Symptoms as Adaptations
Traditional models of psychotherapy, and certainly the medical model, views symptoms as something to diminish or eliminate. After all, symptoms cause immense suffering and interfere with the individual's daily functioning! In a trauma model, symptoms are viewed as adaptations – they began as adaptations to intolerable conditions (child rape, torture, combat, or any other traumatic events), and may serve to adapt to the present day in some respects. An adaptation model emphasizes resiliency in human responses to stress. It helps survivors recognize their own strengths and inner resources, rather than defining themselves by weakness and failure.
How can a symptom be an adaptation? One of the most obvious is dissociation. The individual's ability to cope emotionally is overwhelmed during the traumatic event. The mind helps by turning attention away from what is happening, by “spacing out,” or by “leaving the body” and watching from above, or from across the room. The dissociative skill enables the individual to survive in the moment. Later, dissociation could become a problem. For example, whenever frightened or reminded of the traumatic event, the individual might dissociate and be unable to focus on important matters at hand.
Another obvious example of a symptom as adaptation is avoidance. It is quite clear, for example, why someone who has experienced a serious car accident might avoid driving or even riding in a car. This can turn out to be very disruptive to everyday living.
What are the implications for treatment? First, it is important to help the person respect the symptoms. Rather than denigrating themselves as people who are unable to drive, or so spacey they can't focus when necessary, trauma therapists might help to reframe the symptom, and honor it as something that has an important reason for being. Changing the relationship with the symptom helps to reduce the massive shame often accompanies trauma symptoms. Changing this relationship is the first step toward gaining some control over it. Next, we help with grounding, staying in the present, and remaining calm in the face of previously-frightening situations.
Safety
People who have experienced life-threatening or otherwise terrifying events often have great difficulty feeling safe, anywhere. Trauma therapists make a special effort to create the possibility of feeling safe with the therapist. Traditional psychotherapy doesn't usually examine the possibility that the client might not feel safe with the therapist. Trauma therapists often directly address it. If an individual in therapy makes a reference to being unsure about talking about a certain difficult subject, the therapist might support that hesitation, and suggest that the client wait until there is reason to trust. I have said to people in this situation, “It doesn't make sense that you would trust me so soon, when you barely know me. What in your life has given you reason to trust people, just because they say they are on your side? Why don't you give this relationship some more time, telling me some of the less scary things and seeing how I react, and waiting to tell me the harder stuff until it feels safer?”
Later in therapy, it is common to address issues of safety elsewhere. Cognitive-behavioral techniques, aimed at examining irrational fears (while still honoring that fear as a completely understandable response to the trauma) and taking steps to venture bit by bit into new behaviors, are useful at this point.
World View
People who have underwent horrific traumatic experiences find themselves changed afterwards. They may have viewed the world as a reasonably safe place before, but find this belief shattered after their sense of safety is robbed by the actions of others, or by a natural disaster.
Trauma survivors' belief in the nature of humanity is challenged, too, by such events, particularly those harmed by interpersonal trauma (as opposed to natural disasters, for example). Those who believed that most people were basically good, or well-intentioned, find the loss of faith in humanity devastating. They may look on their previous attitude as pathetically naïve, and refuse to trust or lean on anyone else, or anyone other than a few close relatives.
Some survivors lose all faith in God. They may have previously found great comfort and guidance from organized religion or personal spiritual beliefs. These beliefs are challenged when the individual confronts their sense that a just or loving God couldn't allow such a thing to happen. Some people lose faith in God entirely, and others reconceptualize God as uncaring, mean, or ineffectual.
Recovery of these changes in world view does not happen quickly. Often these beliefs cannot recover at all until safety once again becomes familiar, symptoms no longer dominate daily life, and the individual begins to be able to view the world in some other way than through “trauma colored glasses.” Some of these changes in world view never recover, and although they may soften over time, they remain a permanent change in an individual who has survived terrible trauma.
