1. Know what you are dealing with: When making a plan to address any complex problem, it is necessary to know what we are dealing with. Developmental trauma is no exception to the rule. However, because one of the most common ways of responding to distress is with avoidance, in adulthood developmental trauma can manifest in many ways which are not obviously connected with earlier experiences. In my experience, although public awareness is higher and healthcare provider training better, many people only recognise the traumatic origin of their problem after years of suffering.
It’s not uncommon to have been diagnosed with other mental health disorders such as bipolar disorder, border personality personality disorder and various personality disorders, before the developmental component is recognised (bearing in mind that traumatic issues are often co-present with other problems). Post-traumatic and dissociative symptoms fly under the radar, and the enactments of those issues in personal relationships, self-care and professional life are attributed to other factors—often re-enforcing self-blame, self-defeating patterns and pushing others away. Why? Because there is often a “don’t ask, don’t tell” feeling to trauma. This is typically institutionalised, and is arguably a core component of our culture—to ignore and downplay trauma. Doing so helps maintain the status quo, preserving stability at great expense. Complex PTSD, PTSD and other trauma related disorders often fly under the radar.
Even in clinical evaluation settings, it is very common for patients to omit traumatic experiences, and clinicians are often poorly trained about how to evaluate for them and their consequences. Often the focus is on a presenting problem, depression, anxiety, addiction, eating disorders, and so on—and sometimes trying to address the underlying factors leads to individual and family resistance. The omission of addressing the underlying problems creates a vicious cycle, often driven by feeling such as shame and psychological pain, to create chronic non-recognition – often repeating a core pattern from one’s family of origin to cover-up abuse and neglect, and pretend everything was fine.
Work toward putting trauma in perspective: Even suggesting keeping trauma in perspective can feel like an insult to someone who has lived through terrible experiences. It is difficult to recognise the presence of developmental trauma in oneself because of the challenging feelings evoked and tendency to either avoid or become overly preoccupied with it. It is a delicate balancing act, and takes time. Being over-identified with trauma can re-enforce an identity of victimisation, leading one to live only as a traumatic self in a traumatising world. Likewise, with unresolved trauma, we are more likely to perpetrate against others without knowing it. We may become compulsive caregivers, sometimes even over-empathising with those in need to our own detriment. Putting traumatic experiences in perspective, working toward having a context for understanding trauma in the broader sweep of one’s life while building new experiences which are healthy and self-affirming, can lead to greater empowerment and a shift toward a non-traumatic sense of self.
2. Be aware in the moment: Emotional dysregulation is a common feature of unresolved trauma. Often there is numbing and dissociation, as well as fixation and preoccupation, or some mix of either extreme. Because traumatic experience is often driven by avoidance of one’s core self, memories and emotions, many people with unresolved or resolving developmental trauma struggle to remain present with themselves and others. That basic capacity to sit with and name difficult experiences didn’t develop properly because of early trauma, but can be cultivated as part of recovery and post-traumatic growth. Various forms of meditation, typically in the mindfulness tradition, can be helpful for this. There are structured forms of mindfulness as well, such as mindfulness-based stress reduction and mindfulness-based cognitive therapy, which are becoming more common in clinical practice. Compassion-based meditations and loving-kindness practice, based on eastern traditions such as Tibetan Buddhism and Hinduism, can be additionally useful because they are intended to directly fix core consequences of developmental trauma. However, mindfulness and compassion-based practices can sometimes be problematic because they can make one aware of emotions and memories which one is not ready to handle properly and lead to worsening of other problems in response, triggering re-traumatisation, and generally are most effective as part of a broader recovery plan. It’s important to take self-awareness in small doses, building up proficiency and gradually digesting whatever experiences come up.
Learn to regulate emotions: Because of the emotional regulation challenges unresolved trauma presents, it is crucial to learn how to cope differently. This goes hand in hand with basic awareness, because having effective coping tools empowers one to recognise and respond to challenging experiences in oneself without as much fear of making things worse as a result. Rather than getting stuck in vicious cycles of failed recognition and further suffering, focusing on basic coping and awareness can lead to virtuous cycles of developing greater capacity and making headway with problems which once were intractable. It’s typically a slow process, especially in the beginning, but positive changes build up over time and become more established, hopefully eventually leading to stable and enduring changes.
