Told Complex Trauma Can't Be Treated? What a 2019 Review Found
Quick Answer
Hearing that your trauma can't be treated is painful; and it's not rooted in the research: Complex PTSD can be treated, often with care that builds stability before working through painful memories.
Recovery tends to move in stages. Beyond core PTSD symptoms, the work usually reaches the areas complex PTSD impacts such as steadying emotions, easing a harsh view of yourself, and rebuilding trust in relationships. Some people find it helpful to think of recovery as remission rather than cure.
Maybe you have tried therapy before and still felt stuck. Maybe someone suggested your trauma runs too deep to treat. That can be a lonely thing to carry, especially when the harm was repeated and came from people you depended on.
According to a VA National Center for PTSD overview, early proposals for complex PTSD, made for the DSM-IV under the name DESNOS, listed six symptom areas, from trouble regulating emotions to the loss of beliefs that once sustained a person. The ICD-11 version is much briefer and focuses on symptoms rather than on the type of trauma, so prolonged, repeated harm counts as a risk factor rather than a requirement. Put simply, the diagnosis describes what you are living with now, which gives treatment something concrete to aim at.
How care is paced matters just as much. Writing or talking about safety, strengths and calm can feel too light at first, yet it is foundational, because jumping straight into trauma memories can feel like reliving them rather than processing them. Recovery also tends to move in stages, and Pete Walker's self-help book Complex PTSD: From Surviving to Thriving is built around helping readers find the stage they are in, as reviewer Vico Whitmore describes. Grief often belongs in that work too.
No study can yet tell you which therapeutic approach will fit you best, and the 2019 findings I discuss reach us mainly through later reviews. That uncertainty is real, and it does not mean the condition is untreatable.
A more useful question than the verdict you were given is what kind of care your symptoms call for.
Can complex trauma actually be treated, or is this simply how life will feel? Being told your trauma can't be treated can land like one more door closing, especially after years of surviving harm that came from people who were supposed to keep you safe.
As a licensed professional counselor-supervisor and certified school counselor who has worked with trauma since 2010, I see real reason for hope in the research. Complex PTSD is a treatable condition. The ICD-11 defines it as PTSD plus lasting struggles with emotions, self-worth and relationships, and recovery from it tends to move in stages. You can begin at any stage, even if you only suspect the diagnosis fits.
Part of what makes it feel untreatable is that the diagnostic criteria have arguably been lacking. Ever since PTSD entered the diagnostic manual in 1980, some clinicians and researchers have argued that it does not fully capture the effects of prolonged, interpersonal trauma. In a 2023 podcast interview, social worker and child safety center clinical director Beth Light said trauma-focused cognitive behavioral therapy, developed in the 1990s, has applications for complex trauma. No single therapeutic approach suits everyone, which is why the questions you bring to a therapist can matter as much as the name of the therapy.
Where Does the Message That Complex Trauma Can't Be Treated Come From?
The ICD-11 lists complex PTSD as its own diagnosis, while the DSM-5-TR still does not. When a manual has no name for your pain, treatment can look stalled before it starts.
If someone told you your trauma cannot be treated, these steps can help you make sense of what you heard:
- Ask which diagnosis is in your chart, and which manual it came from.
- Compare your daily struggles with the three ICD-11 areas described below.
- Notice whether past care focused on one event or on years of repeated harm.
- Bring those notes to a trauma-focused therapist and ask how they would plan care.
According to the VA's National Center for PTSD, complex PTSD was the most requested new diagnosis in an international World Health Organization survey of clinicians. The ICD-11 made it a separate diagnosis. The DSM-5, by contrast, folds complex responses into the broader symptoms of PTSD. In a U.S. sample of 1,839 adults described on the same page, 3.8% met ICD-11 criteria for complex PTSD and 3.4% met criteria for PTSD, a combined 7.2% that sits close to the 6% prevalence of DSM-5 PTSD.
Judith Herman first proposed complex PTSD in 1992. The ISTSS Complex Trauma Special Interest Group notes that it was left out of both the fourth and fifth editions of the DSM, and that "the APA still has not accepted the diagnosis," meaning the American Psychiatric Association, which publishes the manual. An earlier proposal, called DESNOS (Disorders of Extreme Stress Not Otherwise Specified), was set aside because its symptoms almost always appeared alongside PTSD itself.
