Safety is not the absence of threat, it is the presence of connection.
— Gabor Mate

What is attachment/relational trauma?

During the first few years of life, it is essential that a level attunement occurs between an infant and a primary care giver. When the primary giver is either unable to attune due to psychiatric or physical illness, domestic violence, emotional immaturity or frightens the child by behaving in an inconsistent way, a secure attachment may not form between the child and caregiver and there is a risk the child will dissociate to cope.

When the unsafe, threatening, or abusive behaviour form the caregiver continues beyond infancy into early childhood and is never addressed or resolved, there is a risk the child will not only dissociate but fragment into parts in order to adapt and survive their inescapable situation. For children from dysfunctional, unstable homes, a further risk to their welfare and development is that they're more vulnerable to abuse outside the home. If the child already dissociates to cope at home, they will us the same skill to survive outside the home and signs of abuse may be harder to detect.

If abuse and instability continues during the tween and teenage years, and the child is unable to find safety with a reliable adult, the wounds and disconnection experienced during early childhood remain dissociated and stuck. As in early childhood, if a tween or teen child has no stable, reliable attachments, they are far more vulnerable to abuse outside the home. If the child is in residential care or is homeless, the likelihood of abuse is exacerbated further and the trust and connection the child is seeking in the world is further ruptured.

Having become familiar with a relational dynamic during infancy where the object of threat is also the only source of comfort, and then re-living this dynamic during their childhood and teen years, it is unsurprising that people with significant relational trauma repeat dysfunctional relationship patterns as adults.

At the heart of the problem for the developmentally traumatised child is a desire to heal the the initial trauma, to repeatedly recreate the initial frightening experience with the primary care giver in the hope of finally finding real safety and connection with a threatening, unsafe person.

Healing relational trauma

When a safe, secure bond is never formed between an infant and a primary care giver, the path to forming a safe, secure relationship with yourself is complex. Whether you lose chunks of time to dissociation, or your sensory experience is disjointed (experience sight, sound smell out of sequence or in delay), the repeated disconnect from your mind and body creates a barrier to connecting with yourself and others.

The first step toward healing relational trauma is building internal, self-trust. Depending on the level of fragmentation we experience, the process of building self-trust can be difficult because different parts of us experience safety or danger in different situations and varying levels of trust with other parts. One way to begin the process of connecting is to build self-attunement.

Some suggestions:

➣ Listen to podcasts, read books or blogs by people with dissociative disorders. Finding resonance with people who've had similar experiences to us decreases isolation and may help us put words to thoughts and feelings.

➣ Explore abstract poetry and visual art. Even if you've never read a poem or visited an art gallery, the world of artistic expression, allows trauma to be expressed in ways that may surprise and resonate. Avoid films or photography that depict graphic violence as it may be traumatising.

➣ Try different activities to identify what is soothing, calming, or pleasurable. Start with small, simple activities like buying or picking flowers, putting them in a vase and, without analysis, identifying whether you found the activity pleasurable, unsettling, or neutral. Next, try brushing your hair or applying a scented hand cream. Pleasurable, unsettling, or neutral? There's no right or wrong answer, the purpose of the exercise is to get to know yourself better.

➣ Journal or create video/audio journals (using your smart phone or dictaphone) to capture the perspective of different parts of you. Getting the people inside your head out onto paper, video or audio will help you better understand yourself and also allow you to create a team dynamic and, ultimately, all agree to move in the one direction. If you feel safe and comfortable, a video recording can be especially helpful because you will better understand your own facial expressions. For those of us who grew up under dissociative, narcissistic, or drug addicted care givers and missed out on parental mirroring, it is especially valuable to learn our own facial expressions as a means of self-attunment.

The role of DBT in self-attunement and healing relational trauma

Radical Acceptance

Radical acceptance is a key concept in DBT and refers to the act of accepting, without reservation, the given moment. To radically accept a passing moment doesn't mean we enjoy, approve, or endorse an action, event, thought or feeling, it simply means we accept that the thought, feeling, event, or action is what's happening. Radical acceptance doesn't mean we are surrendering or acquiescing to a person or situation, and it certainly doesn't mean we're giving up, giving in, or accepting another person's reality over our own.

