One of the fundamental differences between the treatment of shock trauma and developmental trauma has not always been addressed in the healing community.
Whereas treating shock trauma involves the renegotiation of an overwhelming experience that has affected the nervous system left grappling with integrating the “too much, too fast, too soon” experience, it also assumes that there is a “before trauma” state of well-being, involving equilibrium and nervous system regulation in a somewhat established window of tolerance that the client can revert to. There is, we hope, a physiology (the biology of normal functions of living organisms) and a balanced nervous system in place, established long ago in early childhood, that act as a foundation to healthy development and that can be found again when shock trauma is renegotiated in session with the therapist.
But what if this foundation never existed? What if there is nothing to go back to because the basic regulatory structure built at the beginning of human life that guarantees healthy emotional and personality development is missing? When a healthy physiology is not in place early on, we need to re-invent a new one during the course of therapy. This is developmental trauma in its essence: different in its nature and very different in the way we treat it in psychotherapy.
A healthy foundation or physiology means secure attachment. When mom and baby connect after birth, a dance is initiated between them: it is a back and forth which involves ultimate attunement, engagement and moment-by-moment state matching. Their responses are coordinated rapidly, synchronized by their mutual gazes and voices. This deeply unconscious communication allows moments of intense engagement and arousal but also small increments of disengagement to allow for rest states. In this synchronized dance of intense connection and the split seconds of rest, the intuitive mom modulates her baby’s nervous system, his/her brain development, emergent motor skills, immune system, emotional being, body functions and many other facets of development. Even though misattunements will be common and inevitable during these interactions, mom will modulate the baby’s stress responses and repair the hyper or hypo arousals to bring equilibrium back to the system. Through this subtle synchrony, psychological attachment and its associated emotions are slowly built in: bonding can occur in a safe and healthy way, internal emotional structures are constructed as a solid foundation. We call it regulation of the nervous system.
Sometimes the conditions are not optimal for a healthy foundation. A caregiver can be depressed, neglectful, anxious, traumatized, addicted, isolated or lacking support. In some tragic cases, violence is chronically inflicted upon a young child.
When a depressed mother is holding her baby, he/she will match her state of numbness in an ultimate effort to connect and be seen. If an overbearing caregiver is riddled with anxiety, the baby will tune into the anguish as a guide and sometimes even try to regulate mom. These are only two examples of a multitude of scenarios that can present. They can have serious consequences on the development of the nervous system, on the bonding experience and on the subsequent development of disorders. These interpersonal deprivations and failures in the early stage of human development resonate through life and adulthood. Allan Schore, a neurobiology and attachment specialist attributes most of all psychopathology to ruptures of the bonding/regulation sequence that occurs during the first 12 to 18 months of life between the caregiver and the baby. He says we “download” our nervous system from our caregiver’s.
If there is no nervous system co-regulation between the caregiver and the baby, there can’t ever be self-regulation in adulthood: the individual will most likely hover between high states of arousal (anxiety/flight-anger/fight) and shut down (depression/freeze). There is no middle way. Symptoms might appear: anxiety, depression, numbness, fear and worry, irritability and anger. Behaviors and coping mechanisms come into place to the rescue of the symptoms in an effort to maintain some sort of wellbeing (ex: OCD for anxiety). Relationships suffer. Sometimes medication is needed to function on a daily basis. Illness and autoimmune disorders manifest every so often later in life.
This leaves us with the familiar insecure attachment styles coined by Bowlby: anxious, avoidant and disorganized, with their own subdivisions. It also leaves us with a lack of “resilience to stress or a predisposition to psychopathology.“*
Developmental trauma (conception to 3/5 years old) not only encompasses the relational and physiological aspect of the caregiver and the baby’s attachment style but can also include the possible complications of conception, pregnancy and birth or serious illness (preeclampsia, fetal distress, use of forceps, premature birth, to name just a few). When these added challenges occur in a traumatic way, they leave a dysregulated nervous system imprint on the young physiology.
Finally, I need to consider Gabor Mate’s thoughts on genes and environment. He says the genes load the gun but it is the environment that pulls the trigger. When the postnatal environment is less than optimal for the baby’s development (ex: mom has post partum depression, she is not attuned to the baby’s cries, there is violence in the home), these ruptures are likely to give the genes a voice. Early trauma and dysregulation might just turn them on.
The good news is that the part of the brain where the nervous system is regulated and repaired is plastic and malleable enough to be transformed. The other good news is that through the therapeutic work, safety is created and trust is slowly built through the interpersonal work. The best modality I have found to work with these early developmental ruptures is by doing table work and touch therapy in the office. In this way, we recreate the early environment of life in a safe place and repair the fragile nervous system and the bonding mechanisms that failed earlier. You can learn more about it here.
Thank you to my teachers and mentors Kathy Kain and Steve Terrell who tirelessly teach the ins and outs of working with table and touch therapy. Learning with them is an ongoing process. Allan Schore’s thorough writings have brought light to the theory behind the practice.
*Schore, Allan. (2003) Affect Regulation and the Repair of the Self. Norton &Company, p276
Schore, Allan. (2003) Affect Dysregulation and the disorders of the Self. Norton & Company
Schore, Allan. (1994) Affect Regualtion and the Origin of the Self. The Neurobiology of Emotional Development. Lawrence Erlbaum Associates.