{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:58:55Z","timestamp":1791593935400,"version":"4.3.4"},"reference-count":122,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p>The treatment of patients with complex post-traumatic stress disorder (CPTSD) presents significant challenges due to the complexity and severity of the condition. Individuals who have experienced prolonged trauma exhibit, alongside post-traumatic stress disorder symptoms, disturbances in self-organization (DSO). This state of affairs not only complicates the psychotherapeutic process but also impacts the outcomes, making the treatment challenging. This article provides a narrative review of treatment approaches for CPTSD [including dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), trauma-focused therapy (TFT), eye movement desensitization and reprocessing (EMDR), and psychodynamic therapy], with a specific focus on their outcomes and therapeutic factors. Standard evidence-based therapies (e.g., CBT, EMDR, exposure-based treatments) have been shown to be effective in reducing the core symptoms of PTSD but with more variable and often smaller effects for DSO symptoms. Phase-based approaches, including those that integrate evidence-based methods, have shown more significant results in affect regulation, self-concept, and interpersonal functioning. Psychodynamic therapies have shown enduring improvements, especially in the areas of identity and interpersonal relationships. The therapeutic alliance, trust, rupture repair, and the therapist\u2019s empathy emerged as key components for treatment efficacy, especially in fostering safety and emotional regulation. These variables enabled corrective relational experiences and maintained engagement in therapy. These findings highlight the need for personalized, phased interventions that combine evidence-based strategies with a strong relational focus, as found in psychodynamic approaches. Addressing both symptom relief and reduction in DSO requires constant attention to the therapeutic process. The quality of the therapeutic alliance and the therapist\u2019s responsiveness are fundamental to supporting long-term recovery. The article provides insight into the current issues associated with each treatment approach and future directions.<\/jats:p>","DOI":"10.3389\/fpsyg.2026.1684921","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T07:49:14Z","timestamp":1770623354000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Psychotherapy for complex post-traumatic stress disorder: efficacy and therapeutic factors"],"prefix":"10.3389","volume":"17","author":[{"given":"Cenya","family":"Katalan","sequence":"first","affiliation":[{"name":"Faculty of Psychotherapy Science, Sigmund Freud University","place":["Vienna, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Human-Friedrich","family":"Unterrainer","sequence":"additional","affiliation":[{"name":"Faculty of Psychotherapy Science, Sigmund Freud University","place":["Vienna, Austria"]},{"name":"Department of Religious Studies, University of Vienna","place":["Vienna, Austria"]},{"name":"University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University Graz","place":["Graz, Austria"]},{"name":"ARH: Addiction Research Hub, Gr\u00fcner Kreis Ltd.","place":["Vienna, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar C. G.","family":"Gelo","sequence":"additional","affiliation":[{"name":"Faculty of Psychotherapy Science, Sigmund Freud University","place":["Vienna, Austria"]},{"name":"Department of Human and Social Sciences, University of Salento","place":["Lecce, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1037\/0033-3204.38.2.171","article-title":"A review of therapist characteristics and techniques negatively impacting the therapeutic alliance","volume":"38","author":"Ackerman","year":"2001","journal-title":"Psychother. (Chic.)."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e279","DOI":"10.3346\/jkms.2025.40.e279","article-title":"Psychological interventions for complex post-traumatic stress disorder symptoms: a systematic review","volume":"40","author":"Ahn","year":"2025","journal-title":"J. Korean Med. Sci."},{"key":"ref3","volume-title":"Diagnostic and statistical manual of mental disorders","year":"1994"},{"key":"ref4","volume-title":"Diagnostic and statistical manual of mental disorders","year":"2013"},{"key":"ref5","doi-asserted-by":"crossref","DOI":"10.1037\/0000343-000","volume-title":"Common factors therapy: a principle-based treatment framework","author":"Bailey","year":"2023"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.copsyc.2017.09.005","article-title":"A mentalization-based approach to common factors in the treatment of borderline personality disorder","volume":"21","author":"Bateman","year":"2018","journal-title":"Curr. Opin. Psychol."