Those suffering from trauma continue to experience events, often unconsciously, as if it were occurring in the here and now. The chronically aroused Autonomic Nervous System (ANS) does not know that the traumatic event is over. The trauma sufferer is in a vicious cycle; the reality within the nervous system is not of a historic event but of a currently happening event.
It is what Bessel Van der Kolk (1996) describes as ‘a tyranny of the past that interferes with the ability to pay attention to both new and familiar situations’. With the passage of time the person has been unable to integrate the awful experiences and instead develops patterns of avoidance and lives in a chronic state of hyper-arousal.
In non-traumatic stress the sympathetic nervous system (SNS) becomes more active whilst the parasympathetic nervous system (PNS) lowers. Picture the process as a set of scales, two systems working together and complimenting each other. In non-traumatic stress once the threat is over the scales re-balance - arousal in the SNS will lower and the PNS will rise and with it balance is restored.
Traumatic stress is different, both sides of the ANS are activated together. The SNS constantly prepares the body for a threat that does not exist whilst the PNS is also activated leading to tonic immobility (freeze).
When the ANS is hyper-activated a person may experience some or all of the following internal affects without an external cause - rapid heart rate, cold sweating, rapid breath, heart palpitations, tendency to startle, hyper vigilant, difficulties concentrating, visual/auditory or somatic intrusions such as flashbacks. They may have difficulty sleeping, nightmares, loss of appetite and sexual dysfunction. In a chronic state the ANS gradually closes down into deadness, numbness and depression. The numbness might bring a sense of balance but the illusion is one that for most cannot be sustained and if it is comes with a high price tag.
The role of Dissociation
One of the symptoms always present in traumatic stress is some degree of dissociation. Dissociation is a basic defence against mental pain and an attempt to cut off contact with others who might generate further (unpleasant) sympathetic nervous system arousal. Van der kolk (1996) defines dissociation as a way of compartmentalising experience so that its constituent parts are not integrated. Its function is to lessen the impact of an event that was too overwhelming for the system to integrate.
People respond to trauma in a number of ways. Some use dissociation to bury the fragments of their experience to such an extent that it does not really interfere with their overall functioning. There are a significant number of people who do not experience the full debilitation of PTSD but who do suffer with some of the symptoms of trauma to the extent that their life is limited and restricted in some way. Others organise their whole personality around dealing with the aftermath of traumatic experiences. This is particularly the case for those diagnosed with Borderline Personality Disorder.
For some, dissociated fragments manifest only in circumstances reminiscent of the original event, ie, state dependent conditions. This is what is meant by flashback, which may be a visual, auditory, emotional, behavioural or somatic or combined experience. Rothschild (2000) points out that the state-dependent conditions can be triggered by introceptive and extroceptive cues. Introceptive cues are elicited from sensations within the body (heart pounding, sweating, tensing) and extroceptive from stimuli outside the body.
In many cases disassociation is held in the body tissue and re-experienced as physical pain (somatic flashbacks). An example of this is a client who came to me with a pain in his left shoulder and lower back which began at the same time as a violent attack. Another client connected breathing difficulties commencing when witnessing an event in which his daughter was seriously injured. In both cases as the wounded body was given space and the emotional energy digested and integrated these somatic symptoms were no longer required.
What is traumatic?
Just because something is traumatic, shocking or overwhelming does not mean that we will go on to ‘suffer’ long-term consequences in the form of post-traumatic stress or post-traumatic stress disorder.
Traumatisation tends to occur only when internal and external resources are inadequate to cope with the external threat. Factors that may determine whether trauma, shock, stress has a long lasting impact are:
Life threatening experience does not need to be actual it just has to be perceived as such. The threat of something can be as traumatising as it actually happening. At times of high arousal the ability to differentiate between actual and perceived becomes blurred and can lead to our imagined fears feeling like reality.
