Christine A. Courtois PhD, PLLC

Trauma Treatment 


Consulting Services



Christine A. Courtois PhD, ABPP
Christine A Courtois, PhD, PLLC 
PO Box 1326
Bethany Beach, DE  19930
Phone & Fax: 302-616-1747

Recent Publications

Available on Amazon

Posttraumatic Stress Disorder, Second Edition:
Scientific and Professional Dimensions

by Julian D Ford, Damion J. Grasso

Jon D. Elhai, and Christine A. Courtois

Amazon link

October 2014

It's Not You, It's What Happened To You
Complex Trauma And Treatment

Kindle Edition

Christine A. Courtois

October 2014

Spiritually Oriented Psychotherapy for Trauma

Edited by Donald F. Walker, Christine A. Courtois, and Jamie D. Aten

Recent years have brought broader awareness and openness to talking about traumatic life events. Survivors of these events often experience spiritual struggles in the course of healing. Likewise, in helping clients process trauma, therapists too may struggle with spiritual questions such as why people suffer. In this book, readers will learn how to apply spiritually oriented practices within their own setting, approach to therapy, and client populations. They will also learn how to work with the ethical challenges trauma treatment can pose to their own competence and world view. This book describes empirical research and provides case studies showing its application to sexual abuse, partner violence, and trauma resulting from war and natural disasters. 2015. Hardcover. 312 Pages.

July 2013
available in paperback

Treating Complex Traumatic Stress Disorders in Children and Adolescents 
Scientific Foundations and Therapeutic Models

                          Edited by Julian D. Ford and Christine A. Courtois

With contributions from prominent experts, this pragmatic book takes a close look at the nature of complex psychological trauma in children and adolescents and the clinical challenges it presents. Each chapter shows how a complex trauma perspective can provide an invaluable unifying framework for case conceptualization, assessment, and intervention amidst the chaos and turmoil of these young patients' lives. A range of evidence-based and promising therapies are reviewed and illustrated with vivid case vignettes. The volume is grounded in clinical innovations and cutting-edge research on child and adolescent brain development, attachment, and emotion regulation.

October 2012
available in paperback
 Christine A. Courtois & Julian D. Ford, co-authors
Guilford Press

This insightful guide provides a pragmatic roadmap for treating adult survivors of complex psychological trauma. Christine Courtois and Julian Ford present their effective, research-based approach for helping clients move through three clearly defined phases of posttraumatic recovery. Two detailed case examples run throughout the book, illustrating how to plan and implement strengths-based interventions that use a secure therapeutic alliance as a catalyst for change. Essential topics include managing crises, treating severe affect dysregulation and dissociation, and dealing with the emotional impact of this type of work. The companion Web page offers downloadable reflection questions for clinicians and extensive listings of professional and self-help resources.


April 2010

Healing the Incest Wound

Christine A. Courtois

“Highly recommended as an authoritative text on incest

and its treatment” and“essential reading for all therapists,”
Healing the Incest Wound
was a groundbreaking book that put incest studies and treatment on the map.

Now, almost 20 years later this bestselling text is fully updated, offering the most current studies and findings on incest typologies, dynamics, and treatment strategies. Drawing on cutting-edge research on incest and other forms of child abuse, it includes attention to their neurological, attachment, affective, and dissociative sequelae. Courtois—a veteran practitioner an expert in complex traumatic stress disorders resulting from chronic child abuse—presents

a comprehensive revision to this classic treatment manual for therapists.

Table of Contents:

Part I: Incest Characteristics and Dynamics

• 1. Incest: If You Think the Word Is Ugly . . .

