The future of trauma-focused therapy in complex PTSD and personality pathology

For decades, the treatment of complex PTSD and severe personality pathology has been influenced by phase-based models in which trauma processing is preceded by prolonged stabilisation. Increasingly, however, research challenges the assumption that patients with complex clinical presentations require extensive preparatory treatment before traumatic memories can be addressed safely and effectively.

This lecture presents an alternative, memory-based perspective. Drawing on the Adaptive Information Processing model, working memory theory, and recent clinical research, it will explore how symptoms associated with complex PTSD and personality pathology may be understood as state-dependent activations of maladaptively stored traumatic, attachment-related, and other emotionally significant memories. From this perspective, treatment can focus directly on the memories that drive current symptoms, dysfunctional beliefs, interpersonal patterns, and emotional or behavioural dysregulation.

Using findings from recent randomized trials and clinical experience with brief intensive treatment programmes, the presentation will illustrate how trauma-focused interventions can be applied to complex presentations without any form of stabilisation. Particular attention will be given to case conceptualisation, target selection, treatment intensity, adaptations of EMDR procedures, and the clinical implications of moving from a model of stabilisation before processing towards one of precision, intensity, and acceleration.

This presentation will be illustrated by video segments of treatment sessions using EMDR with a wide range of patients.

Speaker: Ad de Jongh, Ph.D., is a mental health psychologist, emeritus professor of anxiety and behavioural disorders at the University of Amsterdam, and honorary or visiting professor at several UK universities. Furthermore, he is affiliated with the research department of the Psychotrauma Expertise Center (PSYTREC) in Zeist (Netherlands), and an approved trainer for the EMDR Europe association. His work focuses on innovative treatments for anxiety disorders, PTSD, and personality disorders. He has authored or co-authored more than 500 scientific publications.

Recent publications and training:

• EMDR trainings (online)
• De Jongh, A., & Hafkemeijer, L.C.S. (2024). Trauma‐focused treatment of a client with Complex PTSD and comorbid pathology using EMDR. Journal of Clinical Psychology, 80, 824–835. https://doi.org/10.1002/jclp.23521
• De Jongh, A., De Roos, C., El-Leithy, S. (2024). State of the science: Eye movement desensitization and reprocessing (EMDR) therapy. Journal of Traumatic Stress, 37, 2, 205–216. https://doi.org/10.1002/jts.23012
• Van der Linde, R.P.A., Huntjens, R.J.C., Bachrach, N., Rijkeboer, M.M., De Jongh, A. & Van Minnen, A. (2023). The role of dissociation-related beliefs about memory in trauma-focused treatment. European Journal of Psychotraumatology, 14:2, 2265182. https://doi.org/10.1080/20008066.2023.2265182