for clinical practice, including a focus on bespoke formulations, and enhanced training programs for Complex PTSD to assist this consolidation process are also discussed. Clinical Impact StatementTwo conflicting perspectives on Complex PTSD therapy include: 1) "unimodal" therapies such as Cognitive behavioral Therapy are effective in traditional PTSD; and 2) "phase-oriented" therapies that have less supporting evidence, but take a more gradual pace due to the challenging nature of Complex PTSD, are more appropriate in such clinical presentations. The present commentary provides clarity for clinicians on the evidence base and clinical viewpoints relevant to both positions, revealing that these 2 perspectives have more in common than previously considered. The article will help clinicians consider more blended practices when treating Complex PTSD, and provides recommendations for research and practice to develop this area.