Treating Complex Trauma & Dissociation
An EMDR and IFS approach
What designates a person’s trauma history as complex? No trauma experience is “easy” or “simple”, but this term refers to prolonged, repeated experiences in interpersonal relationships lasting over time. Usually originating in childhood, these events are often difficult to escape from, and can include minimization or denial from the primary support system. Because the brain is still developing in childhood and adolescence, this can lead to greater difficulty coping in relationships and can include: dissociation, somatization, and more ingrained coping styles that can shape the personality. The nervous system (which remembers everything that has ever happened to you) can be in a constant state of flight/fight/freeze/flee or “wired and tired”, making it extremely difficult to relax. In early recovery, treating these issues is imperative to help reduce the risk of relapse, but also requires an abundance of caution to ensure the client is ready and has the tools to handle such treatment as their body adjusts to newfound sobriety. Treating complex trauma also requires specialized training to ensure safety, best treatment, and to appropriately address potential road blocks. Unfortunately, many clients see therapists and do not get better, feeling as though they might be “untreatable” when in fact they have not yet tried therapy approaches designed specifically for complex trauma.
Our brains are well equipt to protect us from harm. From an Internal Family Systems (IFS) perspective, we all develop internal coping mechanisms to aid in survival. These defense systems (called parts, aspects, pieces, etc.) become experts at a specific way of protection, that continue well past the original trauma and may or may not continue to serve us. An example might be a child developing a part that learns to people please to avoid verbal or physical harm from a caregiver. While in childhood, this behavior might reduce potential harm. People pleasing in adulthood, however, can lead to an inability to verbalize feelings, difficulties in relationships, and with regulating mood. In IFS, we do not view these parts as maladaptive, in fact they were quite adaptive for some time and are capable of learning new ways to protect and serve. The goal of parts work is to get to know your parts, develop curiosity and compassion for them, and help them to work together to learn new ways of serving the system that the entire system agrees with. When the system is not working together, it can look like one part choosing to drink to numb feelings when other parts do not want to engage in that behavior.
There can be fear or phobia of parts or between parts that can be addressed and resolved utilizing EMDR techniques of desensitization. Even if a client is highly motivated for trauma work, they might have a part or parts that aren’t as excited about it and resistant to change. Sometimes parts are still stuck in trauma; they not believe it is safe to stop doing what they believe works best to protect the system. Other times, parts may not know there are other parts and may think they are the only part in town. This might look like an avoidant part whose job has been to avoid anything related to the trauma. We then work to help this part understand why it might be helpful to allow feeling so we can move through and discharge emotions. Avoidance is a normal response to trauma as we are hard wired to avoid pain (think about putting your hand on a hot stove, we have a reflex that immediately tells us to move our hand). So, the idea of moving toward the pain to heal can feel foreign at first and take some warming up to.
Eye Movement Desensitization and Reprocessing (EMDR) is largely thought of in terms of processing trauma. But it also includes psychological resourcing prior to this processing. When we process trauma, the processing continues between session and requires tools to contain emotions or memories that might arise. We teach grounding techniques to cope with dissociation and flashbacks or nightmares. Resourcing also includes adding tools to contain traumatic memories, self soothe, and (when needed) implementing desired characteristics that might be helpful (like courage or assertiveness). Meeting and working with parts is considered extended resourcing; we can even give parts their own tools to self-regulate! New parts can be installed, like a part that is five years older, done with trauma therapy and living their best life. Attachment between parts can be enhanced. This resourcing allows more adaptive information into the overall system and allows the actual reprocessing portion of EMDR to move more quickly and have less defenses (parts) arising to potentially stall processing.
It can feel counterintuitive at first, to be asked to befriend and have compassion for those parts of self that previously we disliked. Ironically, it is in the acceptance of these parts that change can occur. When parts are disconnected, are not communicating, and disagree about how to best protect someone, it can feel loud or confusing in ones’ mind. Many clients with complex trauma also report that they do not believe this process can work for them, as if they are the one person whose trauma is “too severe” to hope for healing. Once undergoing this process, however, it is quite a sense of relief to come to believe that healing IS actually possible for them. When parts work is done, accompanied by reprocessing of trauma, clients report a peacefulness in mind, body, and spirit. This work compliments and enhances recovery from alcohol and drugs in that it allows a person more space between thought and action, moves out of survival mode to that of thriving mode, and supports all the amazing recovery work they have done to create a new life worth living.
For more information on complex trauma and dissociative disorders, please visit The International Society for the Study of Trauma and Dissociation at https://www.isst-d.org/public-resources-home/.
