In choosing a therapeutic model for C-PTSD, counselors should consider intersectional implications. A firm understanding of Feminist, Intersectional, Queer, and Transgender (FIQT) Theory is essential in the treatment of intersectional clients.

GENDER DIFFERENCES

Giarratano, et. al., (2020) published a study the study "Gender Differences in Complex Post-traumatic Stress Symptoms, and Their Relationship to Mental Health and Substance Abuse Outcomes in Incarcerated Adults" in which they note that C-PTSD though childhood abuse, C-PTSD, and behavioral health problems affect both men and women, the prevalence of past child abuse is greater for women and that women "endorsed more psychiatric problems, and greater risk of problematic substance use with hard drugs including heroin and cocaine, than men (p. 1148). This greater prevalence also made women more likely to have an increase in psychiatric co-morbidity and more "more susceptible to further victimization, socioeconomic disadvantage, and legal involvement" (p. 1148). Counselors should integrate affirmative therapy that increases attention to coming, stigma, social support, and discrimination, working toward affirmation (Bryan-Davis, 2019).

REFUGEES & ASLYUM SEEKERS

Kaminer & Eagle (2017) completed a study on the use of interventions for C-PTSD which noted empirical evidence of better outcomes for refugees and asylum seekers when counselors use multimodal approaches and phased TF-CBT.  Research suggests that TF-CBT is the preferred treatment of populations displaced by war or conflict who often present C-PTSD symptoms linked to past trauma and ongoing insecurity and threat.  Bryant-Davis (2019) suggests that counselors should be sure to work with clients on migration experience, loss of cultural connections, acculturation, language, loss of status, family and cultural role expectations, religious belief systems, pessimistic views of fate, and intergenerational conflict.

LATINX IMMIGRANTS

Many immigrants in this country have been diagnosed with C-PTSD due to oppression and marginalization both in their home countries and in the US. Chavez-Dueñas, et. al. (2019) published an article that outlines a framework for counselors working with Latinx immigrants who face ethno-racial trauma. This framework, HEART (Healing Ethno And Racial Trauma) Framework is grounded in trauma-informed care and Liberation Psychology.  Within the HEART framework, elements of TF-CBT are integrated so that "individuals locate their experiences within a historical context of oppression and marginalization" (p. 57) and process the experience in a safe space (consistent with TF-CBT).

INTELLECTUAL DISABILITIES

Stenfort, et. al. (2016) published a study on C-PTSD in people with intellectual disabilities.  They noted that "with regards to people with ID, a further challenge is that standard CBT procedures are difficult to deliver to this population because of their cognitive limitations in relation to logical thinking, planning, memory, language and emotional literacy; therefore, CBT techniques need to be adapted to make them accessible" (p. 301).

SOCIETAL DISCRIMINATION

Bryant-Davis (2019) notes that "individual trauma models overlook the realities of collective trauma and the cultural experience of mass suffering, such as that experienced by African American, Jewish, Muslim, Armenian, and transgender survivors. For these survivors, the rebuilding of social systems is a required component of recovery" (p. 402). Homophobia is another social trauma that counselors should consider when treating LGBTQ+ individuals as it can cause negative self-image and increase trauma responses.

AFRICAN-AMERICAN RACISM

Culturally aware counselors can incorporate incorporating spirituality, movement, art, and music into trauma therapy when treating Black clients with trauma. Black children, especially, can benefit from art therapy and Afrocentric therapy to increase resiliency. Interventions should be geographically accessible, community-based, cost-effective, and attuned to the realities of complex trauma (Bryan-Davis, 2019).