• 2. Incest Characteristics and Categories
• 3. The Dynamics of Child Sexual Abuse and the Incestuous Family
• 4. Parent-Child Incest
• 5. Incest Among Other Relatives and Quasi-Family

Part II : Symptoms, Aftereffects, and Diagnosis
• 6. Incest Symptoms, Aftereffects, and Secondary Elaborations
• 7. Theories Pertaining to Aftereffects and Treatment
• 8. Presenting Concerns and Diagnosis

Part III: Incest Therapy

• 9. Philosophy, Process, and Goals of Incest Therapy

• 10. Treatment Strategies and Techniques
• 11. The Effects of Abuse Dynamics on the Therapy Process

• 12. Group Treatment

• 13. Special Populations
• 14. Special Problems and Issues in Treatment
• 15. Special Family Issues


• A: Incest History Questionnaire

• B: Books and Audiovisual Materials for Incest Survivors

• C: Workbooks

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Treating Complex Traumatic Stress Disorders:
An Evidence Based Guide


Christine A. Courtois PhD (Editor) and

Julian D. Ford (Editor) with
Foreword by Judith Lewis Herman and
Afterword by Bessel A. van der Kolk


Table of Contents:

Foreword, Judith Lewis Herman
Introduction, Christine A. Courtois and Julian D. Ford

I. Overview
1. Defining and Understanding Complex Trauma and Complex Traumatic Stress Disorders,
  Julian D. Ford and Christine A. Courtois
2. Neurobiological and Developmental Research: Clinical Implications,
  Julian D. Ford
3. Best Practices in Psychotherapy for Children and Adolescents,
  Julian D. Ford and Marylene Cloitre
4. Best Practices in Pychotherapy for Adults,
  Christine A. Courtois, Julian D. Ford, and Marylene Cloitre
5. Assessment of the Sequelae of Complex Trauma: Evidence-Based Measures,
  John Briere and Joseph Spinazzola
6. Attachment and Abuse History, and Adult Attachment Style,
  Daniel Brown
7. Treating Dissociation,
  Kathy Steele and Onno van der Hart
8. Cultural Competence,
  Laura S. Brown
9. Therapeutic Alliance and Risk Management,
  Philip J. Kinsler, Christine A. Courtois, and A. Steven Frankel
10. Living and Working Self-Reflectively to Address Vicarious Trauma,
  Laurie Anne Pearlman and James Caringi

II. Individual Treatment Approaches and Strategies

11. Contextual Therapy,
  Steven N. Gold
12. Cognitive-Behavioral Therapy,
  Christie Jackson, Kore Nissenson, and Marylene Cloitre
13. Contextual Behavior Trauma Therapy,
  Victoria M. Follette, Katherine M. Iverson, and Julian D. Ford
14. Experiential and Emotion-Focused Therapy,
  Diana Fosha,Sandra Paivio, Kari Gleiser, and Julian D. Ford
15. Sensorimotor Psychotherapy,
  Janina Fisher and Pat Ogden
16. Pharmacotherapy,
  Lewis A. Opler, Michelle S. Grennan, and Julian D. Ford

III. Systemic Treatment Approaches and Strategies

17. Internal Family Systems Therapy,
  Richard C. Schwartz, Mark F. Schwartz, and Lori Galperin
18. Couple Therapy,
  Susan M. Johnson and Christine A. Courtois
19. Family Systems Therapy,
  Julian D. Ford and William Saltzman
20. Group Therapy,
  Julian D. Ford, Roger D. Fallot, and Maxine Harris

Conclusion: The Clinical Utility of a Complex Traumatic Stress Disorders Framework,

  Julian D. Ford and Christine A. Courtois


  Bessel A. van der Kolk

Excerpt from the book's introduction:

[begin excerpt]

Psychological trauma was originally considered to be an abnormal experience (i.e., "outside the range of normal human experience" in DSM-III (American Psychiatric Association, 1980), but as epidemiological evidence accumulated to demonstrate that a majority of adults (e.g..Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995) and a substantial minority of children
(e.g., Costello, Erklani, Fairbank, & Arnold. 2002) are exposed to traumatic events.