Trauma involves interpersonal failure i.e., experiences of abandonment, isolation, shame and invisibility – all of which are relational. What’s more it is often not the traumatic event that leads to ongoing symptoms of trauma but what happens, ie, whether those around are perceived as supportive, caring, empathic, re-assuring and/or giving assistance.
Different types of Trauma
There are the Big ‘T’ traumas associated with life and death situations and the small ‘t’ developmental traumas that occur during development in responses to our environment.
Small ’t' developmental trauma results from repetitive interactions that modify behaviour. The child creates a defence against the pain, anxiety and frustration of their basic needs not being met. In contrast, big ’T’ shock trauma does not develop over time but is a reflexive process regulated by the limbic system and outside an individuals control. These reflexes are the fight, flight, freeze responses previously mentioned and operate in response to extreme threat (see Rothschild, 2000)
David Wallin (2007) in his book Attachment in Psychotherapy writes about the significance of small ‘t’ traumas, which result from a child’s repeated experiences of fear, helplessness, humiliation, shame and/or abandonment in relation to attachment figures who provided no repair. These small ‘t’ traumas can result in ‘primitive mechanisms of self protection such as dissociation and projective identification’. What is significant for these people is that they experience the therapeutic relationship itself as intolerable in a way that leads to further fragmentation, disintegration and dissociation.
From a biodynamic psychology* perspective trauma persists because we have been unable to restore our internal equilibrium and retained within the autonomic nervous system is a residue of the disturbance. For example a baby who has had a hard struggle through the birth canal recovers unscathed as a result of being able to fully rest and recuperate on the mother’s body. Given an atmosphere of security and trust we recover even from severe trauma but without this emotional cycles cannot complete.
In biodynamic psychology the reason disturbance patterns accumulate is due to interruptions to the startle reflex pattern. The startle reflex is a whole body contraction in response to any sudden shock reaction whether physical, emotional or psychic stress (Boyesen M, 1978). The actual startle reflex is essentially healthy as it prepares the organism for action – fight or flight. Disturbance occurs as a result of what happens after the shock reaction. Once the event has passed the body should return to equilibrium with harmony between muscular response and respiratory rhythm (Boyesen M, 1978). This only happens if emotional expression has occurred.
In my next paper I focus on how restoring organismic regulation to support a return to equilibrium.
Note: * Biodynamic psychology is the branch of psychology developed by Clinical Psychologist Gerda Boyesen (1922-2005).
Boyesen, M (1978) The startle reflex pattern & organic equilibrium. Energy & Character, Vol. 9, No.2
Rothschild, B. (2000) The body remembers; the psychotherapy of trauma and trauma treatment: New York & London, Norton
Van der Kolk, B.A., McFarlane, A.C., Weisaeth, L. Editors (1996) Traumatic Stress, The effects of overwhelming experience on mind, body and society: New York & London, Guilford Press
Wallin D.J. (2007) Attachment in Psychotherapy, Guilford, New York
Unresolved traumatic experiences, to varying degrees, disconnect people within themselves and from the world around them. The symptoms of trauma are survival strategies and attempts to sooth and regulate states of intense fear and terror arising from a sense of there being no safe place even within their own body which seems to manifest all types of weird and wonderful reactions over which they feel they have no control.
According to Leslie Korn (1997) ‘trauma alters the eco-system of the body, mind and spirit’. While Sue Gerhardt (2004) highlights the loss of connection with others stating ‘the bonds that tie you to others are broken. Your physical and psychological integrity is breached. The world that you took for granted, the structure that underlies reality; is shattered’.
Wounding and trauma seems to be an inevitable part of life from which no-one escapes. But some people’s wounds appear to heal and others do not. What is it that distinguishes whether a person will continue to feel these wounds to the extent that it limits their experience of life? That it prevents them from experiencing satisfaction in their relationships and work?