},{"key":"ref7","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1017\/9781108896054.012","article-title":"Trauma","volume-title":"Cambridge guide to mentalization-based treatment (MBT)","author":"Bateman","year":"2023"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1111\/ap.12430","article-title":"Chronic mistrust and complex trauma: Australian psychologists' perspectives on the treatment of young women with a history of childhood maltreatment","volume":"55","author":"Beaton","year":"2019","journal-title":"Aust. Psychol."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/bmb\/ldaf015","article-title":"PTSD and complex PTSD, current treatments, and debates: a review of reviews","volume":"156","author":"Billings","year":"2025","journal-title":"Br. Med. Bull."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"CD003388","DOI":"10.1002\/14651858.CD003388.pub3","article-title":"Psychological treatment of post-traumatic stress disorder (PTSD)","volume":"3","author":"Bisson","year":"2007","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1093\/ptr\/11.4.361","article-title":"Long-term outcome of long-term psychoanalytically oriented therapies: first findings of the Stockholm outcome of psychotherapy and psychoanalysis study","volume":"11","author":"Blomberg","year":"2001","journal-title":"Psychother. Res."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1176\/appi.ajp.162.2.214","article-title":"A multidimensional meta-analysis of psychotherapy for PTSD","volume":"162","author":"Bradley","year":"2005","journal-title":"Am. J. Psychiatry"},{"key":"ref9008","volume-title":"Principles of trauma therapy: A guide to symptoms, evaluation, and treatment","author":"Briere","year":"2006"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1037\/\/0022-006x.57.5.607","article-title":"Brief psychotherapy for posttraumatic stress disorders","volume":"57","author":"Brom","year":"1989","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref9001","doi-asserted-by":"publisher","first-page":"Article 1866423","DOI":"10.1080\/20008198.2020.1866423","article-title":"Complex PTSD: assessment and treatment","volume":"12","author":"Cloitre","year":"2021","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1037\/0022-006X.72.3.411","article-title":"Therapeutic Alliance, negative mood regulation, and treatment outcome in child abuse-related posttraumatic stress disorder","volume":"72","author":"Cloitre","year":"2004","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref9002","doi-asserted-by":"publisher","DOI":"10.3402\/ejpt.v4i0.20706","article-title":"Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis","volume":"4","author":"Cloitre","year":"2013","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref9003","doi-asserted-by":"publisher","DOI":"10.3402\/ejpt.v5.25097","article-title":"Distinguishing PTSD, complex PTSD, and borderline personality disorder: a latent class analysis","volume":"5","author":"Cloitre","year":"2014","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1002\/jts.20697","article-title":"Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices","volume":"24","author":"Cloitre","year":"2011","journal-title":"J. Trauma. Stress."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1037\/0022-006X.70.5.1067","article-title":"Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse","volume":"70","author":"Cloitre","year":"2002","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1002\/jts.20444","article-title":"A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity","volume":"22","author":"Cloitre","year":"2009","journal-title":"J. Trauma. Stress."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1176\/appi.ajp.2010.09081247","article-title":"Treatment for PTSD related to childhood abuse: a randomized controlled trial","volume":"167","author":"Cloitre","year":"2010","journal-title":"Am. J. Psychiatry"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1037\/0033-3204.41.4.374","article-title":"Bridging the gap between posttraumatic stress disorder research and clinical practice: the example of exposure therapy","volume":"41","author":"Cook","year":"2004","journal-title":"Psychother. (Chic.)"