What has to be accepted?

➣ Events that occurred in the past are what they are and can't be changed. Similarly, the present moment is what it is i.e. if your husband beats you, you're in a violent, dysfunctional relationship—that is the reality;

➣ Every event is the result of a sequence of events that came before it. Identifying patterns and behaviours in our life that lead to distress and hardship will help us take charge of our time and get what we want;

➣ There is nothing in our past that compromises who we are or detracts from who we are. Our life experience is the perfect compost to grow something new;

Why accept reality?

➣ Accepting reality is the only way to change your reality;

➣ While dissociation is a clever trick the mind uses to survive unbearable circumstances we can't escape as a child, as an adult we can cultivate the skills and resources to create the life we want. However, this can only happen if we accept our current reality;

➣ If we feel trapped and helpless in toxic family, friendship, or work place dynamics, we have the options of building a bridge out of our current situation and creating a life that suits us. The process starts with identifying how we feel and what aspects of our reality we are refusing to acknowledge or dissociating out of conscious awareness;

➣ Continuously refusing to accept reality, may make us more vulnerable to completely losing touch with reality;

➣ By accepting our current reality, we can slowly start to accept the past and begin the healing process.

Abstract background to the novel Alice in Wonderland..jpg

Mindfullness

Although mindfulness has become a buzz word, it plays an important role in managing dissociation. Given dissociation is the minds way of switching off or switching parts when overwhelmed, it is worth learning the different tools and skills that mindfulness offers to see what helps us self-regulate and create more space for our emotions.

Observing your thoughts

One way to get to know ourselves better is to observe our thoughts. The reason observing our thoughts can be useful is because by observing our mind, we slowly start to gain greater control over our thoughts and the subsequent emotion. To be clear, the purpose of observing our thoughts isn't to block, suppress, or judge our thoughts or emotions, it is to train our mind to slow down and become aware of how one thought leads to another thought and creates a chain of events.

If we have a fast, racing mind and/or experience mania, and have younger parts of us wanting our attention, the process of learning to slow our mind and creating enough space to observe our thoughts will be slow but, like anything, it will get easier over time with practice.

Start slowly, no pressure, remain curious, no judgement, and explore the following questions and concepts:

➣ Where are these thoughts coming from?

➣ What sensations or feelings are these thoughts blocking?

➣ Where does my mind begin and end? If you feel like your mind goes on forever and there's nothing to contain your thoughts, try and picture a home for your thoughts in your mind.

The home might be might be a house, a castle or a dome. Whatever the structure, it has outer walls or a perimeter and that's where your thoughts stop.

If your thoughts try and go beyond the outer walls, it may be helpful to picture the wall in detail—what is the wall made of? Is it brick, stone, concrete? Or perhaps something more advanced like bullet proof, reflective glass that you can you see out of but no-one can see in?

When your thoughts hit the outer wall be mindful of how it feels. Does the thought being contained inside the walls feel overwhelming or reassuring? If you feel overwhelmed, maybe consider allocating the particular thought and feeling it's own room with a door you can close—you're not blocking or dismissing the thought, the purpose of the room is to create a home for the thought and feeling.

➢ Picture your thoughts as waves in the ocean rolling in and out with the tide, try and resist holding onto the thought;

➢ If your thoughts are racing so fast that there's no way to slow and observe them, another option is to get up and shake it out. You don't have to do anything specific just play your favourite song and for the duration of the song jump and shake. Get everything moving—shake your hands, reach your arms over your head, jump and shake.

Cultivating Presence

If we've grown up in an environment where being present in reality is unbearable, it makes sense that our mind has learned to cope by dissociating in out and of reality. While there are many benefits to dissociating, there are many downsides as well. While we're physically but not mentally present in the moment, our safety may be at risk and we miss out on what's happening around us. Being in the flow of life means being present in reality a reasonable amount of the time. If we're constantly missing large chunks of time due to dissociation, it's very hard to process our feelings, form a relationship with ourself and the world around us.

If not being in reality is our default, the process of learning to tolerate the sensory and emotional experience that comes with presence is challenging.

