Dissociation is a way people, to varying degrees, disconnect from their thoughts and feelings in order to avoid pain or traumatic memories. It represents a “lack of normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory,” serving as an unconscious strategy the mind uses to protect from distress. It is a refuge of sorts into an altered state of mind that is often characterized by obsessive thoughts, fantasies, or even non-thinking states. It can be employed consciously or unconsciously as a defense mechanism and can range in intensity from mild daydreams to feeling separate from one’s body.

In our current digital age dissociating is easier than ever. You can simply turn on the television or, better yet, turn on your computer or mobile device and find yourself on a high-speed train through the internet highway, encountering all kinds of people, distracting yourself with all kinds of information, and stimulating yourself in all kinds of ways. Recent research indicates that digital environments and social media can contribute to dissociative experiences, particularly among adolescents and young adults. All the while, your body is there, in the chair or wherever it is, coping with the emotional unrest residing deep inside.

Although dissociation can be an effective short-term strategy for pain management, it often wreaks havoc on relationships.

The Impact of Dissociation on Relationships

Relationships flourish when the participants relate to each other, which requires mutual sharing of thoughts and feelings not just about each other but about their lives and the world around them, about their pasts, and about the future. Relating is the “food” of a relationship.

Dissociation can distress relationships because it undermines the ability to relate and thus starves the relationship over time. Recent research describes this as “dissociative collusion,” where split-off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes destructive to the relationship. It is a bit of a catch-22: people often (unconsciously) choose partners who will bring up elements of their painful past in order to grow, heal, and develop. For those who dissociated during that original pain, however, employing the strategy now starves the relationship of the food of relating to each other.

Many people who frequently dissociate find that relationships can feel quite stifling. Inevitably, painful memories and feelings arise in the relationship and they (unconsciously) dissociate. At the same time, they see this other person there feeling hurt that they’ve disconnected or “left,” and feel trapped. They can’t leave, but they can’t stay, either. It can feel agonizing, lonely, and confusing to both partners when dissociation occurs.

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How Couples Counseling Can Help

A good couples counselor can be an invaluable resource and guide to finding a new way forward, both for the individual who dissociates and for the distressed couple. Evidence-based guidelines from organizations like the International Society for the Study of Trauma and Dissociation support comprehensive treatment approaches that integrate multiple therapeutic modalities. Specifically, couples counseling can help by:

Identifying and naming the issue: It may be hard for a couple to recognize that dissociation is causing distress in the relationship because it often is an unconscious coping process and is easily confused for intentional emotional distancing. If there is something beyond dissociation going on—and there often is—a therapist should be able to help identify that, too.

Helping the couple understand what’s going on: Dissociation often leaves the other partner feeling abandoned, unheard, and unloved. A therapist can help both people recognize that this is not about a lack of interest or love but rather a deep survival mechanism. Research shows that dissociative defenses are particularly relevant for couples with histories of trauma. A dissociating person typically only wants to feel better, not make their partner feel bad.

Making space to slowly reduce dissociative symptoms: This is vital. A therapist can slow things down enough to help each person observe the dissociation and, over time, feel into the pain as a means of reducing symptoms. Individuals with chronic dissociation often struggle to feel safe, especially in relationships, making psychotherapy challenging but essential for healing.

Helping the couple find new skills: This is the creative aspect of therapy—helping the couple discover new ways to respond when painful feelings and memories arise. Individual or couples counseling can explore root causes of dissociation and develop coping strategies, offering stress-management techniques and enhanced communication skills.

If there is unresolved pain or trauma in the background of your relationship and you suspect dissociation may be hurting your ability to relate to your partner, contact a trained and compassionate couples counselor. You don’t have to suffer alone.

Please Note: This article is for informational purposes only and does not constitute medical or therapeutic advice. If you are experiencing severe dissociative symptoms or relationship distress, please consult with a qualified mental health professional for personalized treatment recommendations.

References:

1. Robinson, M. A., Purcell, J. B., Ward, L., Winternitz, S., Kaufman, M. L., Baranowski, K. A., & Lebois, L. A. M. (2024). Advancing research on and treatment of dissociative identity disorder with people with lived experience. American Journal of Psychotherapy, 77(3), 141-150. https://doi.org/10.1176/appi.psychotherapy.20230028
2. Černis, E., Chan, C., & Cooper, M. (2019). Identifying preliminary risk profiles for dissociation in 16‐ to 25‐year‐olds using machine learning. Early Intervention in Psychiatry, 25(2), 1-12. https://doi.org/10.1111/eip.13162
3. Costa, R. M. (2020). Dissociation (Defense Mechanism). In V. Zeigler-Hill & T. K. Shackelford (Eds.), Encyclopedia of Personality and Individual Differences. Springer. https://doi.org/10.1007/978-3-319-24612-3_1375
4. Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727-735.
5. D’Andrea, W., & Pole, N. (2012). A naturalistic study of the relation of psychotherapy process to changes in symptoms, information processing, and physiological activity in complex trauma. Traumatology, 18(2), 26-40.
6. International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187.
7. Johnson, S. M., & Greenman, P. S. (2024). Emotionally focused couple therapy and attachment theory: Understanding emotion regulation in distressed couples. Journal of Couple & Relationship Therapy, 23(4), 295-312.
8. Loewenstein, R. J., Brand, B. L., & Schielke, H. J. (2022). Trauma-related dissociation and the dissociative disorders: Neglected symptoms with severe public health consequences. Frontiers in Psychiatry, 13, 1-24.
9. National Institute of Mental Health. (2024). Post-traumatic stress disorder. U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd

People are drawn to the helping professions for many different reasons. They may feel a calling to assist in relieving others’ suffering and to help them heal from their emotional wounds. They may have been traumatized themselves and wish to share the coping skills they’ve learned with others going through similar issues. Or they may feel caring for others brings meaning and a sense of purpose to their lives.