},{"key":"ref9004","volume-title":"Healing the incest wound: Adult survivors in therapy","author":"Courtois","year":"1988"},{"key":"ref9005","volume-title":"Recollections of sexual abuse: Treatment principles and guidelines","author":"Courtois","year":"1999"},{"key":"ref9006","volume-title":"Treatment of complex trauma: A sequenced, relationship-based approach","author":"Courtois","year":"2013"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1037\/0033-3204.41.4.412","article-title":"Complex trauma, complex reactions: assessment and treatment","volume":"41","author":"Courtois","year":"2004","journal-title":"Psychother. (Chic.)"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1037\/a0025067","article-title":"A naturalistic study of the relation of psychotherapy process to changes in symptoms, information processing, and physiological activity in complex trauma","volume":"4","author":"D'Andrea","year":"2012","journal-title":"Psychol. Trauma Theory Res. Pract. Policy"},{"key":"ref9007","doi-asserted-by":"publisher","DOI":"10.1037\/10380-000","article-title":"Countertransference and the treatment of trauma","author":"Dalenberg","year":"2000","journal-title":"American Psychological Association."},{"key":"ref22","volume-title":"Treating the adult survivor of childhood sexual abuse: a psychoanalytic perspective","author":"Davies","year":"1994"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"788","DOI":"10.3389\/fpsyg.2020.00788","article-title":"What differentiates poor- and good-outcome psychotherapy? A statistical-mechanics-inspired approach to psychotherapy research, part two: network analyses","volume":"11","author":"De Felice","year":"2020","journal-title":"Front. Psychol."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3390\/systems7020022","article-title":"What differentiates poor and good outcome psychotherapy? A statistical-mechanics-inspired approach to psychotherapy research","volume":"7","author":"De Felice","year":"2019","journal-title":"Systems"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1002\/jclp.23521","article-title":"Trauma-focused treatment of a client with complex PTSD and comorbid pathology using EMDR therapy","volume":"80","author":"De Jongh","year":"2024","journal-title":"J. Clin. Psychol."},{"key":"ref26","first-page":"127","article-title":"Patient\u2013therapist attachment: impact on the therapeutic process and outcome","volume-title":"Attachment theory and the psychoanalytic process","author":"Diamond","year":"2003"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.jad.2012.10.010","article-title":"Complex trauma and intimate relationships: the impact of shame, guilt, and dissociation","volume":"147","author":"Dorahy","year":"2013","journal-title":"J. Affect. Disord."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"23613","DOI":"10.3402\/ejpt.v5.23613","article-title":"Evidence-based treatment for adult women with child abuse-related complex PTSD: a quantitative review","volume":"5","author":"Dorrepaal","year":"2014","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1080\/10911359.2018.1435328","article-title":"The impact and long-term effects of childhood trauma","volume":"28","author":"Dye","year":"2018","journal-title":"J. Hum. Behav. Soc. Environ."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1002\/jclp.23773","article-title":"Common elements and differences among treatment approaches to complex post-traumatic stress disorder: a commentary on five case studies","volume":"81","author":"Farina","year":"2025","journal-title":"J. Clin. Psychol."},{"key":"ref9010","doi-asserted-by":"publisher","first-page":"351","DOI":"10.36131\/cnfioritieditore20250501","article-title":"The psychopathological domains of attachment trauma: a proposal for a clinical conceptualization","volume":"22","author":"Farina","year":"2025","journal-title":"Clin. Neuropsychiatry"},{"key":"ref9011","volume-title":"Affect regulation, mentalization, and the development of the self","author":"Fonagy","year":"2002"},{"key":"ref9012","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1037\/\/0022-006x.64.1.22","article-title":"The relation of attachment status, psychiatric classification, and response to psychotherapy","volume":"64","author":"Fonagy","year":"1996","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref32","first-page":"13","article-title":"Defining and understanding complex trauma and complex traumatic stress disorders","volume-title":"Treating complex traumatic stress disorders in adults: scientific foundation and therapeutic models","author":"Ford","year":"2009"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1002\/jts.20051","article-title":"Treatment of complex posttraumatic self-dysregulation","volume":"18","author":"Ford","year":"2005","journal-title":"J. Trauma. Stress."