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March 24, 2025 by BHP Leave a Comment

Trauma and disconnection

Dissociation is a term used to describe the mental process of ‘getting rid of’ painful or traumatic feelings by banishing them to a ‘nothing’ place within – for good and for bad. The paradox of dissociation is that in the process of such banishment, far from being shut down, traumatic experience can take on a life of its own. Locked away, our painful feelings are not available for processing and cannot be integrated into a coherent narrative of our history. The consequent effect is that from this place these unwanted feelings may cause us trouble, without us necessarily having any idea of where the trouble is coming from.

A small child will learn early how to dissociate in the face of overwhelming traumatic experience, as a means by which to survive and to keep trauma out of narrative memory. Should that child find themselves in therapy at some later stage in their life, it is unlikely that there will be a ‘whole’ story of what happened to them available for recovery. It is more likely that memory of traumatic experience will present as disconnected and scattered fragments. Strewn across an internal landscape these scraps of memory may still be signalling distress through here-and-now symptoms: psychological, emotional, physical and relational.

Strategies for survival

There are many ways someone who has experienced trauma might attempt to discount or disconnect from uncomfortable or distressing memories and the feelings associated with them.

Emotional numbness, self-medication, overwork, addictions or psychosomatic illness are amongst the (out of awareness) strategies that can maintain the disconnect. The trouble is that when we are unable to connect to ourselves, we will likely struggle in our connections with others, and this is what can keep the effects of early relational trauma alive. When early experience of traumatic events leads to emotional disengagement and disconnection, this system of relating is likely to be replicated in the here and now, long after the original threats have passed.

Shame

A powerful after effect lingering in the shadows of relational trauma is shame. Shame is corrosive and debilitating and when in its grip we are diminished, privately believing ourselves to be defective. When a child can’t make sense of bad feelings an obvious conclusion is ‘there’s something wrong with me.’ Dissociation and disconnection, once the only option for survival, today prevents us from accessing and integrating painful feelings. This we carry as shame; a dirty little secret that controls us from within. On the outside shame might masquerade as anxiety but it’s likely an anxiety that breeds more shame: shame about the amount of work it takes to ‘keep a lid’ on things, to present a together and coherent face to the world; shame about the habits and obsessions that keep anxiety under control; shame about being isolated; shame about interpersonal difficulties. Shame colonises a fragmented psychic landscape and hijacks our interpersonal potential.

Remembering-with

Remembering, in therapy, how bad things once felt is a significant emotional risk for the dissociated client, especially when so much energy has been spent in putting difficult experience out of sight and out of mind. The attuned, sensitive and empathic therapist will understand the magnitude of risk that a client might feel. Remembering ‘with’ is not the same as revisiting traumatic events in (gratuitous) search of catharsis. Having someone bear witness to and validate all the pain, carried for so long and all alone is transformational. It is the way that pain is transformed into grief, and in its way, grief is the opposite of dissociation. In our grieving we can integrate past and present meanings and feelings, and it is in this way that we might finally lay trauma to rest.

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

 

 

Further reading by Gerry Gilmartin – 

Therapy and art… an intersection

Cultivating a tolerance for uncertainty

The importance of generosity and forgiveness in a hostile world

Understanding sexual desire

Reflections on freedom and security in a turbulent year

Filed Under: Gerry Gilmartin, Loss, Mental health Tagged With: complex trauma, Post Traumatic Stress Disorder, Trauma

July 12, 2021 by BHP 25 Comments

‘The Wisdom of Trauma’ a film by Gabor Maté – A Critical Review

Both the name, Gabor Maté, and the word, trauma, have become synonymous and ubiquitous in recent years.

Dr. Maté is a Hungarian born physician and author of ‘In The Realm of The Hungry Ghosts’, which was first published back in 2008 and offered a compassionate and insightful understanding of addiction as a response to trauma. Since then Dr Maté has steadily risen to fame as an addiction and trauma expert. He has now released a documentary film entitled ‘The Wisdom of Trauma’, which was brought to my attention by a couple of my clients. I decided to watch it.

The film follows Dr Maté on his journey of defining trauma, most specifically, childhood developmental trauma (CPTSD) and covers his work and learnings from treating street addicts in Vancouver’s Downtown Eastside.