There has been a shift to defining psychological trauma without any qualifications about its normality or abnormality. Generally, people who have not experienced traumatic events do not expect trauma to occur in their (or their families' or communities') 1ives, but once psychological trauma has occurred, he or she is both more likely objectively to experience subsequent traumatic events and more prone subjectively to expect trauma to be a possibility. With the increasing diffusion of virtually instantaneous information through the many forms of electronic and other media--not only in Westernized societies but also in socioeconomically underdeveloped countries--people's awareness of traumatic events has been greatly heightened, even if these events never happen to them or to anyone they know personally (e.g., the Silver, Holman, McIntosh, Palm, & Gil-Rivas [2002] national U.S. survey on the effects of the September 11, 2001, terrorist incidents).

[end excerpt]

Here's another excerpt by the same authors:

[begin excerpt]

Another unfortunate reality concerning complex trauma is related to its interpersonal nature.

The closer the relationship between perpetrator(s) and victim(s) and their group memberships (e.g., in a family, religion, gender, political party, institution, chain of command, the more likely they are to face conditions of divided loyalty. As a self-protective strategy, the group

may coalesce around silencing, secrecy, and denial. As a result, victims do not receive the

help they expect and need when the victimization is disclosed or otherwise exposed. This circumstance has been labeled the second injury (Symonds,1975) or betrayal trauma (DePrince & Freyd, 2007). A lack of response or protection--or victim blaming--is betrayal of the victim's trust and the helper's responsibility that can severely exacerbate traumatic victimization. In the worst case scenario, a caregiver directly and repeatedly abuses a vulnerable child or does not

respond or protect the child from abuse by others. Young children exposed to betrayal trauma by caregivers often develop a disorganized/dissociative attachment style in childhood and an adult attachment style described as fearful/avoidant/dissociative (Lyons-Ruth, Dutra, Schuder & Bianchi, 2006). Children, more than adults, are prone to use dissociation to cope with such overwhelming circumstances (Putnam, 2003), and it is now hypothesized that this style transforms the personality, preventing the integration of the traumatization across all aspects of the child's and later the adult's self. The result is a person who maintains a "front" or an "as if" or "apparently normal" personality that seems functional but is numb to and even unaware of the trauma, and an "emotional" personality that is incapacitated psychosocially by the knowledge of the trauma (see Steele & van der Hart, Chapter 7, this volume).

[end excerpt]


"Courtois and Ford present an essential, comprehensive work for clinicians and researchers.

Evidence-based practice recommendations for psychotherapeutic and pharmacologic treatment are presented-carefully adapted for those suffering from complex traumatic stress disorders-and a range of treatment models are clearly described. Rich clinical material, and attention to management of the therapeutic alliance, therapist self-care, and other key challenges in working with these clients, make this a most useful and innovative resource."

--Josef I. Ruzek, PhD, Acting Director,

Dissemination and Training Division,

National Center for PTSD

"This is the single best source for clinical expertise in complex traumatic stress disorders. Leading clinicians and researchers share a rich array of individual, couple, family, and group therapy models that illustrate basic treatment principles and best practices. Informed by recent research, the contributors cover the developmental and neurobiological background against which to frame essential assessment and treatment issues. Chapters on such pragmatic topics

as vicarious traumatization and risk management offer advice on reducing stress for therapists working with these challenging cases."

--Frank W. Putnam, MD,

Departments of Pediatrics and Psychiatry,

Cincinnati Children's Hospital Medical Center

"Treatments based on a traditional conceptualization of PTSD are frequently insufficient to address the diverse, long-lasting, and pervasive effects of complex trauma. This book offers a comprehensive review of treatment considerations, assessment measures, best practices, and evidence-based treatment approaches specifically tailored for psychotherapy with people who have experienced prolonged abuse and neglect by caregivers. An indispensable guide for any mental health professional who works with trauma survivors."