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s12124-019-09494-3","article-title":"Which methodological practice(s) for psychotherapy science? A systematic review and a proposal","volume":"54","author":"Gelo","year":"","journal-title":"Integr. Psychol. Behav. Sci."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1007\/s12124-019-09502-6","article-title":"Correction to: which methodological practice(s) for psychotherapy science? A systematic review and a proposal","volume":"54","author":"Gelo","year":"","journal-title":"Integr. Psychol. Behav. Sci."},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1027\/1016-9040\/a000574","article-title":"Safety in psychotherapy: further steps toward an attachment-informed transtheoretical model of change","author":"Gelo","year":"2025","journal-title":"Eur. Psychol"},{"key":"ref37","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-7091-1382-0","volume-title":"Psychotherapy research: foundations, process, and outcome","author":"Gelo","year":"2015"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"45","DOI":"10.7411\/RP.2012.005","article-title":"Text analysis within quantitative and qualitative psychotherapy process research: introduction to special issue","volume":"15","author":"Gelo","year":"2012","journal-title":"Res. Psychother."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1037\/cou0000104","article-title":"Social representation of therapeutic relationship among cognitive-behavioral psychotherapists","volume":"63","author":"Gelo","year":"2016","journal-title":"J. Couns. Psychol."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/S0140-6736(08)61706-7","article-title":"Burden and consequences of child maltreatment in high-income countries","volume":"373","author":"Gilbert","year":"2009","journal-title":"Lancet"},{"key":"ref41","article-title":"Evaluation and treatment of incest victims and their families: a problem-oriented approach","volume-title":"Modern perspectives in psycho-social pathology","author":"Goodwin","year":"1988"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.brat.2014.01.008","article-title":"A pilot randomized controlled trial of dialectical behavior therapy with and without the dialectical behavior therapy prolonged exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD","volume":"55","author":"Harned","year":"2014","journal-title":"Behav. Res. Ther."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1080\/02668734.2023.2231059","article-title":"Psychodynamic techniques elicit emotional engagement in complex post-traumatic stress disorder","volume":"37","author":"Henley","year":"2023","journal-title":"Psychoanal. Psychother."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1002\/jts.2490050305","article-title":"Complex PTSD: a syndrome in survivors of prolonged and repeated trauma","volume":"5","author":"Herman","year":"","journal-title":"J. Trauma. Stress."},{"key":"ref45","volume-title":"Trauma and recovery","author":"Herman","year":""},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1739","DOI":"10.1176\/ajp.2006.163.10.1739","article-title":"Analysis of the patient-therapist relationship in dynamic psychotherapy: an experimental study of transference interpretations","volume":"163","author":"H\u00f8glend","year":"2006","journal-title":"Am. J. Psychiatry"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"2321","DOI":"10.1002\/jclp.23739","article-title":"Introduction to the in session special issue: psychotherapy for complex PTSD","volume":"80","author":"Horesh","year":"2024","journal-title":"J. Clin. Psychol."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1176\/appi.psychotherapy.1973.27.4.506","article-title":"Phase-oriented treatment of stress response syndromes","volume":"27","author":"Horowitz","year":"1973","journal-title":"Am. J. Psychother."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1111\/acps.12771","article-title":"Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the international trauma questionnaire","volume":"136","author":"Hyland","year":"2017","journal-title":"Acta Psychiatr. Scand."