- Trauma is defined not by what happened in the past, but by how those events became present experiences.
- This concept is central in complex trauma, characterized by childhood inconsistency, neglect, or abuse.
- The therapeutic relationship, more than any specific technique, is essential to heal traumatic experiences.
Over the last few years, "trauma" has become one of those household terms everyone talks about. It has infiltrated our language, our narratives about the world, our relationships, and, in some cases, our sense of identity. The price of increased awareness and lower stigma, which are definitely positive developments, is that our understanding of what trauma is (and what it's not) might be diluted or distorted.
Based on the work at my therapy practice, after listening to my patients talk about their past and their present, I believe we can understand trauma as an experience that overwhelms our capacity to regulate our emotions and make sense of the world and our own experience, resulting in fragmentation, dissociation, and dysregulation. One of the aspects of that definition, which I would like to emphasize in this post, is that trauma is not about a past event, but about a present experience.
Trauma Is Like a Splinter
In his book "The Body Keeps The Score," trauma researcher Bessel van der Kolk suggests the metaphor of trauma as a splinter—the body’s response to the foreign object, as encoded in our nervous system, that becomes the problem, more than the object itself. As Peter Levine, developer of the somatic experiencing approach for trauma treatment, wrote years earlier:
Traumatic symptoms are not caused by the triggering event itself. They stem from the frozen residue of energy that has not been resolved and discharged; this residue remains trapped in the nervous system where it can wreak havoc on our bodies and spirits.
Psychical trauma – or more precisely the memory of the trauma – acts like a foreign body which long after its entry must continue to be regarded as the agent that still is at work.
Psychoanalytic therapy has developed a great deal since the times of Freud. Its focus, particularly when working through trauma, is usually two-fold. On one hand, it involves understanding the meaning, often unconscious, that we gave to our traumatic experiences and the ways it impacted the relationship with ourselves and with others. On the other, the work can help people access states of being that became repressed, dissociated, or disavowed as a result of traumatic experiences. The relationship with the therapist becomes a space where these embodied states can be experienced and, perhaps for the first time, put in words. These two perspectives correspond what psychoanalyst Thomas Ogden has called "epistemological" and "ontological" psychoanalysis.
Regardless of the approach we take to address trauma, it is critical to shift our focus toward the ways in which traumatic experiences stay with us. What makes an event traumatic is not the event itself, but the impact it had in us. Not all suffering is traumatic; the same event might be experienced as traumatic by some and not by others. Trauma is not remembered as something that happened in the past, but repeated, relived, and reenacted in the present. Therapy is, at its core, not a fact-finding mission, but an opportunity to explore how we came to be who we are and imagine who we can become.
It Does Not Take a Big Event
The notion of trauma as an experience is particularly important for complex developmental trauma, which is characterized by an upbringing defined by patterns of inconsistency, neglect, misattunement, or abuse. Emotions were not expressed, not allowed, and may have even been punished. We learned that our needs will not be met, at least not unless we met other people's expectations. Our sense of subjectivity was molded by or adapted to someone else's desires. A specific "big" event is not necessary. Repeated and chronic relational wounds can feel overwhelming, leading to the development of rigid defense mechanisms, unconscious identification with our abusers, and experiences of fragmentation and dissociation.
Most people I have seen in therapy have experienced some form of complex developmental trauma. They felt unseen and unheard by physically or emotionally absent parents. They did not feel taken care of, taken seriously, or taken into account. They had to carry, in silence, destructive family secrets. They had to be parents to their parents from a very early age. They needed to constantly perform, or pretend to be someone else, in order to feel accepted or loved. They had to learn to soothe themselves. They grew up feeling that they were, irremediably, either too much or not enough.
All these past experiences are reenacted and relived in the present, keeping the person from feeling safe, loved, worthy, or trusting in others or themselves. They get in the way of becoming self-aware, of letting go of control, of developing vulnerable and intimate relationships, of loving and being loved. They make people feel either on high alert or depleted. These experiences keep them from feeling free, authentic, and fully alive.
How the Therapeutic Relationship Can Help
The most important thing therapists can do to work through traumatic experiences of this kind is to offer the opportunity for a healing experience. If traumatic wounds were created through our important early relationships, their healing also needs to occur in the context of relationships — including, if therapy is involved, the relationship with the therapist.
The essence of a healing therapeutic experience is not a matter of technique, approach, or theory, and goes beyond the promise of providing a safe, empathic, and reliable environment. From the therapist perspective, I believe the question is about whether they can approach the work with authenticity, humility, and curiosity about their patients and themselves.
As a therapist, this means wondering about my own experience, about how I think of, feel with, and relate to the patient in front of me, as a way to understand something important about them. It is about being a human being first and a psychotherapist second, which is often a difficult task. It is about allowing myself to feel decentered while staying centered in my role at the same time.
A couple of examples:
- Sometimes I might get caught up in the need to make sure that I am saying the right words, offering the most insightful interpretation, or providing the most useful perspective. I must wonder: Why am I so concerned with this? Is my anxiety indicative of something my patient is trying to communicate? What makes it so hard to trust that my presence, my curiosity, my compassion and my humanity, with their flaws and imperfections, will be enough contribution to this process?
- At other times I may feel the urge to be a "good therapist," someone who is always empathic and non-judgmental, and who will offer my patient what nobody else has before. Why do I engage in this kind of omnipotent fantasy? What parts of my experience am I leaving out of the room because they don't fit what I would call my "ideal therapeutic self"? Will my efforts to be "all good" undermine my patients' ability to feel they're relating to a human who can really understand them?
Considering these types of experience as "issues" I need to "work on" and extricate from my role as a therapist misses not only the point, but an important opportunity for exploration and understanding. Are my patients and I re-enacting something meaningful about their experience? Are the relationship dynamics that unfold between us an expression of the patterns created by their trauma history? Are past and present, then and now, there and here, somehow becoming intertwined in our relationship?
In that context, I must also wonder: Does my patient feel heard and seen by me? Would they tell me if they didn't? Do they feel there is room for their feelings and reactions toward me, whether they come from a place of anger, hurt, sadness, joy, love, or desire? Can they express them trusting that our relationship will survive? Can they feel that every part of themselves is acknowledged, accepted, and valued? Do they feel able to take risks in our relationship? Do they feel safe enough to go to unsafe places during our sessions?
I believe these questions are crucial when working through complex developmental trauma. They are what can allow the therapeutic relationship to become an opportunity to be a healing experience. "What is going on here?" is a question I believe all therapists need to consider on an ongoing basis with curiosity and humility.
These questions matter because they can provide a new relational experience in which a "good enough" other (the therapist) is willing to sit with distress, the patient's and their own, to struggle together on the path to make sense not only of the past, but of what's happening in the present moment. We cannot change the past, but we can help our patients change the relationship they have with it, by becoming able to tolerate discomfort and pain, and by creating the opportunity to experience acceptance, hope, and love.
Breuer, J. & Freud, S. (1895). Studies on Hysteria. Standard Edition, Vol II.
Levine, P. (1997). Walking the Tiger. Berkeley, CA: North Atlantic Books
Ogden, T. (2019). Ontological Psychoanalysis or "What do you want to be when you grow up?". The Psychoanalytic Quarterly, 88(4), 661-684.
Van der Kolk, B. (2015). The Body Keeps the Score. New York, NY: Penguin Books