Why is focusing on trauma so important for today’s therapists? All you have to do is pick up a newspaper or glance at your smartphone to be reminded that trauma is everywhere in our world. And its hard to imagine that any of us who choose this tough way to make a living haven’t experienced trauma in one form or another. I hope you’ll come to our workshop on March 18th so that we can talk about how being a trauma survivor affects our work with patients.
Posted by Doris Brothers
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Doris Brothers and Grete Laine presentation
In this TRISP event, Doris Brothers focused on three dynamics that she considers endemic to trauma: trauma involves a shattering experience and attempts at restoration; trauma is relational; and dissociation often emerges in the aftermath of trauma. While Doris Brothers explained and then applied these dynamics to client material, Grete Laine explained how she integrates trauma theory and attachment theory in Self Psychological work with her clients. The following is a brief attempt to integrate their ideas into my own understanding of my work with clients.
Grete described some of her work with clients with disorganized attachment styles. My understanding of the “D” attachment style, variously called Disorganized or Traumatic, is that while it was originally described as disorganized because of the rapid shifting of affect and self-states, it is actually the most organized and affectively attuned attachment style because it was generated in a traumatogenic field in which a child needed to be attuned to a potentially dangerous caregiver whose affect states could turn on a dime- something researchers didn’t figure out until high speed video of parent-child dyads came on the scene to illustrate changes in the children’s affect in response to subtle changes in a parents’ facial expressions or tone of voice milliseconds earlier. I’m wondering if attachment styles function in my work in a way that is similar to Lachmann’s “organizing principles”, with which I’m not very familiar.
In thinking about Doris’ interpretation of dissociation in traumatic relational environments leading to dissociation in relationships later than life, I reflected on my own work with young people still living in the midst of relational trauma. My experience in working with pubescent boys with dissociative responses to those environments is that they are often punished (targeted with aggression and blamed) when they appear observant of the latent emotional communication going on within and around them. Spacing out and even appearing spacey is safer, although it draws its own criticism for incompetence. Gregory Bateson describes the gas-lighting that can occur in these double-bind scenarios in which obvious power dynamics and emotional realities are disavowed and denied (and in fact punished when a child verbalizes them) while simultaneously being the covert rules of interactions. This type of double bind is something more sinister than but inclusive of the parent’s failure to mirror or reflect a child’s inner experience or the child’s subjective experience of the parent. As I understand it, there is no conflict between the understanding of a conditioned and well-rehearsed traumatic neurobiological fight response and the psychological understanding of aggression that arises as a defense against a narcissistic wounding. I have seen many boys and young men develop unhealthy anger as a result of having their experience invalidated in double-bind situations.
Grete described her ongoing and increasingly successful attempts to use the Third Space or intersubjective field between herself and her clients as something akin to Winnicott’s “play space”, which reminded me of the late Buddhist teacher Chogyam Trungpa Rinpoche’s saying: “in the garden of gentle sanity, may you be bombarded by coconuts of wakefulness.” I take this phrase to mean that people who have cultivated themselves by ironing out their gross emotional instabilities should take the next step in their spiritual paths by learning how to increase their ability to experience the present moment as unique. Many clients, however, do not come into themselves in a garden of gentle sanity, and life’s coconuts (particularly interactions with others) are very often destabilizing.
I am intrigued by Grete’s metaphor of play for a few reasons. She spoke of formally inviting clients to play by way of engaging in discussion in a new way as an explicit experiment, which I interpret as a way of interrupting rigid and unconscious relational processes gently, much as a strong idealized parent might help their child to do. She described doing her best to create a garden of gentle sanity in the work of building a working rapport with clients by initially avoiding enacting the relational dynamics that they experience as impossible to manage with other people in their lives. This allows her then to toss a peanut of wakefulness (a coconut might feel like a weapon of mass destruction) by slowly intimating the rigid patterns emerging in the relationship or in the clients other relationships. I also appreciate that the metaphor of play, as a relational activity in the present moment involving spontaneity and fantasy, allows for significant room to grow together as a client-therapist dyad.
There is a way in which psychosis and traumatic stress are similar: both involve poor reality testing. In the case of trauma, the past is projected onto the present in a somewhat gross way. A paradox arose in my mind in reflecting on Doris Brothers’ engagement with the idea of certainty: trauma reveals frightening truths about reality- we are mortal; loved ones can be cruel and dangerous; accidents and violence and loss abound. At the same time a heightened and traumatizing awareness of such facts squeezes out the reality that those things aren’t happening in this moment and creates instead the illusion that danger is true and safety is false. Of course, it’s been important for our species to prepare for danger more than preparing for safety, but what is helpful for our species as a whole can create a hell realm on the individual level. Many therapists would say that we would go to hell and back for (but really with) our clients, I think this is exactly what we mean.