Whatever their reasons for becoming a therapist or other helping professional, they often experience vicarious trauma through the stories told by the people they work with. This secondary trauma, also referred to as compassion fatigue, can seriously hinder their work if they remain unaware of its negative impact and/or do not practice sufficient self-care strategies.

Becoming aware of the signs of compassion fatigue is the first step in addressing the issue. The following are some red flags:

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1. Preoccupation with the traumatic stories of the people they work with
2. Emotional symptoms of anger, grief, mood swings, anxiety, or depression
3. Physical issues related to stress, such as headaches, stomachaches, fatigue, or problems sleeping
4. Feeling burned out, powerless, hopeless, disillusioned, irritable, and/or angry toward “the system”
5. A tendency to self-isolate, be tardy, avoid certain people, or experience a lack of empathy and loss of motivation

Some of the professionals most likely to experience compassion fatigue include therapists, social workers, child welfare workers, emergency workers, police officers, firefighters, and ministers. However, anyone working with trauma survivors is susceptible to vicarious trauma. Helping professionals who have been subjected to trauma themselves also may be more at risk for developing compassion fatigue, especially if they have not worked through their issues.

Developing an adequate self-care strategy is key to preventing or overcoming vicarious trauma. Some of the techniques that can be used include:

• Maintain a good work-life balance. This involves taking time off to recharge and avoiding working long hours and/or carrying too heavy of a caseload or workload.
• Exercise to relieve stress. Developing a good workout routine is important to help increase feel-good endorphins and improve one’s outlook on life. Taking a yoga class, doing aerobic activity, or even just going for a walk can be invigorating and help change one’s perspective.
• Start a meditation practice. Initially, try sitting quietly for just 10 minutes a day, then gradually increase the time to 20 minutes. Meditation has many benefits and can assist one with feeling more peaceful and grounded.
• Develop a good social network. Having a good support system in place is important in order to be able to connect with others in a meaningful way.
• Use humor to unwind. Humor is good medicine when it comes to relieving stress and improving one’s mood. Watch a comedy, play with a pet, read a funny book—whatever moves you and helps you relax.
• Reconnect with Mother Nature. Being out in nature is therapeutic, whether you go for a hike in the woods, a walk on the beach, or just do a little gardening.
• Get involved with activities outside of work. Take your mind off of work by taking a class or engaging in a creative endeavor such as drawing, painting, or writing.
• Meet with a therapist to discuss concerns. Even individuals in the helping professions can benefit from meeting with a counselor, especially when they are experiencing compassion fatigue. A compassionate therapist can help put things in perspective and help identify additional coping skills.

Although all helping professionals are in danger of developing compassion fatigue, especially when working with individuals who have experienced traumatic events, having a self-care plan in place can help reduce the risks.

If you are already working on healing from a history of trauma, dissociation is likely a familiar concept. You are likely aware it is a system of coping that, in times of distress, offers protection from the full realization of trauma and its associated emotions, sensations, images, thoughts, and patterns of thinking.

The lack of realization and integration of these components creates the symptoms that bring people to therapy. The greater the extent and intensity of the traumas, the greater the complexity of the typical dissociative process and, of course, the treatment approach.

The “window of tolerance,” a concept introduced by Daniel J. Siegel, describes the equilibrium our systems need in order to heal from trauma. When we have unhealed traumas, our systems may not be fully present. They might not fully know or feel that the danger has passed and can become fixed in states of hypoarousal and hyperarousal or fluctuate between the two states.

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Hypo- or hyperarousal can result from the dissociative symptoms linked to the trauma, which may be positive (adding to the experience) or negative (taking away from the experience). Positive dissociative symptoms might include intrusive images, emotions, sensations, and thoughts. Negative dissociative symptoms may include amnesia, derealization, and depersonalization.

When we are stuck in these upper and lower zones of hyper- or hypoarousal, the full integration and healing of trauma cannot occur. But in the middle, within the window of tolerance, healing and integration can occur.

The shift outside the window of tolerance into hypo- or hyperarousal is the dissociative process, and it may be subtle or extreme. In those moments we experience what I call the “quantum leap effect,” where aspects of our former self, still stuck in the original trauma, do not have access to what the present self knows. That keeps us stuck in the reliving of the traumatic material, even though a part of us—an inaccessible part, so long as we are dissociating—knows it is in the past.

Anchoring Yourself in the Present

After noticing a dissociative shift into hypo- or hyperarousal, it may be helpful to utilize a skill that anchors you mindfully to the present. The anchor is not just about noticing you are “in the now.” It is imperative you notice and acknowledge the present is different from whatever you think you are stuck in. “I know I may be seeing old stuff,” you might tell yourself, “but that old stuff can’t be happening because I am in this room now, and these are the ways it looks different.”

The shift outside the window of tolerance into hypo- or hyperarousal is the dissociative process, and it may be subtle or extreme.

