When the Body Keeps the Score: Some Implications of Trauma Theory and Practice for Psychoanalytic Work

ABSTRACT

Trauma has wide-ranging effects on somatic functioning, nervous system regulation, relational engagement, and personality integration. This article provides an overview of how posttraumatic dysregulation and dissociation limit patients’ ability to engage in an analytic process, potentially leading to prolonged, stalled, or ruptured treatments. In this context, it offers suggestions for integrating insights and techniques from trauma therapies into psychoanalytic work, focusing on interventions that help people modulate posttraumatic reactions and so build their capacities to work through trauma’s impact.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

¹ Defining pathological dissociation goes beyond the scope of this article. In non-pathological multiplicity, however, individuals sustain access to situationally relevant thoughts, feelings, sensations, and actions. Parts of the personality appear in contexts that suit their capacities, without disrupting autonomic regulation, and they can adjust their goals to those of other parts. As it grows more severe, dissociation increasingly undermines such processes.

² Adequately developing this theme requires a paper in itself. Looking through the window of tolerance, however, we see that virtually any feeling can be profoundly dysregulating. For all the reasons I’ve outlined, if experiencing grief, guilt, uncertainty, shame, anger, fear, or any other emotion means being thrown out of the window of tolerance, people will do everything they can, consciously and unconsciously, to avoid these states and to go on functioning. Character styles built around such efforts are necessarily dissociative, sometimes extremely so (though not always in the DSM sense). They create an apparent window of tolerance based on control of primitive dangers rather than on a genuine experience of feeling safely relaxed. This difference has broad therapeutic implications.

³ In non-maltreatment, middle-class samples, disorganized attachment averages about 15%. The incidence rises to about 25% in low-income samples (Beebe et al., 2012; Fonagy, 2001; Hesse & Main, 2000).

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Vivian Dent

Vivian Dent, Ph.D., began practicing psychoanalytic psychotherapy in the dark ages when self psychology, relational approaches, and object relations theory first mounted their challenge to American ego psychology. About 15 years later, she began to study trauma and trauma therapies, eventually becoming an EMDR Approved Consultant while completing extensive training in Internal Family Systems and Sensorimotor Psychotherapy. She has taught at the Psychoanalytic Institute of Northern California, the San Francisco Center for Psychoanalysis, and Access Institute, among other programs. She has a private practice in San Francisco and Oakland.