Traditional models of psychotherapy, and certainly the medical model, views symptoms as something to diminish or eliminate. After all, symptoms cause immense suffering and interfere with the individual's daily functioning! In a trauma model, symptoms are viewed as adaptations – they began as adaptations to intolerable conditions (child rape, torture, combat, or any other traumatic events), and may serve to adapt to the present day in some respects. An adaptation model emphasizes resiliency in human responses to stress. It helps survivors recognize their own strengths and inner resources, rather than defining themselves by weakness and failure.
How can a symptom be an adaptation? One of the most obvious is dissociation. The individual's ability to cope emotionally is overwhelmed during the traumatic event. The mind helps by turning attention away from what is happening, by “spacing out,” or by “leaving the body” and watching from above, or from across the room. The dissociative skill enables the individual to survive in the moment. Later, dissociation could become a problem. For example, whenever frightened or reminded of the traumatic event, the individual might dissociate and be unable to focus on important matters at hand.
Another obvious example of a symptom as adaptation is avoidance. It is quite clear, for example, why someone who has experienced a serious car accident might avoid driving or even riding in a car. This can turn out to be very disruptive to everyday living.
What are the implications for treatment? First, it is important to help the person respect the symptoms. Rather than denigrating themselves as people who are unable to drive, or so spacey they can't focus when necessary, trauma therapists might help to reframe the symptom, and honor it as something that has an important reason for being. Changing the relationship with the symptom helps to reduce the massive shame often accompanies trauma symptoms. Changing this relationship is the first step toward gaining some control over it. Next, we help with grounding, staying in the present, and remaining calm in the face of previously-frightening situations.
Safety
People who have experienced life-threatening or otherwise terrifying events often have great difficulty feeling safe, anywhere. Trauma therapists make a special effort to create the possibility of feeling safe with the therapist. Traditional psychotherapy doesn't usually examine the possibility that the client might not feel safe with the therapist. Trauma therapists often directly address it. If an individual in therapy makes a reference to being unsure about talking about a certain difficult subject, the therapist might support that hesitation, and suggest that the client wait until there is reason to trust. I have said to people in this situation, “It doesn't make sense that you would trust me so soon, when you barely know me. What in your life has given you reason to trust people, just because they say they are on your side? Why don't you give this relationship some more time, telling me some of the less scary things and seeing how I react, and waiting to tell me the harder stuff until it feels safer?”
Later in therapy, it is common to address issues of safety elsewhere. Cognitive-behavioral techniques, aimed at examining irrational fears (while still honoring that fear as a completely understandable response to the trauma) and taking steps to venture bit by bit into new behaviors, are useful at this point.
World View
People who have underwent horrific traumatic experiences find themselves changed afterwards. They may have viewed the world as a reasonably safe place before, but find this belief shattered after their sense of safety is robbed by the actions of others, or by a natural disaster.
Trauma survivors' belief in the nature of humanity is challenged, too, by such events, particularly those harmed by interpersonal trauma (as opposed to natural disasters, for example). Those who believed that most people were basically good, or well-intentioned, find the loss of faith in humanity devastating. They may look on their previous attitude as pathetically naïve, and refuse to trust or lean on anyone else, or anyone other than a few close relatives.
Some survivors lose all faith in God. They may have previously found great comfort and guidance from organized religion or personal spiritual beliefs. These beliefs are challenged when the individual confronts their sense that a just or loving God couldn't allow such a thing to happen. Some people lose faith in God entirely, and others reconceptualize God as uncaring, mean, or ineffectual.
Recovery of these changes in world view does not happen quickly. Often these beliefs cannot recover at all until safety once again becomes familiar, symptoms no longer dominate daily life, and the individual begins to be able to view the world in some other way than through “trauma colored glasses.” Some of these changes in world view never recover, and although they may soften over time, they remain a permanent change in an individual who has survived terrible trauma.
