Complex PTSD and Childhood Trauma Therapy Online
Clinically reviewed by Karan Singh, Ph.D.
Last reviewed October 16, 2026
Some trauma isn’t a single event. It’s years of abuse, neglect, violence at home, or relationships where you never felt safe. When trauma is repeated and inescapable, especially in childhood, it can shape how you see yourself, how you handle emotions, and how close you let other people get. This is often called complex posttraumatic stress disorder (complex PTSD or CPTSD). It’s treatable, and recovery is possible at any age. At Psychological Healing, our clinicians offer evidence-based therapy for complex trauma by secure video in 20 states, and we’re in-network with many major insurers.
What Is Complex PTSD?
The World Health Organization’s International Classification of Diseases, 11th Revision (ICD-11), recognizes complex PTSD as a diagnosis. It includes the core symptoms of PTSD:
- Re-experiencing, such as intrusive memories, flashbacks, or nightmares
- Avoidance of reminders of the trauma
- A persistent sense of threat, such as hypervigilance or being easily startled
Complex PTSD also includes three additional areas, sometimes called “disturbances in self-organization”:
- Difficulty regulating emotions, such as intense reactions, numbness, or trouble calming down
- A negative self-concept, such as deep shame, guilt, or feeling worthless or permanently damaged
- Relationship difficulties, such as trouble trusting others, feeling close, or staying connected
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) does not list complex PTSD separately, and many of these symptoms fall under PTSD there. Either way, the label matters less than getting care that fits what you’re experiencing.
PTSD vs. Complex PTSD
| PTSD | Complex PTSD | |
|---|---|---|
| Typical cause | Often a single event or a limited period | Repeated or prolonged trauma, often in childhood or close relationships |
| Core symptoms | Re-experiencing, avoidance, and sense of threat | The same, plus problems with emotions, self-worth, and relationships |
| Recognized in | DSM-5-TR and ICD-11 | ICD-11 |
Signs You May Be Living with Complex Trauma
- You feel “on guard” most of the time, even when you’re safe
- Shame or self-criticism feels like part of who you are
- Emotions feel too big, or you feel nothing at all
- Relationships feel confusing, unsafe, or hard to keep
- You notice gaps in memory or feel detached from yourself at times
- Ordinary stress sends you into panic, shutdown, or anger
If several of these sound familiar, a trauma-informed assessment can help you understand what’s going on and what will help.
How We Treat Complex PTSD
Research shows that the same trauma-focused therapies that work for PTSD also help many people with complex trauma histories. The U.S. Department of Veterans Affairs and Department of Defense (VA/DoD) Clinical Practice Guideline for PTSD (2023) recommends them as first-line treatments. Many people with complex PTSD also benefit from building coping skills before or alongside trauma processing. We tailor treatment to you, and it usually includes three parts:
1. Safety and stabilization. We start by building skills for managing intense emotions, grounding during flashbacks or dissociation, and getting through hard days. Dialectical Behavior Therapy (DBT) skills and Acceptance and Commitment Therapy (ACT) are often part of this stage.
2. Processing the trauma. When you’re ready, we use a trauma-focused treatment to reduce the power of traumatic memories and the beliefs attached to them:
- Cognitive Processing Therapy (CPT) helps you identify and change “stuck” beliefs, such as self-blame and shame.
- Prolonged Exposure (PE) helps you safely face memories and situations you’ve been avoiding.
- Eye Movement Desensitization and Reprocessing (EMDR) helps you reprocess memories without describing them in detail.
3. Rebuilding your life. As symptoms ease, therapy focuses on self-worth, relationships, boundaries, and the life you want to build.
Treatment isn’t always a straight line, and you won’t be pushed into anything before you’re ready. Learn more about our trauma-focused treatment and trauma and PTSD therapy.
Healing Childhood Trauma as an Adult
Many adults don’t connect present-day struggles with what happened when they were young until something brings it to the surface: becoming a parent, a breakup, a loss, or simply exhaustion from coping for so long. It’s never too late to work on childhood trauma. Therapy can help you understand how the past shaped your patterns, process the memories that still hurt, and treat yourself with more compassion. You may also find our article on how childhood trauma affects adulthood helpful.
Can Complex PTSD Be Treated Online?
Yes. Research shows trauma-focused therapies delivered by video work about as well as in-person care for many people. For some people with complex trauma, being in their own space makes it easier to feel safe enough to do the work. Before trauma processing begins, your clinician will set up a safety plan, including what to do if you feel overwhelmed or the connection drops. Learn how our teletherapy works.
What to Look for in a Complex Trauma Therapist
Look for a licensed clinician trained in evidence-based trauma treatments such as CPT, PE, or EMDR who also understands emotion regulation and pacing. It’s fine to ask a potential therapist how they approach complex trauma and how they’ll help you feel safe.
Insurance Coverage
Trauma therapy is billed as standard outpatient psychotherapy, so most plans with mental health benefits cover it. We’re in-network with Aetna, Optum and UnitedHealthcare, Oscar (through the UnitedHealthcare network), Anthem and Carelon (through Headway), Blue Cross Blue Shield, Ambetter, and others.
We do not accept Medicare or Medicare Advantage plans.
Where We Offer Care
Our clinicians are licensed across 20 states, and we have in-person offices throughout the US. See our pages for California, Texas, Florida, and New York, among others.
Frequently Asked Questions
What’s the difference between PTSD and complex PTSD? Both involve re-experiencing, avoidance, and a sense of threat. Complex PTSD also involves ongoing difficulty with emotions, self-worth, and relationships, and it usually follows repeated or prolonged trauma.
Can complex PTSD be cured? Many people recover substantially. Symptoms can ease a great deal with evidence-based treatment, and people often go on to have healthier relationships and a stronger sense of self.
How long does complex PTSD treatment take? Usually longer than treatment for single-event PTSD, often several months to a year or more, depending on your history and goals. Many people notice meaningful changes well before treatment ends.
Do I have to relive everything to heal? No. You’ll build coping skills first, and trauma processing is paced so it stays manageable. Some approaches, such as EMDR and CPT without a written account, don’t require you to describe every detail.
What is the best therapy for complex PTSD? No single approach is best for everyone. Trauma-focused therapies such as CPT, PE, and EMDR have the strongest evidence, and adding skills from DBT or ACT can help with emotion regulation. Your clinician will recommend a plan based on your needs.
Is complex PTSD therapy covered by insurance? Usually, yes. Insurance generally covers it as outpatient psychotherapy. We’ll verify your benefits before you start. We do not accept Medicare or Medicare Advantage plans.
If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.