The clinician responded, “Thank you so much for telling me this. I’m glad that you feel safe enough to let me know how you are feeling. It’s much better to talk about it than keep it buried. I am really sorry if you did not feel supported. Would you like to hear why I made the choices that I did then, to see if we can get some perspective on it?” This authentic response, the ability of the clinician to stay connected through the conflict, and having the clinician validate the reality of the client’s experience before doing anything else, allowed the client to remain engaged. Molly was then able to recall that (a) her own agenda for that session with her mother had not been to confront her at that time but, rather, to have her mother acknowledge the abuse by her father and (b) at the time of the clinician’s meeting with her mother, Molly had not yet shared with the clinician the information that, during her childhood, social services had offered her mother help several times, including housing for herself and her children, which her mother had refused to accept. Following this discussion, the clinician told Molly that having access to that information prior to the meeting with Molly and her mother would likely have affected the clinician’s approach. Significantly, after experiencing three years of a solid, caring, and attuned therapeutic relationship, Molly felt safe enough to confront her clinician with her own authentic thoughts and Developmental Attachment The psychobiological concept of attachment refers to an inborn system in the brain that allows infants to seek proximity to their caregivers and to establish communication with them (Schore, 2019a). Schore’s work has shown that the orbitofrontal cortex (which, as discussed in Chapter 4, is housed with the prefrontal cortex, which is important in learning from mistakes and decision making) is immature at birth and develops in children as the result of healthy relationships. At a basic evolutionary level, it improves the helpless infant’s chances of survival. This system is activated in response to danger or fear as well as by separation or threat of separation from the attachment figure. Positive and secure attachment is crucial in protecting children from dangers of many kinds and in the developing organization of the brain (Craig et al., 2021). Attachment relationships serve as a central foundation to the way the mind develops. The caregiver’s consistent, congruent, and engaged interaction and presence enable the child’s healthy development. Daniel Hughes (2007) points out that attachment theory is similar to the framework of individuation and connectedness described by self-in-relation theory, as opposed to older views such as Erikson’s framework of individuation and separateness. Early insecure and problematic attachment serves as a risk factor in the development of psychopathology and disorganized later attachments, whereas secure attachment seems to inoculate the individual with a kind of emotional resilience (Darling Rasmussen et al., 2019). An insecure attachment profile typically develops when an individual’s attachment figures are not sufficiently The Therapeutic Relationship A therapeutic relationship that is consistent, predictable, sensitive, empathic, and perceptive and that allows for the experience of mutuality can mend some of the relational ruptures of prior abusive or unhealthy relationships. Joshua, who was terminating treatment because he was relocating, stated, “The most amazing thing to me after all these years is that when you open the door to the waiting room for me, you still seem happy to see me every time. I can’t remember anyone else ever doing that. That has been as important to me, or maybe more important, than anything else you’ve said or done.”
emotions, feeling secure that she would not be jeopardizing the relationship in the process. The language of the relational model is that of connection and disconnection. Although everyone yearns for connection, trauma survivors, in particular, need healthy connections to heal past relational wounds. The paradox is that a person who has repeatedly met with disconnection in the past (e.g., trauma, abuse, neglect, depression, hostility, abandonment, loss) may become so afraid of trying to connect that they develop techniques to stay out of connection. The desire to make deep connections conflicts with the parts of self that keep the individual out of connection. Case Example Marianne, a periodically suicidal client with a lengthy history of relational trauma, described walking down the street one day after a fight with a friend and catching sight of herself in a store window. She recalled feeling so overwhelmed with disgust and self-hatred at the sight of herself that she had to immediately turn around and go home so that others would not have to bear the sight of her. She had so internalized the abuse and mistreatment she had received from her parents earlier in her life that she blamed herself for causing it, and she could not bear to look at her internalized “disgusting self.” Shame frequently accompanies disconnection and is a central component of interpersonal trauma (Cunningham, 2020). responsive or are rejecting. The inability to form or maintain secure, healthy attachments can become globalized and prevent the development of positive and lasting relationships throughout a person’s life. As discussed in earlier chapters, attachment relationships are a primary healing factor. Just as young children can rely on healthy attachment relationships to buffer against experiences of trauma, all clients can draw on the client–therapist relationship in a similar way. This concept of attachment is relevant as a key regulating factor of emotional attunement between the client and the clinician. “Feeling felt” and deeply understood by another person provides a type of coregulation between the brain of one person and the brain of the other person (Siegel, 2012). When a client meets with the clinician, this emotional resonance provides a crucial part of the healing relational alliance; the insecure attachment patterns of the mind are slowly reconditioned, and new neural network patterns are developed to counter the previously disorganized or insecure patterns laid down by the original caregivers. Interpersonal neurobiology supports the concept that human connections create neuronal connections (Siegel, 2012). Verbal and nonverbal attunement and positive attachment to a safe and compassionate caregiver are the most crucial resources for developing healthy relationships and healing from traumatic events. Developing an environment of radical acceptance of the client through which they can have emotional safety and a secure base for exploration allows room for true therapeutic change (Slade & Holmes, 2019). Mutuality refers to the client’s being able to feel and to know that they can also affect the state of being of the clinician and that they also have something of value to offer in the therapeutic relationship. Because individuals with a history of chronic trauma often view themselves as worthless or helpless, the knowledge that they are contributing to the relational dyad offers them a chance to reconsider their sense of self-worth. The therapeutic alliance provides the holding environment in which all other work takes place. Table 7 describes qualities required of the therapist who works with survivors of trauma.
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