Interpersonal Trauma

Introduction

Although at times western society may portray that the essence of significance is individualism, there is an undeniable inherent connection between the “relational self” (Siegel, 2012, pp. 348 – 349) and a life in which we are able to attain well-being, meaning, and assurance in spite of pain. Yet, when the relational self is affected by prolonged interpersonal trauma (IT), what are the effects on an individual’s overarching sense of safety and significance: on their relational baseline? More importantly, is there the potential, through a counselling framework, to overcome an affected relational baseline?

This paper will explore a framework that has been developed through a deeply personal and research based appreciation for the holistic implications of a malformed relational baseline. Though there are a multiplicity of paradigms in which all trauma can be understood and addressed, and indeed should not be negated due to the vastness of client subjectivity, I seek only to conceptualise and explore the theory and responses that have directly impacted and influenced me. As such, a personal understanding of IT as well as the implications and impact of this understanding will be described and inform the treatment process proposed.

A Personal Understanding of Trauma

In developing the notion of IT it can be understood that the “‘the relational self’ is a fundamental aspect of who we are” (Siegel, 2012, p. 348). It is that which offers an individual safety and significance, and equips someone with the survival mechanisms to resolve overwhelming stress. To further this definition, a Christ-centred Bible-based perspective of the relational self is one that has been called into a life of light (Rev 22, NIV), connected and established in Him, designed for faith, hope, and love (1 Cor 13, NIV; Rev 1:8, NIV; 1 John 4:7-21, NIV; 1 John 3:11,16,19, & 23, NIV). It offers a structure toward living a life in which the relational self, in terms of safety and significance, is demonstrated within a secure primary attachment, however ultimately fulfilled by an omnipresent and omnicompetent God.

With the above in mind, even when viewed through the window of multiple worldviews, IT is the disruption of a sense a safety and significance an individual feels within themself, due to a disruptive primary attachment (Siegel, 2012, p. 114; Ogden, Minton, & Pain, 2006, pp. 41-64; Gingrich, 2013, pp. 29-42; McCann & Pearlman, 1990, p. 77). It is within this disruptive attachment that a complex neurobiological malformation occurs (Cozolino, 2010, pp. 282-283), and an individual’s holistic self becomes extensively impacted, creating a new malformed relational baseline.

To clearly articulate what is inferred by a relational baseline, a clear definition of safety and significance must be provided. Safety is the capacity to have internal integration in which self-regulating equanimity, and the adaption of the many interpersonal realms we reside in (Siegel, 2010, p. 188, Siegel, 2012, p. 349; Heatherton, 2011, p.2; Porges, n.d., p. 14). Such integration is the “heart of health” (Siegel, 2012, p. 339) and stems from the neurobiological needs of a highly functioning amygdala at birth (Cozolino, 2010, p. 281). The amygdala demands attachment, and is at the center of fear (Cozolino, 2010, p. 281); thus the key to safety is developmental experiences in which an individual is both compassionately connected and securely differentiated (Siegel, 2012, p. 339).

In the same internal integration capacity, significance is the meaning making mechanisms an individual has in life. That is to say, a frame of reference (McCann & Pearlman, 1990, p. 158) that allows for the recognition that the world is meaningful and coherent, that there is hope, and that there is a potential for fearless affirmation in simply being. For example, if an individual were to have a frame of reference built upon a Christ-centred, Bible-based foundation they would find significance in their creation as reflecting the image of God, and in finding the potential to live in wonder, truth, and love; revealing once more that the heart of health is found in being shaped through compassionate connection and secure differentiation (Gingrich, 2013, pp. 23-24; Gen 1:27; allaboutgod.com, 2002; Bible Study Tools, 2014a; Bible Study Tools, 2014b).

Yet, when safety and significance is continually disrupted during development, an individual’s ability to internally integrate results in extreme chaos and rigidity (Siegel, 2010, p. 189). This disruption can be attributed to many things that reflect an extreme form of disorganized, frightening or frightened, and mis-attuned parenting, and results in a child feeling abandoned, rejected, conflicted, and ultimately with an incoherent mental model (Seigel, 2012, pp. 357 & 359; Ogden, Minton & Pain, 2006, pp. 47, 51, & 52; Kezelman & Stavropoulos, 2012, p. 80). Eventually, this leaves an individual without the internal capacity to attend to difficulties throughout life, without any sense of safety and significance and susceptible to further IT (Rothschild, 2011, p. 41 & 52; Cozolino, 2010, pp. 268 & 280; D’Andrea, Ford, Stolbach, Spinazzola, & Van der Kolk, 2012, p.189).

