Relational Therapy - by Pete Walker

[Kizzie]

Relational Healing in Complex PTSD

By Pete Walker - http://www.pete-walker.com/

More and more traumatology pundits see attachment disorder as one of the key symptoms of Complex PTSD. In the psycoeducational phases of working with traumatized clients [outlined in my article: "Managing Emotional Flashbacks in Complex PTSD"], I typically describe attachment disorder as the result of growing up with primary caretakers who were regularly experienced as dangerous – dangerous by contemptuous voice or heavy hand, or more insidiously, dangerous by remoteness and indifference. Recurring abuse and neglect habituate children to living in fear and sympathetic nervous system arousal, which over time creates in them an easily triggerable abandonment melange of overwhelming fear, shame and depression.

A child with parents, who are unable or unwilling to provide safe enough attachment, has no one to whom she can bring her whole developing self. No one is there for reflection, validation and guidance. No one is safe enough to go to for comfort or help in times of trouble. There is no one to cry to, to protest unfairness to, to seek commiseration from for hurts, mistakes, accidents, and betrayals. No one is safe enough to shine with, to do "show and tell" with, to be reflected as a subject of pride...to even practice the all-important intimacy-building skills of conversation. In the paraphrased words of more than one of my clients: "Talking to Mom was like giving ammunition to the enemy. Anything I said could and would be used against me. People always tell me that I don't seem to have much to say for myself."

Those with Complex PTSD-spawned attachment disorders never learn the communication skills that engender closeness and a sense of belonging. When it comes to relating, they are typically plagued by debilitating social anxiety, and social phobia when they are at the severe end of the continuum of PTSD. Many of the clients who come through my door have never had a safe enough relationship. Repetition compulsion has compelled them to unconsciously seek out relationships in adulthood that traumatically reenact the abusive and/or abandoning dynamics of their childhood caretakers. For many such clients, we are their first legitimate shot at a safe and nurturing relationship; and if we are not skilled enough to create the degree of safety they need to begin the long journey towards developing good enough trust, we may be their last.

As the importance of this understanding ripens in me, I increasingly embrace an Intersubjective or Relational approach. I believe that it is the quality [rather qualities] of the clients' relationship with me that can provide a corrective emotional experience that saves them from being doomed to a lifetime of superficial connection, or worse, social isolation and alienation. Moreover, I notice that without the development of a modicum of trust with me, many of my PTSD clients are seriously delimited in their receptivity to my guidance, as well as to the ameliorative effects of my empathy. In this regard then, I will describe four key qualities of relating that I believe are essential to the development of trust and subsequent relational healing. These are Empathy, Authentic Vulnerability, Dialogicality and Collaborative Relationship Repair.

[Brandy]

This is similar to what the therapist I saw did with me. Interpersonal therapy with a focus on attachment issues. It was very helpful, but I'm not sure it would have worked so well if I'd known what she was doing.

[Kizzie]

This is similar to what the therapist I saw did with me. Interpersonal therapy with a focus on attachment issues. It was very helpful, but I'm not sure it would have worked so well if I'd known what she was doing.

I'm curious as to why you say that Brandy, can you explain?

[Brandy]

Because I intellectualize and analyze everything! It would have been at the least harder for her to overcome my defenses if I'd been prepared, but I didn't have a clue. I had heard of attachment theory of course, but it wasn't something I'd given much thought outside of the basic description in my psych 101 textbook. I definitely hadn't thought about what happens to those children as adults.

A relational approach means building a relationship of sorts between the therapist and client. I believe that if I'd gone in knowing too much, it would have interfered with this relationship because I would have thought about it too much. It had to be about feelings and not thoughts. There was also no question of me knowing more than her, which made it easier to just go with it and to trust her (and my feelings!)

The value of the bond is hard to put into words. It's why, for example, Pete Walker doesn't treat patients over the phone or internet. (At least, I don't think he does?) Things like validation and empathy simply don't come through as well when you are not face to face.

[Kizzie]

Ok I see now what you meant, you would have been in your head and less able to tap into to your emotions.  I have noticed that in myself more these days and do my best to try to feel rather than intellectualize - it's actually hard work but one thing I'm finding is that things are much simpler than I would have imagined when I'm not overthinking them.