What is attachment and why is it so important in forming and maintaining relationships?
The Unintended Consequences
Perfectionism as a Trauma Response
Did you know that perfectionism, the desire and length one might go through to get everything just right can be a reaction to relational trauma? Perfectionism is an example of an adaptive mechanism that is often used to cope during developmental stages of childhood in the presence of relational trauma. Like many coping skills, perfectionism can be a tool that once served a meaningful purpose, yet later in life, if relied on too heavily, can create restriction and distress versus the desired sense of control and safety. We are adaptive beings with an innate drive to survive, feel safe, and be protected. This drive is incredibly helpful because in life we are often faced with threats to our physical and emotional safety. Threats can come in the form of abuse or neglect by those who are supposed to protect us. When this happens we do what we can to survive by adapting.
Keep in mind that perfectionism can look different for each person and the full range of its manifestations are not possible to cover in one blog post. Highlighted below are a couple of examples of relational trauma that might resonate with you if you are someone who identifies in some way as a “perfectionist.”
Consistently over-reactive, dramatic, violent, or critical reactions by a primary caregiver when you made mistakes.
Making mistakes is a natural part of learning and growing. In a healthy parent/child relationship the parent is able to provide an environment where mistakes can be made and learned from and the self esteem of the child remains intact, whereby the child is encouraged and the parent models the appropriate way to engage in an activity whether it be homework, sports, or in friend relationships. If a parent yells, screams, physically abuses, or namecalls when a child makes mistakes, the child may adapt by putting extra effort into making sure not to make mistakes as a way to avoid the expected reaction of their parents. This might look like coloring within the lines, bringing home perfect grades, or excelling to extremely high standards in sports. A consequence of adapting in such a way is the meaning the child assigns to their actions. They, for example, might think something to the effect of “I’m only lovable if I’m perfect.” As the child moves through various developmental stages and into adulthood if this message becomes internalized and unchecked, it can manifest in a variety of symptoms including panic, feelings of low self worth, self harm, fear of rejection and fear of abandonment.
Consistently under-reactive, flat, or dismissive reactions by primary caregivers when validation is called for, and the inability to compliment your child.
Just as making mistakes is a natural part of learning and growing, so is accomplishing tasks and challenges. Validating and acknowledging is a healthy and important action that attuned parents do in order to aid in the development of healthy self esteem, self worth, and further motivate their children. Think about the clapping, cheering and shouting that takes place when a child takes their first steps and the hugs and kisses that are given when the child finally reaches the parents arms. Think about the verbal affirmations, “good job, we are proud of you, we love you.” These phrases and actions send the message, “you are enough.” On the contrary, if primary caregivers lack the ability to be happy for their children and instead appear to be consistently disconnected and uninterested in them this is emotional neglect. Emotional neglect is a form of abuse within the realm of relational trauma. It can also be coupled with a confusing tendency for the parent to ignore their own child yet have the ability to go on and on about how amazing other people’s children are. This pattern of behavior sends the message to the child that who they are is not good enough. The child becomes at risk for comparing themselves unfairly to others and trying to perfect their performance to get the love that they so desperately need from their primary caregivers. Perfectionism is a survival skill that we employ when love depends on what we do, not who we are.
Perfectionism has a way of seeping into all areas of adulthood including relationships, careers, hobbies, and mental health. It can manifest in a range of ways from rigid and compulsive behavior to being overly compliant, overcompensating, being pessimistic, or shutting down. The part of you that worked so hard to be loved as a child has the ability to heal. The whole of you is inherently worthy, and that worthiness cannot be altered or changed, subtracted or added to-it’s a stable. Each person has the same value, and that value doesn’t depend on how much you do or how productive you are.
In my work with clients, these learnings have been some of the most challenging yet powerful lessons. A suggestion that I often give to clients who are working on healing this part of themselves is to pick a trusted friend to call when you are feeling the urge to strive towards perfection. This friend should be someone who can validate the want to get things right while also gently reminding you that you are right exactly as you are.
Please use the comment section below to share how you took steps to healing and loving the part of you who utilized perfectionism as a coping tool.
