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of Complex PTSD
by Pete Walker
Pete Walker provides a convincing argument for the recognition and proper treatment of emotional flashbacks and
complex PTSD, which result from childhood neglect and emotional abuse.
Early in my career I worked with David,* a handsome, intelligent client who was a professional actor. One
day David came to see me after an unsuccessful audition. Beside himself, he burst out: "I never let on to anyone,
but I know that I'm really very ugly; it's so stupid that I'm trying to be an actor when I'm so painful to look at."
David's childhood was characterized by emotional abuse, neglect and abandonment. The last and unwanted child
of a large family, his alcoholic father repeatedly terrorized him. To make matters worse, his family frequently
humiliated him by reacting to him with exaggerated looks of disgust. His older brother's favorite gibe,
accompanied by a nauseated grimace, was, "I can't stand looking at you. The sight of you makes me sick!"
David was so traumatized by the contempt with which his family
had treated him that he was easily triggered by anything but the
David was so traumatized by
most benign expression on my face. If he came into session
the contempt with which his
already triggered, he would often project disgust onto me, no
matter how much genuine goodwill and regard I felt for him at
family had treated him that he
the time.
was easily triggered by
anything but the most benign
I have come to call these reactions, typical of David and of many
expression on my face.
other clients over the years, emotional flashbacks—sudden and
often prolonged regressions ("amygdala hijackings") to the
frightening and abandoned feeling­states of childhood. They are
accompanied by inappropriate and intense arousal of the fight/flight instinct and the sympathetic nervous system.
Typically, they manifest as intense and confusing episodes of fear, toxic shame, and/or despair, which often beget
angry reactions against the self or others. When fear is the dominant emotion in an emotional flashback, the
individual feels overwhelmed, panicky or even suicidal. When despair predominates, it creates a sense of profound
numbness, paralysis, and an urgent need to hide. Feeling small, young, fragile, powerless and helpless is also
common in emotional flashbacks. Such experiences are typically overlaid with toxic shame, which, as described in
John Bradshaw's Healing The Shame That Binds, obliterates an individual's self­esteem with an overpowering
sense that she is as worthless, stupid, contemptible or fatally flawed, as she was viewed by her original caregivers.
Toxic shame inhibits the individual from seeking comfort and support, and in a reenactment of the childhood
abandonment she is flashing back to, isolates her in an overwhelming and humiliating sense of defectiveness.
Clients who view themselves as worthless, defective, ugly, or despicable are showing signs of being lost in an
emotional flashback. When stuck in this state, they often polarize affectively into intense self­hate and self­disgust,
and cognitively into extreme and virulent self­criticism.
Numerous clients tell me that the concept of an emotional flashback brings them a great sense of relief. They
report that for the first time they are able to make some sense of their extremely troubled lives. Some get that their
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addictions are misguided attempts to self­medicate. Some understand the inefficacy of the myriad psychological
and spiritual answers they pursued, and are in turn feel liberated from a shaming plethora of misdiagnoses. Some
can now frame their extreme episodes of risk taking and self­destructiveness as desperate attempts to distract
themselves from their pain. Many experience hope that they can rid themselves of the habit of amassing evidence
of defectiveness or craziness. Many report a budding recognition that they can challenge the self­hate and self­
disgust that typically thwarts their progress in therapy.
Emotional Neglect: A Primary Cause of Complex PTSD?
Early on in working with this model, I was surprised that a number of clients with moderate and sometimes
minimal sexual or physical childhood abuse were plagued by emotional flashbacks. Over time, however, I realized
that these individuals had suffered extreme emotional neglect: the kind of neglect where no caretaker was ever
available for support, comfort or protection. No one liked them, welcomed them, or listened to them. No one had
empathy for them, showed them warmth, or invited closeness. No one cared about what they thought, felt, did,
wanted, or dreamed of. Such trauma victims learned early in life that no matter how hurt, alienated, or terrified
they were, turning to a parent would actually exacerbate their experience of rejection.
The child who is abandoned in this way experiences the world as a terrifying place. I think about how humans
were hunter­gatherers for most of our time on this planet—the child's survival and safety from predators during the
first six years of life during these times depended on being in very close proximity to an adult. Children are wired
to feel scared when left alone, and to cry and protest to alert their caretakers when they are. But when the
caretakers turn their backs on such cries for help, the child is left to cope with a nightmarish inner world—the stuff
of which emotional flashbacks are made.
Because of this, emotional flashbacks can best be understood as
the key symptom of Complex Post­Traumatic Stress Disorder, a
syndrome afflicting many adults who experienced ongoing abuse
or neglect in childhood. As described by leading trauma theorist
Judith Herman (Trauma and Recovery) and renowned PTSD
researcher Bessel van der Kolk, Complex PTSD is caused by
"prolonged, repeated trauma" and "a history of subjection to
totalitarian control" such as happens in extremely dysfunctional
families. It is distinguished from the more familiar type of PTSD
in which the trauma is specific and defined; because of the
prolonged nature of the trauma, Complex PTSD can be even
more virulent and pervasively damaging in its effects. (Complex
PTSD has not yet been included in the DSM.)
emotional flashbacks can best
be understood as the key
symptom of Complex Post­
Traumatic Stress Disorder, a
syndrome afflicting many
adults who experienced
ongoing abuse or neglect in
childhood.