A more specific example might look like this: “The wall is brown, there is carpet, and I am 22 years old. I can’t be in that old circumstance. I am in the same room as this brown carpet. It must be over, because I am in a different room and I am older. I wasn’t wearing these shoes. In fact, I couldn’t fit in these shoes if I was in that time.”

If you are trying to heal from trauma, think of this anchoring skill as a way to get aspects of your former self more current and stay within your window of tolerance. To really take root, it must be practiced over and over. But it is an essential coping skill for any trauma survivor, even before processing any traumatic material in therapy.

Reference:

Siegel, D. (1999). The Developing Mind. New York: Guilford.

Psychological trauma, defined as the experience of an event in which a person feels their life is threatened or in danger, may be accompanied by a sense of helplessness, horror, or numbing as the internal alarm system becomes activated.

We react to trauma in a number of ways, and certain factors put us at risk for more severe psychological difficulties. Fortunately, there are qualities we can build on to help us manage our reactions to traumatic events.

There are four main types of reactions we may experience following a trauma: emotional, cognitive, physical, and interpersonal.

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1. Emotional reactions include shock, fear, grief, anger, guilt, shame, helplessness, numbness, sadness, confusion, denial, abandonment, anxiety, and depression.
2. Cognitive reactions might include problems with concentration, indecisiveness, difficulty making decisions, and intrusive or unwanted memories. You may notice thoughts such as, “How could someone do this?” or, “It felt like time stood still.”
3. Physical reactions consist of bodily tension, feeling fatigued, insomnia, startling easily, racing heartbeat, nausea, change in appetite, chills, digestive problems, or profuse sweating.
4. Interpersonal reactions involve feeling a sense of distrust, experiencing a loss of intimacy, increased conflict with others, isolation from others, or problems at work or school.

Other reactions to trauma are less common and more severe, and may require professional intervention. These may include:

• Emotional reactions that include intrusive or unwanted reexperiencing of the event after it has happened such as nightmares, flashbacks, and terrifying memories
• Extreme emotional numbing that leads to a sense of emptiness
• Potentially harmful attempts to avoid intrusive experiences through alcohol or substance use, lying, self-injury, or suicide attempts
• Physical reactions that involve hyperarousal, panic, rage, extreme irritability, agitation, restlessness, or violence
• Ongoing anxiety, uncontrollable worry, helplessness, or obsessive or compulsive behavior
• Dissociation (or a sense of being separate from one’s body), having fragmented thoughts, lack of awareness of surroundings, or involuntarily spacing out

Not everyone will develop a mental health condition or posttraumatic stress (PTSD) following a traumatic event. There are certain risk factors that increase the chances of experiencing more severe reactions to trauma, including severe exposure to a disaster, low socioeconomic status, having a preexisting mental health condition, being part of an ethnic minority, lacking social support, and lacking social resources.

Although there are factors that increase the risk of severe trauma reactions, there are also at least seven personality characteristics, described below, that can help a person successfully cope with or manage trauma.

Locus of Control

Locus of control is the extent to which we believe or expect we can control the outcomes of events that affect us. Our locus of control may be internal or external. If we have an external locus of control, we believe our behavior is guided by fate, luck, or other external forces. If we have an internal locus of control, we believe our behavior is guided by our own decisions and efforts, and that outcomes are related to our actions.

Crises challenge our beliefs and expectations about the level of control we have in the situation. Attempting to assert some degree of control following a crisis can aid in more effective coping and can help create a greater sense of meaning and consistency. Some researchers have observed that an external locus of control is related to learned helplessness, a condition in which a person perceives no sense of control, expects that there can be no escape, and believes any attempt to escape will result in failure.

While an internal locus of control can have positive effects in moderation, those who attempt to unrealistically control events may need assistance adjusting their expectations about outcomes. For instance, someone with an unrealistic belief that they could have prevented a crisis on their own by doing A, B, or C may need help focusing on what they can realistically control.

Self-Efficacy

Self-efficacy is our belief about how capable we are to handle situations. If we have high self-efficacy, we exert effort to overcome challenges. If our self-efficacy is low, we avoid actions we think will exceed what we’re capable of. Self-efficacy builds on itself as we add to our successes. It is thought that people who expect to successfully cope with their emotions and moods are more likely to be proactive in their healing and to seek out something positive in threatening situations.

Optimism

Optimism is holding hope and expecting that good things will happen. Optimism is focused on a desired outcome and not on who is in control or how capable one is in reaching the outcome. Optimists emphasize the positive during difficult situations and have been found by some researchers to be less anxious, hostile, depressed, and self-conscious than those with pessimistic attitudes.

Hardiness

Hardiness as a personality characteristic describes someone who is curious, actively involved, believes they can influence outcomes, expects that life will present changes, and tends to believe that challenges are opportunities for development. People with hardiness have a willingness to learn something of value, and merge those lessons into their lives. Hardiness is also associated with active coping and decreased emotional distress.

Resilience

People with resilience are those who are at risk for failure early on in life but who nonetheless become successful. Resilient people can take responsibility for their own part in a situation and let go of responsibility for the things they cannot change. Some qualities of resilient individuals include active problem solving, perceiving difficult experiences constructively, gaining positive attention from others, and an ability to continue finding meaning in their experience.