There may be wounds so injurious that it may be almost impossible for them to be soothed and healed. But on the whole it is not so much the injury that wounds but the lack of sufficient soothing and the ability to be soothed. In childhood soothing comes from our adult caregivers. From them we also learn how to self-sooth. Without adequate soothing wounds do not heal. Without the ability to self-sooth, we do not learn how to heal ourselves.
According to the Oxford Dictionary, sooth is to ‘gently calm and relieve pain and discomfort’. This is a core part of affective self-regulation, a process whereby caregivers attune to and modulate a child’s physiological and emotional arousal enabling him or her to come back into balance (Schore, 1994). Limitations in this capacity are likely to play a major role in long-term vulnerability to psychopathological problems after exposure to potentially traumatic experiences (Schore, 1994).
In body psychotherapy self-regulation means bringing the (human) organism back to a state of equilibrium, homeostasis or balance on a vegetative, muscular and psychological level after a startle, shock or a period of stress. We think about self-regulation as a downswing on the vasomotoric cycle.
The vasomotoric cycle is a way of conceptualising our movement from rest through to expression and back to rest. It also represents the two sides of the autonomic nervous system with the sympathetic nervous system representing the upswing and the parasympathetic nervous system representing the downswing. After a period of stress, startle or shock we need to return to a state of equilibrium which includes finding ways to discharge residual emotional or energetic charge the failure to do so can break up the co-operation and integration of the three layers of embryonic tissue (Boadella, 1987) i.e., endoderm (vegetative/autonomic nervous system), mesoderm (muscle) and ectoderm (psychological/nervous tissue and sense organs including skin).
These three layers can also be understood as representing feeling (vegetative/endoderm), acting (muscle/mesoderm) and thinking (psychological/ectoderm). We can see the split in these three layers particularly in those people who have been scared out of their bodies – scared out of their lives - fleeing to their heads and intellectualising (ectoderm). When people integrate the fragments of their traumatic experience they also bring together the disconnected parts of the self.
Vertical and Horizontal Regulation
Another way we think about self-regulation is as vertical and horizontal process. Vertical self-regulation refers to the regulation of internal processes particularly the rise and fall of emotional energy (Southwell, 1982). The ability to regulate vertically is what enables us to be rooted in self. Horizontal regulation relates to the external interpersonal world where we relate to others. The ability to regulate horizontally brings the possibility of real relationships with others.
These regulatory processes are similar to what Beebe and Lachmann have labelled interactive regulation and self-regulation (Wallin, 2007). Interactive regulation is where someone helps us to manage our emotional states and the intensity of our arousal. Self-regulation is when we perform this function for ourselves. According to Wallin (2007) a balance between the two predicts a secure attachment style, which in itself is a predictor of a person’s capacity to manage stress and recover following a traumatic event.
It is these patterns of self-regulation that develop in early childhood as a result of the quality and security of attachment relationships that are pivotal to our ability to re-establish our equilibrium after a period of stress, startles or shocks.
Rothschild (2000), Brantjberg et al. (2004) and Levine (1997) write about the importance of resources in working with trauma. Our primary source of resources comes via the experience of secure attachment. It is these resources that give people the ‘capacity to land safely back in the ego after a trauma’ (Brantbjerg et al. 2004). It is these resources that do not develop when we are exposed to ongoing relational trauma in childhood.
The resources that securely attached infants and adults are able to draw upon means they are more likely to have a more rooted relationship with self and real relationship with other. They are more likely to have more connection between the three layers of self that we spend so much time enabling those people with trauma residue to connect or re-connect with through body awareness and felt sense. They are more likely to have a basic trust and feeling of safety in themselves and in others that those with particularly disorganised attachments do not have.
The Role Of The Therapeutic Relationship In Healing Trauma
For some time research has pointed to the relationship between the client and the psychotherapist as being the deciding factor in the satisfactory outcome of psychotherapy (Clarkson, 1995).