Ongoing experience convinces me that some children respond to pervasive emotional neglect and abandonment by
over­identifying or even merging their identity with the inner critic and adopting an intense form of perfectionism
that triggers them into painful abandonment flashbacks every time they are less than perfect or perfectly pleasing.
When I encourage such clients to free­associate during their emotional flashbacks, I frequently hear a version of
this toxic shame spiral: "If only I were perfect. If only I were an ‘A' student . . . a baseball hero . . . a beauty queen .
. . a saint. If only I weren't so stupid and selfish, then maybe they'd love me. But who am I kidding? I'll never be
anywhere near that, because I'm just a piece of shit. Who in the world could ever care about someone so pathetic?"
Responding Functionally to Emotional Flashbacks
Emotional flashbacks strand clients in the cognitions and feelings of danger, helplessness and hopelessness that
characterized their original abandonment, when there was no safe parental figure to go to for comfort and support.
Hence, Complex PTSD is now accurately being identified by some traumatologists as an attachment disorder.
Emotional flashback management, therefore, needs to be taught in the context of a safe relationship. Clients need
to feel safe enough with the therapist to describe their humiliation and overwhelm, and the therapist needs to feel
comfortable enough to provide the empathy and calm support that was missing in the client's early experience.
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Because most emotional flashbacks do not have a visual or memory component to them, the triggered individual
rarely realizes that she is re­experiencing a traumatic time from childhood. Psychoeducation is therefore a
fundamental first step in the process of helping clients understand and manage their flashbacks. Most of my clients
experience noticeable relief when I explain Complex PTSD to them. The diagnosis resonates deeply with their
intuitive understanding of their suffering. When they recognize that their sense of overwhelm initially arose as a
normal instinctual response to their traumatic circumstances, they begin to shed the belief that they are crazy,
hopelessly oversensitive, and/or incurably defective.
Without help in the midst of an emotional flashback, clients typically find no recourse but their own particular
array of primitive, self­injuring defenses to their unmanageable feelings. These dysfunctional responses generally
manifest in four ways: [1] fighting or over­asserting oneself in narcissistic ways such as misusing power or
promoting excessive self­interest; [2] fleeing obsessive­compulsively into activities such as work addiction, sex
and love addiction, or substance abuse ("uppers"); [3] freezing in numbing, dissociative ways such as sleeping
excessively, over­fantasizing, or tuning out with TV or medications ("downers"); [4] fawning codependently in
self­abandoning ways such as putting up with narcissistic bosses or abusive partners.
I find that most clients can be guided to see the harmfulness of their previously necessary, but now outmoded,
defenses as a misfiring of their fight, flight, freeze, or fawn responses. In the context of a secure therapeutic
alliance, they can begin to replace these defenses with healthy, stress­ameliorating responses. I introduce this phase
of the work by giving the client the list of 13 cognitive, affective, somatic and behavioral techniques (listed at the
end of this article) to utilize outside of the session. I elaborate on these techniques in our sessions as well.
As clients begin to respond more functionally to being triggered, opportunities arise more frequently for working
with flashbacks in session. In fact, it often seems that their unconscious desire for mastery "schedules" their
flashbacks to occur just prior to or during sessions. I recently experienced this with a client who rushed into my
office five minutes late, visibly flushed and anxious. She opened the session by exclaiming, "I'm such a loser. I
can't do anything right. You must be sick of working with me." This was someone who had, on previous occasions,
accepted and even been moved by my validation of her ongoing accomplishments in our work. Based on what she
had uncovered about her mother's punitive perfectionism in previous sessions, I was certain that her being late had
triggered an emotional flashback. In this moment, she was most likely experiencing what Susan Vaughan's MRI
research (The Talking Cure) describes as a gross over­firing of right­brain emotional processing with a decrease in
cognitive processing in the left brain. Vaughan interprets this as a temporary loss of access to left­brain knowledge
and understanding. This appears to be a mechanism of dissociation, and in this instance, it rendered my client
amnesiac of my high regard for our work together.
I believe this type of dissociation also accounts for the recurring disappearance of previously established trust that
commonly occurs with emotional flashbacks. This phenomenon makes it imperative that we psychoeducate clients
that flashbacks can cause them to forget that proven allies are in fact still reliable, and that they are flashing back to
their childhoods when no one was trustworthy. Trust repair is an essential process in healing the attachment
disorders created by pervasive childhood trauma. PTSD clients do not have a volitional "on" switch for trust, even
though their "off" switch is frequently automatically triggered during flashbacks. The therapist therefore needs to
be prepared to work on reassurance and trust restoration over and
over again. I have heard too many client stories about past
The therapist therefore needs
therapists who got angry at them because they would not simply
to be prepared to work on
choose to trust them.
Retuning to the above vignette, I wondered out loud to my client,
"Do you think you might be in a flashback?" Because of the
numerous times we had previously identified and named her
current type of experience as an emotional flashback, she
immediately recognized this and let go into deep sobbing. She
dropped into profound grieving that allowed her to release the
flashback—a type of grieving the restorative power of which I
have witnessed innumerable times. It is a crying that combines
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reassurance and trust
restoration over and over
again. I have heard too many
client stories about past
therapists who got angry at
them because they would not
simply choose to trust them.
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tears of relief with tears of grief: relief at being able to take in
another's empathy and make sense of confusing, overwhelming pain; and grief over the childhood abandonment
that created this sense of abject alienation in the first place.