Sense of Coherence

People with a strong sense of coherence understand that stress is an inevitable part of life and recognize that dealing with it successfully can be beneficial. Having a sense of coherence means we seek to comprehend, manage, and find meaning in situations. When we attempt to comprehend the crisis situation, we try to make sense of what happened and explain how it occurred. To manage the situation, it can be helpful to utilize available resources. Meaningfulness indicates the situation is worthy of our time and investment. Having high meaningfulness motivates us to search for ways to comprehend the situation and seek out resources to aid in managing the incident.

Creativity

The ability to creatively cope is related to one’s ability to let go of the usual ways of solving problems. People who can produce creative solutions are better able to cope with traumatic events in which there are limited opportunities to exert control. Creativity involves flexibility in dealing with one’s environment.

How we react to a traumatic event can be greatly influenced by a number of factors. There are several common ways we react to trauma, and some reactions are more severe than others. Numerous personality traits were identified here that can be learned or cultivated to deal more successfully with trauma and obtain what is increasingly being recognized as posttraumatic growth.

References:

1. Tedeschi, R.G., & Calhoun, L. G. (1995). Trauma & Transformation: Growing in the Aftermath of Suffering. Thousand Oaks, California: SAGE Publications, Inc.
2. U.S. Department of Veterans Affairs National Center for PTSD. (2010). Mental Health Reactions After Disaster. Retrieved from http://www.ptsd.va.gov/professional/pages/handouts-pdf/Reactions.pdf

When we think about anniversaries, we often think about celebrations and the observation of long-term commitments. However, some anniversaries aren’t necessarily well remembered and can be anything but welcome and joyous.

We often hear about the connection between mind and body, and one of the ways this connection is especially interesting is the way in which we store and remember traumatic memories.

We all know memories are stored in the brain, but what many people are not familiar with is the idea that our bodies also store memories at a cellular level. We experience the world through all of our senses—sight, smell, sound, touch, and taste—and all aspects of our experiences get imprinted into our cellular memory.

This is why the stimulation of certain senses can trigger a memory. For example, you may smell Elmer’s glue and be reminded of your elementary school classroom. Or you may taste a really great pumpkin pie and think of your grandmother. Or, more traumatically, someone may hear the sound of a car backfiring and feel terrified because of the time they witnessed a shooting.

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The specifics of how and where memories are stored is very scientific and outside the realm of my expertise; however, the simple concept of “our bodies remember” is important and can be useful to understand. Sometimes we may not be consciously aware we are coming up on the anniversary of a particularly traumatic or unpleasant event, but knowing our bodies remember can help us understand what might be going on when negative emotions get triggered.

I recently had an appointment with somebody I’ve been working with for a few years. She came to the session feeling uncharacteristically irritated and almost hostile. She was annoyed by my attempts to figure out what might be going on. She reported nothing was wrong, it wasn’t the time of month she often feels more down than usual, and nothing in particular had happened to set her off. But her mood and demeanor told a different story.

When I pointed out that she seemed more agitated than normal, she agreed she felt really “off” and was frustrated because she had no idea why. In an attempt to figure out where to go next, I asked if she was familiar with the idea of “anniversary reactions” or if she had heard of the term “cellular memory.” She replied no but looked interested.

The day you lost a loved one, found out about a betrayal, or experienced some event that made you feel as if your world was crashing down gets imprinted in your cellular memory, and you may find yourself feeling especially vulnerable on the anniversaries of these events.

I explained that our bodies have their own memory systems, at a cellular level, and sometimes our bodies remember things that may not necessarily be at the forefront of our minds. I talked about how I personally think back to what may have happened on a particular date in the past if I find myself feeling unexplainably anxious or upset. I saw an immediate shift in her mood as we began talking about what was going on for her a year prior.

Rather than responding with short, snappy remarks, she began talking about the painful breakup she experienced a year earlier. She revisited the pain, confusion, and anger we had discussed at the time, but this time she demonstrated a greater sense of perspective and gratitude for how she had grown in the months since she experienced the heartbreak. Making the connection to this potential explanation helped her to leave the session in a much more uplifted place.

Our bodies tend to hold on to experiences from the past, and we may find ourselves re-experiencing emotional or physical symptoms at a later date, perhaps when we are better equipped to effectively process and view the experience with a new outlook. The day you lost a loved one, found out about a betrayal, or experienced some event that made you feel as if your world was crashing down gets imprinted in your cellular memory, and you may find yourself feeling especially vulnerable on the anniversaries of these events.

If you notice yourself feeling unusually anxious, weepy, or down and can’t seem to figure out why, stop and consider whether the date correlates with anything particular in your past. Being aware of the concepts of anniversary reactions and cellular memory can help you weather the storm of these emotions. Acknowledging you may be experiencing an anniversary reaction may help you to regain a sense of control. With this recognition comes an option to accept the feelings and know they will pass, or begin to process them with some distance and perspective.

Posttraumatic stress (PTSD) can severely interfere with functioning, resulting in intrusive memories, depression, disrupted sleep, anxiety, and avoidance of situations that bring back memories of the trauma. But the symptoms of some trauma survivors, particularly those who have experienced prolonged abuse or captivity, don’t neatly match traditional symptoms of PTSD. In the 1980s, some therapists and researchers began to advocate for recognition of a new variety of PTSD called complex posttraumatic stress disorder or C-PTSD. Although C-PTSD is not listed in the Diagnostic and Statistical Manual of Mental Disorders, therapists are increasingly recognizing the issue, which requires different treatment and produces different symptoms.

What Is Complex PTSD?