To meet the ICD-11 criteria, a person meets every PTSD requirement plus severe and persistent problems in three areas:
- Affect regulation, meaning the ability to manage how intense feelings get and how quickly they settle
- Self-image, with beliefs about oneself as diminished, defeated or worthless, often carrying shame, guilt or a sense of failure
- Relationships, with real difficulty sustaining them and feeling close to others
These problems must cause significant impairment at home, at work, at school or socially. Clinicians call this cluster disturbances in self-organization, or DSO. It describes how repeated harm can reshape the way you feel, see yourself and connect.
Without a name of its own, complex trauma often gets filed under another one. Vera Hart, MD, PhD, wrote in January 2026 that because the DSM lacks a complex PTSD category, clinicians "reach for the nearest available label," and "Borderline becomes the default." A borrowed label points care at the wrong target. When that care misses, it is easy to conclude that nothing can help.
The common assumption is that a condition missing from the DSM must be beyond reach. However, this misses the gaps that are still in need of further research when it comes to the diagnostic process and the DSM-5-TR. The review committee setting a high bar for new categories for inclusion has made a decision about classification, and that decision says nothing final about whether you can heal.
A missing label is a gap in a book, and potentially your care. If you would like a trauma-focused look at your own history, you can read how our trauma and PTSD therapy in Frisco is offered in person and by video. Our therapists take most major insurances, but your independent benefits determine your specific payment per session. Call 469-238-2686 and we can tell you about your specific plan, and if we cannot accommodate you, we refer you to community partners that take your insurance.
The next question is whether familiar therapies reach those three DSO areas at all, or stop at the flashbacks and the hypervigilance.
Do EMDR and CBT Work for Complex PTSD, or Only for Single-Event Trauma?
EMDR and CBT do help, though often not enough alone. They ease core PTSD symptoms like flashbacks, while gains in self-worth, emotion regulation and relationships tend to be smaller.
A narrative review published in Frontiers in Psychology in February 2026, by researchers from Sigmund Freud University in Vienna and partner universities, compared DBT, CBT, trauma-focused therapy, EMDR and psychodynamic therapy for complex PTSD. Its central finding was that standard evidence-based therapies reduce the core symptoms of PTSD, but with "more variable and often smaller effects" on the DSO symptoms. Phase-based approaches, which build safety and coping skills before processing memories, showed "more significant results in affect regulation, self-concept, and interpersonal functioning."
Much of the research on treatment approaches comes from single-diagnosis PTSD work. In a 2022 video, licensed marriage and family therapist Emma McAdam cited U.S. Department of Veterans Affairs figures showing that around 53% of people who did cognitive therapy, and around 53% who did EMDR, no longer had PTSD after 3 months of treatment. Those figures describe PTSD. They say little about shame, a harsh inner critic or the fear of closeness. Those aspects of trauma should also be addressed in the treatment plan if complex PTSD is present.
The 2019 research the review draws on explains some of the caution. Work by Karatzias and colleagues is cited for why prolonged exposure, a structured form of CBT that revisits trauma memories directly, is occasionally less favored: it risks re-traumatization in people with DSO symptoms. Re-traumatization means reliving harm without enough support to process it. Work by Hyland and colleagues the same year found that every complex PTSD symptom cluster was associated with dissociative experiences. Dissociation is a sense of being cut off from your body, your feelings or your surroundings.
For complex PTSD, EMDR is often delivered in phases: stabilization, trauma processing and reintegration. DBT, first developed for borderline personality disorder, is used to steady clients before trauma processing begins.
| Therapeutic approach | What it mainly works on | What the evidence shows |
|---|---|---|
| Cognitive therapy and CBT | Thoughts and memories linked to trauma | Reduces core PTSD symptoms; smaller, more variable effects on DSO (2026 review) |
| EMDR | Processing traumatic memories using bilateral movement, such as side-to-side eye movements | Reduces core symptoms; for complex PTSD, often given in phases (2026 review) |
| Prolonged exposure | Repeatedly facing trauma memories | Occasionally less favored with DSO symptoms because of re-traumatization risk (2019 work cited in 2026 review) |
| DBT | Emotion regulation and distress skills | Used to stabilize clients before trauma processing (2026 review) |
| Phase-based care | Safety first, then processing, then integration | Stronger results for affect regulation, self-concept and relationships (2026 review) |
| Somatic experiencing | The body's stress reactions | Smaller studies found 67% saw a reduction in PTSD symptoms; a meta-analysis of 16 studies found positive effects (reported by therapist Emma McAdam, 2022) |
| Somatic Internal Family Systems | Body awareness combined with parts work | No independent evidence base yet |
Body-based therapies are drawing real interest, and some of that interest is ahead of the research. Graduate counseling student Emmy Marie, writing in 2026, notes that Somatic Internal Family Systems "lacks its own independent evidence base" and "remains under-researched," even though its parent models, Internal Family Systems and Somatic Experiencing, have growing trauma research behind them.
