GlamoramaBrideAndGroomI’ve been reading Allan Schore’s “The Science of the Art of Psychotherapy.” Schore is starting to convince me about the efficacy of psychoanalytic techniques in relation to what is being discovered in neuroscience about trauma response, affect regulation, the myriad ways we dissociate and how that all stems from early development of the right brain in relation to attachment styles.

It all starts with the adverse childhood experiences ( ACE’s – see the Kaiser Permanente/CDC study(s): ), that cause insecure attachment.

For example: maybe my mother was deeply depressed, dissociated much of the time, not a bad mom, but the infant brain associated that with a terrorizing sense of neglect – the infant brain needs to tune in to the caregiver, for right brain formation, to regulate safety and fear. When mom isn’t dissociated she lashes out in frustration, an occasional rage perhaps. Again the infant cannot tune, and regulate safety or fear in right brain formation. Mom’s ‘spaced out’ state Schore and others would call ‘hypoarousal’. The agitated state is ‘hyperarousal’.

These states are not regulated states (cortical thinking brain regulates limbic emotional brain), they are dissociated states (limbic/emotional, fight, flight, or freeze states prevail). The infant feels a terrifying sense that its very survival could be compromised. More importantly, the infant, suggests Schore and others, actually develops it’s own right brain ability to regulate emotion, and tune in empathically to others, from the caregiver’s ability to mirror that in the first precious moments of life, and first few years of life. If the infant does not experience that, the infant’s empathic attunement with others is impaired.

Mom persisting in these dissociated states, characterized by hyperarousal (rage, fear, distrust, “someone/thing is always messing with me”) or hypoarousal (space out, tune out with drugs or alcohol, withdraw into cocoon) almost insures that the infant/toddler will develop that tendency also.

This is the face of disoriented, disorganized attachment. This is what can cause what psychoanalysts call ‘personality disorder’. (a much broader concept for psychoanalysts than you will find in the DSM – see their PDM).

The individual, because of the early attachment trauma, has various ways of dissociating through those arousal states, throughout life, in response to interpersonal relations, making interpersonal relations extremely difficult, and obviously seriously effecting their lives and their ability to get along with other people. They have an impaired ability to tune in empathically with others. They live out of the limbic system (fight, flight or freeze), not having that regulated by the higher right brain cortical centers in ways that regulate affect. To have developed that ability would have required a caregiver in infancy that gave the infant a sense that their fears could be repaired, to help them feel safe, or that everything was always going to be alright in the end. (what Donald Winnicott would have called ‘the good-enough mother’), the mother who helps create a secure attachment.

The therapist now, in the therapeutic alliance and process, must help the client reconstruct those lost states. Schore and others believe that the methods of psychoanalysis, with its emphasis on transference and counter-transference, being in the field intuitively with the client, not cognitively detached, works best. He believes that the repair needs to go back to right brain formation, back to the pre-verbal time when the client was an infant – that the client will eventually regress to or reenact that state in therapy and the therapist must seek to reconstruct the repair intuitively.

Cognitive insight oriented interventions (such as you have with cognitive-behavioral or family systems and other modalities) are verbal and left-brain oriented. The client might get some relief from insight and learning, and in the case of behavioral methods some training and conditioning, but, says Schore, these don’t persist over time. The damage was done pre-verbal and needs to be solved there with empathic attunement, allowing the client to regress to primitive states, uncomfortable for the therapist, staying in those states intuitively (without escaping in some cognitive left-brain way), and helping the client repair the primordial wound. I still have lots to learn about that!

Nancy McWillilams, a prominent teaching psychoanalyst, in her book, “Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process (2011)”, makes the following observations:

Take the case of a person


     “with borderline personality organization contacting an emergency service with a threat of suicide. Emergency mental health workers are ordinarily trained in a generic crisis-intervention model (ask about the plan, the means, and their lethality), and that model usually serves them well. Yet people with borderline psychologies tend to talk suicide not when they want to die but when they are feeling what Masterson (1976) aptly called ‘abandonment depression.’ They need to counteract their panic and despair with a sense that someone cares about how bad they feel. Often, they learned growing up that no one pays attention to your feelings unless you are threatening mayhem. Assessment of suicidal intent only exasperates them, since the interviewer is, in terms of the patient’s not-very-conscious subjective experience, distracted by the content of their threat when they feel desperate to talk about its context.”