Learning to Trust Your Gut
The Difference Between Single Episode Trauma and Complex Trauma
There is a difference between single episode trauma and complex trauma and whether you are a therapist, a client, or someone who is interested in learning about trauma it’s helpful to understand the difference, here is why:
In order to effectively treat trauma we have to understand what type of trauma we are working with; this in turn helps us understand how the event(s) impact the stress response systems and what type of events may cause either
Post Traumatic Stress Disorder or
Complex Post Traumatic Stress Disorder.
Trauma has been hard for the world to define, this is because whether or not an event was traumatic depends on how the individual experiences the event. What may be traumatic for one person may not be traumatic for another. This depends on many factors including the timing of the event, the way the event is perceived by an individual, and whether or not the individual’s stress response system was activated in an extreme or prolonged way. To help with defining trauma SAMHSA (The Substance Abuse and Mental Health Services Administration) convened a group of academics and clinicians and conceptualized the 3 E’s definition of trauma. The 3 Es are 3 main components:
Event (For example an accident, natural disaster, a break up)
Experience (For example it was experienced as overwhelming, induced panic, possible dissociation)
Effects (these are the symptoms that exist after the event such as nightmares, panic attacks, changes in mood, avoidance etc.)
To determine whether an event was traumatic you would need to identify a specific event, understand how the person experienced the event, and explore what the effects were-if you’ve got something in all 3 categories then you’ve got trauma.
So let’s say that a person has a single episode event such as a car accident and up until this point in their life things have been stable. For this person there haven’t been any other traumatic events, they’ve had minimal significant life transitions, they have healthy relationships, and we assume they have a pretty healthy stress response system. Then after the accident they develop:
Flashbacks
Nightmares
Avoidance symptoms
Panic Attacks
AND their symptoms persist past 1 month
We would say that this person has Post Traumatic Stress Disorder and we would likely treat the person’s symptoms with combination of:
Supportive Counseling
Psycho-education
CBT
EMDR
Med Referral
We would expect that although the person would never be exactly the same again that with time and treatment they would be able to recover and that they would return to a regulated state that was baseline for them before the accident and that this baseline of a regulated state is a familiar place for them to return to.
Now let’s say that a person has experienced Complex Trauma. For example, a baby who experienced high levels of stress while in utero, exposure to toxins while in utero or it’s mother was in an unsafe environment, perhaps there was domestic violence. Then the baby is born and the parents are distracted by food insecurity and are living in poverty. All of these events and experiences are happening when the brain is having it’s most rapid development and so this baby’s stress response systems are developing in response to stressors in the environment. The baby is experiencing trauma during developmental periods that will impact that way that the brain continues to develop.
Unfortunately, this was very misunderstood for a long time and people believed that it didn’t matter what happened to children because they wouldn’t be able to “remember”; that children were “resilient.” Now we know this couldn’t be further from the truth. As Dr. Bruce Perry says, “children are not resilient, children are malleable.” Complex Trauma is trauma that is:
Unpredictable
Prolonged/ongoing (such as in the case of abuse or neglect)
Within the context of important relationships
Occuring during key developmental period of life
When a person experiences complex trauma they are at high risk for developing a sensitized stress response system, which is one that is very sensitive to stress.
When there is a sensitized stress response system it is possible to develop Complex Post Traumatic Stress Disorder (CPTSD). This can be very confusing because CPTSD can look like a myriad of many familiar diagnoses, if it is often said that trauma can mirror any mental health diagnosis. A complex trauma survivor might say something like, “I don’t have memories, I have symptoms.” Because of this, the treatment for Complex Trauma is different from treatment for Single Episode Trauma and often involves working around themes of attachment, self-regulation, self-esteem, relationship building, attunement, empathy, and acceptance.
No matter the kind of trauma you have experienced
post traumatic healing and growth is possible.