The Impacts of Trauma

From a holistic perspective the impacts of IT can be seen as mechanisms created to counteract the emotionally charged mind body sensations (Rothschild, 2011, pp. 42-43), that have been stored within the implicit memory and fed back in times of dysregulated stress and representative situations (Rothschild, 2011, pp. 42-43; Kezelman & Stavropoulos, 2012, p. 66; D’Andrea, Ford, Stolbach, Spinazzola, & Van der Kolk, 2012, p.192; Cozolino, 2010, p. 263). The more an individual is subject to the continual disruption of safety and significance, the more separate and extreme the boundaries between the emotional states (Cozolino, 2010, p. 270). IT causes the inability to create self-identity or to remain aware of “needs in the presence of compelling others”. An individual may easily become susceptible to “triggered perceptions of oneself as inadequate, bad, or helpless; expectations of others as dangerous, rejecting or unloving; and a view of the world as hopeless” (Briere & Scott, 2015, pp. 55 & 112; Cozolino, 2010, p. 270), and as such apply conditioned survival mechanisms to these feelings (Cozolino, 2010, p. 284).

Survival mechanisms manifest in a multitude of behaviours including both process and symptom responses evaluated (Briere & Scott, 2015, pp. 71-80). These can be interpreted through both objective and subjective observations respectively (Briere & Scott, 2015, pp. 71-80). This entails a combination of activation and avoidance responses; affect deregulation; relational difficulties; and presents as:

• altered consciousness or mental functioning
• psychotic symptoms
• evidence of self-injurious or suicidal thoughts and behaviours
• potential danger to others
• mood disturbance
• substance abuse or addiction
• personality dysfunction
• reduced ability to care for self. (Briere & Scott, 2015, pp. 71-80)

IT causes the brain, body, and psyche to react in such a way where neural networks adapt and form enduring survival mechanisms against mis-attuned attachment, resulting in the inability to integrate experiences and emotions (Cozolino, 2010, p. 284). This suggests that IT is most detrimental in enduring safety and significance, thus intrinsically affecting well-being; and as such informed processing involves a diverse style in which each client is attended to individually.

Proposed Trauma Treatment Process

In understanding that IT has a detrimental effect on enduring safety and significance, we can now explore the notion that a survivor of IT will continually be re-traumatised by intrusive triggers and reactions (Kezelman & Stavropoulos, 2012, p. 66) until such a time as (a) safety is restored; (b) traumatic memories are processed; (c) the holistic self is integrated thus creating a new relational baseline (Van Der Hart, Brown, Van Der Kolk, 1989, p.3; Rothschild, 2011, p.57; Scaer, 2006, p.4). Essentially, the IT treatment process provides the client a holistic experience in which they are authentically modelled safety and significance in order to reestablish well-being. This creates a new relational baseline in which to live, in the most part, no longer overwhelmed by their past (Fisher, 1999, p.1).

(a) Safety

Fisher (1999) provided a client centred theory of safety and stabilization which resonates personally as it acknowledges the inability for an individual affected by IT to feel a sense of safety due to the lack of a relational baseline (p. 1). Furthermore, Fisher’s work (1999) acknowledges the desperate need for a “teacher” to not only repair the damage done, however to continually model a secure base (p. 1) through an “enriched environment that promotes the development of cognitive, emotional and behavioural abilities” (Kezelman & Stavropoulos, 2012, p. 64).

Having experienced IT, I am able to sincerely acknowledge the imperative nature of the therapist attuning to the client respectfully, positively, and authentically, as well as to acknowledge the courage within the client to face the adversity they have experienced (Briere & Scott, 2015, p. 100). Within this process, attunement to attachment issues may be considered via a model of assessment (Shapiro, 2010, pp. 35-37; Siegel, 2010, pp. 158-157) in which the therapist can more accurately assimilate to interpersonal issues, and thus more deeply understand the client. It is only within this therapeutic relationship of respect, attunement, and courage that modelling, psychoeducation, skill building, and empowerment can occur (Fisher, 1999, p. 2).