As you might guess, I’ve been trained to integrate neuropsychobiology and attachment theory into psychodynamic work in a way that is more relational insofar as it is enactment-focused and less intersubjective, which leads me to be curious about integrating a conception of intersubjective developmental striving. I also feel motivated to keep thinking about Doris’s prompt to consider how a therapist’s dreads and uncertainties might interact in the creation of impasses in the clinical work
I feel very grateful to Paul Sireci for his very interesting and thoughtful responses to the TRISP workshop that Grete and I led last Friday. I was intrigued by his noting that the “D” attachment style is often highly organized. I wonder if the inflexibility and constriction of what I think of as “traumatic attachment patterns” as a way to combat unbearable experiences of uncertainty about psychological survival is involved. I imagine that what Lachmann calls “organizing principles” I think of as “systemically emergent certainties” or SECs. The hyper-attunement of children to a parent’s rapidly changing affect states could be thought of as a reflection of a trauma-generated SEC.
I was also very taken Paul’s mention of the dissociative responses he has observed in boys who react to the emotional communication going on around them. Girls, I believe, are less likely to be targeted with aggression for such reactions. I suppose this reflects the still powerful gender binary that continues to affect our lives.
I was also delighted by Paul’s reaction to Grete’s inspired invitation to her patient to engage in play. I thought this was a terrific way of engaging with her challenging patient.
Paul notes that trauma can create the illusion that “danger is true and safety is false.” I believe that our efforts, extreme at times, to combat a sense of uncertainty about going-on-being in the aftermath of trauma sometimes leads to feeling that one must be perpetually on-guard against reoccurrences of a traumatic experience.
It was wonderful to know that Paul’s integration of neuropsychobioloy and attachment theory with relational perspectives motivates him to consider how a therapist’s dread of uncertainty might affect his or her clinical work.
I’d like to express my thanks to Paul Sireci for sharing his experience of the TRISP workshop Doris and I led this past Friday.
In particular, I’m appreciative of his efforts to think about integrating some of our ideas into his own work with clients. It’s my belief that interchanges like these help to enrich our field and enable us to continue a dialogue.
Paul, I’m very interested in your training in the areas of neuropsychobiology and attachment theory. This is very beneficial for the continued development of understanding how one impacts the other. There are studies now being conducted on the developing brain within the various attachment styles.
I like to think about attachment styles as patterns of relating. Therefore, I’m curious about your understanding of the “D” attachment as being “the most organized and affectively attuned”. I tend to view what you describe as hyper attunement on the part of the child. When the caregiver is not attuned to the child, I believe there is a potential for a role reversal. This makes me think of Brandchaft’s concept of “pathological accommodation”.
The films of secure dyads portray a beautiful reverie that is co – created. It’s an open as opposed to a constricted system. It’s been my experience that this reverie is missing from “D” attachment ones.
I found Paul’s reference to Rinoche’s “garden of gentle sanity” a wonderful example of where traumatized individuals’ longings rest. A place to recover from the horrors of being and feeling exiled. These people struggle to obtain this by creating all types of pathways to certainty.
I’m excited that Doris’s notion about how therapists’ own trauma and uncertainties can be unveiled in their work with clients, has motivated Paul to give this more thought and consideration.
Thank you, Doris and Grete. I so enjoyed the talk and very much appreciate this opportunity to continue the conversation. I am very interested in Doris’s idea that a traumatic reaction can function as a sort of fixative- reinforcing a binary stance that simultaneously “helps” the sufferer yet also harms him- and how this stance can function as a refuge because it is “known” while also harm him in its reductivity/all that it keeps out. When one responds to trauma by hunkering down in the certainty that the world is a fearful bad place, it can essentially function as a safeguard against desire and longing- for to live with desire and longing is a huge challenge and entails such a tolerance for a sense of vulnerability and a trust. Both of your privileging of this idea of the analytic dyad sharing a space of play feels very precious as it allows for these rigid stances to be less embraced and for a tolerance of longing to become possible.
Thanks again! I look forward to our next TRISP gathering.
And! Thank you, Paul, for your very rich comment. There are so many threads of thought you wrote here that feel interesting. One I keep thinking about is your sort of broadening of the term dissociation. It seems like you’re making a distinction btw. a response that is structural and one that is protective/defensive?
Also, I’m curious about a distinction you make btw enactments and inter subjectivity (“is more relational insofar as it is enactment-focused and less intersubjective…” ). Is this a reference to theoretical models? A way of being in the room?
Thanks again for this opportunity to reflect more on this rich subject!