In health and healing,
Dana
When you love someone with CPTSD; A Guide for Understanding When Your Partner has Experienced Relational Trauma
I was recently asked to write a blog post for The Couples Institute Counseling Services, an institute that specializes in working with couples with a model called The Developmental Model of Couples Therapy, created by Dr. Ellyn Bader and Dr. Peter Pearson. The topic for the article could be anything of my choice so long as it is helpful for couples reading it. As this was my first blog for their website I decided to write about a topic that is close to my heart, Complex Trauma and Complex Post Traumatic Stress Disorder. After having spent most of my career providing direct service to children, adolescents, and adults who have experienced Complex Trauma, I hope to have done the topic justice and contributed in a way in which Complex Trauma can be better understood within the context of your relationship. This article was adapted from its original version sourced from the website of The Couples Institute Counseling Services Blog. Warmly, Dana
When You Love Someone With Complex PTSD
This article gives a brief overview of some basics about Complex Post Traumatic Stress Disorder (CPTSD) and what you can do to support yourself as well as nurture your relationship when you love someone with Complex PTSD. You may be wondering if reading this article will be helpful to you.
If your partner experienced significant trauma during childhood and you find yourself in awe of all that they are in spite of what they have been through, yet uncertain at times about how to provide the right kind of support, then this article is for you.
If you recognize the wisdom within your partner that is derived from their experiences, but struggle to access your own wisdom when you see your partner suffering then this article is for you.
Lastly, if you sometimes see your partner as someone who would benefit from healing work but, are not sure of the right place to start then this article is for you.
This article is about how to bring your best self to your relationship by forging one that is defined by security, consistency, and honesty as well as understanding the importance of your own self-care in cultivating these bonds.
Complex Post Traumatic Stress Disorder (CPTSD) can occur when a person experiences multiple or prolonged traumatic experiences (Complex Trauma) over the course of a lifetime. Oftentimes, the traumas are relational in nature which means that the events occur within relationships during developmental periods such as childhood. For example, periods of child abuse or neglect and/or multiple ruptures or transitions with primary caregivers; such as multiple foster placements in which attachment bonds are ruptured or substance abuse or dependence by a primary caregiver.
There are two areas of human development that are impacted by Complex Trauma. When these areas are impacted it can result in CPTSD. They are:
1. Attachment: the ways in which a person learns to have relationships with others
2. Self-Regulation: the way in which a person handles self soothing in the face of stress.
Let’s look at both more closely.
In terms of Attachment, a child who experienced multiple adverse experiences such as abuse, domestic violence, neglect or community violence is likely to, as an adult, experience frequent mistrust, fear of abandonment, and difficulty feeling secure in their intimate relationships. The reason for this is that the template that was formed early on about how to have relationships was developed under the pretense that “those who love me either hurt me, or leave.” These recurring experiences often cause the belief that people are not safe to trust; leading to the lived experience of, “I’m hurt when you stay and I’m hurt when you leave:a double edged sword.”
Self-Regulation is a set of skills that are learned by internalizing the soothing actions of our caregivers when we are hurt, scared, hungry, sad etc. The capacity by which we are able to do this for ourselves as adults is largely made possible by the quality and quantity of that which was given to us. The opportunities to learn from and observe adults practicing self regulation in ways that are healthy and nourishing for children with Complex Trauma often are minimal. Instead, the stress response system, the internal regulation system that is in charge of keeping us safe in the face of stressors, becomes overloaded due to a lack of opportunities to return to a calm state. In CPTSD this results in an elevated baseline and a stress response system that is overly sensitive to stressors. Thus the system responds by vacillating between extreme states of hyperarousal to hypoarousal (dissociation) rather than remaining within an ideal, more balanced "window of tolerance.” People who have not experienced trauma typically remain in this window within their normal day to day lives. This might account for why your partner may appear to have seemingly disproportionate reactions to stimuli that doesn’t impact you as severely: their system's degree of sensitivity and reactivity is such that a smaller event can cause them great distress and dysregulation.
The hopeful news is that the medicine for CPTSD can be found within the healing power of relationships and within our brains’ incredible ability to create new templates for relationships by a process called neuroplasticity, our brain’s ability to make new neural connections throughout our lifetime. The incredible healing power of relationships as they relate to Complex Trauma has been well documented by neuroscientists such as Dr. Bruce Perry, who specializes in the impacts of childhood trauma and neglect and its impact on neurodevelopment, and Dr. Daniel Siegel who has also well documented the process of neurodevelopment. What this means is that you and your partner have the ability to form a secure attachment in adulthood EVEN IF your partner has not yet experienced that in their life -VERY EXCITING!!! But where do you begin? It is important to know the following:
You can not erase existing templates but you can create new ones.