       “A clinician’s effort to follow standard crisis-intervention procedures without a diagnostic sensibility can be counter-therapeutic, even dangerous, because it can frustrate borderline patients to the point of feeling that to be heard, they must demonstrate rather than discuss suicidal feelings. It also leaves the therapist hating the client, since the person seems to be asking for help and then rejecting the helper’s earnest efforts to give it (Frank et al, 1952). Emergency workers trained in identifying borderline patients become adept at responding to the painful affects behind the suicidal threat rather than doing an immediate suicidal inventory; paradoxically, they probably prevent more self-destructive acts than colleagues who automatically evaluate suicidality. They may also have fewer demoralizing experiences of hating clients for ‘not cooperating’ or ‘not being helpful.’”

McWilliams’s observations and understanding of borderlines seems to match my own. After years of working with borderlines, it gives me a framework for understanding what I often get to intuitively.

A client of mine has been suicidal. She is in her mid-50s, with major depression, serious anxiety, and borderline characteristics, with some minor medical disabilities. The combination has made her unemployable, failing vocational rehabilitation, and petitioning for Social Security Disability. She has been rejected once, and while she “is running out of money to pay rent and live, she knows she may well be rejected again.” She will “not live in a shelter, debase herself to live at that street level, and might as well kill herself and get it over with…”

After being rejected by SSA the first time, she threatened suicide with a plan, means and high intent, I got County agents to take her from our rural area to a metropolitan emergency center. There it was determined that, as a Veteran, she could be triaged to a Veteran’s Administration hospital. In both places she was subjected to the crisis assessment and intervention model described above, with constant camera surveillance to counter any suicidal lethality. That was followed by a course of “evidence based cognitive-behavioral therapy, individual and group at the VA.”

The VA would never consider a psychodynamic approach, such as a psychoanalytic approach where the emphasis is on the relationship, transference/countertransference, and invocation of the abandonment depression between the therapist and client. They would not consider it because psychodynamic/psychoanalytic approaches are not ‘evidence based (the complexity of the psychoanalytic approach and its effects cannot be adequately tested in the scientific lab).

My client called me during her VA hospital stay, explaining that “no one really listens to me and connects to me like you do….they are trying this cognitive reality testing and training stuff on me, telling me I’m going to be fine, that I might have to go to a shelter, but that will be alright…my stubbornness is nonsensical and self-defeating and so on…” Classic cognitive-behavioral stuff. The truth is: all psychotherapists, myself included, utilize cognitive-behavioral (and to some extent its latest variant, Dialectical Behavioral) therapy).

Paradoxically I have tried the same techniques with her in the past and failed, only succeeding when I agree with her about the brutal truth that she has no way out of her dilemma that seems to satisfy her desire to live. She “knows I get her…even when I throw up my hands, and say I have nothing for her (except compassion).”

I believe that the cognitive-behavioral and dialectical-behavioral techniques are effective for many mental health treatment plans, but can be useless when used dispassionately, without attention to how the interaction with therapist and client is invoking the primordial relationship (from earliest childhood), with its attendant issues of trust or distrust, senses of nurturing or abandonment, and the clients experience of constant distrust and disappointment; an experience not necessarily matched by reality, but constantly present in the borderline. This causes people, therapists included, to intensively dislike borderlines to the point of hating them, but if you understand what is going on, you can get past that. It is at that point, that you reach a higher level in your abilities as a psychotherapist, and I believe the psychoanalysts have much to offer on this level!

GlamoramaBrideAndGroomThe art of coupling and staying together for a long period of time in a world where each partner is often self-reliant; where relationships can split and re-form is seriously challenged. Children often find themselves shuttled between the newly formed partnerships, and life gets complicated.

