Publish at March 30 2022 Updated April 29 2022
" As long as there is life, all trauma is curable. "
" Brain plasticity to reshape neural networks is now recognized as infinite. "
As I began writing this column, music came on all by itself on the computer: Amma, Love is the answer. An amazing message for a thesis that concerns how to address and transform complex and chronic trauma, one component of which concerns the dimension of connection and attachment.
Already this thesis by Hélène Dellucci had come up in research with the keyword " succeed ".
How indeed to succeed in refounding one's existence when one has experienced trauma? Trauma. A big word that quickly brings to mind representations of brutal shock, of break-in, of injury as its etymology invites us to do: τραυματισμο, trauma, action of injuring.
But this word also concerns situations of people who have experienced more or less early disorganized intra-familial ties, mistreatment, transgenerational memories or other situations experienced by them, sometimes forgotten, that they have not been able to integrate and that still act in the foundations of their lives.
In order to continue to function in a survival modality on a daily basis, people in traumatic situations put aside a part of themselves with a high emotional charge, which they cannot integrate in order to learn from it.
This is not voluntary, it is like a way of protecting a precious treasure that they will know how to retrieve when the environment is stabilized and welcoming, and possibly after therapy.
This process of dissociation is a distancing of a part of oneself from one's consciousness. A dissociation of consciousness is not necessarily a dissociation of personality. It is therefore not a psychosis.
Dissociative processes can be more easily recognized within certain institutional contexts of child welfare, adolescent welfare, addiction centers, systemic discrimination, in the histories of our colonial or colonized countries.
They can be spotted as well as made invisible by people who will have learned to put on a show and who, doing the best they can with the resources they have, " are often left in the loneliness of noticing that they are not functioning as others do, while being unable to do anything about it ".
These are people who for example need more to recuperate between emotionally taking events. It can just be a time to relax with friends, when the trauma is about relationship building and bonding.
Their " window of tolerance " is thinner:
" The larger our window of tolerance, the more we are able to experience strong emotions without going through survival reactions as a result. "
" During a period of crisis, if we are in pain, we can imagine that the window of tolerance is reduced, thus considerably decreasing our capacities to be in connection, to face emotional stimuli. Our abilities to learn and integrate are curtailed in favor of what we would call survival reactions. "
This has consequences for how we go to school, how we network, how we build a family life. The energy to get into a basic connection is then greater than for most people. People with complex trauma have an " heightened sensitivity for inconsistent messages and power-grabbing " and respond to it " either by trusting or immediately withdrawing ".
Without mentioning these repeated situations, as long as the trauma is reactivated, the survival methods are in place. And these people can become so adept at survival that they won't imagine that there could be any other modality of existence. It's played out at a level below consciousness.
For people whose profession is relationship, even without being a therapist, it is interesting to read this thesis, which allows us to put psychotraumatology back together and to discuss in depth the most efficient methods to approach and heal it: here EMDR (Eye Movement Desensitization & Reprocessing) refocused in an integrative modality of the competence dimension (Brugge model).
Beware, however, for those involved to be mindful of their own emotional responses. And therefore, if one is too directly concerned, take care to have or have had appropriate therapeutic support. You can find your own clinical vignette or an approaching clinic by reading the thesis. It's also rich in learning.
This brings us to the essential and primary stabilization for any intervention in a psychotrauma clinic. The researcher was a trauma nurse in intensive care. She has observed that bodily responses can be very different from speech. The focus on the body has remained in her practice as a psychologist:
" If the body can soothe itself then we are well on our way."
The first step is to stabilize complex patients with a traumatic dimension, by setting up a securing and anchoring through the body: through breathing exercises, body scans, anchoring. By being oneself in a calm and receptive body modality (mirroring neurons).
This first gives a sense of security, conducive to the work, and it allows one to refine one's body awareness and to calm it down. And then it's about building attachment and restoring the ability to hope and have prospects for the future.
One of the models that underpins the researcher's therapeutic practice is the Bruges Model. This one values skills over a problem dimension approach:
" Survivors of complex and chronic trauma have already done the basics to stay alive. Beyond survival, they seek us out to move to another dimension. "
This model proposes three fundamental questions, which guide the therapeutic path:
It is useful to read the whole thesis to know how, in our own practices as teachers, sophrologists, trainers, therapists, the methods and tools echo our own ways of doing things.
How, for example, the Bruges method allows us to establish a therapeutic alliance that mobilizes the patient in a bond of expertise of his or her own history and collaboration.
This work explores in several places and under several lights the need for the therapist to work on his or her own practice in the framework of supervision or intervision. It is punctuated by articles and clinical vignettes that illustrate both the pitfalls and the solutions found.
To measure the commitment to both mastery of practice and navigation of the unknown, the author quotes a patient, Julie:
" Such a therapeutic journey would be like agreeing to navigate in the middle of the night sea, without any visibility, without a pre-established map and being able to apprehend the obstacles that arise in front of you at the moment of their irruption, being able to draw a map as the journey goes on, accepting to feel lost without losing hope, holding on to the envisaged course while agreeing to modify one's route and one's way of navigating as one goes along, according to what comes up, adjusting one's speed according to the hazards one meets. "
The dissertation describes how the presence of patients under the complex and chronic psychotraumatology umbrella has led to the creation of tools and adaptation of methods, including EMDR, an already recognized practice for treating trauma - Eye Movement Desensitization and Reprocessing.
It is interesting to read that the method was discovered " by chance " by Francine Shapiro in 1987, while walking in a park. She noticed that intrusive negative thoughts lost their strength as her eyes moved in a certain way to explore the landscape. Kind of like how we can heal ourselves by riding the train...
" How did I do that? " was the anchor of his scientific research to understand, structure and develop the method whose " premise is based on the body's self-healing methods ".
The protocol was practiced and then redesigned with an eye toward adapting it to chronic patients and transgenerational traumas.
The redesign focused on:
The redesign also incorporated work using letter writing, proposed by a creative patient who did not have the financial resources to unfold the entire method in a longer modality.
The researcher finally proposed a bi-axial model of EMDR intervention, with an emotional and a bonding axis. This model allows the degree of exposure to be tailored to what the person is able to address.
Blocking...
" the goal of therapy could be the restoration of integrative abilities "
The emotional axis, with the gearbox:
The bonding axis:
Therapy follow-up materials are offered: on page 332 an extended targeting plan, on page 371 a resource CV.
" Whatever the therapeutic methods chosen, we invite each professional to follow the rules proposed in psychotraumatology, leading to giving the body a prominent place, inviting it as a co-therapist rather than considering it as a hindrance to the process. "
Illustration: Patti Black from Unsplash.
Hélène Dellucci, An integrative approach in EMDR psychotherapy of complex trauma and dissociative disorders with adults, Psychology, University of Lorraine, 2016.
Thesis available at: https://www.theses.fr/2016LORR0326
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