Assessment and treatment of complex PTSD and dissociative disorders in childhood and adolescence, the role and use of EMDR


Damage occurs to a child’s self in the context of relationship when raised in an environment of abuse and neglect. This damage to self is manifested through disruptions in development. A child or adolescent will be unable to perform tasks a non-traumatized child or adolescent has not difficulty mastering. These tasks may be physical, emotional, intellectual, sexual, social, or spiritual. When these disruptions become manifest in the environment with which the child or adolescent is interacting, home, school, or community, conflict arises. The conflict is both internal with self and external in relationship, behavioral, and biological. This is generally when a child or adolescent is brought into therapy for intervention Caregivers are not always aware of the impact traumatic events have on a child’s life or may not want to deal with the impact and the long term implications. The therapeutic relationship is a context outside of the system where the child was traumatized that provide the potential environment and relationship which can facilitate healing for the child, adolescent, and possible, the system in which they live.

Children and adolescents with a complex PTSD will often employ the use of dissociation as a way to cope with overwhelming events or chronically dysfunctional lifestyles. The degree and way in which the child dissociates to self regulate internal systems will determine behavioural and neurological trajectories in their life such as, how the child will cope, rupture of developmental task attainment, and it will determine what type of attachment process the child experiences. Also determined are: impulse control, sleep regulation, meta cognitive functioning, neurobiological processes and the integrative processes of self. When there is no therapeutic intervention, the self which emerges as a result of these processes is a “traumatic self” organization, that is a self structural in response to traumatic experience determined to avoid the repetition of the traumatic experience “at all costs.” The biological body that emerges is the traumatized body organized for avoidance in the forms of fighting, fleeing, or freezing and submitting.

The assessment phase of therapy will map for the therapist and client where the internal dysregulation occur, what are the maladaptive response which have been developed, and what the negative beliefs are which all contribute to the construction of the “traumatic self." There are a variety of assessment tools specifically designed for this purpose.

Once the map is established, a plan can be developed to use with children and adolescents and family for therapy and for EMDR. There are a variety of models which have been developed to use with children and adolescents to process bad memories, negative cognitions and to strengthen internal resources. EMDR can also be used to facilitate state change, strengthen self regulatory capacities, and promote integrative processes of authentic self, facilitating healing throughout self, body, and relational systems.






A. Carter

Original Work Citation

Carter, A. (2007, June). Assessment and treatment of complex PTSD and dissociative disorders in childhood and adolescence, the role and use of EMDR. Presentation at the 8th EMDR Europe Association Conference, Paris, France



“Assessment and treatment of complex PTSD and dissociative disorders in childhood and adolescence, the role and use of EMDR,” Francine Shapiro Library, accessed November 30, 2020,

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