American Psychological Association guidelines for complex trauma, posted in August 2024, make a related point. As Dr. Scott Giacomucci of the Phoenix Center for Experiential Trauma Therapy summarizes them, older PTSD guidance leaned on single-incident trauma and manualized, session-by-session treatments. The review's authors land in a similar place, calling for personalized, phased care with a strong relational focus.
Because complex PTSD so often arrives alongside anxiety and mood disorders, the authors also stress integrative care. If anxiety is the loudest part of your day right now, our page on anxiety therapy in Frisco describes the support available for that piece.
I would gently question any plan that starts with your hardest memories before you have steady ground. What matters is less which therapeutic approach a therapist offers and more whether they know when to use it.
What helps when complex trauma has been called "treatment resistant"?
Spending years in therapy and still feeling stuck is exhausting, and some people with complex trauma are handed a label that sounds like a verdict.
Dr. Scott Giacomucci founded the Phoenix Center for Experiential Trauma Therapy in Media, Pennsylvania. In a 2025 talk, he named the label directly. Complex PTSD, he said, is "often missed or misdiagnosed," and "sometimes it's just labeled as treatment resistant," as though there is "something fundamentally flawed with the client." Vera Hart, MD, PhD, a practicing clinician who writes about trauma diagnosis, wrote in January 2026 that people often reach her practice with chart notes reading "Cluster B traits" or "probable borderline," after years of medication changes.
Two clinicians' accounts cannot tell us how often this happens. They do raise a question worth asking whenever therapy stalls: was the care built for the whole of complex trauma, or only part of it?
One answer has to do with order. Researchers from Sigmund Freud University, the University of Vienna and other institutions published a narrative review in Frontiers in Psychology in February 2026. They found that phase-based approaches "have shown more significant results in affect regulation, self-concept, and interpersonal functioning." The section above explains that standard approaches tend to help less in those same areas. The review also reports that EMDR for complex PTSD is often delivered in phases. It notes that prolonged exposure, a structured form of CBT, is "occasionally less favored due to the potential for re-traumatization" in people who struggle with emotion regulation, self-concept and relationships.
Professional guidance points the same way. Giacomucci walked through practice guidelines for complex trauma that a division of the American Psychological Association wrote together with the International Society for the Study of Trauma and Dissociation. He said they were posted in August 2024. One guideline is sequential: care moves through three phases so that "we don't just dive into telling trauma stories or reprocessing traumatic memories."
Three phases of care for complex trauma
- Safety and stabilization. Coping skills, steadier footing, and building a relationship with your therapist.
- Trauma processing. Working through traumatic memories.
- Integration and reconnection. Meaning-making, post-traumatic growth and reconnecting with others.
As Dr. Scott Giacomucci described the 2024 complex trauma practice guidelines. The 2026 Frontiers in Psychology review describes EMDR for complex PTSD in a similar order: stabilization, trauma processing and reintegration.
Memory work sits in the middle of care. Hart explained why: "In trauma, the task is to restore safety." If you have been told nothing works, a first phase that feels slower than you expected may simply be care following the order these guidelines describe.
The therapeutic relationship also shows up in the evidence. In the Frontiers review, "the therapeutic alliance, trust, rupture repair, and the therapist’s empathy emerged as key components for treatment efficacy, especially in fostering safety and emotional regulation." Rupture repair is the work of mending moments when the connection between you and your therapist feels strained. Giacomucci, discussing the guidelines, explained why that connection carries so much weight:
"…many trauma survivors never had a safe or attuned relationship in their life, someone that protected them or nurtured them or cared about them without taking advantage of them."
Dr. Scott Giacomucci, founder, Phoenix Center for Experiential Trauma Therapy, 2025
One figure needs a caveat. In a 2022 video, licensed marriage and family therapist Emma McAdam cited the VA for a finding: around 53% of people who do cognitive therapy, and around 53% who do EMDR, "no longer have PTSD after 3 months of treatment." The figure covers PTSD in general, and we could trace it only secondhand. The VA's own clinician page on complex PTSD, written by Sadie E. Larsen, PhD, of the National Center for PTSD and dated September 2026, says that clearer definitions allow for "future treatment studies to examine whether, in fact, different treatment approaches are needed for CPTSD and PTSD." Research on what complex PTSD needs is still unfolding.
