Decoding the trauma and using psychodynamic skills to journey with clients towards healing

by Siobhan Rock

It is often the case that clients will embark on the journey of therapy with no real conscious idea as to why they are there; the reality is, however, that their unconscious knows exactly why they have come to therapy. I often say that psychotherapy is like peeling an onion; a few layers in and clients get to the layer that makes their eyes water. It is at this stage, usually around session five, that therapy can end; one of the reasons for this is resistance. It may be useful to reframe resistance as ambivalence (Engle & Arkowitz, 2008). This article explores the areas of resistance, repression and dissociation; why clients deploy these defence mechanisms and some strategies that therapists can use to help clients to face and recognise the unconscious dynamics at play in their psyches.

Resistance
According to the American Psychological Association, resistance is defined as a defence which can fall into one of three categories: conscious resistance, id resistance and repression resistance (American Psychological Association, n.d. a). The purpose of resistance is to protect the client from remembering and going back emotionally to that place of trauma, a time-space reality they have worked so hard to forget. Resistance is a defence mechanism deployed by the psyche in response to trauma; it involves a pushing down into the subconscious or unconscious mind any memory that was confusing, painful or shameful. There can be reluctance from clients to explore any traumatic area of their life that might hold resistance; if the trauma is in the subconscious mind the client may articulate to the therapist that he doesn’t want to talk about it or there can be a changing of the subject; with unconscious resistance a client may fold his arms and say he doesn’t remember.

Clients must very often wade through the murky waters of shame in order to heal. This is an arduous journey fraught with tension and anxiety. Clients with repressed memories often have (metaphorically) one leg in and one leg out of therapy until they feel, at some level, safe enough to allow that nailed-shut box of their psyche to be opened. It may appear at times that the client is not getting anything from therapy, they are not progressing; the therapist may feel guilty that she is wasting the client’s time and money or that she is failing the client in some way. There is, however, a lot going on at a deeper level; clients need to build up enough trust in the therapist before they can allow themselves to engage in the real work of therapy.  It is very easy for a therapist to tell a client that he is in a safe place, the client, however needs to feel that for himself. He needs to know that he can really trust the therapist, to know that he won’t be rejected or judged before he will know that it is safe, it is only then that he will be willing enough to loosen his resistance and explore why it is that he came to therapy in the first place.

Repression
“Memory repression is a useful and necessary tool that unburdens your mind, leaving you free to focus your conscious energy on the here and now” (Fredrickson, 1992: 22).

Sigmund Freud initially developed the concept of repression (Breuer & Freud, 1895). Memories or thoughts that are too painful to hold in the conscious mind are pushed into the unconscious (Freud, 1957). These buried memories will never fully go away, however, and as long as they remain unconscious they cause problems for the individual in the form of a symptom. Freud (1920) wrote about unpleasurable experiences being split off by the process of repression. In his paper, “Beyond the Pleasure Principle” Freud (1920) gave an account of a young boy he was caring for while his mother was away. He noticed that the boy was not playing with his cars in the way he was expecting him to, rather he was flinging them to the far corners of the room saying “gone”, then hunting for them and joyfully uttering “back” when he had found them. Freud discovered that this small boy was recreating loss; his distress as a result of his mother’s absence, which wasn’t consciously displayed by the child, was being relived in his play.

Borella (2019) posits that traumatic memories are often beyond recall as they are stored as implicit rather than explicit memories. Implicit memories are stored in the limbic system which is not in the part of the brain involved with language or speech (Borella, 2019). Bessel van der Kolk (2014) states that the body can remember what the mind forgets; trauma is often relived rather than remembered. It can seem like a hopeless task to expect clients to remember forgotten traumas in order to be healed, however, the unconscious mind is clever enough to create a trail of breadcrumbs on the pathway towards healing. In order to remember the forgotten we will repeat and relive traumas and, with the help of therapy, work through or transition these traumas (Freud, 1958).  

