When Understanding and Connecting aren't Enough: Working with Traumatic States1

Over the past quarter century, researchers and clinicians have learned an enormous amount about how trauma affects people's ability to benefit from psychoanalytic work. Above all, these discoveries help us understand those painful times when our efforts to help our patients connect, think, and feel not only fail to contain their distress, but sometimes even heighten it. Appreciating how trauma disrupts nervous system regulation, cognitive functioning, and interpersonal connectedness can enhance our engagement with people in pain and help us find new ways to help them. This knowledge becomes even more essential as we navigate so much current turmoil, with all the individual and collective trauma it generates.2

Current use of the word trauma ranges widely, sometimes extending to normal suffering and sometimes excluding all but the most extreme events. I base my working definition closely on that of Pat Ogden (2012), the founder of sensorimotor psychotherapy. By focusing on trauma's psycho-physiological impact rather than on the nature of any given event, this definition distinguishes trauma from pain and strain, even severe pain and strain, that do not have traumatic effects. Traumatic injury occurs when an event, a series of events, or a set of enduring conditions overwhelms a person's capacity to integrate emotional experience and/or is perceived as threatening safety or survival, triggering subcortical defensive responses and autonomic hyper- or hypoarousal.

Before going into more detail, it's important to note that something else must happen for traumatic injury to result in long-term symptoms: after the threat has passed, the person fails to receive adequate comfort and containment, which ensures that the traumatized person cannot integrate what has happened, may occur within a person, through an