My client released some of the pain of her original trauma and of the times she had previously been stuck in the
unrelenting pain of flashing back to her original abandonment.
As her tears subsided, she recalled to me a time as a small child
As her tears subsided, she
when she had literally received a single lump of coal in her
recalled to me a time as a small
Christmas stocking as punishment for being 10 minutes late to
dinner. Her tears morphed into healthy anger about this abuse,
child when she had literally
and she felt herself returning to an empowered sense of self.
received a single lump of coal
Grieving brought her back into the present and broke the amnesia
in her Christmas stocking as
of the flashback. She could then remember to invoke the self­
punishment for being 10
protective resources we had gradually been building in her
minutes late to dinner.
therapy with role­plays, assertiveness training and
psychoeducation about her parents' destruction of her healthy
instinct to defend herself against abuse and unfairness. The
ubiquitous childhood phrase of "That's not fair!" had been severely punished and extinguished by her parents. She
reconnected with her right and need to have boundaries, to judge her parents' actions unconscionable, and to
fiercely say "no" to her critics' subsequent habit of judging her harshly for every peccadillo. Finally, I reminded her
to reinvoke her sense of safety by recognizing that she now inhabited an adult body, free of parental control, and
that she had many resources to draw on: intelligence, strength, resilience, and a growing sense of community. She
lived in a safe home; she had the support of her therapist and two friends who were her allies and who readily saw
her essential worth. I also observed that she was making ongoing progress in managing her flashbacks—that they
were occurring less often and less intensely.
Managing the Inner Critic
In guiding clients to develop their ability to manage emotional flashbacks, my most common intervention involves
helping them to deconstruct the alarmist tendencies of the inner critic. This is essential, as Donald Kalshed
explains in The Inner World of Trauma, because the inner critic grows rampantly in traumatized children, and
because the inner critic not only exacerbates flashbacks, but eventually grows into a psychic agency that initiates
them. Continuous abuse and neglect force the child's inner critic (superego) to overdevelop perfectionism and
hypervigilance. The perfectionism of Complex PTSD puts the child's every thought, word or action on trial and
judges her as fatally flawed if any of them are not 100­percent faultless. Perfectionism then devolves into the
child's obsessive attempt to root out real or imagined defects and to achieve unsurpassable excellence in an effort
to win a modicum of safety and comforting attachment.
The hypervigilance of Complex PTSD is an overaroused sympathetic nervous system fixation on endangerment
that comes from long­term childhood exposure to real danger. In an effort to recognize, predict and avoid danger,
hypervigilance develops in a traumatized child as an incessant, on­guard scanning of both the real environment
and, most especially, the imagined upcoming environment. Hypervigilance typically devolves into intense
performance anxiety on every level of self­expression, and perfectionism festers into a virulent inner voice that
manifests as self­hate, self­disgust and self­abandonment at every turn.
When the child with Complex PTSD eventually comes of age and launches from the traumatizing family, she is so
dominated by feelings of danger, shame and abandonment that she is often unaware that adulthood now offers
many new resources for achieving internal and external safety and healthy connection with others. She is unaware
that a huge part of her identity is subsumed in the inner critic—the proxy of her dysfunctional caregivers—and that
she has had scarce room to develop a healthy self with an accompanying healthy ego.
This scenario arises frequently in my practice: A client, in the midst of reporting some inconsequential miscue of
the previous week, suddenly launches into a catastrophizing tale of her life deteriorating into a cascading series of
disasters. She is flashing back to the danger­ridden times of her childhood, and her distress sounds something like
this: "My boss looked at me funny when I came back from my bathroom break this morning and I know he thinks
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I'm stupid and lazy and is going to fire me. I just know I won't be able to get another job. My boyfriend will think
I'm a loser and leave me. I'll get sick from the stress, and with no money to pay my medical insurance and rent, I'll
soon be a bag lady on the street." It's disturbing how many
catastrophizing inner critic rants end with the bag lady on the
It's disturbing how many
street. What a symbol of abandonment!
catastrophizing inner critic
rants end with the bag lady on
the street. What a symbol of
abandonment!
Teaching such clients to recognize when they have polarized into
inner­critic catastrophizing, and modeling to them how to resist it
with thought stopping and thought substitution, are essential
steps in managing flashbacks. In this case I reminded my client
of the many times we had previously caught the inner critic
laundry­listing every conceivable way a difficult situation could
spiral into disaster, and I invited her to use thought stopping to refuse to indulge this process. I suggested that she
visualize a stop sign and say "no" to the critic each time it tried to scare or demean her. I reminded her that she had
learned to catastrophize from her parents, who noticed her in such a predominantly negative and intimidating way.
I also reinvoked the thought substitution process we had practiced on numerous occasions, encouraging her to
remember and focus on all the positive things she knew about herself. Finally, I reminded her of all the positive
experiences she had actually had with her boss, and I listed the essential qualities and accomplishments we were
working to integrate into her self­image: her intelligence, integrity, resilience, kindness, and many successes at
work and school.
Rescuing the Wounded Child
Over the course of a therapy, I often reframe emotional flashbacks as messages from the wounded inner child
designed to challenge denial or minimization about childhood trauma. It is as if the inner child is clamoring for
validation of past parental abuse and neglect: "See this is how bad it was—how overwhelmed, terrified, ashamed
and abandoned I felt so much of the time."