The internal defence forces                          
The primary purpose of the limbic system in the brain is to protect us from harm and to keep us alive in a world that is often full of danger. The amygdala, part of the limbic system, plays a role in consolidating memories. It consolidates or encodes memories in other parts of the brain including the caudate nucleus and the cortex, as well as stimulating muscarinic receptors that are involved in the parasympathetic nervous system. This process allows for a reaction to occur in the bodily organs and tissues, thus ensuring that experiences that are emotionally significant are never forgotten; they are embodied (McGaugh, 2004). Experiences that are significantly positive or negative can activate neurobiological processes which result in the creation of long-lasting memories (McGaugh, 2004). Anything that is stimulating, in particular frightening stimuli, activates the sympathetic nervous system causing a release of stress hormones – cortisol and adrenaline from the adrenal glands. The purpose of these hormones is to prepare the body for fight or flight. The amygdala keeps a record, as it were, of the stimuli that caused this fight or flight reaction so that it can send out an immediate, split second warning in the future; for example, a person may develop a fear of snakes, either following a documentary on snakes that incited fear, or because he was once bitten by a snake. If at any stage in that individual’s future, he sees something snake-like on the ground, a fight-flight response will be triggered instantaneously. When the trauma that is triggered is not conscious it can cause a much more prolonged episode of anxiety within a person (Brosschot et al, 2010). It goes without saying that the task of the psychotherapist is not an easy one when triggers are not conscious, however, encouraging the client to journal, to document dreams as well as their good and bad days can sometimes provide a pattern from which clues may emerge.

Where the sympathetic nervous system acts as a stimulant as it were – it puts the individual on their guard to protect them from perceived harm; the parasympathetic nervous system is a relaxant. It soothes the individual and brings the body back to homeostasis. Mindfulness and meditation are perhaps the best practices available to stimulate the parasympathetic nervous system which will in effect calm down the fight or flight response within the limbic system and reduce the feeling of anxiety. A meditation that I would recommend is RAIN by Tara Brach. RAIN is an acronym for Recognise, Allow, Investigate and Nurture (Brach, 2016). This practice encourages self-compassion which can counteract feelings of shame.

Dissociation                                
In the late 1890s Pierre Janet, a French psychologist and psychotherapist, was a pioneer in the area of dissociation – a defence mechanism used by individuals in response to traumatic memory (van der Hart et al., 2006). The American Psychological Association defines dissociation as “a defence in which conflicting impulses are kept apart or threatening ideas and feelings are separated from the rest of the psyche” (American Psychological Association, n.d. b). Dissociation is a type of compartmentalisation, splitting off or the numbing out of a painful memory. The main part of the psyche that remains unaffected by the trauma is called the apparent normal part (ANP); the split off, traumatised part of the psyche is called the emotional part (EP) (van der Hart et al., 2006). It is possible for an individual to have more than one EP – each EP holding a traumatic part or set of memories (van der Hart, 2018). Dissociation involves compartmentalising traumatic events so that the person is not living in trauma time all of the time.

Memories that are frightening can be dissociated or split off by the psyche from conscious awareness, and these split off parts often show up in the individual as a symptom; what the ANP has forgotten, the EP - the split off part of consciousness - remembers (van der Kolk & van der Hart, 1989). It is the part of the psyche that is involved with personality that creates dissociation (Steele et al., 2016).

When a person is confronted with a person, a situation, or even an aroma that is associated with dissociated trauma, this can trigger a memory, either in the conscious mind or in the body. However, this is not always the case; the psyche can keep that dissociated part in abeyance. A client of mine once recalled a memory of sympathising with her cousin when this cousin revealed to her that her father had been sexually inappropriate with her as a child. It took another twenty years before her own memories of abuse at the hands of the same man – her uncle – came back into her conscious mind.

It can take years of therapy, working through shame and slowly building trust, before a client will allow themselves to remember trauma, particularly in relation to childhood abuse. Part of the reluctance in females particularly to reveal sexual abuse may revolve around some ownership they took as a child, perhaps handed out by the perpetrator. There may also be also a fear of being blamed or not being believed. Male victims of abuse tend to fear that they will be viewed as being homosexual or as victims (Alaggia, 2005).