Reducing dissociation and increasing presence is something that can only occur when we have enough safety and security in our life to begin regulating our nervous system. If we're in a crisis situation or unable to leave an environment where we feel unsafe, we may not have the emotional space to practice presence. If we're in a crisis situation, it may be a better time to practice internal communication.

Suggestions for practicing presence:

➢ Move your energy down from your head into your hips. If your having trouble doing this try guiding your energy down away from your head with you hands. First, place your hands, palm down on your upper chest, count to ten, feel the energy moving from your head to your chest. Repeat this process with your hands on your sternum, lower abdomen, and finally one hand, palm down on each hip, count to twenty, feeling your energy move down you spine, moving out to meet you hands. As your mind starts to race again and draw your energy up from the hips, keep breathing and repeat the exercise with your hands, slowly encouraging your focus and presence back down to your hips.

➢ Moving energy down your body with your hands can also be a way to redistribute and reduce pain when your body is processing trauma. If the pain is in your chest, place one hand on your belly and the other on your lower back. Breathe into your hands.

➢ What can you hear, smell, taste? Where is there tension in your body?

➢ What are five objects you can see around you? If you're driving and struggling to stay present, try spelling out street signs or overpass signs as you pass them.

Distress Tolerance

As children, it is our parents role to teach us how to regulate our emotions by role modelling stress and distress tolerance as well as guiding us to feel, articulate, and process emotions. Sometimes the role of a parent in guiding us to regulate emotions and tolerate distress is as simple as playing a consistent, nurturing role.

If our parents or carers were unwell, unavailable, neglectful or abusive, we may find ourselves unable to process big emotions and find ourselves falling into uncontrollable sadness (crying, self-harm), anger (lashing out, self-harm) or stuck in a numb, dissociated state. If we didn't get the chance to process emotions early in life and we've been shamed or punished for expressing emotions, we may have intense, confused emotions i.e. laughing uncontrollably when sad, angry or afraid, or dissociating when excited because the emotion is too much to contain.

Distress Tolerance is a key module in DBT and teaches skills designed for people with intense, fast moving emotions and can help increase our capacity to sit with big emotions and create a space for trauma held in the body. Given dissociation is protects us from feeling, the skills taught in distress tolerance are equally as applicable to those of us who are dissociated, fragmented, or who have no outward emotions.

Although our emotions may feel so powerful and fast moving, or dissociated and absent, that they seem impossible to feel, process, tame and guide, DBT offers a method for breaking down the moment, tracking thoughts and feelings to sit with the emotion instead of exploding, imploding, or dissociating.

A big part of distress tolerance is accepting when we are in distress, validating the emotion, and giving ourselves permission to self-soothe and distract yourself from the distress. If we've grown up in an abusive environment where there is constant chaos and no option but to be in a constant state of hypervigilance, it's likely we haven't been taught to understand, monitor, and prioritise our own feelings. A key step in beginning to navigate distress tolerance is self-validation. When we have been gaslit as children, punished for expressing feelings, or chronically denied our own perceptions and reality, we may find it difficult to validate our own opinions, feelings, perceptions and beliefs. How this presents in a day-to-day context may look like constant self-doubt to the point of paralysis, debilitating social anxiety, an inability to access our own intuition, and complete reliance on outside opinions. In some cases, we may have an atrophied or inaccessible self that results in our being easily manipulated and taken advantage of by strangers as well as those close to us.

The feeling of complete disorientation from self may result in chronic overwhelm leading to acute distress. The DBT distress tolerance module can help manage overwhelm and acute distress (i.e. self harm or suicidal impulses) and also help us identify what leads to distress and how we can modify our lifestyle to minimise activities or contact with people that cause distress.

Tips for managing distress:

➢ The first step to managing acute distress is to accept without judgement that we are extremely distressed. Don't fight the feeling. If we're around people who either shame us for our emotions or refuse to hold a space for us, we need to, where possible, relocate to a different environment i.e. finding privacy in a different section of the house, driving to a quiet parkland near your house, or, if you become overwhelmed by distress while at work, the best solution may be to find a quiet, private-as-possible toilet cubicle. If our overwhelming urge is to cry, don't fight the urge. Find a private space and cry. Something as simple as allowing ourselves to cry for as long you feel the desire to cry can alleviate the urge to self-harm.