When seen in this light, emotional flashbacks are also signals
from the wounded child that many of her developmental needs
have not been met. Most important among these are the needs for
safety and for Winnicottian good­enough attachment. There are
no needs more important than those of a parent's protection and
empathy, without which a child cannot own and develop her
instincts for self­protection and self­compassion—the
cornerstones of a healthy ego. Without awakening to the need for
this kind of primal self­advocacy, clients remain stuck in learned
self­abandonment and rarely develop effective resistance to
internal or external abuse, and seldom gain the motivation to
consistently use the 13 tools for managing emotional flashbacks
at the end of this article.
emotional flashbacks are also
signals from the wounded child
that many of her
developmental needs have not
been met. Most important
among these are the needs for
safety and for Winnicottian
good­enough attachment.
When clients recognize that their emotional storms are messages from an inner child who is still pining for a
healthy inner attachment figure, and when they are able to internalize the therapist's acceptance and support, they
gradually become more self­accepting and less ashamed of their flashbacks, their imperfections and their dysphoric
affective experience. When the therapist repeatedly models feeling­based indignation at the fact that the client was
taught to hate himself, the client eventually feels incensed enough about this experience to begin standing up to the
inner critic and of investing in the extensive work of building healthy self­advocacy. When the therapist
consistently responds compassionately to the client's suffering, the client's capacity for self­empathy and self­
forgiveness begins to awaken. He gradually begins to desire to comfort and soothe himself in times of cognitive
confusion, emotional pain, physical distress, or real­life disappointment, rather than surrender to an inner torture of
self­hate, self­disappointment, and self­abandonment.
Around this time in therapy, the client also solidifies her understanding that the lion's share of the energy contained
in her intense emotional flashbacks are actually appropriate but delayed reactions to various themes of her
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childhood abuse and neglect. Gradually—often at the rate of two steps forward and one back–­she is able to
metabolize these feelings in a way that not only resolves her trauma, but builds new, healthy, self­empowering
psychic structure as well. This, in turn, leads to an ongoing reduction of the unresolved psychic pain that fuels her
emotional flashbacks, which subsequently become less frequent, intense and enduring. Eventually, a person
experiencing an emotional flashback begins to invoke a sense of self­protection as soon as she realizes she is
triggered, or even immediately upon being triggered. As flashbacks decrease and become more manageable, the
defensive structures built around them (narcissistic, obsessive­compulsive, dissociative and/or codependent) can be
more readily deconstructed.
Moving through Abandonment into Intimacy: A Case Study
A sweet, middle­aged male client of mine from an upper­middle­class family had suffered severe emotional
abandonment in childhood. Both parents were workaholics and therefore unavailable; as the youngest of five
children, my client was hamstrung in the sibling competition for scarce parental resources. His adulthood reenacted
the relational impoverishment of childhood. He was hair­triggered for retreat and isolation. He had never
experienced an enduring relationship. As a result of our long­term work, however, he became more motivated to
seek a relationship, and successfully dated a healthy and available partner. For the first six months of their
relationship, her kind nature, along with my coaching, enabled him to show her more and more of himself, and he
was rewarded by increasing feelings of comfort and love while relating with her.
When he accepted her request to move in together, however, it became harder to hide his recurring emotional
flashbacks to the overwhelming anxiety and emptiness of his childhood. He was more convinced than ever that the
abandonment melange of fear, shame and depression at the core of his flashbacks was the most despicable of his
many fatal flaws. As we worked with this belief in therapy, he remembered many times when even the mildest dip
in his mood triggered his psychotherapist mother to turn her back on him and flee to the inviolability of her locked
room. He saw that the occasional utility his mother found in him depended on his keeping her buoyant and lifting
her spirits. He was traumatized into a staunch conviction that social inclusion depended on his manifesting a
bravura of love, listening and entertainment. A codependent defense of fawning and performing had been instilled
in him. Now he could not shake off the fear that if he ever deviated from being loving, funny and bright, his new
partner would be disgusted and abandon him. He reported that, in fact, his flashbacks at home had increased,
provoking a desperate need to isolate and hide. His freeze response was activated and he increasingly disappeared
from her into silence, the computer, excessive sleeping, and marathon TV sports viewing. During his most intense
flashbacks, his fear and self­disgust became so intense that his
flight response took over and he invented any excuse to get out
During his most intense
of the house. He was besieged by thoughts and fantasies of being
flashbacks, his fear and self­
single again. His inner critic was winning the battle; he was sure
his partner was as disgusted with his affect as his mother had
disgust became so intense that
been. He was on the verge of a full­fledged flight response into
his flight response took over
the old habit of precipitously ending relationships, as he always
and he invented any excuse to
had in the past when the brief infatuation stages of his few
get out of the house. He was
previous relationships came to an end.
besieged by thoughts and
fantasies of being single again.
We spent many subsequent sessions managing these emotional
flashbacks to his original abandonment. He understood more
deeply that his silent withdrawals were evidence that he was
flashing back, and he committed to rereading and using the 13 steps of flashback management at such times. With
my encouragement and gentle nudging, he grieved over his original abandonment more deeply and more self­
compassionately than ever before in our work together. Over and over, he confronted the critic's projection of his
mother onto his partner. He practiced grounding himself in the present, and at home began talking to his girlfriend
about his experiences of flashing back into the abandonment melange. A crowning achievement occurred when he
was finally able to disclose to her that talking vulnerably made him feel even more afraid and ashamed—and
deserving of abandonment.
