Defining “Trauma” Part 4: A Way Forward
Humans are staggeringly resilient. As a therapist, it’s important to have curiosity and compassion for what my patients have endured and to believe in their ability to grow and stretch and reach past where they are currently. It’s important to relate to a patient's defenses and hacks they have come up with on their own to survive as expressions of their resourcefulness. A common inspiration that brings patients into treatment is when their hacks no longer work and when they are faced with a quandary that they cannot figure out on their own. Often, this has to do with relationships.
Friends, partners, lovers, bosses, coworkers, children, family members, even that guy that keeps bumping into you on the A train- you name the relationship, it’s been talked about in therapy. The single most thing I spend talking about with my patients in treatment are their relationships. As humans, our relationships are the source of our greatest joy and our greatest pain. The desire to have healthier and more fulfilling relationships is a great motivator for a patient to want to get better.
As I’ve written about previously, humans gravitate towards what is familiar. This is great news for some, those lucky enough to have had good enough caregivers and environments growing up to have created a secure base. However, for those who were not so lucky, they may end up recreating abusive or insecure relationships and still be left with some very strong defenses from growing up designed to keep out the bad but instead keep out the good.
I often grapple with questions about relationships alongside my patients such as: Why do I keep ending up with people like this? Why do I feel so alone in my relationships? What does healthy conflict look like? Why am I so triggered when my boss does x?
In an effort to answer these questions and identify “the” problem, my patients and I slowly and organically flesh out what their relational pattern is. We do this for three very important reasons. First off, it’s hard to find a solution to something until you have thoroughly understood the problem. Secondly, when a patient is able to realize and internalize that they are in the middle of a pattern, it can give them some emotional distance and help them be less reactive when they realize that the pattern is playing out. Lastly, whatever they are doing in the current day can give us important information about what they experienced in their earliest relationships.
As my patient and I dig into this process, we begin to relate to feelings and incidents that arise in relationships as important pieces of data on our journey to create more secure and stable relationships. This takes a lot of labor on the part of the patient and an orientation of ownership; even if things were done to my patient that are hurtful and unfair, they are the only ones who can do the work to heal and they are accountable for their actions.
Owning their process and their actions is key but can be really hard. Coming to the realization that you are recreating painful dynamics in relationships can make someone feel hopeless and full of despair. There is a need for a lot of mourning in regards to basic things that one did not get growing up. Even with the right type of care and support both in and outside of the therapy room, an adult will never get another shot to be a kid again. There’s no redo.
Additionally, there can be something a little controversial about the type of ownership I aim to inspire in my patients. As I touched on in this piece, it can be a tough sell to say to someone coming out of an abusive relationship, “this has been painful and I am seeing how broken you are feeling. When you are ready, we will need to reflect on why you chose this person and participated in something abusive for as long as you did”. The best thing you can do for someone who has been victimized is to teach them how to be smarter and more self protective and to discover alongside them how to help them gravitate towards people who will treat them with care and respect. Most importantly, if you don’t relate to someone as capable of growing, they will not grow.
It is absolutely imperative to make space to explore the things that a patient has done in a relationship that has been hurtful or harmful to someone else. This should be done neutrally, without judgment or shame and a ton of compassion, however, without sugarcoating that they have been hurtful. If a patient is being very hard on themselves and is steeping in shame, helping them understand why they did what they did can help to dissolve some shame and use their feeling bad as motivation and fuel to grow and act differently in the future. This also gives the patient an opportunity to experience what loving accountability feels like, which can be a reparative experience in itself.
For me, “trauma-informed” means to understand what trauma is, all of the forms that it can take, and that it has a big impact. People don’t feel things for no reason. Whether the root of someone’s emotional reaction is obvious or not, it’s important to keep in mind that their reaction is coming from somewhere. We should have a lot of curiosity and compassion for someone else’s experience but also relate to them as having the capacity to grow and stretch and to learn how to do new things.