3. Rewrite your story: Because fear-based brain systems dominate in trauma, one’s story of oneself becomes dominated by generally one-sided, negative perceptions of oneself and others, and the expectations of an unsafe and indifferent or even malevolent world. This is a self-protective story, but sadly comes with high costs as a result of erring on the side of staying away from new experiences which may be positive and useful because of exaggerated fears. It is common to interpret others’ intentions and events in one’s life negatively to manage expectations and try to avoid repetition of injury and disappointment. Mistrust is a dominant theme and shapes decisions. It makes sense – surviving in a traumatic developmental experience often called for such measure, but out of context in adulthood as a sole view of life, it is too rigid and too often leads to repetition which is painful, but confirms the belief in a traumatising world.
Re-writing one’s story, putting trauma in context, has been shown to be an effective approach for getting out of survival mode and shifting our approach to ourselves, others and life in general. It’s easier said than done, because doing so involves further engagement with very challenging subjects. Narrative therapy, and narrative exposure therapy, are structured apron aches which are intended to re-contextualise trauma, and help to re-tune the brain so fear-based systems exert the right amount of control – neither too much nor too little. Regular talk therapy may also be useful, but sometimes is not geared toward addressing trauma, and related issues, specifically.
It’s key to practice new patterns in real life as part of rewriting our stories. Seeking out positive experiences, cautiously especially at first, over time leads to building a track-record of more optimistic expectations and chips away at the belief that life is incontrovertibly bad. Even just the idea of doing so can feel upsetting, challenging basic adaptations to chronic distress, and the suggestion of doing so can be met with confusion, anxiety and even hostility. Making a sustained effort to be rationally optimistic can seem like a very misguided concept. Hand-in-hand with banking positive experiences, resisting repetitive negative experiences is just as important, and just as challenging. For one thing, as mentioned, a lot of self-protective perspectives and behaviours, out of context, lead back into disappointment and even re-traumatisation.
Furthermore, many drivers of traumatic experience are habitual or unconscious, and efforts to make better choices can lead to disappointment and feelings of helplessness when they inadvertently don’t work out. It’s important to have the basic ability to be aware of and manage emotions in order to understand that unlearning old patterns and re-learning new ones is going to have ups and downs before becoming more consistent and reliable. There’s a lot more to this, because taking emotional risks isn’t always going to work, and the times it doesn’t can lead to major setbacks if one is not well-prepared.
4. Practice self-care: Unresolved developmental trauma too often leads to a negative sense of self. We can feel undeserving of love and care, we can be too-self blaming and having a basic sense of unworthiness, and can come to belief that any attention to ourselves is “selfish”. In addition, taking care of oneself can simply be unfamiliar, a skill set which never fully developed, especially if self-care is overly focused on basic survival. Self-care is about both taking care of oneself physically, but also emotionally, psychologically and spiritually.
The basic orientation toward self-care can be minimal, almost absent, and the idea of anything more than the barest minimum, especially if neglect was a major part of one’s upbringing, can be alien. It’s important to work toward self-care in a gradual manner as well, first working toward accepting the idea that self-care is not only not bad, not only is ok, but also is potentially a source of accomplishment and even enjoyment. Building self-care over time leads to a sense of greater self-efficacy, creates resilience, and reduces the negative health impacts of trauma, both mental and physical. Forgiveness, permission to grieve, gratitude and related practices can come with time, and are an important part of self-care as well.
5. Work with others: Because trauma often divides people, especially in families leading to fragmentation and an “every man for himself” mentality, it is important to recognise that working on recovery alone may not be efficient, and may even stall at some point. Working with others can be informal, or can involve seeking out groups of people in different settings ranging from meditation groups, recovery groups and clinical settings. Being able to ask for help is an important part of self-care, and can be difficult to do especially when trauma came from trusted others who betrayed that trust. Having a supportive group is important during periods of forward motion as well as during challenging periods, and having a plan to reach out for help especially when things are at their worst is often the decisive factor.
6. Cultivate patience: Growth takes time. There are periods where things may get better, and other times where it looks very bleak and terrible things happen. The overall goal is to establish a different pattern and to have a goal of maintaining the process, rather than focusing on short-term successes and failures (though goals along the way are useful to establish as long as they are flexible). Patience, compassion, curiosity – are likewise long-term process goals, good to cultivate with the understanding that the ongoing effort is worthwhile rather than having an expectation of developing them overnight. Our basic attitude about change itself may change, providing relief and room for development in new directions.