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1080\/15299732.2019.1675113","article-title":"The relationship between ICD-11 PTSD, complex PTSD, and dissociative experiences","volume":"21","author":"Hyland","year":"2019","journal-title":"J. Trauma Dissociation"},{"key":"ref9009","doi-asserted-by":"publisher","first-page":"112871","DOI":"10.1016\/j.psychres.2020.112871","article-title":"A longitudinal study of ICD-11 PTSD and complex PTSD in the general population of Israel","volume":"286","author":"Hyland","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref9017","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1037\/tra0000908","article-title":"Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM-5","volume":"13","author":"Hyland","year":"2021","journal-title":"Psychological trauma: theory, research, practice and policy"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"e61","DOI":"10.1017\/S0033291725000169","article-title":"Mapping connections between complex post-traumatic stress disorder and psychotic-like experiences among adolescents: a gaussian and Bayesian network study","volume":"55","author":"Jannini","year":"2025","journal-title":"Psychol. Med."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1002\/da.22934","article-title":"Risk factors and comorbidity of ICD-11 PTSD and complex PTSD: findings from a trauma-exposed population-based sample of adults in the United Kingdom","volume":"36","author":"Karatzias","year":"","journal-title":"Depress Anxiety"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.3390\/brainsci13091300","article-title":"Enhanced skills training in affective and interpersonal regulation (ESTAIR): a new modular treatment for ICD-11 complex posttraumatic stress disorder (CPTSD)","volume":"13","author":"Karatzias","year":"2023","journal-title":"Brain Sci."},{"key":"ref54","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1017\/S0033291719000436","article-title":"Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis","volume":"49","author":"Karatzias","year":"","journal-title":"Psychol. Med."},{"key":"ref9013","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1080\/10615806.2020.1803006","article-title":"ICD-11 posttraumatic stress disorder, complex PTSD and adjustment disorder: the importance of stressors and traumatic life events","volume":"34","author":"Karatzias","year":"2021","journal-title":"Anxiety, Stress, & Coping"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1159\/000538428","article-title":"Enhanced skills training in affective and interpersonal regulation versus treatment as usual for ICD-11 complex PTSD: a pilot randomised controlled trial (the RESTORE trial)","volume":"93","author":"Karatzias","year":"2024","journal-title":"Psychother. Psychosom."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.jad.2016.09.032","article-title":"Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) based on the new ICD-11 trauma questionnaire (ICD-TQ)","volume":"207","author":"Karatzias","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref57","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1111\/bjc.12172","article-title":"The role of negative cognitions, emotion regulation strategies, and attachment organization in complex post-traumatic stress disorder: implications for new and existing therapies","volume":"57","author":"Karatzias","year":"2018","journal-title":"Br. J. Clin. Psychol."},{"key":"ref9014","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1111\/j.1745-8315.2008.00046.x","article-title":"Transference focused psychotherapy: overview and update","volume":"89","author":"Kernberg","year":"2008","journal-title":"Int. J. Psychoanal."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1037\/bul0000438","article-title":"A systematic review and meta-analysis of predictors of response to trauma-focused psychotherapy for posttraumatic stress disorder","volume":"150","author":"Keyan","year":"2024","journal-title":"Psychol. Bull."},{"key":"ref60","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1891\/1933-3196.3.4.264","article-title":"EMDR and the treatment of complex PTSD: a review","volume":"3","author":"Korn","year":"2009","journal-title":"J. EMDR Pract. Res."},{"key":"ref61","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1002\/jclp.10067","article-title":"Brief psychodynamic treatment of PTSD","volume":"58","author":"Krupnick","year":"2002","journal-title":"J. Clin. Psychol."