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Trauma Therapy and Clinical Practice: Neuroscience, Gestalt, and the Body


A common experience in trauma is dissociation.  One of the clinical therapies most focused on grounding and being present – the opposite of dissociation – is Gestalt.  The intersection of these two opposites is an interesting space for healing.  Trauma Therapy and Clinical Practice: Neuroscience, Gestalt, and the Body walks in the middle of the experiences and shows how one might connect the two.

If you need a definition of psychological trauma, please see Trauma and Recovery.

Living in an Uncertain World

The heart of the problem with trauma is some event that shatters our beliefs about the world.  Psychological trauma is an event – something you’ve experienced or done – which cannot be integrated into your beliefs.  Too often, the belief that’s called into question is the one about the world being predictable.

Many people see the universe as a big clock with gears spinning and whirring.  Everything has the mechanical precision of cause and effect.  There’s no room for chaos theory or Lorenz’ tornado-causing butterfly.  (See Facilitating Organization Change.)  It is this predictable world that we live in, because it’s a place of safety.  If we believe the world is probabilistic, then we’ve got to accept that bad things can happen to good people, and that’s not okay.

Still, we know that probabilities exist.  We watch batters swing and miss at the baseball plate.  We play the lottery and expect to win – knowing that the probability is very small.  We spin the wheel and roll the dice but keep for ourselves a separate thought about the safety of our world.

The first thing to accept about our world is that it’s random and impermanent.

The Disconnect

Central to Gestalt is being in contact with oneself.  This is a conscious, and non-judgmental, assessment of the body and mind.  This includes feeling our breathing, our heartbeat, the state of our muscles, and so on.  It also includes an assessment of our emotions and whether they appear to be influencing bodily processes.

In some cases, trauma victims believe that exploring these sensations is dangerous, because it will bring back the traumatic event or that, once experienced fully, they’ll not be able to contain them.

Expanded Choices

A sign of trauma is constricted thinking.  Some things are, quite literally, unthinkable.  So, one sign that someone is recovering from – or healing from – traumas is the capacity to consider other options.  Capture explains how thoughts can sometimes enter downward spirals.  In Trauma Therapy and Clinical Practice, the statement is about the barriers to escaping those cycles.

The reality is that we always have choices.  Instead of the tightly coupled idea that someone or something “made you” do something, the more accurate statement is that you reacted to their action.  Emotion and Adaptation explains there’s a gap between stimulus and response, and that gap allows us to respond rather than react.  We can, in fact, choose our responses, if we decide we want to and we practice it.

Regulated Arousal

Much of the work on psychological trauma resolution is on increasing our capacity to process the event.  This can mean increasing our resources or decreasing the impact of the event.  Much of that is finding ways to regulate our arousal as we consider the event.  If we can reduce the emotional responses, including fear, to a more manageable level, we can better process the event.

On the surface, it sounds simple, but it requires a set of techniques like desensitization, building safety, and the core work of Gestalt, grounding.  These tools and others allow traumas to be processed and thereby stop their intrusive nature.  (See Trauma and Memory for more.)

Between Too Ordered and Too Disordered

Live is about making decisions.  It’s selecting the right choice or option for us at the current moment.  Much has been written about how we make decisions – and the consensus seems to be that there’s an optimal range for people to operate.  (See Decision Making and Sources of Power for more on how we make decisions.)

Gestalt views this from the lens of being too ordered – or too disordered.  You wouldn’t expect that even creativity is helped by some bounds, but that’s what Creative Confidence says about how to be creative.  So, despite getting a bad reputation, constraints can be helpful.  Simultaneously, they can be too restrictive and can choke off both creativity and joy.

Sometimes the traumatized person has added constraints to their world (by themselves).  It’s important for them to determine whether those constraints are too much – or if they need to add some healthy boundaries and limits.

Hovering at the Thresholds of Tolerance

Flow is a highly productive state that lives in the narrow band between challenge and capability.  (See Flow, Finding Flow, and The Rise of Superman for more.)  In this gap, research finds 5x performance gains and real growth.  It’s not hard to imagine how hovering around the edge of our tolerance might be a powerful way to learn to process trauma.  In fact, this is the core of desensitization: keeping people safe while moving them progressively closer to something that triggers them.

By hovering at the edge of tolerance, at the edge of safety and our capacity, we expand that capacity and make it more likely that we can process trauma at some point.  It’s critical here to celebrate the progress, because it can seem painfully slow when you want a solution now.

They Can’t Hurt Me, I’m Not There

Dissociation is a natural response to an overwhelming event.  When the event is very close to the threshold for processing, it may be that it’s only compartmentalized.  That is, we’re aware of it, and we can’t process it, but we’re still present and connected.  At the other end of the continuum, there’s severe, clinical dissociation.  Dissociation is a process of distancing ourselves from an event to protect ourselves from it and its impacts.

Obviously, if there’s physical trauma, dissociation doesn’t prevent that physical trauma from happening.  It does, however, separate the processing of physical trauma.  For instance, someone in an accident may see the scene from outside (and often above) their body.  They don’t feel the pain associated with physical trauma, because their consciousness is separate from their body.  It’s this dissociation that led more than one trauma victim to say, “They can’t hurt me, I’m not there.”

A technique recommended in the book when speaking with people who may be dissociating is to ask them what percent “in the room” they are.  It’s a continuum between wholly present and not present at all.  Often, the person you are speaking with – when prompted – can judge the degree to which they are currently dissociated, providing clues about whether it’s time to add more safety to the conversation or whether it’s safe to press on.

Relationships for Healing

Healing happens in relationships.  When you look at the factors that most impact outcomes in psychological care, the number one answer is called the “therapeutic alliance.”  (See The Heart and Soul of Change for more.)  It is the relationship between the therapist and the patient.  It’s much more important than the actual techniques in use.

In difficult work with substance use disorder (SUD) patients, Motivational Interviewing starts with engaging the patient, because without a relationship – even a professional relationship – nothing else matters.

While this book is focused on clinical applications, we know that we are most likely to influence the people with whom we have a relationship.  In fact, Everett Rogers in Diffusion of Innovations believes that it’s the only thing that can change someone’s attitude – and ultimately their behaviors.

Disorganized Attachments, Trauma, and Cults

Perhaps the most disturbing thought from Trauma Therapy and Clinical Practice is the way that trauma creates a disordered attachment style where none existed before.  Terror, Love, and Brainwashing explains that it’s disordered attachment that makes cults possible.  Often, the cult leader induces the trauma – but it’s also possible that a recent trauma could make people more susceptible to cult leaders, because they’re already partially or completely in a disordered attachment style.

I don’t believe you need to be a clinician to find ways to help people who have experienced trauma reconnect, and Trauma Therapy and Clinical Practice may have the tips to make that easier and faster.