Symptoms of dissociation can include - apart from the obvious amnesia - depression, anxiety, OCD behaviours, bizarre thinking, depersonalisation as if they are living someone else’s life, an out of body experience - as well as somatic complaints. Somatic complaints can include idiopathic symptoms such as stomach problems or temporary blindness that cannot be explained. A client, ‘K’, with whom I had been working for a number of years suffered swelling in one of her ankles from time to time, a swelling that often disappeared as quickly as it arrived, a symptom that baffled both her doctors and her physiotherapist. Over time this client discovered that when she was around men who made her feel uncomfortable, that particular ankle spontaneously began to swell and would subside without any treatment when she was no longer around the men who seemed to trigger this bodily reaction. On one occasion, she had a temporary lodger staying with her for a period of three weeks who as she described gave her “a bad vibe”. For almost the entire time she had a swollen ankle which subsided almost as quickly as the lodger left. K recalled on another occasion that the man who lived in the semi-detached house next door to her had once exposed himself to her outside of her sitting room window, since then he evoked a fear response in her. This gentleman only stayed in his house on occasion and very often when he arrived back, K’s ankle would begin to swell. K did not know the origins of this bodily response; however, she would spontaneously recall the dangerous turn at the top of the stairs in the home of the uncle who had abused her. It is possible that K twisted her ankle to some extent on the steep stairs with the dangerous turn; she does not consciously remember this, however, it is feasible that she repressed this memory in the same somatised location as her abuse – in her affected ankle. Freud (1958: 207) refers to his studies on Hysteria with Breuer in relation to hysterical symptoms being “residues of profoundly moving experiences, which have been withdrawn from everyday consciousness”.

The conscious mind may not remember the trauma; however, the body will react to stimuli similar to the original trauma, in K’s case anything linked to her adverse experience since she can remember she has had an issue with stairs and very often cannot negotiate them on her own.

Treatment of dissociation can be particularly difficult as it is often a process in itself to identify a dissociated part. Very often when children have been sexually abused, they have been silenced by the abuser; they cannot ever tell their terrible secret for fear of the promised consequence. This part of their psyche seems be stuck in trauma time, in a childlike way of thinking, often leaving the adult who was abused years earlier by a long dead perpetrator still living in fear of the threat. A way of bypassing this, according to van der Hart, is to invite the victim/survivor to write about the abuse – they were warned as a child not to speak; they were not warned about writing about it, so writing about it now may empower them to feel free to add that part (van der Hart, 2018).

Case histories
A psychotherapist is at times like the TV detective, Columbo: the task is to pick up on all of the clues from the client, all of what is communicated verbally and non-verbally. These clues can easily be missed if the therapist is not fully attuned to both the client and to themselves; what am I feeling or thinking now that may be relevant to this client in front of me? I once had a client who had no memories of trauma from childhood, in particular with regard to when she would have been criticised. As she was telling me that she had no memories that she could recall I noticed that she was rubbing her left arm. She had informed me some weeks earlier that she had fractured this arm twice in the same place when she was three and again when she was six. Though the client had no conscious memory of the times when she was criticised, she was unconsciously giving me the timeline via her body language.

I had been working with a client (whom I referred to above as K) who initially presented to therapy for help with her with anxiety, an anxiety that was often projected into different situations like the weather or driving, particularly over bridges. On one occasion, some years into therapy, she was talking about a gentleman who was at that time currently employed to work in her parents’ house. From how she described this gentleman’s behaviour I would have expected her to feel annoyance, however, I noted that there seemed to be a fear response activated in her, despite the fact that this man certainly posed no threat to her. I asked K if she had any memories of a man frightening her as a child; she responded in the negative. I invited her to ask her mother which she agreed to do. In one of our subsequent sessions K informed me that she had felt extremely angry with me after leaving that session which she agreed was unlike her; it seemed that a defence had been mobilised within her. K then said that she thought that she was sexually abused by her uncle when she was young. This repressed memory (which eventually emerged with more clarity in the following months) was remembered by gentle enquiry and discussion of the various possibilities, what I call “scattering the seeds for the unconscious”.

