[“Unlike traditional models of treatment, the assumption in neurobiologically informed trauma treatment is that clients are just as likely to be dysregulated by therapy than to feel “safe,” more likely to come to therapy with limitations imposed by trauma-related hypo- or hyperarousal, sensitivity to triggering, and some degree of structural dissociation. The most complex regulating challenges are posed by clients with dissociative disorders and more severe structural dissociation (see Chapter 8 on Treatment Challenges: Dissociative Systems and Disorders).
Tessa came to her first therapy session with a very sophisticated question, “How does one deal with the effects of attachment trauma in personal relationships?” But as she talked about her new dating relationship, it became increasingly clear that she was describing structural dissociation: “I really like him, but when we’re together, I start feeling very ambivalent. I begin questioning: should I have come on this date? Should I let him hold my hand? What if he becomes sexual?”
The picture she described suggested conflicts between several parts: a part that liked him and longed to be his girlfriend, a part that pulled away and began questioning as soon as things got closer, a part that wanted sex, and a part disgusted and frightened by the thought. “So I keep my distance when we’re out taking a walk, but then I get home to an empty apartment, and I feel a longing for him, and I wish I’d let him take my hand. I hate this—I can’t think about anything else at home, but then I get ambivalent in his presence.”
ME: “Of course it’s a battle …” I knew that validating the normality of her internal conflicts would help her feel understood. “How could it not be? This is what relational trauma leaves as a legacy: the terrible longing when you’re not together and a ‘yuck, don’t get too close’ feeling in his presence.” The “of course” is said with conviction but also a softness and sadness. “How could it not be?” is said with a smile that normalizes and lightens it. “Terrible longing” conveys the yearning in its tone; “yuck” is equally spoken with conviction but also toughness. Both are expressed as if each is entirely normal and to be expected.
“What generally happens next?” I ask.
TESSA: “I don’t know … I try to be honest about my ambivalence but at the same time, he’s all I ever think about … Usually, these guys stop returning my texts and emails, and I don’t know why, so I get very upset and keep texting to explain myself. And then I get brushed off. He isn’t ready for commitment either, he’ll say. But what’s the ‘either’? What makes him think I’m not ready for commitment?” [Note that she is out of touch in this moment with the part of her that speaks openly to her dates about feeling ambivalent.]
ME: [Again, I mirror her words so she can hear herself better:] “So the ambivalent part discourages him, and then the part that yearns for connection encourages him—the guy must get very, very confused!” [Laughs softly.]
TESSA: “Why do you keep talking to me like I’m some multiple personality?” she suddenly says in a new gruff, irritated tone.
I use an authoritative but empathic tone: “Because I can hear both sides in your story, Tessa. Both sides of you are there. This is what happens when we have relational trauma when we’re young: a battle starts up inside whenever we might possibly, maybe get close to someone.” [The last few words are said with a tone of regret or sadness.]
If clients like Tessa are willing to embrace the structural dissociation model, learn to consciously and voluntarily “split off” the intense affects and assign them to younger, more vulnerable parts, they can achieve the necessary mindful distance to feel some relief without having to resort to denial or disconnection. Only when they are able to “see” the parts in these paradoxical responses will they be able to begin healing their wounds.”]
janina fisher, from healing the fragmented selves of trauma survivors: overcoming internal self-alienation, 2017
