Difficult Work

• Call for questions and comments....... by Jessica Boitman, 10/14/98
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    • The role of attachment in trauma by Diane Suffridge, 11/30/98
      
      

Diane, it is so helpful to have the author, yourself, reply to my posting above in which I refer to your very interesting article. I did not miss the somber note of your reply in which you express the opinion that time and experience have tempered your optimism.

I am very appreciative of the cautionary tenor of your remarks in implicity advising readers here that this kind of clinical work can be demanding and challenge one to explore whatever theory or method may be of use. Although I have no experience as a therapist with trauma patients, I, like anyone who has lived a long while and who has had lots of contacts with lots of friends and acquaintances, have known several severely traumatized persons.

And as a psychologist and educator who tries to provide public information about these and related topics so that we can better understand one another and make the world a little more humanistic in outlook, I have studied the matter somewhat and have some ideas to share with you and other readers.

No doubt none of this is new to you, but others who read this may find something of interest or of value. And it is my hope that you will again have some reactions in which you can correct my comments based on your own much greater experience and closer familiarity with this immensely important issue.

I unfortunately do not have anything to suggest now by way of ideas from attachment theory, which, as you suggest, appears to be an important area for exploring the issue of trauma. Instead, I basically would like to bring together with CMT some ideas on trauma from the works of Van der Kolk and John Briere.

Bessel van der Kolk, a well known specialist in psychological trauma, showed that one effect of trauma may be greater levels of cortisol, a condition that may be associated with difficulty managing intense negative feelings.

Difficulty managing intense negative feelings in trauma survivors would occur, for example, in finding it hard to "resolve" intense fear by verbal reassurances that otherwise may calm persons who are not trauma survivors.

Accordingly, someone with a high background level of emotional responsivity due to truama may find that only a little additional provocation results in intense bursts of, say, fear or anger.

This increased readiness to more frequently and more easily experience neagative feelings may interfere to a considerable degree with the survivor's finding empathic understanding from others. Not finding much understanding, a trauma survivor may accordingly find many interpersonal encounters that fail in that just as one most needs soothing, one is least likely to find it.

Such failures may then lead the survivor to hide one's longing for soothing understanding in order to avoid the recurrence of yet another moment of empathic failure and, thus, of regarding oneself as a defective representative of humankind. The survivor then tries to self-treat the frequent bursts of negative emotional intensity by inhibiting their expression. This is reminiscent of Stolorow's notion of first and second traumas--the first being the original unmanageably intense trauma and the second being the failure of the environment to make possible a means of talking about it in order to experience it in dialogue in the hope of finding surcease.

In short, trauma leaves one with high responsivity to negative emotionality and immense difficulty discussing the problem.

Trauma survivors may report feeling misundestood and thus alienated by ostensible reassurances designed to soothe negative emotionality (e.g., "You'll feel better later; It's not so big a problem as it may seem."). Such commonplace well-intentioned but unavailing counsel may appear to a trauma survivor as proof that others do not and perhaps cannot understand how one feels.

In short, it may happen that a trauma survivor is repeatedly provoked (by inadequately soothing efforts at reassurance from others): (1) to regard oneself as fundamentally defective in being unable to calm onself with ordinary measures that seem to work for others and, as a consequence, (2) to have to continually struggle to hide feelings that seem so hard for others (and for onself!) to understand. These are persons who would easily identify with Albert Camus's statement, "Nobody realizes that some people have to expend a tremendous amount of energy to be normal."

As emphasized by Van der Kolk, conscious cognitive control over intense feelings is difficult for trauma survivors. And based on what I have written above, perhaps a key component of treatment for trauma survivors is working through feelings about occasions of empathic failure in which one's level of intense emotional distress were not understood or calmed.

Trauma patients may also need help keeping their level of background emotional arousal more generally calm in order that they not bo so quickly and easily aroused to intense negative emotionality. Therapists and others may be able to help in this regard by closely monitoring any sign the patient is pulling back from exploring a negative experience or memory that may excite a level of anger, fear, or distrss higher than the patient is prepared to manage.

Without this kind of protective monitoring and help from others, trauma survivors may be too susceptible to experiencing therapy (or any other dialogue in which negative emotions are aroused) as a repetition of the emotional flooding of traumatic experiences.

John Briere is a therapist of trauma survivors who suggests that therapists protect these patients from too much negative emotionality in sessions.

I see this recommeded protection, too, as compatible with CMT in that the trauma survivor, insofar as s/he believes s/he is unentitled to protection, would discover that, instead, a therapist takes measures to protect a patient from anguishing emotional experiences in sessions that the patient would easily experience (and understandable regard) as trauma repetitions until the emotionality can be better managed.

By taking precautions to protect the patient from his/her own emotional lability and high responsivity in sessions--by trying, that is, to have the patient's encounters with emotionally disturbing subject matter kept at small doses that the patient can tolerate--the therapist's actions communicate strong support for the patient's presumed unconscious plan to want to become better adapted to experiences in which s/he feels entitled to protection.

John Briere'a recommendation that a therapist take measures to protect patients from flooding could imply, in CMT, that a patient's blaming the therapist when flooding occurs may represent the patient's unconscious plan to feel entitled to protection from harm. Blaming the therapist is, in effect, a test to see if the therapist will, under circumstances adverse to the therapist, nonetheless uphold the patient's desire for protection. Unlike others in the patient's past, the therapist may pass the test by advocating that the patient is entitled to an environment safe from excessive levels of unmanageable negative arousal--and entitled to a therapist who is a mortal human and thus not infallible but nonetheless truly concerned for the patient's welfare.

Based on these ideas from Briere and Van der Kolk and CMT, the conclusion seems to be that therapy of trauma survivors that encourages sharing negative emotional experiences may suddenly make more intense a patient's negative emotional condition and work against the patient's likely unconscious plan to be able to feel entitled to desire safety from harm. It is inevitable, however, that the patient will sometimes be inadvertently overaroused.

• C-M and trauma work by Michael Simon, 12/11/98