Trauma

As a therapist who is always learning more about what is and isn’t therapeutic…

I start this blog post with a brief foray into the root of the word ‘therapy’ itself, moving toward a more somatic, metaphoric sense of its meaning. The noun ‘therapy’ derives from the ancient Greek verb ‘therapeuein’: ‘to be an attendant,’ someone who attends, joining the prefix  ‘ad’ (toward) to the verb ‘tendere’, (to stretch, or lean), in other words ‘ to stretch toward, to get closer to.’  The etymology implies that a therapist stretches toward their client, stepping into their experience, feeling into it (em-pathizing), to feel what they feel, to experience how they experience. 

“What is most therapeutic is to resonate with the person you are tending to…”

This brings us close to the therapeutic approach of trauma therapists like, Diedre Fay, who teaches that what is most therapeutic is to resonate with the person you are tending to, which is the essence of successful attachment.  Fay and D.W. Winnicott preceding her and writing in the 40’s through the 60’s, root this capacity in the attuned mother’s skill at registering and experiencing her nonverbal infant in a way that accurately reflects back to them what the infant experiences as their own inner, as yet wordless reality. The baby then reinternalizes and identifies with this reflected image of them as a ‘self.’ When the mother’s mirroring is accurate rather than projective and pre-emptive, the infant establishes a secure base of identity, because what they get back is close enough to what it feels like to be them: smiles and playfulness when they are happy, but concerned distress, when they are in pain. When this identity-forming function of reflection misses or negates what the infant is actually experiencing inside, they identify with an image that is not them.  Later in life, a therapist or attuned partner may make up for the resulting lack of affirming connection to ourselves.  When optimal, this act of mirroring attaches us to others and makes us into trusting social beings from the very beginning of life. When not optimal, we unconsciously assume identities and beliefs about ourselves based on what others pressure us to be, resulting in self-alienation.

The American Heritage Dictionary, in spite of its deep attention to etymology, offers the following definition for ‘therapy:’  the treatment of illness or disability.  And even ChatGPT translates the etymology to signify a much more active, instrumental function aimed at fixing a deficit or fault in the person being therapized, all in keeping with the Western medical model of fixing disorders- rather than offering a developmentally missing experience of attunement from someone capable of it. This capacity is the essence of parental love and the opposite of narcissistic parenting in which the parent reverses roles and looks into the mirror of their child to see themselves, having failed to receive adequate mirroring themselves at the beginning of life.  The narcissist’s parent’s unmet internal baby looks to their own children as the missing parent who will affirm them.  The healing assumption of the attuned, resonant therapist is more likely to be that the solution to a patient’s psychological distress lies within the patient’s own selves, who more than anything need a quality of attunement that helps them notice and engage the solutions within. rather than presuming the need for a fix from the outside.  This approach enhances agency over dependency.

Therapy for Relational Trauma

It is important in the treatment of trauma to distinguish between event trauma and relational trauma, the very distinction that characterizes the difference between PTSD (Post-traumatic Stress Disorder)  and CPTSD (Complex Post-traumatic Stress Disorder).  While PTSD is defined as the intrusive and overwhelming impact of our external environment -ranging from natural disasters to bodily assault-, CPTSD is the result of extreme and chronic misattunement of a parent to their child, depriving the traumatized child of the very attention they need to recover from event trauma like sexual abuse.  Since this attunement is missing by definition in the adult who abuses a child, the lack of it from the parent they look to for protection often feels more damaging than the abuse itself, because it undermines identity and the right to own our own experience.

Therapy for relational trauma needs to be based in attunement that provides the healing experience of coming home to an authentic and secure sense of self, through seeing me accurately reflected in your reactions to me.  Left to our early coping strategies in the absence of attunement, life, and relationships tend instead to reinforce a sense of self or set of selves that are anxious, ambivalent or disorganized, insecurely attached, and above all, sacrificially other-oriented at our own expense.