--Pamela C. Alexander, PhD,

Senior Research Scientist,

Wellesley Centers for Women


Recollections of Sexual Abuse: 

Treatment Principles and Guidlines


Christine A. Courtois PhD, 2002, 1999



Advance acclaim

"Recollections of Sexual Abuse is a clinical and academic tour de force, bringing the most recent contributions of the scientific literature to a sound and cogent discussion of the memory

controversy. . . . Christine Courtois has dedicated her professional life to understanding and helping abuse survivors, and here she brings a new and rational perspective to their treatment."

—James A. Chu, M.D., Director,

Trauma and Dissociative Disorders Program,

McLean Hospital

"To the extent clinicians need information about treatment principles and guidelines this book can be highly recommended. If therapists follow the suggested guidelines, there will be better therapeutic outcomes and far fewer cases of false memories."

—Joseph de Rivera,

Contemporary Psychology


Provides clinicians with treatment guidelines for working with delayed/repressed memories of sexual abuse. This book has a two-fold purpose:

(1) to provide the practicing clinician with information about the controversy surrounding delayed/repressed memory of sexual abuse and

(2) to provide treatment principles and guidelines for working with these issues.

Since the eruption of the recovered memory controversy in 1992, the treatment of adults who report abuse as children (whether their memory has been relatively continuous or has been recovered) has become a high-risk area, as numerous lawsuits have been filed alleging false memory of abuse due to suggestive therapeutic practices. In this climate, clinicians have become fearful, cautious, and confused about how to practice responsibly with this

population. Since a large percentage of those seeking psychotherapy have a history of

sexual abuse, all clinicians need a clear articulation of the current evolving standard of care for clients reporting memories of abuse. Drawing together material from many sources, this book provides state-of-the-art principles and guidelines for treatment when memories of past abuse are at issue. It covers available empirical and clinical data on human memory processes

for normal and traumatic events and on the treatment of posttraumatic conditions

in general and child sexual abuse in particular; the critiques and concerns voiced by cognitive psychologists who investigate memory and suggestibility issues; the recommendations made by a number of professional task forces and advisory committees charged with studying the issues involved in the controversy and making recommendations for practice; and the recommendations of expert clinicians and clinical researchers. Especially useful is Courtois’s application of the treatment decision model to a range of clinical scenarios, from continuous, corroborated memory of abuse to suspicions of abuse based on symptomatology. Speaking with authority and empathy, Courtois shows clinicians how to practice responsibly and safely while doing memory work. Her guidance is invaluable.

Partial Table of Contents

1. Establishing the Context: The Recovered Memory/False Memory Controversy in Sociohistorical Perspective

2. The Present Context: An Overview of the Recovered Memory/False Memory Controversy

3. Trauma and Memory

4. Child Sexual Abuse and Memory

5. Evolving Standards of Practice and the Standard of Care: Philosophy and Principles of Practice

6. The Evolving Consensus Model of Posttrauma Treatment

ISBN 10: 0-393-70281-2

1999 / 416 pages / hardcover

Healing the Incest
Adult Survivors in

Christine A. Courtois PhD, 1996, 1988



A comprehensive guide to the dynamics of incest and to therapy for survivors. Occasionally a book for psychotherapists instantly becomes a classic. Not only do clinicians recognize the excellence and importance of the book, but their clients respond enthusiastically to the accurate portrayal of their experiences and the model for healing. With the publication of Healing the Incest Wound, such a
classic was born.

Incest is not a rare aberrant happening, but a common childhood experience for a substantial minority of children. Since incest is generally hidden and denied, the victims are left to cope with their reactions in an atmosphere that contradicts their reality. Yet all incest is not the same; for instance, one-time fondling by an uncle has different effects from rapes repeated over many years by a stepfather. The book describes these variations and the symptoms, short-term aftereffects, and long-term secondary
elaborations of incest from four theoretical perspectives: traumatic stress, developmental, feminist, and loss. The author not only comprehensively discusses the salient issues of incest therapy but also illustrates these with
numerous case studies, showing how incest survivors can heal and build a core of self-respect and dignity.

ISBN 10: 0-393-31356-5
1996 / 416 pages