To his great relief, he was rewarded not only by her empathic response but also by her gratitude for his
vulnerability, and she began to share an even deeper level of her own vulnerability. For the first time, he began
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talking to her while he was actually depressed. Their love then began to expand into those special depths of
intimacy that are only achieved when people feel safe enough to communicate about all of their cognitive,
emotional and behavioral experiences—the good and the bad, the gratifying and the disappointing, the loving and
the mad. (One of the great rewards of this kind of recovery work is that the individual achieves a depth and
richness of communication and contact that many non­traumatized people miss out on because wider social forces
have scared and shamed them out of ever sharing anything truly vulnerable.) As my client became more skilled at
being vulnerable, he was rewarded with the irreplaceable intimacy that comes from commiseration—another gift
that many less­traumatized members of our culture never get to discover. The degree to which two individuals
mutually share all aspects of their experience is the degree to which they have real love and intimacy.
As clients learn to identify flashbacks as normal responses to
abnormally stressful childhood conditions, they become free of
As clients learn to identify
the fear and shame that have made them isolate, overreact, or
flashbacks as normal responses
push others away at such times. Most clients experience
tremendous relief when they learn to interpret their
to abnormally stressful
overwhelming or excessively numbing experiences as emotional
childhood conditions, they
flashbacks, rather then as proof that they are bad, defective,
become free of the fear and
worthless or crazy. Such realizations—as rapidly evaporating as
shame that have made them
they can be in early recovery—heal the fear and shame so central
isolate, overreact, or push
to emotional flashbacks. As clients learn to stay in contact and
communicate functionally from their pain, they begin to heal
others away at such times.
their core abandonment depression; they gradually discover that
they are not detestable but lovable and acceptable in their deepest
vulnerability. This begins to heal their attachment disorders, the most deleterious part of Complex PTSD. It allows
them to evolve toward what some traumatologists call an earned secure attachment. For many people this first
secure attachment is achieved with the therapist, which in turn allows the client to know that such an invaluable
experience is possible. With ongoing psychoeducation and coaching from the therapist, this first safe­enough
relationship can become the launching pad for seeking such a relationship outside of therapy. The ending phase of
therapy is typically characterized by the client building at least one good­enough, earned secure attachment outside
of therapy—one relationship where she has learned to manage her flashbacks without excessively acting out
against others or herself.
Challenges and Rewards for the Therapist
What I find most difficult about this work is that it is often excruciatingly slow and gradual. Nowhere is this truer
than in the work of shrinking the toxic inner critic. Progress is often beyond the perception of the client, especially
during a flashback, and flashbacks are unfortunately never completely arrested.
The hardest thing of all is getting the client to see that emotional
flashbacks, a bit like diabetes, are a lifetime condition that will
always need a modicum of management. Good­enough
management creates a good­enough life—one where flashbacks
markedly and continually decrease but inevitably recur from time
to time. Failure to accept this reality typically causes the client to
reinvoke her old reactions to flashbacks, which in turn cause her
to get lost in the self­abandonment of blaming and shaming
herself.
The hardest thing of all is
getting the client to see that
emotional flashbacks, a bit like
diabetes, are a lifetime
condition that will always need
a modicum of management.
What I love most about this kind of trauma work is seeing clients
with a long history of developmental arrest, as well as feelings of helplessness and hopelessness, begin to become
empowered. I am delighted every time a client responds to her own suffering with kindness or reports an action of
self­protectiveness in the world at large. I love witnessing the gradual growth of self­confidence and self­
expression in my clients. This inevitably seems to grow out of their recovered ability to get angry about what
happened to them in childhood and to use that anger to empower and motivate themselves to face the fear of trying
on new, more assertive behavior. I am also especially moved when a client learns to cry for himself in that fully
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functional, unabashed way where tears release fear and shame. In my experience, nothing catharsizes fear and
catastrophizing obsessiveness like egosyntonic tears. I have, on thousands of occasions, witnessed clients grieving
in a way that resurrects them from a flashback, back into their growing self­esteem and resourcefulness.
Another highlight of this work for me comes in the early and middle stages of therapy. I like to call it rescuing the
client from the hegemony of the critic. I believe there is an unmet childhood need for rescue that I help meet when
I "save" my client from the critic—unlike Mom who didn't save him from his abusive dad, or unlike the
neighborhood that didn't rescue him from his alcoholic family. Decades of trauma work have taken me to a place
where my heart no longer allows me to be silent, and hence tacitly approving, when clients verbally and
emotionally abuse themselves in a gross overidentification with the inner critic. I am additionally motivated to do
this because of the failure of my own first long­term experience of psychoanalytic therapy, where my "blank
screen" therapist let me flounder and perseverate in endless iterations of my PTSD­acquired self­hate and self­
disgust. Never once was it pointed out that I could and should challenge this anti­self behavior. UCSF trauma
expert Harvey Peskin would call this a failure to bear witness to the traumatization of the child. I have learned to
take this a step further by not only vocally witnessing the client's flashback into the helplessness of his original
abandonment, but also giving him a hand to climb out of that abyss of fear and shame.