Your efforts should be patterned and repetitive, as these templates live in lower, less “plastic” ie. not as easily changed, parts of the brain that are only accessed and changed through doing things over and over again.
You don’t need to figure this out on your own. Finding a couples therapist educated about Complex Trauma is recommended and can help facilitate the healing process.
Here are some other ideas you’ll want to consider:
Be Consistent, be predictable: Repetition is the key to building a secure attachment. It also facilitates the ability to trust. For example, calling your partner every night before bed to say goodnight, this may seem simple, but it can have a profound effect on shaping a new, loving, and secure template of what a relationship can be in your partner’s brain.
Know your boundaries: This is a big one and related back again to being consistent and predictable. What is and what is not in your control? If your partner is struggling with mood symptoms including anxiety or depression and struggling with self regulation, it is not your job to fix that, but you can encourage your partner to establish a relationship with a therapist or make an appointment with an existing one. It can be powerful to validate your partner's suffering while simultaneously acknowledging that you do not have the power to make it all better. In all relationships it is important for each partner to own their own struggles and work on them independently from the relationship.
Establish and keep up with your own self care plan: When we fall in love it is so easy to give and give and then one day we wake up and we realize, “Oops! I have given to everyone except me!” You have got to fill your own bucket. Keeping up with a routine that nourishes you and keeps you connected to yourself and those in your support system is crucial. You are modeling for your partner that it is okay to practice self care and encouraging the process called differentiation (an ongoing process of self-defining within the context of the relationship that is a key developmental milestone within relationship and is that which sets the stage for further development and deeper intimacy as your relationship progresses).
Don’t try to explain, instead “connect and redirect”: Emotions are not logical, yet it is our tendency to try to explain our way through them. When your partner is in an emotional state of activation, remember, first connect by reflecting back what you hear them say, including their feelings. Listen and mirror without the intention of problem solving. Once your partner has expressed to you that they are feeling heard, ask them if they want support in problem solving (re-direct). Once you check for their interest, you may find that you have already helped enough!
Do find out what is soothing to your partner: People who have experienced complex trauma are often well aware of what they do and do not like. Ask them their preferences, you may find out that your partner can not tolerate massage but loves a warm bath. If so, draw them a bath and draw it often! Remember: repetition, consistency, predictability.
Practice consent in intimacy and beyond: Trauma is defined as an extreme loss of control to a perceived threat or life threatening situation. Healing for trauma survivors always includes establishing a sense of safety. A way to safety is though experienced control-- practicing consent is a powerful vessel for this. This means asking permission before and during intimate encounters as well as throughout your day-to-day interactions, for example, “Is it okay if I move your things while I clean this room?”
Anticipate events that could cause anxiety for your partner: Work together to create a safety plan. For example, if your partner feels anxious in social settings like big events such as a wedding, decide ahead of time where to sit during the ceremony and have a signal that you can give to one another if your partner needs a break. This can be a good opportunity to step outside and get a breather, check in about how you are both doing, and make adjustments to your plan as necessary.
Don’t take it personally: Your partner has been through a lot. It is likely that if your partner has a reaction to something that you do or say that it has less to do with you than you think and more to do with what that thing reminds them of. When this happens take a deep breath and do your own physiological self soothing, then when you feel regulated check back in, try to think of these moments as opportunities to learn more about what your partner’s triggers are so that you can work with them in a thoughtful and meaningful way.
Remember, it all goes back to the incredible healing power of relationships and the bonds that are formed when we are present and available for one another. Even as therapists we can get stuck in the trap of thinking that we should be able to fix it all right then and there and we jump too quickly to problem solving. Yet it is always meaningful to take a step back and remember that the key to building a secure relationship is not in your ability to offer a quick fix. Rather, it lies within your ability to take your time, be consistent, and show your commitment to being there again and again. If past trauma is impacting you or your relationships and you need help, reach out to us, establishing a relationship with a therapist can be the first step in creating a path to healing that can seem overwhelming and uncertain, more clear, manageable, and supportive.