Empowerment begins in decreasing levels of shame through normalization and by redefining the client from “victim” to “survivor” (Fisher, 1999, p. 2). Naming self-reductive thoughts, emotions, and behaviours as symptoms of IT (Fisher, 1999, p. 1) creates the space for the client to utilise their left-brain’s capacity for analysis and mastery over their reactions and actions (Fisher, 1999, pp. 12-13). The client masters control through understanding intrusive memories, feeling flashbacks, and triggers, and is able to, in part, attain a sense of safety and control through knowledge enrichment.

A further sense of safety comes from the ability of the therapist to model safety and self-regulation. If a client can directly experience safety, through stabilization and containment in a consistent nature within the therapeutic relationship (Fisher, 1999, pp. 4-5; Briere & Scott, 2015, p. 106) their ability for self-regulation in terms of emotional and life stability will directly increase (Briere & Scott, 2015, p. 106). In saying this, it is the therapist’s role to provide stability through: grounding and centring; coping strategies; contracting for safety; anticipation of stressful events; calming mind and body; distinguishing past from present reality and how to “stay in the present”; recognizing and making use of disassociation (Fisher, 1999, pp. 5-12). In all of these a variety of techniques can be utalised, dependent on the nature of the client (Ogden, Minton & Pain, 2006, pp. 174-176; Briere & Scott, 2015, pp. 110-111; Van Der Hart, Brown, Van Der Kolk, 1989, pp. 4-5; Kezelman & Stavropoulos, 2012, p. 72). Time, in combination with continued modelling and psychoeducaiton, will further allow the client to build skills within themselves for staying stable (Fisher, 1999, p.5).

As a result, it can be seen that in providing stabilization, as well as creating, modelling, and teaching a sense of safety, both actual and perceived (Briere & Scott, 2015, p. 105), the relational self of an individual inflicted by IT can begin to be restored.

(b) Traumatic Memory Processing

Within the holistic experience of IT treatment once safety and stabilization is predominantly a self-regulated skill the client can move toward processing memories in an attempt to integrate them (Rothschild, 2011, p. 59; Kezelman & Stavropoulos, 2012, p. 71). In keeping with the vital need for the therapist to be attuned to the client, the courage of the client in directly attending to their memories and psychological distress should be continually acknowledged throughout the process (Briere & Scott, 2015, p. 99). Moreover, my own experience has highlighted that due to the overarching intense emotional and relational nature of IT, two aspects in therapy cannot be negated: first, that safety, stabilization, and affect-regulation will continue to be an aspect to be revisited (Briere & Scott, 2015, p. 76; Rothschild, 2011, p.59); second, that the ability to recognise, access, and process underlying traumatic memories involves, in the most part, becoming mindful in daily experience (Siegel, 2010, p. 185).

While mindfulness has definitions that stream from the scientific realms to the spiritual realms, in terms of IT processing, mindfulness can be seen as the ability to heighten an internal holistic understanding of oneself through body mind awareness and attentiveness (Briere & Scott, 2015, pp. 91-92). Within this, awareness to somatic experience is potentially more evoking of change than simple attentiveness to explicit memories. With an increasing awareness of, and tolerance for bodily sensation, implicit memory can be observed as it arises allowing the client to interpret behaviours, emotions, and enduring schemas through a “lens shaped by prior experience” (Siegel, 2010, pp. 190 & 194; Ogden, Minton & Pain, 2006, pp. 168-169; Kezelman & Stavropoulos, 2012, p. 68). Moreover, Ogden, Minton & Pain (2006) acknowledge the positive neurological benefits of mindfulness and its ability to reactivate the “prefrontal cortices and cognitive functions” associated with defensive actions stimulated by unresolved trauma (p.169), further allowing for IT memory processing.

Subsequently, with practiced mindfulness the client and therapist become more attuned, working towards “equal attention and commitment, to notice, track, observe, consider, translate, and experiment…” (Ogden, Minton & Pain, 2006, p. 172). This attuned relationship and exploration then moves the client further toward understanding and re-orientating fear and powerlessness, and towards mastery through a variety of client focused processing methodology.