PTSD is a reaction to a threatening event, and the event is usually a single event that occurred for a brief duration. Traumatic events that might cause PTSD include watching a loved one die, witnessing a violent act, rape, assault, and military combat. C-PTSD, by contrast, is more likely to occur when a person experiences multiple or ongoing traumas or when a single trauma lasts for a long time and leads to feelings of captivity. Survivors of concentration camps, people who were regularly abused as children, domestic violence survivors, military personnel who are exposed to ongoing violence, people who have experienced repeated sexual assaults, and kidnapping victims may experience C-PTSD.

While PTSD typically causes disturbances—such as flashbacks, avoidance of locations or situations that remind a person of the event, or chronic fear and depression—to the traumatic event, C-PTSD is more likely to cause identity and personality disturbances in addition to the symptoms of traditional PTSD. This is because people exposed to prolonged trauma may begin to view the trauma as a core part of their identity or as something they caused, and sometimes they might question their own memories—believing, for example, that perhaps the trauma didn’t really happen.

Symptoms of Complex PTSD

C-PTSD has many of the same symptoms as PTSD, including intrusive memories or flashbacks, depression, anxiety, avoidance, and changes in personality. However, people with C-PTSD also experience symptoms that people with PTSD don’t normally have. These include: [fat_widget_trauma_ptsd_right]

• Chronic fear of abandonment. Many people with C-PTSD are diagnosed with an attachment disorder, and neediness, fear of abandonment, and even regression during times of stress are common in C-PTSD.
• Difficulty controlling emotions or changes in personality.
• Disturbances in self-perception and persistent feelings of shame.
• Obsession with the perpetrator and frequently changing perceptions of the perpetrator. A sexual abuse survivor, for example, might go back and forth between viewing the abuser as evil and loving, and might continue an unhealthy entanglement with that person.
• Emotional flashbacks: Rather than intrusively remembering the traumatic event, a person with C-PTSD might instead simply get emotionally overwhelmed and re-experience the emotions he or she felt during the traumatic event without ever actually recalling or thinking about the traumatic event. This is particularly common during periods of stress. A person might, for example, begin sobbing or feel terrified during a minor disagreement with his or her partner.

Treatment for Complex PTSD

Because C-PTSD is a relatively newly recognized condition, there’s still some debate about how it should be treated. Exposure therapy, which is highly effective with PTSD, is still being studied for its effectiveness in treating C-PTSD. As C-PTSD may mean dozens of traumatic memories or years of trauma, some clinicians have argued exposure therapy is impractical. C-PTSD researchers have generally recommended a stage-based treatment approach that includes the following phases:

1. Establishing safety and helping the client find ways to feel safe in his or her environment or eliminate dangers in the environment.
2. Teaching basic self-regulation skills.
3. Encouraging information processing that builds introspection.
4. Helping the client to integrate his or her traumatic experiences.
5. Encouraging healthy relationships and engagement.
6. Strategies designed to reduce distress and increase positive affect.

References:

1. Complex PTSD. (n.d.). National Center for PTSD. Retrieved from http://www.ptsd.va.gov/professional/pages/complex-ptsd.asp
2. ISTSS complex PTSD treatment guidelines. (n.d.). International Society for Traumatic Stress Studies. Retrieved from http://www.istss.org/AM/Template.cfm?Section=ISTSS_Complex_PTSD_Treatment_Guidelines
3. Walker, P. (n.d.). Emotional flashback management in the treatment of complex PTSD.Psychotherapy.net. Retrieved from http://www.psychotherapy.net/article/complex-ptsd

Marriages are often perceived by those who aren’t in them or by those who have suffered in them to be a place of restriction, resentment, and lack of understanding. Many other people, meanwhile, consider marriage to be the holy grail, the fountain of youth, and the best thing since sliced bread.

So why are so many bad marriages bad? What do so many of them have in common?

Although it may be a gross overgeneralization, trauma is often a major culprit. It’s sneaky, hides in the darkest and deepest places within a person, and boy, is it persistent!

If you’re married, I want you to reflect on your life and your marriage. What experiences have you had that could be affecting your marriage today? If you are having trouble coming up with answers, let me cite a handful I have seen come into play: growing up in a single-parent home, economic struggles, parental infidelity or divorce/separation, physical abuse, emotional abuse, sexual abuse, neglect, lack of affection, trust breaches, deployment, illness, death of a loved one, miscarriage, even the birth of a child (yes, that can be traumatic, too!). I can list pages of experiences that might be considered traumautic.

For the purposes of explaining how trauma can undermine a marriage, I am going to use the example of childhood sexual abuse experienced by a female.

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When Childhood Traumas Haunt Adult Relationships

Elliott and Briere (1992) confirmed their long-held belief that women who experience childhood sexual abuse were not only more likely to have symptoms of posttraumatic stress, but also to have increased negative outcomes across several areas, including their marriages. For example, women participating in the study who had been sexually abused were more likely to have reported divorces than their non-sexually abused counterparts.

The fact the extent of the abuse (whether it was an inappropriate lap-sit or a long-term incestuous relationship) did not correlate to better or worse outcomes is important to consider in the context of relationship issues. The presence of ANY sexual abuse, no matter its form or extent, may be detrimental to a person’s relationships in the long run.

So if someone wants to prevent sexual trauma from affecting their marriage, what should they do? Where should they go?

The Role of Therapy

Time and time again, couples counseling has paid off for people who worked through such trauma together. In a research study by Macintosh and Johnson (2008), dealing with the trauma of childhood sexual abuse helped more than half of participating couples achieve improved relationships.

