Emotional, spiritual, and physical struggles faced by individuals who come for psychotherapy frequently find their origins in painful, frightening childhood experiences. People whose minds and bodies are still in a state of trauma, or who are living according to childhood survival tactics and rules of cause and effect, often lack the skills needed to lead healthy lives and have satisfying relationships.
A common defense mechanism employed to cope with intense helplessness, terror or rage that accompanies childhood trauma is dissociation. Symptoms can include feeling detached from the moment or one’s body, feeling emotionally numb, re-experiencing physical sensations of a trauma, or regressing mentally and emotionally to a younger age. Episodes, often triggered by situations reminiscent of a painful early experience, can be persistent and intense, interfering with daily functioning.
Age regression episodes can be so emotionally crippling that they are commonly what drives people into psychotherapy. Often the individuals don’t even know there is a name for what they are experiencing. Regression can include spontaneous changes in voice, posture, emotional state, ability to stay in touch with reality, converse rationally, or care for oneself. Behavior is childlike. Speech can become repetitive and robotic, such as “I can’t, I can’t!” or “I hate it, I hate it!” Anxiety and hopelessness take over. Dangers and cause-effect rules from childhood become one’s current reality, despite evidence that the current situation is safe. One responds to perceived threat through long-practiced avoidance methods and by reenacting childhood roles. In fact, the entire episode is a flashback to an early traumatic situation. The ability to use skills, problem-solve, or carry on a conversation can be extremely limited.
During an episode, there can be a lack of awareness that a shift is happening, or one may be aware in a numb or detached way. It is not uncommon for a therapist to hear, “I’m not here right now.”
In treating dissociative disorders, education is key. After listing symptoms, identifying current and past stressors, and creating a family tree in which dynamics are discussed, it can be empowering for a psychotherapist to give an impression of what may be playing out. Psychoeducation includes explaining that people dissociate to cope with an experience too overwhelming to handle in an adaptive way, especially if reminiscent of past trauma. Goal-setting and a preview of what will occur avoids uncertainty around not knowing what to expect. Clients are encouraged to take notes to stay clear and grounded.
Therapy for dissociation focuses on: a) identifying what signals the beginning of an episode; b) practicing skills to reduce severity and duration; and c) slow exposure to and processing of emotions being avoided through this coping mechanism.
Since control is a major issue for survivors of abuse, learning new ways to control symptoms can be empowering. Tools to get grounded in the reality of here-and-now and self-soothe include: breathing exercises, meditation, improving mind-body connection, distraction and focusing on neutral stimuli in the room. These can also reduce hypervigilance practiced since childhood. Cognitive therapy can help establish factual evidence of a threat and reframe interpretations of situations. Practice occurs in session and at home.
Mastery over internal experiences is also crucial to replacing childhood helplessness and uncertainty with clarity and mastery. The first step is to understand the difference between: feelings, flashbacks and behaviors. This may look like: I felt worthless, heard my father telling me I’m bad, felt my eyesight blur, and reacted by yelling criticisms. This is a far cry from: I don’t know. I felt overwhelmed. It was so bad, I can’t! I hate myself! I can’t!
A child who did not have words for, or a safe place to verbalize feelings, grows into an adult lacking clarity about feelings. Having a list of negative and positive emotions and keeping a log scoring intensity builds familiarity.
Ultimately, dissociative episodes will not be eliminated until feelings about oneself being avoided through dissociation are faced willingly. Deeply painful “I am’s” from childhood can include: unsafe, abandoned, not good enough, worthless, unacceptable, unlovable, bad, vulnerable, nonexistent, used, helpless.
The next step is to delve into the crucial concept that the ultimate fear isn’t of a situational danger; rather, that the “I am” being attached to a situation might be true. For example, one who dissociates when someone is displeased with them is not reacting traumatically to the displeasure, but to a belief: “I am bad” or “I am abandoned.” Thus, one must differentiate between what it’s about and what it’s really about. Having grasped that triggers must be changed internally, in lieu of futile attempts at changing another person, one can begin identifying the roots of these “I am’s” and then release these meanings.
Redirection, pacing, and encouragement prevent dissociation as past experiences and associated “I am” feelings are explored. One learns to hear that “inner child” without becoming him/her. Writing, drawing, or even acting out stories can help clarify painful memories being triggered, deepening the concept that it is not the current situation that is traumatic, but something old. Eventually a small list of “I am’s” will become so familiar, that one will see clearly when they are being activated.
The work of disbelieving childhood “I am’s” is a battle of bravery and willingness. “But they are my parents! I must have caused them to treat me that way!” The idea that one’s parents were unstable, not attuned, incompetent, neglectful, abusive, etc. is grief-laden. Mourning and self-forgiveness need to occur. The idea of mentally shifting responsibility, feelings of not being good enough, and shamefulness off oneself, is akin to relocating a mountain. As painful and terrifying as these “I am’s “ are, therapists see, time and time again, that a person would rather hold on to them than attribute them to those who were supposed to nurture and protect them.
This work occurs in the safe, predictable relationship with a therapist. Through this healthy attachment, old rules of engagement with an authority figure (“I’ll be controlled/used/abandoned”) are redefined. When one is regarded as good, loveable, and valuable, self-acceptance develops. Firmly planted in their adult place and able to comfort that “inner child” who has been through so much, they can enter daily situations armed with a new set of healthy “I am’s” they know to be true.
Lili Grun, LCSW-R maintains a private practice in Monsey, New York. She works with teens, adults and couples.