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Symptoms often persist after first-line PTSD treatments, highlighting the need for additional approaches.

Trauma-related symptoms often persist because they serve psychological functions in reaction to the trauma.

Early experiences shape how trauma is interpreted, influencing views of self and others, and relationships.

Linking symptoms to trauma, conflict, and defenses can help patients attain more lasting psychological change.

The most recommended psychotherapies for Posttraumatic Stress Disorder emphasize exposure-based approaches (Foa and Rothbaum, 1998; Resick and Schnicke, 1993), encouraging patients to recount and reexperience traumatic events. Exposure treatments have helped many people, but a significant number of patients drop out of them, in part because directly focusing on traumatic experiences can be intolerably painful (Steenkamp et al., 2020). Additionally, these treatments often focus narrowly on an “index trauma,” ignoring other traumatic experiences that may be emotionally relevant. They also typically do not address the deeper psychological meanings of trauma or explore how childhood adversity shapes the impact of later traumatic events. Moreover, even with current best treatments, about two-thirds of patients still have enough symptoms to meet a PTSD diagnosis (Shalev et al., 2017). Clearly, we need additional ways of understanding and treating trauma.

One such approach is Trauma-Focused Psychodynamic Psychotherapy (TFPP) (Busch et al., 2021), a form of Problem-Focused Psychodynamic Psychotherapy (Busch, 2022) adapted for PTSD. Rather than focusing on retelling the traumatic event (although this is sometimes important), TFPP explores how traumatic and early life experiences have affected the individual’s emotions, self-assessments, expectations of others, and relationships. Additionally, this approach describes how we use this information to address posttraumatic symptoms.

Traumatic experiences can disrupt memory, identity, and emotional regulation. People often report alternating clarity and haziness in recalling events, difficulty forming a coherent narrative, and emotions that feel unpredictable or overwhelming. A central psychodynamic idea is that trauma may be repeated unconsciously (Freud 1920). These reenactments are not intentional but are often a way the mind attempts to........

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