My suggestion, however, is for couples in situations like this to go beyond couples counseling and for each partner to also pursue individual therapy. Many therapists will see both partners individually as well as together. If you choose this route, it is important to do your research on prospective therapists. Generally speaking, you want someone who specializes in or is highly experienced with trauma.

What to Expect During a Consultation

In my own practice, my routine is to meet with couples prior to beginning treatment for a consultation where I listen to general issues and history (I always assess for trauma), formulate a treatment plan, and give an estimation of therapy length. I talk about the risks, some of the difficulties, and the importance of the couple’s engagement and commitment to doing the needed work. Then I let the couple decide if they want to schedule a session.

No one gets the same treatment plan or approach. Some couples see me individually as well as in couples counseling, while in other cases I see the couple together only. For some, I may even suggest a different therapist to provide the individual or couples therapy.

Whatever you pursue and whoever you choose to pursue it with, please make sure it is a good fit.

References:

1. Elliott, D. M., & Briere, J. (1992). Sexual abuse trauma among professional women: Validating the Trauma Symptom Checklist-40 (TSC-40). Child Abuse & Neglect, 16(3), 391-398. doi:10.1016/0145-2134(92)90048-v
2. Macintosh, H. B., & Johnson, S. (2008). Emotionally Focused Therapy for Couples and Childhood Sexual Abuse Survivors. Journal of Marital and Family Therapy, 34(3), 298-315. doi:10.1111/j.1752-0606.2008.00074.x

Fourteen years ago, when I was first trained in EMDR therapy, there was less of an understanding of its benefits, as well as a lot of confusion about what eye movement desensitization and reprocessing actually was. One thing it’s never been is a quick fix. And while I make it a point to educate people about this reality, I have found there is another layer to that common misunderstanding: lack of awareness that the existence of complex trauma, as opposed to single-incident trauma, can make EMDR an even longer-term treatment.

When working with those with single-incident trauma—a survivor of a car accident, for example—the standard eight-phased, three-pronged EMDR protocol has the potential to guide the treatment process in a relatively straightforward manner. Treatment can also be more clear-cut and focused when there are multiple traumas that can be grouped into the same category. Someone who reports being raped at various times in their life would be an example of this. Neurologically, the traumas can travel down a similar “track” when processed.

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However, it is usually the cumulative effect of multiple traumas, of multiple kinds and categories, that brings folks to my office. The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences—developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.

Complex trauma is identified by Judith Herman and other leaders in the field of traumatology as “the existence of a complex form of posttraumatic disorder in survivors of prolonged, repeated trauma” (Herman, 1992). An example of a history of complex trauma would be a woman who was adopted at birth, experienced sexual abuse by her brother, experienced ongoing physical abuse by her mother, and perhaps had a series of abusive relationships throughout her teenage and early adult years. She has an extensive history of interpersonal traumas at various ages and developmental stages, and spanning multiple categories.

The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences, developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.

As part of our healing journeys, we must pay attention to traumas of both omission and commission; both matter and can impact a person’s mental health. Neglect and abandonment, among others, are traumas of omission. Sexual abuse, physical abuse, and violence are clearly acts of commission. Perhaps a person experienced ongoing parental misattunements, significant attachment losses, a parent’s hospitalization or depression, or witnessed a mother grieving the loss of a sibling. These and myriad other experiences are examples of traumas that, at the time, impacted the person’s sense of emotional and physical safety and, more often than not, included caregivers. If they happened in childhood, they may greatly impact the person’s perceptions of the world today. All of this adds up to complex trauma.

Many leaders in the field of trauma treatment believe the newest diagnostic criteria for posttraumatic stress (PTSD), as outlined in the DSM-5, are not comprehensive enough. Although an improvement over the DSM-IV, the latest guide for mental health practitioners does not account for the full clinical picture when it comes to developmental trauma.

The term “complex trauma” didn’t even make it into the DSM-IV; instead, “DES NOS” (disorders of extreme stress not otherwise specified) was often used in clinical application. In the DSM-5, some of the symptoms of DES NOS, such as re-experiencing, avoidance, negative cognitions and mood, and arousal, were included in the PTSD criteria.

Which brings us back around to EMDR therapy. Yes, it is possible to heal from a history of complex trauma. Doing so just takes a conscious, methodical, and phased approach to treatment. If you are considering EMDR and have a history of complex trauma, I highly recommend ensuring that your therapist has experience in working with both. Make sure, also, that your therapist talks to you about extensive preparation and stabilization; these aspects will be a necessary part of your healing journey.

Reference:

Herman, J. (1992). Trauma and Recovery. New York: HarperCollins.

I imagine it took a lot of courage to share this deeply painful experience with a doctor and to write in and share it here, too. It seems like you are ready to begin to address the past trauma and take a look at how it might be impacting your life in the present.

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While I cannot make a diagnosis with the information you provided here, it does sound possible that you are dealing with posttraumatic stress (PTSD) related to the sexual abuse you experienced as a child. Whether or not you actually meet the diagnostic criteria for PTSD, there is probably a connection between your past abuse and the problems you are dealing with today. These problems—difficulty trusting, unexplained anger, periods of depression, conflicted feelings about children, and nightmares—are warning signs that an underlying issue needs to be addressed.

