It Happened, It's Not My Fault, and I Can Trust Again”: Compassionate Imagery to Enhance Trauma‐Focused Cognitive Behavioural Therapy for Complex PTSD

Imagery is a central part of Compassion‐Focused Therapy (CFT), which teaches individuals to create affiliative motives and emotions for oneself and others in order to recover from the multiple sequelae of trauma including shame, guilt and fear of trusting others. This case illustration describes the use of imagery during an ongoing 15‐month intervention based on CFT and trauma‐focused CBT for Sam, a 35‐year old male with CPTSD and OCD. Pre‐therapy, symptoms included dissociation, nightmares and flashbacks, doubting the abuse, hyperarousal, fear of relying on others and aggressive obsessions. A series of compassionate imagery techniques were used to reduce self‐doubt, self‐blame, suppressed anger, disgust and an ongoing sense of threat. Large changes were observed in SUDs for trauma memories and dissociation frequency, as well as in conviction in positive beliefs about self and others. PTSD symptoms reduced from severe to non‐clinical. This illustrates the potential of CFT to tackle the rational‐emotional divide, whereby cognitive techniques often fail to reduce distress underpinned by early traumatic memories.