➢ If we're at work or home and we're becoming increasingly dysregulated, where possible, leave early or cease work for the day and simply go to bed. We may receive negative judgement from colleagues for leaving early and taking sick leave, but learning to prioritise self-care instead of succumbing to other people's values and judgements is a key part of developing self-validation, self-trust, and self-respect.

➢ If we're prone to moving from mild distress to extreme distress (i.e. self-harm, suicidal impulses) rapidly, we need to develop a crisis plan. What our crisis plan looks like depends on our situation and needs, but the most important part of the plan is that you can independently implement it. If the plan is to call an ambulance if we're in crisis, some questions to consider are: Do I have ambulance cover? How far away is your nearest hospital? What is the standard wait time for an ambulance where I live? If the crisis plan is to call a friend to take us to the hospital, is the friend reliable? What if they don't answer their phone? If the plan is to be admitted as an inpatient, do I have private hospital cover? Does the private hospitall cover include psychiatric inpatient services?

Interpersonal Effectiveness

The ability to build mutually beneficial relationships, communicate and negotiate with people are essential skills required to navigate life and get our needs met. Ideally, these skills are developed during childhood and refined and honed as we move through adolescence and young adulthood. If we've grown up in an environment where you're primary care givers are unreliable, unsafe, or abusive, or simply emotionally immature, we may have difficulty building and sustaining friendships and relationships. If we struggle with close interpersonal relationships, we may also find ourselves running into conflict in everyday life, struggling to maintain boundaries, or feeling incapable of getting our needs met both professionally and personally.

For people raised by mature parents who role model reciprocal respect and boundaries, the path to communicating directly most likely requires some tweaking but comes naturally due to it being role modelled during childhood. If we missed out on learning direct communication, our unsuccessful efforts to make reasonable requests, protect our boundaries, and have basic needs met may have left us frustrated, bewildered, or despairing. Thankfully, it's never too late to learn direct communication and interpersonal effectiveness.

Identifying and attaining objectives

When we have unhealed, unresolved complex trauma, we may get caught in survival mode and may never get the opportunity to pursue the things we truly desire. Instead, we may go through our lives struggling to survive; never getting the opportunity to relax and settle into the moment let alone reach our potential. When we're stuck in freeze mode, it can be hard to identify what we truly desire, it may also be difficult to believe that we can get what we want. One of the first steps in Interpersonal effectiveness is identifying what we want and ensuring our objectives to guide our actions. Once we've identified our objective, we can outline the actions needed and steadily move toward our goals.

What does identifying objectives have to do with interpersonal effectiveness?

When we're uncertain, have doubts, or our commitment to our objectives wavers, we leave room for people to dissuade or stop us getting you want. However, when we have identified our values and objectives, and cultivated the ability to self-validate, there is little to stop us achieving realistic goals.

What does it mean to be skillfull?

Handling situations skillfully means applying DBT skills to regulate our emotions, maintain boundaries, and communicate in an effective way with other people. In dysfunctional families, a common dynamic is for people to communicate along a vertical axis (top to bottom, bottom to top, queen to servant, servant to queen) rather than horizontally (equally). If a member of the toxic family attempts to communicate directly, the are gaslit or silenced by violent, aggressive, or passive-aggressive communication. Another common dynamic in toxic families is baiting the family member who is attempting to communicate directly. At some point, the person being baited will respond and this dynamic may result in reactive abusive.

Baiting or goading is a manipulative tactic used to flip the script and position the victim as the abuser.

When we've grown up in a home where people only communicate in an indirect, dysfunctional or abusive way, it can be incredibly difficult to navigate day-to-day interactions. Getting what we need and want, even in the most basic sense, can seem impossible and leads to frustration, overwhelm and more interpersonal trauma. DBT skills and attaining skilfulness will gives us the confidence and knowledge to effectively handle both day-to-day, and significant life events, in a way that is effective and respects the boundaries and rights of everyone involved.