Self-reliance takes away one of the fundamental glues that kept relationships together over a long period in the past, but conversely we could say that self-reliance is really about individuation, the capacity to realize one’s true potential in life, without relying so heavily on someone else. Our ancestors, living perhaps in a more limited, sometimes brutal world, didn’t focus so much on this individuation thing. Today, however, we can achieve that capacity for individuation and self-reliance, and that gives us options in relationship, including living alone outside of relationship.

Generally we still do, however, want to form partnership, to feel the physical and emotional attraction of the other, to form a team to accomplish life goals together, each pulling on their own strengths. The goals may be raising children to their full potential, forming partnerships in education, business or the arts, or other pursuits, where it is exciting to be a team with each other.

Relationships don’t often form this way however! That is, they don’t form after one has achieved a degree of self-reliance and individuation, because that is a process that can take well into middle age, and even then there is still plenty of work to be done!

Therapists working with couples and individuals on the issues of relationship see the same thing over and over again. In the 1970’s it was called co-dependency (the opposite of self-reliant), and this term still works fairly well.  The partners are dependent on each other to fill some void or piece of something in life that they could not achieve on their own. Maybe one is very logical, orderly, confident and bold, but not very empathic or intuitive. Their partner is sensitive, empathic and intuitively attuned, but not always logical and their confidence is undermined because they feel everything around them so intensely, including negative vibes from other people. In heterosexual couples the logical one is often enough the man and the more empathic one the woman. Hence John Gray’s idea that “Men are from Mars and Women are from Venus” (Gray, 2005). This dynamic is prevalent in Gay and Lesbian relationships as well.

When working with these couples or individuals, I like to consider a couple of things. First, what is their individuation path, if we can find it? What were they supposed to develop into, to bring to this world? The concept of individuation comes from the psychology of Carl Jung (Sharp, 1998). It is also an idea that comes up in Family Systems theory where it is called differentiation (Nichols, 2012). The idea is that you have a potential for something in life that gets arrested in the process of forming codependent relationships, and/or self-destructive behaviors (e.g. addiction). These compensating behaviors get in the way of your potential.

Let’s say you are a real foodie, you love food, and are fascinated and intrigued with all facets of food including preparations, nutritional aspects, food from different cultures and so on. You are a great cook, cooking satisfying meals for your family, but they rarely appreciate it, and it means so much to you to be appreciated for his gift. Your husband is dismissive. He is absorbed in some important work, and takes you for granted, especially in this area. The kids may have picked up on some of that also. You have that sensitivity and empathic attunement, coupled with the lack of confidence and boldness described above. Your husband has the confidence and boldness but takes your nurturing contribution with the food and other things for granted. With you taking care of those things, he is freed up for his business focus for example. You are frustrated.

Before I go into the resolution of this scenario, I want to describe the second thing I look for when working with couples and individuals in relationship. What is there attachment style? If they are in therapy it is likely that they suffer from one of the three kinds of insecure attachment (Main, 1995). These are (1) Dismissive – always in control – in my first years of life, I couldn’t depend of caregivers so much, there was some neglect of my needs, so I have developed this – “My way or the highway, I’m in charge, in control, you’re lucky I’m around taking care of things!” attitude towards life. (2) Preoccupied – always wondering whether I am measuring up to my primary attachment figure because in my first years of life, sometimes they were with me, and sometimes I couldn’t be so sure! – I’m preoccupied with this, and lack confidence, but I’m very sensitive to everyone’s needs, and always trying to serve them. (3) Disoriented-Disorganized – I was terrorized by my caregivers, they neglected me, abused me, let me be abused by others – I can’t really trust people – I don’t know who I am really – I first go towards people, then run away – I have no boundaries. Some believe that this last type, is inclined towards Personality disorder (see my last Post).