Whether or not you actually meet the diagnostic criteria for PTSD, there is probably a connection between your past abuse and the problems you are dealing with today.

We are very adaptive beings. We figure out what we need to do to survive a situation. As a child, you probably developed coping mechanisms that allowed you to get through the trauma of sexual abuse and survive. Unfortunately, the coping mechanisms that facilitate survival in a traumatic environment can create problems when they are applied in a healthier environment. For example, you say you have difficulty trusting people; as a child who was sexually abused by your stepfather, learning not to trust people was an adaptive way to prevent abuse at the hand of others. Using mistrust as a way to prevent further abuse probably also allowed you to feel a sense of control over your life. As an adult, however, this mistrust may prevent you making yourself vulnerable to others, which is a key ingredient to happy, healthy relationships.

The good news: there absolutely is hope for healing from this. I have worked, successfully, with many people over the years who have similar stories. We have worked together to help them heal from the pain of the past traumas and to gain insight into how the traumas impact their lives in the present. This insight creates the opportunity to find new ways of being in the present—ways that don’t create obstacles for living full, healthy lives.

I encourage you to find a therapist near you who can partner with you on this journey. You deserve to live a full and healthy life, too!

Best wishes,

Sarah

“Why do I feel scared even when I’m not in danger?”

This question, or something approximating it, is one of the most commonly asked by people seeking treatment for trauma, many of whom describe an intense fear when they encounter something that isn’t, in reality, a threat to their safety. These people are aware of this fact cognitively. They can articulate the truth of the situation, but it doesn’t take away the intense symptoms that are experienced.

There is a very good reason for this—and it lies within the structure of the brain and nervous system.

First, let’s talk about fear and its function. Fear is a hard-wired emotion in the brain. We are born with it, and thank goodness. Think of fear like an alarm system. It alerts us to threats in our environment so we can respond effectively and keep ourselves safe. This comes in handy when there is an actual threat. When there is a risk to our safety, the fear circuit is naturally engaged to alert to danger.

Under normal circumstances, we are able to check in with the situation to determine if there is a real threat. For example, if you are walking down the street and hear a loud sound that startles you, your body responds and you look around to see what made the sound. If you discover it was a car backfiring, you see there is no threat and you are able to continue on, recognizing that your safety is not compromised. If it is something truly threatening, such as someone with a gun, you go into survival mode of flight, fight, or freeze. Once the threat has passed, ideally you would be able to talk about what happened, process through it, and know that even if you weren’t safe at the time, you are safe now that the threat is gone.

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Although the fear response is normal and key to survival, the fear circuit can get stuck in a type of feedback loop and over-coupling with danger, which tends to cause a person to experience the common symptoms associated with trauma. When a traumatic event is experienced, certain structures of the brain go offline because traumas are intense and the brain goes into survival mode. As a result, the traumatic memory is not stored like a normal memory. It is instead stored in an isolated, fragmented, and frozen way. Because it is isolated from other memory and knowledge, when one is triggered by something that reminds the brain or nervous system of the memory, that information does not have the ability to readily connect with other information in the brain, which makes the nervous system believe the person is in danger.

When a traumatic event is experienced, certain structures of the brain go offline because traumas are intense and the brain goes into survival mode. As a result, the traumatic memory is not stored like a normal memory.

The nervous system then does its job very well, trying to alert the person to danger, even if there is none. Keep in mind this process in entirely unconscious. We can’t think ourselves out of the nervous system’s automatic response.

It is common, post-trauma, to see an over-linking between fear and danger because of the brain process described above: the person has frozen fragments of the trauma that are maladaptively stored in the brain, which means there are also maladaptive linkages. The brain does not know it is safe because parts of it are frozen in time. The over-coupling of fear and danger is even more severe when a person has experienced pervasive trauma throughout life.

Once people understand this process, it is usually relieving to know they are not “crazy” and their nervous systems are simply trying to promote survival. Understanding the dynamic that is happening in the body is the first step to uncoupling fear and danger. Some of the work in uncoupling is done with specific interventions such as EMDR (eye movement desensitization and reprocessing) therapy, somatic experiencing, and/or ego state therapy. However, between sessions a person can aid this process by simply paying attention to the moment. Paying attention to body sensations, emotions, reactions, and the environment is a big part of the work. Periodically checking the environment for safety can be especially helpful. Noticing what it’s like to be triggered, have fear, and still notice you are safe takes it to another level and can advance the uncoupling process.

Editor’s note: This article represents the second of two parts. The first part moves from disconnection to autopilot, then from autopilot to self-awareness.

“Until you make the unconscious conscious, it will direct your life and you will call it fate.” —Carl Jung

Complex trauma represents an expected response to ongoing and extreme interpersonal threats, revealing in its process the capacity of a core “Self” to preserve what matters most, even when it means separating from it. Part I of this article framed multiple selves as a natural adaptation to systems in which we must “fit” by placing parts of Self in storage, giving examples of potential self-containment strategies. Part II now moves toward reintegration of what was necessarily preserved while navigating the tunnel of childhood.

From Awareness to Attuned Self-Compassion

After years of automated disconnection and internal judgment, integration is often felt as an awakening, a softening toward what was once perceived as an enemy, a protective hesitance becoming a grateful encompassing. It is felt most profoundly in the surprising arrival of ownership and empathy for Self. The epiphany, or “aha” moment: a recognition that “I am not this intense emotion, nor the judgment of it.” It’s the point at which we realize this “part in exile” has been trying to get our attention, to elicit from us a response it never got from our caregivers. This gives us a chance to feel what it felt, to finally see it, to stop containing it as something evil and instead embrace it and feel with it.