As a mental health professional and clinician, I am all in favour of any well-researched productions that aim to highlight the impact of CPTSD, educate the masses and ideally bring about change at a societal level in how we conceptualise trauma and treatment. I therefore had high hopes for Dr Maté’s oeuvre. Sadly, as the film progressed, I became increasingly uneasy with the content and was ultimately left with the impression that the film was more about glorifying Dr Maté and his self-professed ‘new’ trauma informed approach to treating trauma, than a piece of work aimed at bringing together the teachings and learnings of many clinicians over the years on whose shoulders Dr Maté, like the rest of us, stand (see Alan Shore, Babette Rothschild, Pat Ogden, Steven Porges, Antonio Damasio, Daniel Siegel to name a few).

There is a powerful sequence in the film filmed in a prison where Fritzi Horstman, founder of the Compassion Prison Project, undertakes some meaningful work with inmates based on the ACE principles (see Adverse Childhood Experiences study 1995 – 1997, conducted by Kaiser Permanente). The work of the Compassion Prison Project is clearly meaningful, research based and healing, however, the link between this project and Gabor Maté remained at best utterly unclear and secondly, there was no reference to the original ACE study and the importance of it so viewers were left in the dark around context and thus perhaps invited to imagine that this was somehow connected to Dr Mate. To be clear, the ACE study has nothing to do with Dr Maté.

As the film progresses, Dr Maté moves into sharing his experiences of healing through the use of psychedelics, namely Ayahuasca, with footage shown of a ceremony taking place in Peru. The study of psychedelics and their possible use in treating mental health problems is in its absolute infancy and the research being conducted is done so in strictly controlled environments where participants combine the use of medical doses of psychedelics with psychotherapy – no mention was made of this. Whilst promising in specific clinical settings (as opposed to the Peruvian rain forest) and for specific applications, psychedelics can potentially do more harm than good,
particularly for patients with weak egos or personality disorders. There also remain valid questions about the long-term benefits of psychedelics in treating trauma, with most studies showing that symptoms tend to return over time once psychedelic use was suspended (generally 6 months to a year).

There is then a sequence wherein a man in his early 50’s with a stage 4 prostate cancer diagnosis appears to enter into remission through therapy with Dr Maté with the implied cause of his previously terminal illness being put down to trauma. I am a clinician who profoundly believes in the body-mind connection as have many more learned clinicians before me (see Winnicott and psyche-soma integration), however, whilst our emotions are experienced through the body and the ACE study has shown correlation between adverse childhood experiences and illness,
correlation is not the same as causation.

Finally, there are numerous sequences where Dr Maté is conducting his own brand of ‘trauma informed therapy’ which he suggests is in some way unique and the way to heal trauma. And yet again, trauma informed therapy is neither a new phenomenon nor something that has been invented by Dr Maté; indeed, any well-trained and experienced psychotherapist who works with trauma (and we all do), should be educated in understanding the presentation and defensive structures around CPTSD.

The message of the documentary – a trauma informed approach to healing society as a whole – is a positive one and yet despite his profile, I was disappointed to see how Dr Maté fails to engage and influence policy makers, educators, physicians and mental health professionals and actively seems to undermine his own message through an irresponsible focus on psychedelics, terminal illness being healed through trauma talk-therapy and a guru-esque approach to practicing his own therapeutic approach.

The sad reality of relational trauma is that it occurred in relationship and so can only be treated and worked through in relationship. And working through is not necessarily the same as ‘healing’.  Good psychotherapy is painful and slow and the main reason it takes time is because the traumatised part of the patient (client) needs to overcome resistance and form a dependent relationship on their therapist; thus the client dictates the speed of therapy.

The Wisdom of Trauma seemed to me to subscribe to an all too common narrative of recent years – there is a ‘fix’ for everything and it can be quick. This is not my experience of working with trauma and nor is it that of my clients, many whom learn to live with their trauma rather than somehow leave it behind. Perhaps a better title would have simple been: ‘The Wisdom of Gabor Maté’ as the documentary was essentially about him and his views, despite the enormous work in this field undertaken by the likes of Freud, Winnicot, Bowlby etc., all the way through to ordinary psychotherapists like myself and all my ‘ordinary’ colleagues.