The woman in the scenario could have a Preoccupied style and her husband a Dismissive style. I often see this in therapy. They were attracted to each other to fill a void in their lives. He found a receptive emotionality indirectly from her, and she found strength and confidence in him instead of herself. In the beginning they were intensely attracted to each other, had an amazing sex life, but now their sex life and intimacy in general are zero. Why? He has a low opinion of her lack of confidence; she is disgusted with his lack of empathic attunement. It comes out in how they parent the children. It is really a mess!

Jung’s concept of individuation is an anecdote because it recognizes that with strength and confidence, and a sense of order, the woman could parlay her love of “all things about food”, perhaps into a career in catering or by becoming a restaurateur, or nutrition expert; something beyond the role of codependent servant.  Jung called this idea of integrating the weak functions (those she projects onto her husband) the transcendent function; that is, she can realize her true potential (transcend) by taking on those characteristics she has projected onto her husband (confidence, orderliness) and coupling them with those qualities (sensitivity, empathic attunement) that she naturally has as a result of her psychological wound.

The work in therapy focuses on this potential, but also working through scenarios where the woman enacts her preoccupied attachment style to her detriment, working on how it feels to step out of that; feel more self-serving, confident (at first it feels unnerving, anxiety producing, coupled with some depression about the box that she has put herself into).  If I am working with the couple, then the man, with his whole host of issues related to integrating sensitivity and empathic attunement has to be worked through.

Couples counseling often works better on relationship than individual counseling if both are committed to change, achieve the same realization about what has happened and is happening in their relationship, and both are willing to hang in there. The dynamic has to change between the two, in front of you the therapist, rather than just helping the individual achieve the insight. But an individual may have a partner that is not willing to commit to this process. In this case, more often than not, it will be about assisting this person to find a new relationship!

(2005) Gray, John  “Men are from Mars, women from Venus”, Harper Perennial, NY.

(1995) Main, Mary “Recent studies in attachment: Overview, with selected implications for clinical      work.” In: Goldberg, Susan (Ed); Muir, Roy (Ed); Kerr, John (Ed), (1995). Attachment theory: Social,        developmental, and clinical perspectives. , (pp. 407-474). Hillsdale, NJ, US: Analytic Press, Inc,    xiii, 515 pp

(2012) NIchols, Michael P. “Family systems”, Pearson, NW.

(1998) Sharp, Daryl “Jungian psychology unplugged: My life as an elephant”, Inner City Books, NY

Cannon Beach Nov 2013 - Crescent BeachThis idea of the ‘personality disorder’ gets a lot of traffic in the game of accusations, criticism, judgement, blaming and shaming that goes on in the toxic breakdown of relationships. It’s easy to blame the other of a ‘personality disorder’ based on a superficial understanding, gleaned from online information, or perhaps a psychotherapist. “It’s always about you, you have no concept of what others are feeling so you must have narcissistic personality disorder”, or “first you love me, then you hate me…I’m always walking on eggshells around you so you must have borderline personality disorder”, or “you have no conscience, you lie, and deceive…you don’t care about people, so you must be a ‘sociopath’ (a common term for ‘antisocial personality disorder’).”

There may be a grain of truth to some of these quick and easy street diagnoses, but I think it is important to know what we are talking about when we talk about personality disorder.

Having a ‘personality’ or having character traits that distinguish us from others, implies that we are separate from others, of course, and that we developed those traits when we separated from the maternal field, in the first 18 months, through the 3rd year of life. In that process we developed a sense of ‘other’ that allowed us to be empathically attuned to others, how they see things the same or differently, based on their experiences.

This seems like common sense to an adult, but an infant is primarily narcissistic and can only develop this sense of other, and empathy for the other, by going through a trusting and secure attachment to the primary caregiver. This is the mother in most cases – they break, get disappointed that they can’t remain narcissistic, then there is loving repair, with a sense that I can trust other people, starting with my Mother, or other caregivers.