},{"key":"ref62","doi-asserted-by":"publisher","first-page":"2333221","DOI":"10.1080\/20008066.2024.2333221","article-title":"Improvements of complex post-traumatic stress disorder symptoms during a multimodal psychodynamic inpatient rehabilitation treatment \u2013 results of an observational single-Centre pilot study","volume":"15","author":"Lampe","year":"2024","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref63","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1037\/a0034332","article-title":"Expanding the lens of evidence-based practice in psychotherapy: a common factors perspective","volume":"51","author":"Laska","year":"2014","journal-title":"Psychotherapy (Chic.)"},{"key":"ref9015","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1002\/jclp.22443","article-title":"Benefits of a psychodynamic group therapy (PGT) model for treating veterans with PTSD","volume":"73","author":"Levi","year":"2017","journal-title":"J. Clin. Psychol."},{"key":"ref64","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1080\/02650533.2019.1648246","article-title":"The role of hope in PSYCHODYNAMIC THERAPY (PSYCHODYNAMIC THERAPY) for complex PTSD (C-PTSD)","volume":"34","author":"Levi","year":"2019","journal-title":"J. Soc. Work. Pract."},{"key":"ref9016","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1097\/NMD.0000000000000302","article-title":"Relationship between interpretation, alliance, and outcome in psychodynamic psychotherapy: control of therapist effects and assessment of moderator variable impact","volume":"203","author":"Levy","year":"2015","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref65","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1080\/10926771.2014.904467","article-title":"Cognitive behavioral therapy for PTSD: the role of complex PTSD on treatment outcome","volume":"23","author":"Lonergan","year":"2014","journal-title":"J. Aggress. Maltreat. Trauma"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/S0140-6736(22)00821-2","article-title":"Complex post-traumatic stress disorder","volume":"400","author":"Maercker","year":"2022","journal-title":"Lancet"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.jad.2018.09.059","article-title":"A systematic review and meta-analysis of group treatments for adults with symptoms associated with complex post-traumatic stress disorder","volume":"243","author":"Mahoney","year":"2019","journal-title":"J. Affect. Disord."},{"key":"ref68","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1080\/09638237.2020.1803229","article-title":"A participatory study of patient views on psychotherapy for complex post-traumatic stress disorder, CPTSD","volume":"30","author":"Matheson","year":"2021","journal-title":"J. Ment. Health"},{"key":"ref69","first-page":"202","article-title":"The dialectics of Hope","volume-title":"Hope and dread in psychoanalysis","author":"Mitchell","year":"1993"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.cpr.2010.10.004","article-title":"A critical review of psychological treatments of posttraumatic stress disorder in refugees","volume":"31","author":"Nickerson","year":"2011","journal-title":"Clin. Psychol. Rev."},{"key":"ref71","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1016\/j.jad.2021.12.056","article-title":"Evidence-based individual psychotherapy for complex posttraumatic stress disorder and at-risk groups for complex traumatization: a meta-review","volume":"299","author":"Niemeyer","year":"2022","journal-title":"J. Affect. Disord."},{"key":"ref72","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1080\/09515070.2011.623542","article-title":"Psychotherapy and the dialectics of hope and despair","volume":"24","author":"O\u2019Hara","year":"2011","journal-title":"Couns. Psychol. Q."},{"key":"ref74","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1080\/10503300903505274","article-title":"Efficacy of two versions of emotion-focused therapy for resolving child abuse trauma","volume":"20","author":"Paivio","year":"2010","journal-title":"Psychother. Res."},{"key":"ref75","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1023\/A:1007891716593","article-title":"Efficacy of emotion focused therapy for adult survivors of child abuse: a preliminary study","volume":"14","author":"Paivio","year":"2001","journal-title":"J. Trauma. Stress."},{"key":"ref76","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jad.2010.07.005","article-title":"Psychosocial treatment of posttraumatic stress disorder in adult refugees: a systematic review of prospective treatment outcome studies and a critique","volume":"131","author":"Palic","year":"2011","journal-title":"J. Affect. Disord."