The term rescuing and what it represents has become a taboo in the 12­Step Movement (e.g. Alcoholics
Anonymous, Adult Children of Alcoholics, Incest Survivors Anonymous, etc.) and many psychotherapy circles.
The word is often used in such an all­or­none way that any type of active helping is pathologized. However, I think
helping clients out of the abyss of emotional flashbacks is a necessary form of active helping, or rescuing. The
rescuing I refer to is different from the kind that many therapists correctly view as disempowering and unhealthy
for the client. One example of this type of countertherapeutic rescuing is inappropriate or excessive advocacy.
Colluding with or encouraging personal irresponsibility, such as exonerating a client's regressed or infantile acting
out without steering him towards learning to interact more responsibly and salubriously with himself and the world
is also a common type of problematic rescuing.
A final great reward I experience in helping clients manage their emotional flashbacks is witnessing the
development of their emotional and relational intelligence. At the risk of sounding Pollyannaish, I believe
Complex PTSD actually has a silver lining: the potential to reconnect with these intelligences at much deeper
levels than those who are not traumatized in the family, but who suffer a truncation of their emotional self­
expression and relational capacity. Wider social forces can strand individuals in the loneliness of superficial
relating and can cause them to hide significant aspects of their emotional experience. A number of my clients in
the later stages of recovery work have built and earned relationships that exhibit a depth of intimacy I rarely see in
the general population.
*All names and identifying information have been changed to protect client confidentiality.
Managing Emotional Flashbacks: A Handout for Clients
1. Say to yourself: "I am having a flashback." Flashbacks take us into a timeless part of the psyche that feels as
helpless, hopeless and surrounded by danger as we were in childhood. The feelings and sensations you are
experiencing are past memories that cannot hurt you now.
2. Remind yourself: "I feel afraid but I am not in danger! I am safe now, here in the present." Remember you
are now in the safety of the present, far from the danger of the past.
3. Own your right/need to have boundaries. Remind yourself that you do not have to allow anyone to mistreat
you; you are free to leave dangerous situations and protest unfair behavior.
4. Speak reassuringly to your Inner Child. The child needs to know that you love her unconditionally—that she
can come to you for comfort and protection when she feels lost and scared.
5. Deconstruct eternity thinking. In childhood, fear and abandonment felt endless—a safer future was
unimaginable. Remember the flashback will pass as it has many times before.
6. Remind yourself that you are in an adult body with allies, skills and resources to protect you that you never
had as a child. (Feeling small and little is a sure sign of a flashback.)
7. Ease back into your body. Fear launches us into "heady" worrying, or numbing and spacing out.
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Gently ask your body to relax. Feel each of your major muscle groups and softly encourage them to relax.
(Tightened musculature sends unnecessary danger signals to the brain.)
Breathe deeply and slowly. (Holding the breath also signals danger.)
Slow down. Rushing presses the psyche's panic button.
Find a safe place to unwind and soothe yourself: wrap yourself in a blanket, hold a stuffed animal, lie down
in a closet or a bath, take a nap.
Feel the fear in your body without reacting to it. Fear is just an energy in your body that cannot hurt you
if you do not run from it or react self­destructively to it.
8. Resist the Inner Critic's catastrophizing.
(a) Use thought­stopping to halt its exaggeration of danger and need to control the uncontrollable. Refuse
to shame, hate or abandon yourself. Channel the anger of self­attack into saying no to unfair self­criticism.
(b) Use thought­substitution to replace negative thinking with a memorized list of your qualities and
accomplishments.
9. Allow yourself to grieve. Flashbacks are opportunities to release old, unexpressed feelings of fear, hurt, and
abandonment, and to validate—and then soothe—the child's past experience of helplessness and hopelessness.
Healthy grieving can turn our tears into self­compassion and our anger into self­protection.
10. Cultivate safe relationships and seek support. Take time alone when you need it, but don't let shame isolate
you. Feeling shame doesn't mean you are shameful. Educate those close to you about flashbacks and ask them to
help you talk and feel your way through them.
11. Learn to identify the types of triggers that lead to flashbacks. Avoid unsafe people, places, activities and
triggering mental processes. Practice preventive maintenance with these steps when triggering situations are
unavoidable.
12. Figure out what you are flashing back to. Flashbacks are opportunities to discover, validate and heal our
wounds from past abuse and abandonment. They also point to our still­unmet developmental needs and can
provide motivation to get them met.
13. Be patient with a slow recovery process. It takes time in the present to become un­adrenalized, and
considerable time in the future to gradually decrease the intensity, duration and frequency of flashbacks. Real
recovery is a gradual process—often two steps forward, one step back. Don't beat yourself up for having a
flashback.
Copyright © 2009 Psychotherapy.net. All rights reserved. Published September, 2009.
Pete Walker is director of the Lafayette Counseling Center. He has been working as a teacher
and mental health professional for thirty years, and is the author of The Tao of Fully Feeling:
Harvesting Forgiveness Out of Blame. He presents on this topic annually at JFK University and
has also presented the topic at the 40st Annual CAMFT Conference and several EBCAMFT
chapter meetings.
Elaborations of the principles in this article—the importance of shrinking the inner critic, the
role of grieving in trauma recovery, and the need to be able to stay self­compassionately present
to dysphoric affect—as well on his writings on trauma typology and the role of trauma in
codependence, can be downloaded for free from his website: www.pete­walker.com. He can also be reached at
925­283­4575.
