What’s at the Heart of Trauma Resolution
Skilled therapeutic intervention is key to resolving trauma, and fortunately there is not just one method or modality to accomplish resolution of traumatic experiences! At the heart of mental/emotional trauma resolution is therapeutic memory reconsolidation as articulated by Bruce Ecker’s (2018) methodology literature review.
When is it trauma?
So many of us have brushed aside the notion of being traumatized because our self-image, our self-talk, our reliable defensive stance in life don’t allow us to reflect inside. “It was my fault. I shouldn’t have been dressed that way. Maybe then they wouldn’t have followed me outta that bar and beaten me up…” is what I heard one new client referred by the Victim Witness Assistance Program tell me when speaking about their most recent hate crime.
My client didn’t consider themself a victim, and they were proud of that. I respected their personal experience of the beating, and I knew their take on it was protective for them. My understanding of their beating (which I didn’t share with them at intake) was that they had likely dissociated from the vulnerable feelings and sensations that were a part of the beating in that dark parking lot. While this client presented a more obvious story of trauma that therapy could, and would resolve, other traumas are less obvious…yet just as devastating to the mind-body psyche.
Interestingly, conscious awareness at the time of traumatic experience is not a prerequisite for people to [subconsciously] register experience as traumatic. At clinical intake, the psychotherapist may hear, “My childhood? Mine was just great. Wonderful parents! Funny thing though…I don’t remember anything specific about it now that you ask.” Only many sessions later may the therapist begin to discover the client’s abusive/neglectful childhood if there is one. This kind of dissociative process happens automatically as a built-in survival mechanism attendant to the human condition. Why? -----because we are built to cordon off that which we cannot metabolize consciously. And kids are especially susceptible to dissociating when life gets to be too taxing for their burgeoning personal psychology in the midst of abuse and/or repeated experiences of emotional neglect.
My client who had been beaten up did not begin to consciously register their trauma until they sensed it was safe enough with me to explore this possibility within a paced, therapeutically shared internal journey. Resolution of trauma came quite slowly. After careful clinical interviewing, it became apparent to me that this client had Dissociative Identity Disorder (DID), and we worked through a serious history of early trauma extending up to the present at age 21 years. Their trauma healing process took a handful of years altogether in therapy with me.
When does the trauma response cease to be triggered?
Skilled therapeutic intervention is key to resolving trauma, and fortunately there is not just one method or modality to accomplish resolution of traumatic experiences! At the heart of mental/emotional trauma resolution is therapeutic memory reconsolidation as articulated by Bruce Ecker’s (2018) methodology literature review. Healed trauma cannot be re-triggered. It’s permanently gone. Erasure of memory’s traumatic aspects connected to the declarative (aka, factual) and episodic recall is complete. This is fantastic news!
At present, there are ten different therapy modalities that have the backing of published scientific research explaining therapeutic memory reconsolidation. Check the list out here. These distinct therapies provide a framework for established best practices in the field of trauma psychology. The International Society for the Study of Trauma and Dissociation (ISST-D) has treatment guidelines for adults which can be found here, and for child treatment of trauma, the guidelines can be viewed here. Working within these guidelines leaves ample room for applying the various treatment modalities alluded to above. FYI, please look them up!
To be frank with you, in my early years of treating Complex PTSD and DID, I hardly knew how to recognize what the heart of the matter was with these clients! I definitely contributed to the well-known statistic of DID clients being in therapy for an average of seven years before being given an accurate diagnosis of DID. Fortunately, I found ISST-D via one of my mentors, and my confidence in working with traumatized clients has blossomed over the years. I now utilize the treatment modality of EMDR as a framework with nearly all of my clients, and it requires a specialized, advanced application with traumatized persons. If you are a client needing trauma-informed care, or if you are a psychotherapist treating trauma, aren’t we so fortunate as seekers and deliverers of therapy at the current time when trauma truly can be healed! Please share this blog with anyone you know who may benefit.
Ecker, B. (2018). Clinical translation of memory reconsolidation research: Therapeutic methodology for transformational change by erasing implicit emotional learnings driving symptom production. International Journal of Neuropsychotherapy, 6(1), 1–92. doi: 10.12744/ijnpt.2018.0001-0092
Instinct, Defense, and the Development of Complex Trauma
Pierre Janet (1859-1947) once wrote, “Traumas produce their disintegrating effects in proportion to their intensity, duration and repetition.” (1909) He was the first in a long line of clinician theorists who have attempted to explain what happens to the human condition as a result of enduring repeated, ongoing neglect and all manner of abuse.
Not All PTSD Is Created Equal
Pierre Janet (1859-1947) once wrote, “Traumas produce their disintegrating effects in proportion to their intensity, duration and repetition.” (1909) He was the first in a long line of clinician theorists who have attempted to explain what happens to the human condition as a result of enduring repeated, ongoing neglect and all manner of abuse. And though contemporary understandings have made PTSD a commonly recognized acronym, a majority of mental health professionals grapple with efficiently treating the complexity that PTSD often involves. Why? The simple answer is that not all PTSD is created equal. Here’s an illustration: Surviving the fallout from a fiery car crash (having previously enjoyed a trauma-free upbringing) is quite different from surviving the latest trauma of a fiery car crash given the backdrop of an abusive, neglectful and chaotic upbringing.
The roots of psychological disintegration that Pierre Janet so elegantly outlined for us come from an instinctual, desperate attempt to survive perceived threat. Humans (at any age) will do whatever is necessary to survive when escape from perceived threat is impossible. Infants cry instinctually in an attempt to get attention, so their physical survival is maximized. And when aggressors are much larger, the primacy of the fight instinct is abandoned for fleeing as the best way to cope. And when fleeing is not an option, what’s left is to submit and comply with the powerful other’s demands; submittal with analgesia (the body goes limp and internal endorphins are released) is the last survival strategy by instinct. These automatic survival processes are designed by nature to segregate traumatic experiences, especially severe and chronic ones. This process helps the survivor to most efficiently focus on daily life despite their trail of traumatic experiences.
The success of survival from chronic, perceived threat comes at the price of a disintegrated psyche via traumatic learning.
Traumatic learning is very difficult to undo because it holds strong survival value. Here’s an example: A child learns to wall off the realization that the parent who molests her late nights is the same parent smiling and making small talk at the breakfast table the next morning. This child cannot escape the molestations and must carry on a “normal” relationship with that parent. This girl who submits to and experiences the molestations may be remotely aware (or even unaware) of the one who makes small talk with her molester-parent at the breakfast table. This is but one possible effect of traumatic learning processes that are born out of an instinctually defensive purpose to survive.
How Do We Begin To Help Our Clients?
So where do we start as clinicians with treating such complex trauma? We start with gentle kindness, with friendly curiosity. We hold space for our clients’ confusion, their knowing and not knowing about what their past experience holds. And when the time is right, we reaffirm whatever the client had to do in order to survive was alright. That’s where we begin, and that’s where we stay as long as is necessary.
When we, as clinicians, understand these instinctually defensive roots of traumatic response, we can help our traumatized clients begin to stabilize their daily living and to build customized skill sets that address what is needed to eventually confront the realization of their traumas. Out of this process, our clients will eventually make sense of their trauma in terms of who they intend to become—not only as survivors, but also as thrivers.
Click the button below to learn more about how the treatment of PTSD can be achieved through EMDR Therapy.
Photo by Camila Quintero Franco on Unsplash