Experiences of Psychotherapy Among Adult Survivors of Complex Post-Traumatic Stress Disorder: A Systematic Review and Meta-Ethnography

Abstract

Background

Complex post-traumatic stress disorder (CPTSD) is associated with significant relational, emotional and identity-related difficulties, often rooted in prolonged interpersonal trauma. Despite increasing recognition of CPTSD, less is understood about how individuals experience accessing and engaging in psychotherapy, particularly within real-world service contexts. This review synthesised qualitative research to develop a conceptual understanding of these experiences and the therapeutic journey from the perspective of those directly affected.

Method

Systematic searches across four databases identified 15 studies, representing the perspectives of 242 adults with CPTSD. A meta-ethnographic approach was used to analyse and integrate findings, allowing for the development of higher-order interpretations across studies.

Results

Three interconnected processes characterised participants' experiences of therapy. Establishing relational safety and trust was central to engagement and formed the foundation for therapeutic work. This enabled trauma processing and the development of coping strategies, often described as gradual and emotionally demanding. Over time, participants described increasing empowerment, self-compassion and acceptance, alongside a growing capacity to make sense of their experiences. Recovery was experienced as cyclical rather than linear, with individuals revisiting earlier stages in response to new challenges and changing life circumstances.

Conclusions

Findings highlight the importance of relational, trauma-informed and flexible approaches to psychotherapy. Improving access to specialist, consistent support and addressing systemic barriers remain essential to meeting the complex and evolving needs of people with CPTSD, particularly within stretched service systems.