},{"key":"ref77","doi-asserted-by":"publisher","first-page":"e43","DOI":"10.1017\/S0033291725000030","article-title":"A temporal network analysis of complex post-traumatic stress disorder and psychosis symptoms","volume":"55","author":"Panayi","year":"2025","journal-title":"Psychol. Med."},{"key":"ref78","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.3390\/brainsci14121207","article-title":"\"I am longing and afraid to depend on you\": a case report on breakdowns of therapeutic Alliance and interpersonal cycles in complex trauma","volume":"14","author":"Papa","year":"2024","journal-title":"Brain Sci."},{"key":"ref79","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1002\/jts.20052","article-title":"Clinical applications of the attachment framework: relational treatment of complex trauma","volume":"18","author":"Pearlman","year":"2005","journal-title":"J. Trauma. Stress."},{"key":"ref80","volume-title":"Trauma and the therapist: countertransference and vicarious traumatization in psychotherapy with incest survivors","author":"Pearlman","year":"1995"},{"key":"ref81","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1023\/A:1024800212070","article-title":"Development of a criteria set and a structured interview for disorders of extreme stress (SIDES)","volume":"10","author":"Pelcovitz","year":"1997","journal-title":"J. Trauma. Stress."},{"key":"ref82","doi-asserted-by":"publisher","first-page":"787","DOI":"10.4088\/jcp.v61n1010g","article-title":"Psychodynamic psychotherapy for PTSD","volume":"61","author":"Plakun","year":"2000","journal-title":"J. Clin. Psychiatry"},{"key":"ref83","doi-asserted-by":"publisher","first-page":"193","DOI":"10.36131\/cnfioritieditore20230304","article-title":"The functions of safety in psychotherapy: an integrative theoretical perspective across therapeutic schools","volume":"20","author":"Podolan","year":"2023","journal-title":"Clin. Neuropsychiatry"},{"key":"ref84","doi-asserted-by":"publisher","first-page":"403","DOI":"10.36131\/cnfioritieditore20240505","article-title":"The role of safety in change-promoting therapeutic relationships: an integrative relational approach","volume":"21","author":"Podolan","year":"2024","journal-title":"Clin. Neuropsychiatry"},{"key":"ref85","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1002\/jclp.23737","article-title":"Management of the therapeutic relationship in a patient with complex PTSD and personality disorder","volume":"81","author":"Popolo","year":"2025","journal-title":"J. Clin. Psychol."},{"key":"ref86","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1002\/jclp.23809","article-title":"Long-term improvements of complex post-traumatic stress disorder (CPTSD) symptoms after multimodal psychodynamic inpatient rehabilitation treatment\u2014an observational single Center pilot study","volume":"81","author":"Riedl","year":"2025","journal-title":"J. Clin. Psychol."},{"key":"ref87","doi-asserted-by":"publisher","first-page":"104734","DOI":"10.1016\/j.chiabu.2020.104734","article-title":"Complex trauma and trauma-focused cognitive-behavioral therapy: how do trauma chronicity and PTSD presentation affect treatment outcome?","volume":"111","author":"Ross","year":"2021","journal-title":"Child Abuse Negl."},{"key":"ref88","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1023\/A:1024837617768","article-title":"Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV field trial for posttraumatic stress disorder","volume":"10","author":"Roth","year":"1997","journal-title":"J. Trauma. Stress."},{"key":"ref89","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1037\/pap0000473","article-title":"Unlocking the therapist\u2019s capacity to intersubjectively attune with the patient as a relevant factor in the treatment of a patient with severe personality disorders: a clinical case study","volume":"41","author":"Salvatore","year":"2024","journal-title":"Psychoanal. Psychol."},{"key":"ref90","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1516\/0020757001600291","article-title":"Varieties of long-term outcomes among patients in psychoanalysis and long-term psychotherapy","volume":"81","author":"Sandell","year":"2000","journal-title":"Int. J. Psychoanal."},{"key":"ref91","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-662-59783-5","volume-title":"S3-Leitlinie Posttraumatische Belastungsst\u00f6rung","author":"Sch\u00e4fer","year":"2019"},{"key":"ref92","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1002\/cpp.480","article-title":"Psychotherapy for PTSD in the community: reported prototypical treatments","volume":"13","author":"Schottenbauer","year":"2006","journal-title":"Clin. Psychol. Psychother."