If the infant and developing toddler had what we call an ‘adverse childhood experience (ACE)’ such as a feeling of neglect, terror, ambiguity and confusion about caregivers, the developing child will most likely internalize the terror and ambiguity of the external environment and, throughout life, project out the expectation that this will happen again and again with anyone they are relating to, which results in a feeling that they can’t trust anyone from moment to moment. Fear and/or anxiety that ‘something bad is going to happen’ can be released at the slightest provocation, causing an eruption of affect or emotion from the lower part of the brain, the part that promotes fight, flight or freeze. Emotions become dysregulated (out of control). If the person being related to is in a position of authority, such as a supervisor in a work environment, the problem can be exacerbated. Intimate relationships are also difficult because they work on trust, and on the unconscious assumption that the primary secure attachment is being re-established, though with an adult sense of separation and boundaries.

An individual whom has had this Adverse Childhood Experience (ACE), leading down the path described above, is said to have ‘insecure attachment issues’, or in a sense we could say ‘unresolved attachment issues’, which results in fear of the other, or excessively clinging to the other or a moving back and forth between the two, with no real sense of the boundary. They would not have that sense of separation, and empathic attunement with the other that someone would have that experienced secure attachment with the primary caregiver.

They give the impression, without boundary, and projecting both negative (and sometimes excessively positive) characteristics onto the other, that they have ‘no core sense of their own selves’. We say that they seem to have no specific character or personality. Hence the terms ‘personality disorder’ or sometimes ‘characteriological disorder’. They seem to have the narcissism of the infant, and they also seem to have an altered sense of reality, because they are projecting and lack that attunement with the other. The term ‘borderline’ was an indication that the individual is ‘on the border between reality and psychosis’, but this is increasingly being seen as an inadequate way to perceive this behavioral phenomenon. The person with personality disorder does project their sense of reality onto the other, but, unlike the schizophrenic, they do understand reality, and often what they have done, in the aftermath, and this can lead to a painful sense of shame, and despair as they are cut off from loving attachments and relationships. In the worse case scenarios, they can become so cut off from the ability to form relationship or to take supervision at work, that they find it difficult to survive, to take on social responsibilities required in the process of making a living as an adult. This can lead to despair, and not uncommonly, suicidal despair.

The therapist helps to heal this issue, by staying with the client, holding all of the swings from positive to negative projection, understanding what is going on, not taking it personally, and often tolerant of the constant breaking and repair in the therapeutic relationship that is painfully necessary and difficult over time. As the person with personality disorder starts to heal, and their old projective defenses start to fall away, they get anxious and depressed. “Can they really replace that old defense with trusting, loving attachment with boundaries?” This is where the therapist stays with the client, often building up that first relationship.

The approach I am describing is largely psychodynamic, emphasizing the healing power in the ‘relationship between the therapist and client – the attachment dynamics’, but other techniques such as Dialectical Behavior Therapy (DBT) are also useful for developing skills in distress tolerance, coping, emotional regulation, and group and interpersonal interaction. The client does really need to develop social skills, and it often takes a group and other processes besides individual psychotherapy to accomplish this.

The good news is that neuroscientists are telling us that the neural and memory circuits in the brain change as we adapt to new ways of relating in the therapeutic setting, and this really can promote healing!

We have all encountered children who are defiant, belligerent, overly aggressive, unwilling to share, and difficult to manage because they don’t appear to have developed a capacity to reflect, empathically on the emotional state of another. Conversely we have encountered the fearful, withdrawing child. The child who doesn’t want to go out to play where there might be strangers, or other children that they do not know. These children might shrink away from new, novel experiences and lack a sense of adventure. They might be overly compliant.

That children are adversely impacted by bad parental behavior is not a revelation, but psychology and psychiatry are beginning to increasingly understand that these behaviors, at opposite extremes on a spectrum, are predicted by particular negative environmental influences, acting on the child’s brain, in the period from birth through early childhood. Why does this kind of child differ from the child who has compassion and empathy for other children and adults; a child with a strong  sense of adventure?