Read side by side, the evidence offers no support for the word untreatable, and it shows where stalled care may have been thin. Standard approaches reach some parts of complex trauma less reliably: how you handle emotion, how you see yourself and how you connect with people. Those parts appear to respond best when care builds safety first and unfolds within a trusting relationship. If a course of therapy skipped those pieces, a stall may say more about the fit of the care than about you. Researchers have not settled whether complex PTSD needs entirely different treatment, so think of this as a direction worth following, held with some humility.
- Ask a therapist you are considering what the first phase of work would look like, and how the two of you will know when you are ready for memory processing.
- If earlier trauma processing left you flooded or stuck, ask whether stabilization skills came first. The answer can help shape a gentler plan.
- Ask whether your treatment goals include emotion regulation, self-worth and relationships, alongside reliving and avoidance.
- If you were told you are treatment resistant, or given a personality disorder diagnosis, ask whether complex PTSD was considered.
- Let your therapist know when something in a session did not sit right. Mending those moments is part of what the review found matters.
How we checked this
We drew on a 2026 peer-reviewed narrative review, a 2025 talk by a trauma center founder on the complex trauma practice guidelines, a 2026 essay by a practicing clinician, a VA National Center for PTSD clinician page, and a 2022 educational video by a licensed therapist. None of the figures here are ours.
We did not read the 2024 guidelines themselves. We relied on Dr. Giacomucci's description, and he gave both August 2024 and the end of 2024 as the release date. The accounts of the "treatment resistant" label come from two clinicians' experience, so they cannot show how common it is. We traced the 53% figure only through a secondhand video, and it applies to PTSD generally. Giacomucci runs a trauma therapy center, and we are a trauma and EMDR counseling practice, so both of us have a stake in this topic.
Still unknown: how long each phase usually takes, and whether complex PTSD needs treatment that differs from PTSD treatment. The VA says future studies still need to answer that.
- Frontiers in Psychology, narrative review of psychotherapy for complex PTSD, February 9, 2026.
- Dr. Scott Giacomucci, Phoenix Trauma Center, video on the complex trauma practice guidelines, April 2025.
- Vera Hart, MD, PhD, essay on complex PTSD and diagnosis, January 25, 2026.
- Sadie E. Larsen, PhD, National Center for PTSD, U.S. Department of Veterans Affairs, complex PTSD page for clinicians, September 2026.
- Emma McAdam, LMFT, Therapy in a Nutshell, video on trauma treatment approaches, May 2022.
How Do You Find the Best Trauma Therapist Near Frisco for Complex PTSD?
Start with a free consultation, where you can ask how a therapist paces trauma work. We offer one so you can decide whether we are a good therapeutic match.
Reaching out after years of being hurt, or after being told nothing will help, can take real courage. A consultation is a conversation, not a commitment. To me, the best fit is about how someone paces the work with you as much as which therapeutic approach they name. You are allowed to ask questions, take your time and notice how your body feels while you talk.
Questions worth bringing to that first call include:
- Will we build stability and coping skills before we talk through trauma memories? Ask what the first stretch of therapy looks like, and how the two of you will know you are ready for memory work.
- How do you help when emotions feel too big, or when I go numb? This is emotion regulation, and it deserves its own answer.
- How will we work with shame and the way I see myself? Complex trauma often shapes self-worth, not only memories.
- How do you approach relationships and trust, including trust between us?
- What happens if old reactions return after I start feeling better?
On that last question, in a 2023 thread on Reddit's r/CPTSD forum, the person who asked whether complex PTSD is curable first argued that it was, then reconsidered. “So I think maybe ‘remission’ is the right way to think of it,” they wrote, and they planned to keep up self-care and journaling long after feeling recovered. Another forum commenter added: “However you cannot heal in an environment that's making you sick, so that might mean leaving relationships, households, jobs, cities or countries in order to heal.”
A thread is not a study. Still, the shift from cure to remission gives you a fair standard for any consultation: a careful therapist will talk about setbacks and ongoing support, not only about finishing. Progress can be real even when some weeks are harder.
Not everyone is ready to call a therapist this week. In a 2024 review of Pete Walker's book Complex PTSD: From Surviving to Thriving, writer Vico Whitmore described it as a guide that helps readers pinpoint their current stage of recovery, and wrote that “Walker does not assume that you’re ready to walk into therapy tomorrow or that you have a host of stabilizing resources at your fingertips.”