 

To enquire about psychotherapy sessions with Mark Vahrmeyer, please contact him here, or to view our full clinical team, please click here.

 

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy.  Mark is available at the Lewes and Brighton & Hove Practices.

 

Further reading by Mark Vahrmeyer

‘The Wisdom of Trauma’ a film by Gabor Maté – A Critical Review

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

What is the purpose of intimate relationships?

Why ‘Cancel Culture’ is about the inability to tolerate difference

Filed Under: Mark Vahrmeyer, Mental health, Psychotherapy Tagged With: complex trauma, Gabor Maté, The Wisdom of Trauma, Trauma

February 8, 2016 by Brighton & Hove Psychotherapy Leave a Comment

What doesn’t kill us makes us weaker: Developmental trauma and attachment styles

There is a lot of wisdom in sayings that have been part of our language and culture for as long as we can remember.  For example, being ‘on the back foot’, meaning to be at a disadvantage or on the defensive, is a perfect expression of how our relationship to our body influences how we relate to ourselves and the world around us.  Likewise, to have a ‘gut feeling’ about someone or something, is really very profound as our emotional system (our unconscious) resides in the body and expresses itself somatically through, amongst other parts of our body, the gut.

However, one expression I come across quite often that is not only incorrect but also harmful is ‘what doesn’t kill us, makes us stronger’.  It is an expression which is frequently accompanied by a disavowal of any felt emotion in relation to the event being described and suggests that somehow we grow stronger and more resilient through trauma.  The latter is particularly true of childhood developmental trauma where an individual has been regularly misattuned to, neglected or abused.  In the case of developmental trauma, what doesn’t kill us makes us weaker and less adaptable to the realities of life.

Developmental trauma, also known as complex trauma, arises ‘when caregivers are emotionally absent, inconsistent, frustrating, violent, intrusive, or neglectful, children are liable to become intolerably distressed and unlikely to develop a sense that the external environment is able to provide relief’ – Dr. Bessel van de Kolk (2014).  Developmental trauma directly impacts on cognitive, neurological, psychological and immunological development of infants and maps onto our attachment patterns in later life.  In other words, we grow our brains and minds from our early experiences with our primary caregivers which lays down a belief system about ourselves, about those around us and about the world in general.

A little about attachment

OK, so developmental trauma correlates to attachment patterns.  What are attachment patterns and why do they matter?  It is generally accepted that there are four types of attachment: secure; avoidant; anxious-ambivalent; insecure-disorganised.

If a parent has been available to their infant and able to attune to their child’s needs, the child learns that it is safe to turn to that parent in order to seek soothing and reassurance, and then safe to turn away and carry on exploring the world when they feel calm again.  This child is securely attached and will likely carry this attachment style into his or her adult relationships.

The other three attachment styles are all classed as insecure and arise from childhood developmental trauma.  Avoidant infants learn that they need to be self-reliant despite their anxiety; Anxious-ambivalent children seek out their caregiver but fail to be soothed through a lack of attunement – they pick up their mother’s anxiety; children with disorganised attachment feel enormous conflict in their main attachment relationship wanting to approach for security and feeling frightened of doing so.

Attachment patterns matter for a whole host of reasons, however, on the most fundamental level, attachment patterns dictate whether we are able to use relationships (with ourselves and others) to regulate our emotions, arousal and anxiety.  An inability to regulate our arousal state means it is more likely that we will suffer with higher levels of anxiety and be predisposed to emotional, mental and physical illness.

Thus, in the context of trauma, attachment and our relationship to self and other, what doesn’t kill us progressively makes us weaker.

The role of psychotherapy is to help individuals process trauma and through the therapeutic relationship start to challenge attachment styles and patterns.  It is possible to shift over time from an insecure- to secure attachment pattern.

 

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice and palliative care.

Face to Face and Online Therapy Help Available Now

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Filed Under: Attachment, Mark Vahrmeyer, Mental health Tagged With: Attachment Styles, Bessel Van der Kolk, childhood developmental trauma, complex trauma

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