In the late 1990’s the HMO, Kaiser-Permanente, developed a structured study looking at Adverse Childhood Experiences (ACEs).  They found that children, in the first years of life, exposed to neglect, abuse, or family dysfunction will generally grow up with a host of maladaptive behaviors. If caregivers expose the child to total neglect, or erratic unpredictable attention, physical abuse, sexual abuse, emotional abuse, family alcohol or drug abuse, domestic violence such as one parent battering the other, or mental illness, such as depression, bipolar behavior, anxiety, psychosis and other unpredictable destabilizing behaviors, the child adjusts to life in a way far different from other children. They grow up with a greater propensity towards suicide attempts, drug and alcohol abuse, sexual promiscuity and sexually transmitted disease (STDs), domestic violence, cigarette smoking, and eating disorders (van der Kolk, 2005, p. 401). They also seem at higher risk for auto-immune disorders (e.g. Fibromyalgia in adult women), cardiac disease, stroke, liver disease, diabetes, cancer, and other medical issues.

Trauma researchers are recognizing that a child’s early exposure to terrorizing behavior, from parents or others who are responsible for their care, causes a kind of conditioning in the brain, that is similar to what is called Post Traumatic Stress Disorder (PTSD), but with many more complex developmental features.

A typical example of an individual suffering from PTSD would be a combat veteran returning from a war. In the war with the insurgents of Iraq, waged by the United States and its allies from 2003-2012, combat veterans were constantly exposed to garbage cans and other objects on the side of the roads, which were rigged by insurgents as Improvised Explosive Devices (IEDs), detonated by contact or remotely. Many soldiers were killed or maimed by these IEDs in Iraq and other wars. The veteran returning to civilian life, often had (and has) the three characteristics of PTSD described by Harvard trauma expert, Dr. Judith Herman (Herman, 1997). These are:

  • Hypervigilence – a tendency to be constantly and anxiously watching for situations where the terrorizing event could happen again. (e.g. The soldier does not go near garbage cans, in his small rural town, because he feels that they could explode, like they did in Iraq!).
  • Flashback – Sounds, visual impressions, night-time dreaming, and unpredictable events triggering the feeling that the terror is happening again; feeling like it is once again brought into the present (e.g. Noises that sound like gunfire).
  • Life constriction – I am not going to go to places or get involved in situations or events that could remind me of the terrorizing event, where I know I would be triggered (e.g. Not wanting to go onto busy city streets).

The child, exposed to seeing Mom being beat up by Dad, or having a parent or family member violating them sexually, or erratic unpredictable anger that results in their physical abuse, or seeing a parent gone (dissociated) in a depressive state, or an intoxicated state which feels like an unpredictable neglect, is terrorized by the experience. Like the veteran she is conditioned to want to avoid the behavior, with hypervigilence, flashback, and avoidance, but is powerless to do anything. Instead the child’s brain learns to promote a dissociation in her that causes  her to act out in a controlling, bullying, lying, or aggressive way with no empathic attunement to the other (trying to control or fight before she gets hurt), or to withdraw into a shell, paranoid and fearful (trying to fly or escape before she gets hurt).

This childhood trauma is part of a general class called complex trauma. Dr. Bessel van der Kolk, one of the world’s leading trauma experts (van der Kolk, 2005), has suggested that, with children, this phenomenon be called, Developmental Trauma Disorder (DTD), which allows the clinician to have one focus (rather than weeding through a variety of disconnected diagnoses like ADHD, or Depression, or Oppositional-Defiant).

Julian Ford (Ford, 2009, p. 32) says that when a child is exposed  to complex trauma:

in infancy and early childhood, there is a shift from a brain (and body) focused on learning to a brain (and body) focused on survival. The learning brain is engaged in exploration (i.e., the acquisition of new knowledge and neuronal/synaptic connections) driven and reinforced by a search for an optimal balance between novelty and familiarity. The survival brain seeks to anticipate, prevent, or protect against the damage caused by potential or actual dangers, driven by a search to identify threats, and an attempt to mobilize and conserve bodily resources in the service of this vigilance and to the defensive adjustments that maintain bodily functioning. The learning brain and the survival brain are the same brain, with the same capability and core processes (i.e. neural networks and pathways), but their orientations to the environment and their utilization of core processes are critically different. The survival brain relies on rapid automatic processes that involve primitive portions of the brain (e.g., brainstem, midbrain, parts of the limbic system, such as the amygdala-fight or flight), while largely bypassing areas of the brain involved in more complex adaptations to the environment (learning brain, e.g., anterior  cingulate, insula, prefrontal cortex, other parts of the limbic system, such as the hippocampus…).

