Relationship and Collective Trauma
Accompanied by significant fear and helplessness, which overwhelms one's capacities to cope. Each relational and collective trauma, incorporating a unique set of factors, set in cultural context, with particular cultural meaning, and crossing the developmental continuum, may affect the individual, the community, and broader society. And while distinctions exist within each category of trauma, commonalitie sexist in the characteristic continuum of human responses. Adaptations become the survival repertoire after trauma, including PTSD; the more inclusive, relationally-oriented Complex Post-Trauma reactions; the continuum of dissociative experience; and trauma-specific dynamics.
Uncertainty and Disruption
Accompanying all trauma is the loss of safety, predictability, and security in the world. One lives with a level of uncertainty, and adaptation, and perhaps a complexly hidden terror in surviving. There is a discontinuity of experience, a deep disruption of attachments and bonds, and for some, a disruption of a relationship to oneself.
Interpersonal or relational traumas, often isolated, stigmatized, and secret, each an abuse of power and authority, occur within intimate, trusted relationships, and thus include deeply personal betrayals and losses. The impact on issues of relatedness and attachment is central to these traumas, and the treatment relationship in its complexity becomes the foundation of growth and change. For example, childhood sexual abuse, most often undetected in childhood, and long-hidden from awareness later in life, as a possible result of dissociation, impacts an individual in multiple arenas, including cognitive, affective, somatic, self-regulatory, behavioral, and interpersonal levels. Its developmental significance and its central issue of betrayal by needed, depended-upon caretakers, suggest the absence of both nurturance and the physiological calming of secure attachments, needed to mitigate dependencies, emotions, and stresses. Affecting self and social development, disrupted attachments challenge capacities to comfortably adjust, regulate affect, and modulate stress. A range of seemingly self-soothing behaviors may be developed, most often self-harming in nature. Adult survivors' frequently disguised presentations of these early traumas at all settings and within all populations, indicate the hidden prevalence of this trauma in general, and its possible presence as a historical factor in the full range of later traumas.
Of core importance in the clinical arena, and for any work to progress, is attention to establishing safety, and an authentic, collaborative, progressively trusted treatment dyad. That relationship becomes central for processing trauma-based interpersonal dynamics, and for distinguishing past experience from the present. Careful pacing and timing, attention to boundaries and the therapeutic frame, delicately balancing containment and exploration, listening deeply to content, affect, and context, creating an arena for verbalization of undefined, unsymbolized, somatic experience, and gradually processing memories, associations, and affects if they safely evolve, with developmental context considered, are basic foundations.
Leaving the interpersonal arena for the broader frame of social context, the collective, shared experience of community and social traumas suggest a parallel social, community engagement in healing, with careful attention given to cultural meaning. For instance, the myriad losses, often earlier terrors, and cultural aloneness of immigrant and/or refugee experience require development of secure community, group, and if possible, family connections, as much as individual attention to a complicated bereavement process or severe post-trauma symptoms. A normalization of trauma reactions, a mourning process that allows acknowledgment of multiple losses, attention to exposure to and proximity to death and to the impact of pervasive, unrelenting fear, including physiological factors, a context allowing expression of disappointments in relocation, and continual attention to identity issues, enhance the long-term processing of this experience.
Working within the context of trauma we are vicariously traumatized. Through cumulative empathic engagement with clients' trauma material, our inner experience is predictably transformed. Parallel to our clients' experience, our sense of safety, relationship with others, the world, and our world view are effected. It becomes essential to create a context of support and self-care, including: awareness of our own resources; balancing our work with self-nurturing to counter hopelessness and despair; and enhancing connections with colleagues, informed supervisors, a therapist, and continuing learning. Advocacy and activism distinctly separate from our clinical work allow us, much like our clients, to take initiative, maintain hope, and experience our own resilience, enriching our engagement with this challenging and demanding work.