I think of reading as a respectful first step. A book can help you name where you are. A therapist adds something a book cannot: a steady relationship in which skills are practiced before the hardest memories are opened. If you want to prepare a little more, our page of questions people ask before they call covers common concerns. When you feel ready, you can call our office at 469-238-2686 for a free consultation, and the question about pacing can be the first one you ask.
Is There Real Hope If You Were Told Complex Trauma Can't Be Treated?
Yes. Complex trauma can be treated, especially when care builds stability first and then addresses emotions, self-worth and relationships alongside memories. Recovery is often uneven, and that is expected.
In a 2022 video, therapist Emma McAdam cited VA figures that put the share of people no longer meeting PTSD criteria after 3 months at around 53% for both EMDR and cognitive therapy. For complex PTSD, I expect the next real gains to come less from brand-new therapies and more from research catching up with care that treats the whole person, not only the memory. Writing for the CPTSD Foundation in 2023, a contributor noted that because complex trauma leaves deep scars, “the journey may take longer than you want, but not as long as you fear.”
In the 2023 r/CPTSD thread mentioned earlier, one forum commenter wrote: “And it's okay to believe, or fear, that you're too gone to ever see real healing, just as long as you don't allow those fears to prevent you from trying.”
If you are thinking about suicide or feel unsafe right now, call or text 988 to reach the 988 Suicide & Crisis Lifeline. If you are near Frisco, or anywhere in Texas by video, our team offers a free consultation so you can decide whether we are a good therapeutic match. Call 469-238-2686 when you are ready.
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Frequently Asked Questions
What Else Do People Ask About Treating Complex Trauma?
People often ask about cure, diagnosis, training, insurance, cost and timing. Each answer below is brief, and you can bring any of these questions to a free consultation.
Can complex PTSD be cured?
Research has not settled on one definition of cure for complex PTSD. I find it more useful to ask whether symptoms can ease enough that they stop running your life. In a 2024 review, writer Vico Whitmore said Pete Walker's book is geared toward helping people with complex PTSD “improve their lives and dampen their symptoms to a dull roar.”
What is the difference between PTSD and complex PTSD?
In the ICD-11, complex PTSD means meeting the criteria for PTSD plus disturbances in self-organization, which are significant difficulties with emotion regulation, self-concept and relationships. No specific type of trauma is required. Prolonged, repeated trauma raises the risk but is not a prerequisite.
How can I tell whether a therapist is trained in EMDR?
Ask directly. In a 2022 video, Emma McAdam, a licensed marriage and family therapist, said EMDR certification required “something like 40 hours of training, and 50-plus hours of supervised practice.” She added, “just because someone says they are trauma-informed, or they practice a certain modality, doesn't mean they're certified in it.”
Does insurance cover trauma therapy?
Our therapists take most major insurances, but your independent benefits determine your specific payment per session. Our licensed professional counselor associates can take your insurance too. Call 469-238-2686 and we can tell you about your specific plan. If we cannot accommodate you, we refer you to community partners that take your insurance.
How much does a session cost?
Sessions with our therapists can be as little as a co-pay. We take most major insurance plans. Call and ask about your coverage. Sessions with a licensed professional counselor are $165, and the first session is $185 for 75 minutes. Sessions with a licensed professional counselor associate are $125, with a first session at $150, and you get the associate's expertise plus the years of experience their supervisor has accrued. In Texas, LPC Associate, LPC and LPC-S are stages on one regulated path. The letters tell you nothing about the warmth, connection or specialties of the therapist, and how they can support you. Applicants are fully vetted by the state before the license is granted, through a national exam, a background check, the Texas Jurisprudence Examination and a 1.5-year academic internship working with real clients under faculty supervision, so an associate begins with at least 1.5 years of experience as a counselor. Sliding scale therapy is also offered in Frisco.
How soon can I start?
Most weeks, we can see you within seven days, sometimes sooner. You can meet in person in Frisco or by video anywhere in Texas, with evening appointments available. Call 469-238-2686 to set up a free consultation.
Written by
Bonnie King
PhD, LPC-S, CSC
Bonnie King, PhD, LPC-S, CSC, has practiced as a counselor since 2010, working with children, adults, and teens with a variety of mental health concerns, including trauma, mood disorders, and specific concerns related to LGBTQ+ marginalization.
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