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Likewise, the containing part ceases to be perceived as a bully when we realize it has been protecting us all these years, that some part of us believed our core to be so valuable and worthy of protection and preservation. It’s a simple moment of self-compassion (often with a response felt physically), telling Self: “Yes, this did happen. This present feeling is how you felt for so long. I feel it in my body. I get it. You did not deserve this pain nor create it, and I will not punish you or leave you.”

After years of automated disconnection and internal judgment, integration is often felt as an awakening, a softening toward what was once perceived as an enemy, a protective hesitance becoming a grateful encompassing.

“I am too much for others” becomes, for instance, “I have been judging myself as too much in order to contain myself and avoid re-creating the feeling of distance I felt from my father.”

One might realize: “I am afraid of others because I fear myself.” Or: “I depend on others because I have abandoned myself.” Or: “My emotions grow and overwhelm precisely because I try to diminish and dismiss them.”

In the experience of abuse and neglect, these are the missing ingredients: attunement and compassion, allowing a moment of empathy for that contained part, that child who was hurt, who reacted the only way a child could. And a recognition in that moment of empathy: “All of this pain is also me, and everything that matters most in me has been preserved.”

From Compassion to Integration

Healing comes through integration, balancing of extremes, an olive branch offered between “enemies,” an internal dialogue of acceptance and compassion. It requires access to some part of Self that can simply observe—some witness able to watch our thoughts and emotions without landing in them, without becoming them. (This is where mindfulness comes in.)

When we know each part—when we can observe without judgment and treat it with compassion—it has no reason to polarize or amplify. It calms and centers. It synchronizes. It trusts our own core.

Many people, when imagining some part of Self as a child outside of their body—experiencing that child’s life, feeling their feelings—notice an internal stirring, even a release, recognizing that as they are empathizing and speaking compassionately to a child outside of Self, they are also landing in their own child part, hearing their own words of compassion, and feeling accepted.

This internal love—acceptance and appreciation without judgment—changes the entire experience of living.

Intentional self-compassion offers release from all these arbitrary rules we’ve carried. It’s a chance to experience both freedom and connection simultaneously, internally, knowing that as we navigate the countless systems of the world, external integration echoes internal.

If the title of this article threw you off a bit, it’s OK—I understand why it would. After all, forgiveness is quite the hot topic. Religious leaders, spiritual gurus, and even some mental health professionals emphasize the importance of forgiveness as a part of finding true happiness and freedom. I get where they are coming from. I can understand how forgiveness could be beneficial in some circumstances. For example, if a loved one says something uncharacteristically harsh in the heat of an argument, and you would like to keep that person in your life, it may be beneficial to understand that we all sometimes say things we don’t mean when we are upset and to forgive him or her in order to move forward in the relationship.

I work with people who have experienced horrific traumas at the hands of other people. These traumas include acts of sexual abuse, rape, exploitation, and physical and emotional abuse. Some of the perpetrators are relatives and some are not. Regardless, the degree of trauma in each of these cases is significant and has had a major impact on their lives and well-being.

The people I work with in the therapy room are resilient and courageous. They are able to work through their traumas, but many get caught up on one point: They believe they are supposed to forgive the perpetrator but can’t seem to get there.

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This is what I tell them: You don’t have to forgive in order to move on.

Understand that if a person comes in and finds that the word “forgiveness” resonates, I do not discourage it. We roll with it. But often people struggle with this word, and rightfully so. They do not want to imply what happened to them was in any way OK. They don’t want to excuse the perpetrator’s behavior. They feel the perpetrator is not deserving of forgiveness. The worst thing I can do as a therapist is to talk people out of the way they feel.

Emotions are important and automatic. When we can acknowledge and appreciate even the darkest, most negative-feeling emotions, they often soften and release. As soon as I say, “You don’t have to forgive,” the person usually breathes a sigh of relief.

Once we have determined that forgiveness is not necessary, we work on finding a word that will be more congruent for the person in his or her trauma work. I like the word unburdening.Once we have determined that forgiveness is not necessary, we work on finding a word that will be more congruent for the person in his or her trauma work. I like the word unburdening, which is something I first heard in Richard Schwartz’s book Internal Family Systems Therapy. I understand unburdening as a letting-go process. That is, letting go of the power the trauma has over a person, expressing and releasing anger and other strong emotions about what happened without criticism or expectation of what needs to come next. This includes allowing a person to have as much time as is needed to feel whatever he or she is feeling. This may include rage, hate, and resentment, among other emotions.

It is equally important for others to refrain from pushing someone into forgiving a perpetrator. Even if the intention is coming from a good place, trying to get someone who has been violated to forgive can feel like being victimized all over again. Instead, it is more helpful to validate that the person is entitled to his or her feelings. Being a listening ear instead of trying to fix the issue is much more supportive and healing. The person needs to be able to have a voice and express what he or she is feeling and thinking without the fear of judgment.

The brain and body are so intelligent. It is important to allow the natural process of working through trauma to happen and to remove any barriers that may get in the way. This includes the belief we aren’t supposed to feel “negative” emotions or that we have to forgive. Once we remove that expectation, the natural process moves through. Even if someone doesn’t get to a place of forgiveness, he or she can still move on, unburden themselves, and thrive.