Also, neurobiologists (cf. Siegel, 2008), state that that memories of terror go into an area of brain memory called intrinsic (or raw) memory where they are cordoned off, so to speak, from autobiographic memory. That is, these memories are too much, too difficult to integrate, so they are not remembered unless something in the current environment triggers them, abruptly, and then they come flooding out in a raw autonomous way, often with a lot of negative affect or emotion (the person is uncontrollably upset, like the soldier who feared the sight of a garbage can in his town). Regular memories are stored in extrinsic memory where they are remembered, in an integrated way, where the memory is associated with the emotional response(tolerable at the time), autobiographically, and the person learns from the experience (Siegel, 2008).

Putting this information together we can begin to understand that the child, terrorized by relational and physical interactions from infancy through childhood, such that they have more of a survival brain than a learning brain, would be constantly hypervigilant about reliving terrorizing experiences, trying to avoid flooding emotion, and would try to keep things under control by acting out aggressively to control their experience in a dissociated way, or in a fearful paranoia, by withdrawing into a shell.

We can understand why social interactions with other children and adults is so difficult, exacerbated by the school experience, which forces social interaction, and in addition structures learning, which the child, in their survival mode, is ill equipped to experience. Hypervigilent about the next thing that could go wrong, they want to dissociate; they want to be aggressive or withdrawn, and in fact their attention is often scattered and unfocused, which may, in the end, be the explanation for what we know as Attention Deficit Hyperactivity Disorder (ADHD)!

When the child reaches adolescence, he or she is exposed to even more creative avenues of dissociation, including drug and alcohol abuse, and sexual promiscuity. These activities, tragically, are experienced as relief. Also, as they pull away from family towards peers, their aggressive or withdrawal behaviors are accentuated as they find peers to act out their behaviors. A teen who has been a bully child, may solidify as an aggressive abuser in peer relationships. A withdrawing teen might unconsciously gravitate towards a “strong” peer who is actually controlling and abusive, or get together with like-minded peers in a cohort that emphasizes withdrawal.

What to do therapeutically?

I work with kids with these problems every day in my experience as a mental health counselor, working with children and adolescents in a community mental health clinic, associated with a K-12 school system. A typical scenario, for a troubled child, would be that they were exposed to horrible terrors until the age of, say, 6 years, with a biological family that engaged in so many transgressions, that Child Protective Services was summoned, and the child is taken from the parents, and moved to the Foster care system, or was adopted.

The new parents are taught, primarily in the Behavioral psychology paradigm, to build up a structure for the child that promotes house rules, predictable and expected behaviors, enforces boundaries, and works to gently help the child realize that they do not need to act out, lie, steal, manipulate, be a bully or fearfully withdraw from life’s events.  They can survive in a family with loving care, with consistent expectations about rules and responsibilities, and still get what they need.

In addition to this, there is the issue of Attachment bond. In the terrorizing family environment, the child generally does not really attach to the caregiver in the way that John Bowlby described as Secure Attachment (Bowlby, 1988), the kind of attachment that promotes loving consistent caregiving, and the learning brain described by Ford above. This child does not trust or attach to the new parent, because they have already developed the survival brain, and this tends to promote the feeling that anyone will be a terrorizing perpetrator, no matter how well-intentioned.

So in addition to teaching the behavioral structure to the new parents to help the child feel safety and trust in the new environment, the therapist also wants to bring the new parents into the session, to promote bonding between the new parent and the child. This involves developing a gentle reflection on bad memories, and how they are no longer going to happen because they now have these new parents, dedicated to helping them be loved and safe at all times.

