repeated experiences of mutual attunement, connection, caring, and vitality within the therapeutic relationship in order to counteract the disrupted attachment schemas generated by ongoing trauma. The attachment relationship can be harnessed to facilitate trauma healing with short-term dynamic psychotherapies. This type of treatment is a deep, psychoanalytic approach that can facilitate the uncovering of unconscious material related to traumatic experiences (Iwakabe et al., 2020). Short-term dynamic psychotherapies emphasize the “here-and-now” experience of previously suppressed affect (e.g., early attachment failures), using the current client–therapist relationships as a secure base for unresolved feelings. According to this approach, individuals who experience trauma within early interpersonal relationships learn to ward off reality and affective experiences that could jeopardize the bond with caretakers. These people develop defense mechanisms—unconscious, maladaptive distortions of reality—that become embedded in personality structures and contribute to future interpersonal relationships (Iwakabe et al., 2020). When treating trauma survivors using this approach, the goal is to create a safe therapeutic environment that allows clients to maximize authentic affective experiences and minimize the impact of maladaptive defenses (Iwakabe et al., 2020). Neurofeedback Clinicians need a working understanding of how the brain is organized, how it functions, and the ways that acute and prolonged traumatic experiences affect the brain (as outlined in Chapters 2 and 4). This knowledge will enable clinicians to offer clients a window into their physiology as well as their emotional and behavioral responses. A map of the internal biological processes can aid clinicians in appreciating and understanding their clients’ responses to their experiences. Access to this information can also be empowering for clients and allow them to have a “cognitive lifeboat” on which to rely when they are feeling overwhelmed. Both clinician and client need to remember that “knowledge is power” and “knowledge binds anxiety.” Empowerment and skills of mastery are needed to overcome the effects of trauma. Clinicians need not merely tell their clients about biological knowledge; they can actually demonstrate the neurobiology for them. Neurofeedback is a therapeutic approach that teaches clients how to monitor their neurobiological responses with technology and then to retrain or recondition their physiological responses (Gapen et al., 2016; Romero et al., 2020; van der Kolk et al., 2016). For example, clients can use heart-rate monitors in session to view any physiological arousal they may be experiencing and then practice heart-rate variability training—using synchronized deep breathing—to lower their heart rates. Also, some professionals use electroencephalographic (EEG) equipment to show clients a mirror of their brain wave activity (van der Kolk et al., 2016). The professional can train clients to translate the EEG data into digestible information about problematic brain wave patterns and then watch how their brain wave activity shifts after intervention activities (van der Kolk, 2014). Neurofeedback has been shown to significantly reduce PTSD symptoms and improve affect regulation (Gapen et al., 2016; Romero et al., 2020; van der Kolk et al., 2016). However, meta-analyses have critiqued studies for their imprecision and encourage the performance of additional studies to increase the certainty of evidence for the efficacy of neurofeedback in this population (Panisch & Hai, 2020; Steingrimsson et al., 2020). Self-in-Relation Theory As outlined in Chapter 7, self-in-relation theory holds that healing occurs within relationships, rather than outside
of them. This perspective can inform individual, group, couples, and community approaches to healing from trauma. The stance of healing within relationships also provides the holding environment for the crucial work of internal healing. Integration, acceptance, and compassion for the various parts of the self that have been split off or rejected as part of a reaction to trauma can become reincorporated in an experience called self-empathy, or experiencing empathy for oneself. As one member of a group stated: “When I heard your story, it was crystal clear to me that the abuse wasn’t your fault. Then I suddenly remembered the picture of myself in my jumper and blouse with the Peter Pan collar when I was about 5 years old. That was how old you were, too. I suddenly thought to myself, Wow! If it wasn’t Jan’s fault, then maybe it wasn’t mine, either.” Empowerment and Strength Perspectives and Resiliency Theory Empowerment and strength perspectives and resiliency theory hold that focusing on clients’ strengths as well as their symptoms is crucial in the healing process. Holding an empowerment perspective allows clients to feel a sense of self-efficacy that is crucial for recovery and healing from trauma. Empowerment theory is aimed at reducing powerlessness, finding strength within the self, and being able to participate in the world. The clinician’s recognition of client strengths, skills, and creativity within the session can help to balance feelings of futility, hopelessness, and helplessness. For example, when presented with a story of success or an exception to the rule of the usual trauma lens–based response or reaction, a clinician might ask, “How did you do that?” This will allow the client to discover the process by which they overcame a difficulty and enable the client to do so more easily in the future, now that the process is conscious. Resiliency theory speaks to the ability of people to rebound from adversity. It does not suggest that wounding or injury is not real but allows the hope for recovery and sustained adaptive healthy functioning to be part of the framework of the survivor’s mindset. Raising awareness of preexisting protective factors or adding them to the survivor’s life as part of the current treatment will enhance the recovery process. Some of those protective factors include basic internal style or temperament, family relationships or patterns, external supports, and environmental resources (Masten, 2015). Viktor Frankl (1946/1992), in his classic Man’s Search for Meaning, describes an aspect of resiliency that he discovered while interned in a concentration camp. The experiences of camp life show that man does have a choice of action. There were enough examples, often of a heroic nature, which proved that apathy could be overcome, irritability suppressed. Man can preserve a vestige of spiritual freedom, of independence of mind, even in such conditions of psychic and physical stress. We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms— to choose one’s attitude in any given set of circumstances, to choose one’s own way. (pp. 74–75)
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