Incident trauma enters our lives unanticipated and uninvited. It ruptures the fabric of life and can be devastating—whether it be motor vehicle collisions, medical diagnosis, assaults of any kind, natural disasters, accidents, illnesses, loss, and the list goes on. As therapists, we need to be cognizant not only of the intense disruption and dysregulation to the autonomic nervous system (ANS), but we need to be aware of the disruption to identity that often comes with the experience. The loss of self, the loss of who I was, who I am, and who I can become, can be called into question, depending on the type and severity of the trauma, the disruption, and the injuries—psychological, neurophysiological, and physical.
One of the things I talk about as a trauma therapist and educator, is that the theory and process of metabolizing incident based traumatic material is relatively straight forward, particularly when there is a secure base, as there is with secure attachment—where there is a foundational integrity of the integrative functioning within the self. Often healing or resolution gets stymied when working with a person who has an underlying insecure attachment, where there is a deficiency in the integration capacity in the bodyself. This is when we as therapists, are called not only to travel to the abyss of trauma itself, but to negotiate that journey with a psyche and ANS that have foundational injuries that unconsciously thwart the integration of material. Kalsched (1998) aptly captures this dynamic: “for the traumatized psyche, integration is the worst imaginable thing, apparently equivalent in the ‘mind’ of the defending Self to some early horror—never to be repeated. It is as though integration threatens a re-experience of the ‘unthinkable’ affect. Therefore, connections among the components of experience are attacked in true ‘auto-immune’ fashion” (p. 89). These defenses are employed to maintain some stability in the system and to protect the psyche from re-experiencing the unbearable anguish of the affective experience of the trauma—the terror, pain, and unknown. For the insecurely attached system or psyche, the processing of traumatic material is threatening—too threatening for the systems to allow it to emerge, to surface, and involuntarily, unconscious defense structures emerge to shut down the process.
As clinicians, we also need to be cognizant of ramifications of what happens after a traumatic event, and the myriad of ways in which people’s early relational dynamics may be replicated as they navigate their post trauma reality. For some folks who have to interact with insurance companies (disability or otherwise), the medical and legal systems, employers, and other institutions, they may experience the recapitulation of their relational dynamics of early life. This can be particularly potent when interfacing with overburdened or profit driven systems, where they are left to languish unattended and in the unknown, a familiar abyss for some.
The Canadian healthcare system is a prime example, where people often wait for months to over a year for diagnostic imaging, access to specialists, and for adequate pain intervention and management, all of which can feel like there isn’t anyone to help them, evoking experiences that: no one cares, they don’t matter, no one sees them, etc., which may be reminiscent of early experiences wired into their internal working model. We can also see replication of early life experiences activating feelings that: there’s not enough for me, I have to manage this on my own, there is no relief, I don’t know what to do to make it better, to feel okay, to be safe—all of which can incite fear, anger, and/or helplessness for people, and complicate healing.
When people land in our clinical practice, we as therapists must be aware of the post trauma context in which people are living. For some clients, they may feel unmoored and unsafe, due to the recapitulation of early relational injurious experience, which destabilize them and needs to be attended to in the treatment process. In attending to our clients with this larger lens, and being tuned to the underlying relational security, or lack thereof (as with insecure attachment), therapists are better able to understand the complexity of processing traumatic incidents when there is underlying relational trauma.
Kalsched, D. E. (1998). Archetypal affect, anxiety, and defence in patents who have suffered early trauma. Post-Jungians Today, 84 – 104.