Finding Home: Contextual Trauma Therapy

I spent Friday attending a workshop entitled Contextual Therapy:Treating Survivors of Complex Trauma presented by Dr. Stephen Gold. I find conferences like this really energizing and a good reminder about why I do the work I do. I was impressed with Dr. Gold. It is clear he really know what he is talking about, but perhaps even more importantly his empathic connection to and passion for the work of trauma recovery was so very apparent.  He started off framing his approach to trauma therapy, stating it is about more than listening to the problems of others (though this is how therapy is often characterized by those not in the know. As in “how can you stand to listen to the problems of others all day?”). He sees the work as about actively engaging with clients in overcoming the aftermath of trauma so they can  dramatically improve the quality of their lives.

The contextual therapy approach in brief refers to the idea that it is not the traumatic events alone that impact a person but also what Dr. Gold describes as an “ineffective family environment” in which the child’s basic needs are unmet.  It made me think of what I call “little t” traumas or the less obvious childhood experiences that can have a negative impact. Growing up without your basic needs met prevents folks from developing basic skills necessary for adult functioning in the first place. Trauma further complicates the matter, can disrupt even skills already in place. Thus, it is not just the traumatic events that lead to  the disruption of basic developmental tasks such as self-soothing, seeing the world as a safe place, trusting others, organized thinking for decision-making and avoiding exploitation, it is the very structure of the family itself. He aptly described this kind of family environment as “growing up in hell”.

This quote sums up the concept:

Various types of adverse childhood experiences] do not occur in isolation; for instance a child does not grow up with an alcoholic parent or with domestic violence in an otherwise well-functioning household (p.361)*

The point of this is to help us become aware that many trauma survivors may need to learn skills and develop basic capacities that have been missing or lacking since childhood. Processing traumatic material alone will not take care of this. It is why the concept of a the phase approach to trauma treatment is so crucial. Phase I, safety and stabilization, needs to focus on things like how to get and stay present (for many dissociative clients this is a totally new experience), how to reduce distress and how to be connected to self and others.

Like with any really good workshop or conference, my mind is a buzz with ideas, concepts and their application to practice. More posts may very likely follow! For now, I want to highlight some of the thoughts and quotes that really resonated with me, in bullet point format.

• Trauma spectrum disorders are about what you have been through. This means it is not your fault and reversible!
• If we do not teach clients the skills to cope with the traumatic material now, processing cannot be effective (instead likely to be retraumatizing)
• Trauma survivors know what most people do not: that sometimes horrible things happen, even if you are careful and follow all the rules. How do you connect with others who have not had this experience, who do not know this reality?
• Therapy may be the first collaborative relationship that some trauma survivors have ever experienced.
• People are not born knowing what they feel. It is a skill you learn. If not in your family as a child it is important to learn later in order to live well and connect to others.
• Dissociative Identity Disorder is often described as very rare. In reality, it is as prevalent as agoraphobia or obsessive compulsive disorder.
• Most trauma survivors dissociate to some extent. It may not be readily apparent and is important to ask about in therapy sessions. How can healing/learning take place if someone isn’t really present?
• Learning the early warning signs of dissociating for you as an individual is important. You can learn and employ grounding techniques successfully at that point.
• Many trauma survivors never had a sense or experience of “home”. Our goal as therapists is to help them develop the ability to be at home in themselves and their present lives.

To be really home means to be emotionally present and engaged. -Jonathan Shay, M.D., Odysseus in America: Combat Trauma and the Crisis of Homecoming

Kathleen Young Psy.D.

*Felitti VJ. The relationship between adverse childhood experiences and adult health: Turning gold into lead. The Permanente Journal, 2002;6:44–47.