This article is absolutely wonderful and healing. I just found it after going through many of these steps on my own
and feel validated. Thank you so much!
Anon
Thank You, Thank You, Thank You, You have answered what is wrong with me? and my sis. You have clarified
my life perfectly . Given me the answers I have been searching for to help me . We have Complex PTSD . Oh the
relief . Ahhh! at last. Now have hope and understanding . Very Grateful :­)
Suzanne M
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Thanks so much for a succinct ­ but detailed and practical enough ­ overview of flashbacks and addressing them.
As a parent of two teen­agers by adoption, with a therapist working on addressing flashbacks, I really needed this
kind of overview.
Janet P
Thank you so much, I have been in therapy for a while now and was still very confused as to what my diagnosis
was, and now I have clarity after reading your article, I attend group analytical therapy, is this what you would
recommend
Jayne
This is the most amazing thing I have learned in my life. No one has ever explained the disasters of my life like
this approach does. you have totally described my life, and more than that, opened the door for me to walk out and
live. I cannot express my gratitude towards you for publishing this information in its entirety instead of asking me
to pay to find out. I am quite speechless in finding words to thank you.
Cheryl
This article gave me the conceptual language I needed to give myself permission to talk about my childhood
without feeling embarrassed about the need to.
Carol Steffens
Thank you for your intelligent and empathetic article. I feel like the patient who, after suffering debilitating
symptoms for ages, has finally been diagnosed with a specific and real illness. Emotional flashbacks describe the
agonising emotional pain and self hatred accurately.
Lesley
Well written, succinct, and very helpful. The article provided me a new frame of reference for two of my clients ­
both experiencing complex PTSD ­ and how I might work with them in a more directive way in the session.
Thanks, Pete!
George Kraus, Ph.D., ABPP
Thank you for writing your article about Complex PTSD ­ I never knew such a thing existed. Your explanation of
Complex PTSD and most importantly, what to do about emotional flashbacks has been enormously helpful. It's
been my personal experience that when a parent has a physical, mental, or emotional disorder (in my case, my dad
had a pituitary tumor for 10 years and he exhibited intense hormonal mood swings, turning his anger and wrath on
me on a daily basis ­ during those years, there were no PET/CT's nor MRI's, only X­rays), a child can suffer
greatly and then in adulthood, unconsciously try to recreate the past in order to heal the present ­ doesn't work, I
can say. I haven't seen much in the literature about Complex PTSD and families who have an ill parent ­ this may
be a good topic to continue to write about within that context, yes?! Anyway, thank you again ­ your techniques for
dealing with Complex PTSD have added to my healing and I am grateful.
SB
i am glad you are alive! i'm so happy to have found this thank you so much!
keith
There is nothing I could ever find (religion, substance, etc.) that assists in putting together my 'what is wrong with
me?' puzzle more than knowledge, and this article is powerful. I much like Mike have that same hope, but I know
where that comes from and have the power to squash it now. Thank you.
CP
Thank you so much for your writing. I am a mental health therapist (social worker) who has taken time off to deal
with my own issues. Your writing was a source of comfort and rang very true for me, personally.
Laurie
Thank you for trying, but in some cases there is absolutely no hope. My life is hell and no amount of therapy can
change that. I hope I die soon.
Mike
I first reading this article about 6 months ago. Today I was experiencing fear and suddenly realized it was my little
child who was the frightened one and that my adult self was strong and healthy. Immediately the fear dissipated. I
am 71 and I am glad this information is available. Thank you so very much for your own process that led you to
help so many others.
Margie
Thank you. "Resonant" expresses my reaction to this article. Gentle tears falling because of Your understanding.
Cherrie
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I have never (in my entire life of research into abuse) read a better article. Thank you Pete Walker for changing my
life today and giving me hope for my future.
Danielle Christopher
Thank you so much for this article; thank you for writing and sharing so eloquently your years of insight and work.
Janet
This is the most helpful and informative information I have ever found.At 72 I'm still fighting PTSD and
flashbacks. I'm taking this page to my Doctor who is terrific, but using this info will help because it talks of whats
in my mind that I had no idea was important.God bless whoever researched and published this excellent work.
C Brooks
Thank you, Pete, for this revelatory essay. I am 70 and finally understand that my emotional disturbances come
when I am overwhelmed ­ as they did when I was a child. I'd never heard of emotional flashbacks before and now I
have a footing on which to address this. What a relief!
Margie Borchers
I'm glad to know that I am not alone in all of my feelings. Thanks.
I recently plunged into three months of utter despair after seemingly getting to grips with emotional flashbacks.
Reading this article reminded me that all was not lost and I could move forward again I had just temporarily
forgotten how to. Thank you so much.
Nicola
This is awesome, so spot on. Great help.
Mavis
Peter, thank you so much for your articles on PTSD. I have read many and yours show so much real knowledge
that every time I read them I understand more and more what has and what happens to me. In that way they are
truly freeing.
Brenda
Yes, like everyone else says, thank you for articulating this issue so eloquently ­ something that seems to escape
the grasp of most every therapist I've seen in my life (and I've seen PLENTY).
CF
Wonderful article! Your clients are so fortunate to benefit from your wisdom and sensitivity.