Some time ago I was working with a lady in her late thirties (I will call her A), who had never been in a romantic or sexual relationship. During our sessions we would explore possible reasons for this including the possibility of childhood abuse. Initially, A talked about having a vague memory of being in the loft of a barn playing with kittens or puppies or even chickens and seeing the farmer at the top of the loft’s ladder. This man had sexually abused A’s sister but A had no memory of him abusing her. As time went on A became convinced that this memory was not her memory, it was her sister’s memory that she had shared with A some years ago. The recalling of this memory was not evoking an encoded bodily response as is often the case when clients remember trauma; nothing emerged from the enquiries that mobilised any reactions, memories or dreams. This may be because this was indeed her sister’s memory and not hers, or perhaps it could also be that it was her own experience but whatever happened next in that barn was still repressed and she was not yet ready to face it.

A young mother once presented herself for therapy following a disclosure from her six-year-old daughter of sexual abuse at the hands of a close family member. One of her most upsetting experiences was witnessing her young daughter lying still in the middle of a medical procedure as if not noticing or feeling the doctors probing her and taking blood from her. This mother knew that this was not normal behaviour; years of sexual abuse had mobilised the defence mechanism of dissociation in this child, she was habituated to emotionally leaving her body so as to not be aware of the trauma.

Conclusion
Decoding the unconscious trauma buried in the client’s psyche can be difficult but very rewarding work. Allowing the client time, as much time as he needs to build trust is, I feel, of the utmost importance alongside the building of the client-therapist relationship. Psychoeducation is very often useful in helping clients to understand themselves and their feelings better as well as using Roger’s core conditions (Mearns & Thorne, 1995). Rogers posits that each client knows innately why he is hurting and how best to heal (Mearns & Thorne, 1995). Understanding the unconscious dynamics such as repression, resistance and dissociation will help the therapist understand and thus better help the client to navigate his way from trauma and the repetition of negative patterns towards healing. 

Siobhan Rock is an IACP accredited psychotherapist and supervisor and she has worked as a therapist for over 20 years. Siobhan has an MA in Addiction Studies and is a qualified couples therapist. Siobhan works full time in private practice as well as tutoring with ICPPD college. She has a particular interest in childhood trauma. Siobhan can be contacted at siobhanrock27@ gmail.com or by phone at 087 2647839.

References
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American Psychological Association (n.d. a) APA dictionary of psychology. Retrieved 19 March 2020 from https://dictionary.apa.org/repression-resistance

American Psychological Association (n.d. b) APA dictionary of psychology. Retrieved 19 March 2020 from https://dictionary.apa.org/dissociation

Borella, P. (2019). Working with repressed memories: Paola Borella explains the mechanisms underlying repressed and recovered memories. Therapy Today, 30(6), 32-35.

Brach, T. (2016, September 27). Tara Brach leads a guided meditation: The RAIN of self compassion. [Video] YouTube. https://www.youtube.com/watch?v=wm1t5FyK5Ek

Breuer, J., & Freud, S. (1895). Fräulein Anna O. Studies on hysteria, 2, 21-48.

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Mearns & Thorne. (1995). Person-centred counselling in action (1st ed.). Sage.

Steele, K., Boon, S. & van der Hart, O. (2016). Treating trauma related dissociation: A practical, integrative approach (Norton series on interpersonal neurobiology). WW Norton & Company.

van der Hart, O., Nijenhuis, E. R., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. WW Norton & Company.

van der Hart, O. (2018, 24-25 November). The haunted self: Understanding and treating trauma-generated dissociation, with an emphasis on working with dissociative parts. [Conference presentation]. Professional Counselling & Psychotherapy Seminars Ireland (PCPSI), Dublin, Ireland.

van der Kolk, B. & van der Hart, O. (1989). Pierre Janet and the breakdown of adaptation.  American Journal of Clinical Hypnosis, 1530-1540.

van der Kolk, B. (2014). The body keeps the score. Penguin.