},{"key":"ref93","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1521\/psyc.2008.71.1.13","article-title":"Contributions of psychodynamic approaches to treatment of PTSD and trauma: a review of the empirical treatment and psychopathology literature","volume":"71","author":"Schottenbauer","year":"2008","journal-title":"Psychiatry Interpers. Biolog. Processes"},{"key":"ref94","volume-title":"Dialogues with forgotten voices: Relational perspectives on child abuse trauma and treatment of dissociative disorders","author":"Schwartz","year":"2000"},{"key":"ref9018","volume-title":"Affect regulation and the repair of the self","author":"Schore","year":"2003"},{"key":"ref95","doi-asserted-by":"publisher","first-page":"119","DOI":"10.2147\/PRBM.S10215","article-title":"Psychodynamic psychotherapy for complex trauma: targets, focus, applications, and outcomes","volume":"3","author":"Spermon","year":"2010","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref96","doi-asserted-by":"publisher","first-page":"423","DOI":"10.31128\/AJGP-08-19-5039","article-title":"Adult survivors of childhood trauma: complex trauma, complex needs","volume":"49","author":"Su","year":"2020","journal-title":"Aust. J. Gen. Pract."},{"key":"ref97","doi-asserted-by":"publisher","DOI":"10.1037\/trm0000550","article-title":"The empathic response of relational therapists treating trauma: a dialectical experience","author":"Toporek","year":"2025","journal-title":"Traumatology"},{"key":"ref98","first-page":"3","article-title":"Practice guidelines for the treatment of patients with acute stress disorder and posttraumatic stress disorder","volume":"161","author":"Ursano","year":"2004","journal-title":"Am. J. Psychiatry"},{"key":"ref99","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1002\/jts.20047","article-title":"Disorders of extreme stress: the empirical foundation of a complex adaptation to trauma","volume":"18","author":"Van der Kolk","year":"2005","journal-title":"J. Trauma. Stress."},{"key":"ref100","doi-asserted-by":"publisher","first-page":"122","DOI":"10.3389\/fpsyg.2020.00122","article-title":"Core interpersonal patterns in complex trauma and the process of change in psychodynamic therapy: a case comparison study","volume":"11","author":"Van Nieuwenhove","year":"2020","journal-title":"Front. Psychol."},{"key":"ref101","doi-asserted-by":"publisher","first-page":"1783955","DOI":"10.1080\/20008198.2020.1783955","article-title":"Trauma-focused treatment outcome for complex PTSD patients: results of an intensive treatment program","volume":"11","author":"Voorendonk","year":"2020","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref102","doi-asserted-by":"crossref","DOI":"10.4324\/9780203582015","volume-title":"The great psychotherapy debate: the evidence for what makes psychotherapy work","author":"Wampold","year":"2015"},{"key":"ref103","doi-asserted-by":"publisher","first-page":"2332104","DOI":"10.1080\/20008066.2024.2332104","article-title":"Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial","volume":"15","author":"Wigard","year":"2024","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref104","volume-title":"Psychodynamic treatment for complex posttraumatic stress disorder","author":"W\u00f6ller","year":"2020"},{"key":"ref105","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1521\/bumc.2012.76.1.69","article-title":"Psychodynamic psychotherapy for posttraumatic stress disorder related to childhood abuse\u2014principles for a treatment manual","volume":"76","author":"W\u00f6ller","year":"2012","journal-title":"Bull. Menn. Clin."},{"key":"ref9020","volume-title":"International classification of diseases (11th rev.; ICD-11)","year":"2019"},{"key":"ref9019","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1017\/S0954579408000321","article-title":"A prospective study of child maltreatment and self-injurious behavior in a community sample","volume":"20","author":"Yates","year":"2008","journal-title":"Dev. Psychopathol."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1684921\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T07:49:22Z","timestamp":1770623362000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1684921\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,9]]},"references-count":122,"alternative-id":["10.3389\/fpsyg.2026.1684921"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1684921","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,9]]},"article-number":"1684921"}}