Laura
Reading this pulled me out of a really bad funk this morning. I found myself relating to just about everything you
wrote. I just could not bear the thought of buying another book to figure out what is "wrong" with me. Your clients
are lucky and we are lucky to have found this article to make sense out of what feels senseless. Finally, KUDOS to
all of us for finding the articles because it means we are "doing the work" to better ourselves. Thank you so much
Pete Walker
Stephanie D
Like so many others, I find this approach really useful and I have a very strong inner critic. On occasion, I actually
hear my parents' voices (most usually mom) say things like 'oh, just leave it' or 'for goodness sake'. This
encourages my dissociative freeze response. But here Complex PTSD sufferers are perfectionists and workaholics,
not me at all. I feel I need to know more about how someone like me, a Freeze who dissociates and simply stops
working, should approach things.
Anonyomous
Peter, I've read your stuff and have to thank you for your work. You understand me so well. I've suffered PTSD for
35 years from abuse and neglect in childhood. I've never heard anyone who can explain it so well.
Kyl
This article is excellent. I am a therapist as well as a complex PTSD survivor. I appreciated what the author had to
say on many levels. Showed t to my therapist who happens to get it. I'm fortunate to have found someone who
does. Previous comment about some therapists not getting it and making things worse ­ absolutely true,especially
of my first therapist. Thanks for writing this.
Beth
Absolutely brilliant. Thank you so much for writing this, I have done 3 years of various therapy & through much
research of the many comments by my psychiatrist & issues I seem to have that just dont quite fit the label. Ive had
a lifetime of misery & depression & finally reached out for help when I began projecting my shame & distress onto
my children. Thank God I got fantastic Help through the NHS. I was very lucky. The past couple of weeks I have
been researching complex trauma & complex PTSD & it all makes so much sense. Brilliant.
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JoBlogs
This is an amazing article. I wonder if you even have a sense of how powerful it is. I am going to share it with my
counselor. It gave me hope just reading it. I have so much empathy for you going through the psychoanalytic
psychotherapy...I did that too, with disastrous results. The good news is, if we are still alive and breathing and can
talk and listen, there is always hope to heal. Thank you for taking the time to put all of this information in a very
accessible, practical format. It's a gift. God bless you as you continue your work.
Sara Ann
Who are you how wonderful a human being to have cared enough to figure us out. Omg 40 years ive lived like this
and people think we are weak. Thanks from the bottom of my heart. I truly hope i don't forget and slide back. I
saved u to my home screen my current theripist doesnt have clue she should not be helping people like me they can
make us sicker if they dont know what they are doing. Kat (CPTSD) You are a needle in a hay stack god bless u
Kat
I too feel reading your article has transformed my life, thank you :­) After 30+ years of searching for support, I
have in the past few years been in supportive therapeutic relationships, & am now seeking resources for myself.
Your words have brought me huge, healing, relief, Blessings :­) xm
Maree Robertson
Excellent article! I was researching PTSD in graduate school and learned about complex PTSD back in 2006. You
article was right on target, practical and useful, as are your 13 tools for managing emotional falshbacks. Keep up
the good work!
Ed Saddy
Thank you. This piece is uplifting and I feel permission to be kind to myself. Please keep writing.
amy
This is a fantastic and deeply compassionate and human centered perspective. It could also be applied to people
who have been subjected to less intense forms of neglect but which nevertheless cause the person to behave in
selfabandoning ways, particularly within relationships. The interventions list is a much needed 'how ­ to' set of
tools that is all too often absent in and amongst all the theorising that abounds in the world of the helping
professions.
francesca Zammit Cutajar
I wonder, can a form of PTSD be caused by emotional abuse and abandonment in adult life, say from adultery and
a nasty divorce. The have experience I have had with some people rings very true to PTSD from childhood abuse.
What are the main differences, if any, between symptoms and treatments for PTSD (or PTSD like reactions) as
result of abandonment and emotional abuse in adults?
MikeC
I feel the same way as the other commenters.. what a helpful, thoughtful, thorough, well written article! I feel like I
have been 'set free' so to speak. ­ Years of trying to put words to what I go through ­ depression, anxiety, panic,
triggers, mood swings, ­ self loathing, worthlessness ­ and all of it connected, I knew, to the parenting I never got
and to the family that still treats me like the garbage can for all of their troubles as I sink deeper into self blame.
Thank you, thank you, thank you. I will be working on the techniques you recommend. I will never forget this
article.. ever.
sherri
Thank you so much for such a deeply caring article. It's helped enormously now and I have no doubt will continue
to in the future. The pain of the shame of existence can't be trumped. But thank you again for showing me it can
slowly be put to rest.
Alice
Pete Walker. You have given me a model and words with with which to materialize and emote my lifelong pain of
infantile issolation and emotional neglect. You are the only one I have found writing directly on this. You are
feeding my tramatized inner child. Thank you for loving him through you work.
Mike
This article was so dead on....unbelieveably helpful. Fortunately, I have a great therapist, but even so ­ it added
enormously to my understanding of things. Thank you, Pete Walker!!
Roberta
No comments?! Reading this article has done more to help me heal than my five years plus worth of weekly
psychotherapy sessions that I currently participate in! Eternally grateful to you, Pete Walker!
Shelley
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CE credits: 1.5
Learning objectives:
• Define emotional flashbacks.
• Describe therapeutic tasks for working with clients who suffer emotional flashbacks.
• Educate clients about the author's thirteen tools for managing their own emotional flashbacks. https://www.psychotherapy.net/article/complex­ptsd
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