References
1. Perry, Bruce Duncan, and Maia Szalavitz. The Boy Who Was Raised as a Dog: and Other Stories from a Child Psychiatrists Notebook: What Traumatized Children Can Teach Us about Loss, Love, and Healing. Basic Books, 2017.
2. Siegel, Daniel J., and Tina Payne. Bryson. The Whole-Brain Child. Constable & Robinson, 2012.
3. Wallin, David J. Attachment in Psychotherapy. Guildford Press, 2015.
4. Bader, Ellyn, and Peter T. Pearson. In Quest of the Mythical Mate: a Developmental Approach to Diagnosis and Treatment in Couples Therapy. Routledge, 2014.
5. Siegel, Daniel J., and Tina Payne. Bryson. The Whole-Brain Child. Constable & Robinson, 2012.
Welcome to my Practice; Client-Centered, Trauma- Informed, and Attachment-Based Therapy
Welcome to my practice! It’s not easy to arrive at a place in your life where you need help with something as important as your mental health, relationships, or healing wounds left from childhood, let alone deciding on a therapist that would be a good fit for you or you and your significant other. Because I absolutely believe that finding a therapist that is the right fit for you is essential to positive outcomes in therapy I’ve put together this article and video to help you to get to know me better and understand what I am about. This will help you decide about whether or not we’d be a good fit for each other. Believe me, there are a lot of amazing and talented therapists out there, but if they don’t have the skill set or certain capacities that you need to meet your goals then you’ve just wasted your time, money, and energy on something that could have been spent in a more meaningful way.
My practice has 3 main pillars that set the foundation for healing and growth in sessions.
First, my practice is whole-heartedly client-centered. Carl Rogers, the founder of client-centered therapy once said, “The curious paradox is that when I accept myself just as I am, then I can change.” What that means is that you can count on my office being a place where you feel accepted and appreciated for who you are right when you walk in the door, for who you are today before any personal changes take place. Throughout the course of our time together I will get to know you and the experiences that have impacted your life. I will listen to your goals and collaborate with you on how to meet them, this is the commitment that I make to my clients. I will not prescribe or enforce any agenda that feels authoritarian. Maybe you are someone who has been to therapy and have had the experience of agreeing on a goal with a therapist but then what they suggested you do felt more like an order and misattuned to what you intuitively thought would be an appropriate and achievable next step. Client-centered therapy is not that! That’s not to say that I will always make suggestions that are perfect or that I will always be perfect but I will work hard to be attuned to you and repair the impacts of mis-attunements within the context of our relationship when they arise.
Second, my practice is Trauma-Informed. That means that I enjoy working with clients who have experienced traumatic events in their lives that have been too overwhelming for them to cope with on their own. Healing from trauma means re-establishing or establishing for the first time a sense of safety, security, and confidence in your own ability to learn techniques to help you to return to “the now” when your body, mind, or spirit is forcefully drawn to the past or worrying that what once happened will happen again. By providing you with control, choice, and a place to unravel shame that is often accompanied by surviving traumatic experiences you will be able to step into a reality that is defined by you and on your terms.
Lastly, the third pillar of my practice has to do with attachment. I’m a firm believer that our first relationships with primary caregivers sets the stage for future relationships, how we come to know ourselves, and what we believe about ourselves. In my practice I spend time getting to know this part of your story and how formative experiences impact you today. Maybe you are someone who has noticed that no matter who I’m partnered with, no matter how kind they are to me, or how much they love me, I always end up thinking that I’m just not good enough. By looking at patterns such as these, in a supportive environment that is defined by consistency, predictability, and an assumption of your inherent goodness, you can begin to experience freedom from these beliefs which I believe are at the root of so much suffering.
So that’s it! That’s my practice in a nutshell-I should also add that I have a pretty good sense of humor, so laughing can absolutely be a part of the package. I hope that if you do feel drawn to me or my practice that you reach out and together we can start the journey of healing that you deserve.