Compassion Focused Therapy to Address Shame and Guilt: A Case Study of a Client With Complex PTSD

This paper presents the case of "Ava" a woman in her late 40s diagnosed with ICD-11 Complex Posttraumatic Stress Disorder (CPTSD), whose life was shaped by chronic childhood abuse, pervasive shame, and intense self-criticism. Ava struggled with intrusive trauma memories, relational hypervigilance, fears of compassion, and enduring guilt regarding the impact of past substance misuse on her children. A phased Compassion Focused Therapy (CFT) approach was implemented to address her chronic threat state (persistent hypervigilance and relational alarm) and facilitate a shift from shame-based self-attack toward compassionate self-relating. Phase 1 involved 12 group sessions focused on developing compassionate resilience and social safeness. Phase 2 consisted of 28 individual sessions integrating trauma memory processing with compassion focused interventions. Phase 3 included an optional, pilot 8-session group, consolidating compassionate identity and values-based living. The therapeutic journey involved relational challenges, including fears of judgment, ambivalence about relinquishing self-criticism and moments of alliance strain. Over the course of treatment, Ava demonstrated clinically significant reductions in CPTSD symptoms and trauma related shame, alongside increased self-reassurance, emotional regulation, and consolidation of a compassionate identity. Clinical implications of trauma focused CFT for those with complex PTSD are discussed.