Advances in neuroscience have provided concrete evidence regarding the importance of relationship not only in our early development but also throughout our lives in determining our well-being. What many in the psychotherapeutic world have believed regarding the importance of relationship has been borne out by research. According to Siegal (1999) “human connections create neural connections”. He also states “the brain becomes literally constructed by interactions with others...our neural machinery...is, by evolution, designed to be altered by relationship experiences (Siegal, 2003). It has been shown that nurturing relationships are correlated with better physical health including heart and immune function and resistance to stress (Fishbane, 2007).
I have already mentioned how trauma disrupts our ability and potentially our desire to connect deeply, intimately, with others. This ability to connect is essential to our health. Our social interactions play an important role in the everyday regulation of our internal biological systems throughout our lives, such an important role that we cannot do without significant ‘others’ and remain in health.
For psychotherapy to support healing the therapist must be perceived as an ally. The creation of trust and safety is paramount and needs to be in place before working with traumatic material. There is less of a focus, if not a clear intention to avoid, inviting transference and counter-transference. For some people trauma work is all about ‘feeling secure in relationship with another’ and traumatic material will arise in the interaction between them. The healing occurs in working through the anxiety that being in relationship can provoke and re-establishing trust and safety in the presence of another.
Boadella, D (1987) Lifestreams: an introduction to Biosynthesis, Routledge & Kegan Paul, London
Brantbjerg H., M., Marcher, D., Kristiansen, M. (2004) Resources in coping with shock, a pathway to a resource-oriented perspective on shock trauma: Copenhagen, Kreatick Publishing
Clarkson, P. (1995) The Therapeutic Relationship in Psychoanalysis, Counselling Psychology and Psychotherapy: London, Whurr Publishers Ltd
Gerhardt, S. (2004) Why love matters; how affection shapes a baby’s brain: London & New York, Routledge
Levine, P.A. (1997) Waking the Tiger; Healing Trauma: California, North Atlantic Books
Rothschild, B. (2000) The body remembers; the psychotherapy of trauma and trauma treatment: New York & London, Norton
Schore, A.N. (1994) Affect Regulation and the Origin of Self, Lawrence Erlbaum Associates Inc., New Jersey
Siegel, D. (1999) The developing mind; how relationships and the brain interact to shape who we are: New York, Guildford Press
Siegel, D.J. (2003) An interpersonal neurobiology of psychotherapy; the developing mind and the resolution of trauma: New York, Norton
Wallin D.J. (2007) Attachment in Psychotherapy, Guilford, New York
Journal Articles & Papers:
Fishbane, M.D. (2007) Wired to Connect: Neuroscience, Relationships, and Therapy. Family Process, Vol. 46, No.3.
Southwell, C., Biodynamic massage as a therapeutic tool – with special reference to the biodynamic concept of equilibrium, Journal of Biodynamic Psychology, Journal of Biodynamic Masage, No 3, Winter, 1982
Korn, L. (1997) Community Trauma and Development; Presented at The World Conference on Violence and Co-existence; Dublin, Ireland. Available at: http://www.centerfortraditionalmedicine.org/research/com_trauma.pdf
I came across Mayet’s work, broken landscapes, whilst searching for images for essays about traumatic stress. Broken landscapes, gives voice to Jorge Mayet’s experience of living in exile, removed from his homeland, Cuba. It consists of floating landscapes, limbs and roots twisted and dangling, threads clinging tenuously to fragmented ground.
Mayet say about his work, “maybe subconsciously, I live like a tree pulled from its roots and in that way my installations are a metaphor for my life, but on a conscious level, I believe that we have to value each part of this Earth that belongs to us, because it is from she that we are able to live.”
The experience labelled traumatic stress is exile from self. It is common in therapeutic work for people to use imagery similar to Mayet’s to describe how they feel - sometimes trees, sometimes bulbs, roots dangling disconnected from the ground below, wanting to reconnect but not knowing how to and feeling it is unsafe to do so.