Such methodology may include EMDR, EFT, TRE, Somatic Experiencing, Sensorimotor psychotherapy, emotional processing, and /or cognitive interventions (Ogden, Minton & Pain, 2006; Rothschild, 2011; TRE Australia; Eye Movemvent Desensitisation & Reprocessing Association of Australia, 2014; EFT, 2015). By creating a space for meaning making through processing traumatic memories, the client can more easily move from a malformed relational baseline where safety and significance are continually disrupted, toward forming a solid sense of significance, which in turn, along with safety, allows for integration (Ogden, Minton & Pain, 2006, pp. 174-176; p. 269).

(c) Integration

Though the platforms of the IT treatment process are described separately, integration of self to self, self to other, and self to society (Siegel, 2010, pp. xviii-xxv) is intertwined and facilitated throughout the first two platforms of safety and memory processing (Rothschild, 2011, p. 60). Furthermore, integration is enhanced when the client is encouraged to find a sense of significance. Throughout the treatment the therapist may engage the client in “building bridges” from the past to the present and assist the client in identifying how they can forge a new life in the “here and now” (Rothschild, 2011, p. 61). Additionally, the therapist may engage the client in their ability to link the differentiated aspects of their body, mind, and relationships creating a harmonious flow, and ultimately the integrated system that is the “heart of health” (Siegel, 2012, pp. 336-337)

When a client presents with their holistic self extensively impacted, their relational baseline impaired, and without differentiation, a client’s sense of significance is unattainable. Not only is significance association to the traumatic memories inaccessible, however the client’s ability to maintain a sense of self through an internal reference point or an enduring truth is ambiguous (Siegel, 2010, pp. 88-93; Ogden, Minton & Pain, 2006, p. 187; Briere & Scott, 2015, p. 198; Kezelman & Stavropoulos, 2012, p. 77).

As previously mentioned, a sense of self with an internal reference point is more easily accessible when an individual holds a specific worldview. In expanding the Christ-centred, Bible-based worldview as a tool to change, the client can find significance in scripture, in community, and in enduring knowledge. While at the same time, a Christ-centred therapist can vision the client’s inherent potential and their significance (Gingrich, 2013, p. 24); they can rely, even without a Christ-centered client, on the wisdom of the Holy Spirit, and the knowledge of The Word (1 Cor 2:12-14, NIV; 1 Cor 12:8, NIV; 2 Timothy 3:16-17, NIV; Gingrich, 2013, p. 24) to provide a coherent understanding of the past, present, and future that “makes sense” enough for the client to become integrated (Siegel, 2010, p. 89).

Integration further requires the therapist to be constantly aware of the client’s changing holistic and relational connections and to model healthy variations of safety, self-regulation, and mindfulness; as well as to continually discover and reflect the client’s significance (Siegel, 2012, pp. 351, 356-357; Ogden, Minton & Pain, 2006, p. 198). With the ability to integrate experiences and emotions, enduring safety and significance within the client will be restored, thus intrinsically affecting their relational baseline and as such, state of well-being.

Therapist Self Awareness & Care

It cannot be negated that an essential aspect in working with the client in creating a new relational baseline, the therapist must be present, attuned (Siegel, 2010, p. 35), and have “interoception” (Siegel, 2010, p. 44) of both body and mind; this is fundamental to mindfulness as a therapist. These skills allow the therapist to be both vulnerable and strong simultaneously (Siegel, 2010, pp. 48-49), to work to integrate their own experiences into current reality and to create authentic and unimpaired resonance with a client (Siegel, 2010, pp. 71-73).

Once again, personal experience has awakened me to the imperative nature of creating space in my life to be both interoceptive and mindful both personally and professionally. Professionally, the therapist must respect the need to incorporate into daily life the aspects of safety, memory processing, and integration that is modeled and taught to the client. The IT therapist must be openly aware of their own IT, and spend time in supervision working through triggers and developing concrete methods of self-care.

When the therapist allows for interoception and mindfulness, interpersonal integration is grounded in a sense of self (Siegel, 2010, p. 245) and assimilates the need for objective empathic distance without risking the therapeutic relationship or the safety of the client. That is to say, the therapist can remain present and attuned while attending to the needs of the client (Rothschild, 2011, p.138), and to avoid and minimise chances of compassion fatigue, vicarious trauma, or burnout (Rothschild, 2011, p. 133).