With teens, as they build their identities, you find their strengths (creative not maladaptive strengths), what they really might love, if they were not so busy covering up their post-traumatic fears. You try to help them understand their development from childhood, how it got off course with their reflexive responses to trauma in early childhood. What their true Self might be if they can free themselves from the false Self that developed because of the trauma. You get into their darkness, and show you get it, but model a better way if you can!

All of this sometimes works, or sadly sometimes does not. A lot depends on how early you acquire the child in counseling and how dedicated the parents are to reducing and eliminating unpredictable, terrorizing or neglectful behaviors. With teens, its how much they look to you as a positive role model; how well you connect. You come a long ways by being ruthlessly true and authentic with them.



ACES study,, Center for Disease Control and Prevention (orig. study: Kaiser-Permanente, Inc.)

Bowlby, J. (1988) “A secure base”, Basic Books, New York.

Herman, J. (1997) “Trauma and recovery”, Basic Books, New York.

Ford, J.D., (2009) “Neurobiological and developmental research”, p. 32, In “Treating Complex Traumatic Stress Disorders”, The Guilford Press, New York.

Siegel, D. (May 1, 2008) “The neurobiology of we”: How relationships, the mind, and the brain interact to shape who we are”, Audiobook, Sounds True, Inc.

van der Kolk, B. (2005) “Developmental trauma disorder: towards a rational diagnosis for children with complex trauma histories”, Psychiatric Annals; 35, 5; Psychology Module pg. 401.


Healing Fiction - James Hillman [Book Cover]I recently listened to a Podcast of an interview by the anthropologist, Jeremy Narby (KUOW.ORG, 2012). Jeremy was studying for his PhD at Stanford in the 1980’s, and lived with the Ashaninca Indians of the rainforests of Peru. The Shaman there, coaxed him to drink the hallucinogenic Ayahuasca tea, so that he could participate or enter into their experience. You can listen to his experience (if the link above persists) or read his book The Cosmic Serpent (Narby, 1998) where he reflects on what it all meant to him.

Jeremy went to Peru ‘as a marxist anthropologist, a materialist scientist’, interested in recording, objectively, the experiences of the indigenous people there. He describes himself as ‘Agnostic to belief’ (2012). After ingesting the tea, he was ‘confronted by two massive serpents who helped him understand how small and insignificant he was in the total scheme of the things’ (2012). He was transported ‘out of his body, many miles above the earth, then the Ayahuasquero (Shaman singing or chanting the song underlying his experience), brought him down to his body, where he saw 100,000 images, including the many veins of his hand, and how these corresponded with the veins of a leaf.’ (2012). Jeremy reflected that ‘these images were of nothing that he had seen before…not images repressed into his subconscious'(2012). They seem to have been images and communications with ‘spirits’ independent of his life memory system.

In his seminal work, Healing Fiction (1983, pp 78-81), James Hillman describes the process of Active Imagination, which I believe, as an experience, could be similar to what Jeremy Narby experienced with the Shaman of Peru, although Hillman might take exception with the drug induced state of experience (1983, p. 79).

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James Hillman

I have been a psychotherapist for 6 years now, working in a community mental health, with a small private practice. I work with children, teens, single adults, couples and families, and I do that while complying with the clinical focus, or ‘evidenced based’ methods, mandated by government and third-party reimbursers…family systems, cognitive-behavioral methods, the neurobiology of trauma and it’s aftermath, along with developmental considerations. These all have their place in my work, as I seek to ease the suffering of people cut-off from a comfortable connection with life.

Hillman though, has always beckoned with is maverick, literary, imaginal, and mythopoetic approach. Along with Freud and C.G. Jung, and all those that have followed in the traditions of psychoanalysis, and Jungian analysis, Hillman has helped me navigate the deeper world of the Unconscious, the place of art, dreams, and imagination.

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