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The Middle Ground

Trauma

There’s No Reason to Celebrate Trauma

But there have been advances in treatment.

Posted Nov 16, 2015

Note: This article is dedicated to the victims and survivors of the city of Paris, 11/13/15.

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Source: Google Images

New paradigms, not only for the way we think about trauma, but in how we think about emotion itself, social engagement, empathy and memory, have swept the psychotherapy field. And innovations based on these new understandings have first become assimilated into the trauma field and then influence virtually all other treatment modalities—from ‘standard’ (unspecialized) psychotherapy practices to couples and family work and more.

Is traumatic memory different from normal memory? How and why are traumatic memories relived—re-experienced as flashback, as if the trauma were re-occuring in the present? Why are they not simply recalled, remembered, as events understood to have happened in the past? Can traumatic memory be reprocessed so that it can be recalled as memory without being re-experienced? Or is a trauma survivor destined to always relive their horror as if it were occurring again and again in the present?  How does the brain accommodate destructive experience and, to the extent possible, preserve personality structure? Only within the past thirty years have answers to such questions emerged on the basis of scientific data rather than theoretical hypothesizing. These cutting edge perspectives first become assimilated into trauma treatment and then reach the rest of the psychotherapy field.   

Pioneering writings—of Philip Bromberg, Steven Mitchell, Thomas Ogden, Christopher Bollas and others—bring a reconceptualization of Self to the forefront. A revolution in theory of mind conceives of the Self as a constellation of inner self-states. Each self-state, or sub-identity, carries its own individuality, character and purpose. The therapist’s goal is not to unify the parts but to help the client harmonize them. Note: this view involving a multiplicity of selves describes normal development and should not be conflated or confused with Multiple Personality Disorder, a pathological condition.

Cognitive and behavioral techniques have earned their place in the pantheon of effective psychotherapeutic theory and practice. A preponderance of neural pathways originate in the limbic system, the emotional center of the brain, and are unidirecitonal. These pathways deliver messages to the cortex which is associated with all manner of higher-level cognition. The influence that the emotional center of the brain exerts on the cortex is implicit in the very structure of the brain's wiring. Messages flow from the limbic system to the cortex and not the other way around. Given that the limbic system is believed to have evolved approximately 500 million years ago and the cortex only 5 million years ago, this makes sense. Research findings indicate that decision-making, planning, as well as meta-cognition—thinking about thinking, thinking about feeling—are not only under pervasive influence of emotion; but that emotion effectively trumps cognition as the pathway to psychological healing. The felt-sense, the incipient wisdom of the body, outweighs the cognitive realm as a portal to restoring health. And this sea change in perspective, once again, is spearheaded through clinical applications innovated from within the trauma field.

Clarification: Antonio Damasio and other neuroscientists have detailed ways in which all parts of the brain—including the most primitive, the brain stem—communicate with and influence the functionality of all other parts. The distinctions made above regarding where the emotional and cognitive centers of the brain are located then, need to be understood as meaningful but not meant to obscure the profound sense in which the interconnection between all brain parts affect one another.

Clinical approaches that favor a bottom up approach (unconscious or felt-sense to conscious awareness) rather the reverse are precisely the type of treatments that have been developed within the trauma field; to name a few: EMDR (Eye-Movement-Desensitizataion-Reprocessing), SE (Sensory Experiencing), the other SE (Somatic Experiencing). These challenge the status quo in other modalities.

Richard Schwartz’ treatment method, called Internal Family Systems, presupposes the theory or mind (multiplicity of self) discussed above. Schwartz developed his approach in work with anorectic clients, his clients had significant trauma in their experience. Because of its effectiveness, Schwartz’ approach has been adopted by many trauma therapists. Schwartz repurposed the method himself to extend its use to couples therapy.

In the Jewish tradition there is a saying, “The truest measure of the worth of a community rests with how well they treat their most vulnerable members." The idea behind it is that helping those in need elevates collective morale. Victims of trauma rank among the most vulnerable in our society. The innovation in treatments that meet their needs lifts all.

New Yorkers remember the tone of the city immediately following the events of September 11, 2001. The streets had never before been so neighborly. The approach of a stranger, in the aftermath of the terror attack, was likely to be experienced as a demonstration of concern and not arouse suspicion of intent to pick a pocket or pose some other threat. Trauma work reinforces our need for one another and can bring out the best, most heroic, in many of us. In the aftermath of the November 2015 horror in Paris the increased array of trauma-alleviating treatments abets a hope that relief from the stunning pain and grief is within the realm of possibility even though events were so grim and dangerous.

Rosemary Masters, LCSW, JD, founder of the Trauma Division at ICP (the Institute for Contemporary Psychotherapy) has led expeditions to Uganda yearly for close to a decade. She and others have been training Ugandans to administer trauma therapy to their own. In a land torn by war and on-going brutality, in which many were pressed into service as child soldiers, there is much to trauma to overcome. It makes me proud to be affiliated with ICP and its Trauma division. Here is another type of leadership that many in the trauma field exhibit; sheer courage in facing adversity and its impact. As a couples therapist, I feel empowered by the clinical breakthroughs derived from the trauma field. The City of Lights still flickers in the aftermath of carnage. There are few heartening signs on the horizon, progress in the treatment is one.