Finally, in relation to therapist self awareness and care, I take hold of the notion that if I am self compassionate (Siegel, 2010, p. 233), integrated, and attuned to my own holistic needs, specifically in relation to safety and significance, I can:

…harness the power of presence to promote integration in [myself] and in others that heals ancient wounds and liberates the reality of our belonging to one another… clients, our society, our planet are waiting to join us and awaken to this reality of our lives. (Siegel, 2010, p. 260)

Conclusion

Although I have stated that there are multiplicity of paradigms in which trauma can be understood and addressed, it has been my personal experience that specifically when IT is experienced the holistic self is detrimentally affected. This effect is seen in ways that are almost incomprehensible to those who have not suffered similar loss of identity. The experience of IT leaves an individual, and indeed left me, with an impaired sense of safety and significance: an incoherent mental model in which a malformed relational baseline creates the incapacity to internally regulate and integrate experiences with emotions. As such, I have proposed a framework that brings to light the theory and responses that have given me the ability to work through aspects of my past and present, and to begin to form a new relational baseline in which a sense of safety and significance is implicitly known. This then, suggests that through a holistic understanding of interpersonal trauma and its impact of the relational self an individual does indeed have the capacity to undertake a process in which a new relational baseline is formed, and where well-being, meaning, and assurance in spite of pain is ascertained.

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References

All About God. (2002). God’s Goodness. Retrieved from http://www.allaboutgod.com/gods-goodness-faq.htm

Bible Study Tools. (2014). 20 ENCOURAGING Bible Verses – Scripture Words to Uplift. Retrieved from http://www.biblestudytools.com/topical-verses/encouraging-bible-verses/

Bible Study Tools. (2014). Inspirational Bible Verses – Encouraging Scripture Quotes. Retrieved from http://www.biblestudytools.com/topical-verses/inspirational-bible-verses/

Briere, J., & Scott, C. (2015). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (2nd ed.). Thousand Oaks, CA: Sage Publication.

Cozolino, L. J. (2010). The neuroscience of psychotherapy: Healing the social brain(2nd ed.). New York, NY: W.W. Norton & Co.

D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & Van der Kolk, B. (2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2), 187-200. Retrieved from DOI: 10.1111/j.1939-0025.2012.01154.x

Fisher, J. (1999). The work of stabilization in trauma treatment. Paper presented at The Trauma Center Lecture Series 1999, Boston, MA.

Ginrich, H. D. (2013). Restoring the shattered self: A Christian counselor’s guide to complex trauma. Downers Grove, IL: InterVasity Press.

Heatherton, T. F. (2011). Neuroscience of Self and Self-Regulation. Annual Review of Psychology, (62), 363–390. doi:10.1146/annurev.psych.121208.131616

Kezelman, C., & Stavropoulos, P. (2012). The last frontier: Practice guidelines for treatment of complex trauma and trauma informed care and service delivery. Mansfield, CT: National Institute for the Clinical Application of Behavioral Medicine.

McCann, L., & Pearlman, L. (1990). Psychological trauma and the adult survivor: Theory, therapy, and transformation. London, Great Britain: Brunner-Routledg.

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York, NY: W.W. Norton.

Porges, S. (n.d.). The Polyvagal Theory for treating trauma. Interview by R. Buczynski. Retrieved from http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf

Rothschild, B. (2011). Trauma essentials: The go-to guide. New York, NY: W.W. Norton.

Scaer, R. (2006). The Precarious Present. Retrieved from http://www.traumasoma.com/documents/ThePrecariousPresent.pdf

Shapiro, R. (2010). The trauma treatment handbook: Protocols across the spectrum. New York, NY: W.W. Norton & Co.

Siegel, D. J. (2010). The mindful therapist: A clinician’s guide to mindsight and neural integration. New York, NY: W. W. Norton & Co.

Siegel, D. J. (2012). The developing mind: How relationships and the brain interact to shape who we are (2nd ed.). New York, NY: Guilford Press.

Van der Hart, O., Brown, P., & Van der Kolk, B. (n.d.). Pierre Janet’s Treatment of Post-traumatic Stress. Journal of Traumatic Stress, 2(4), 1989.