Note: This article is dedicated to the victims and survivors of the city of Paris, 11/13/15.
New paradigms, not only for the way we think about trauma, but in how we think about emotion itself, social engagement, empathy and memory, have swept the psychotherapy field. And innovations based on these new understandings have first become assimilated into the trauma field and then influence virtually all other treatment modalities—from ‘standard’ (unspecialized) psychotherapy practices to couples and family work and more.
Is traumatic memory different from normal memory? How and why are traumatic memories relived—re-experienced as flashback, as if the trauma were re-occuring in the present? Why are they not simply recalled, remembered, as events understood to have happened in the past? Can traumatic memory be reprocessed so that it can be recalled as memory without being re-experienced? Or is a trauma survivor destined to always relive their horror as if it were occurring again and again in the present? How does the brain accommodate destructive experience and, to the extent possible, preserve personality structure? Only within the past thirty years have answers to such questions emerged on the basis of scientific data rather than theoretical hypothesizing. These cutting edge perspectives first become assimilated into trauma treatment and then reach the rest of the psychotherapy field.
Pioneering writings—of Philip Bromberg, Steven Mitchell, Thomas Ogden, Christopher Bollas and others—bring a reconceptualization of Self to the forefront. A revolution in theory of mind conceives of the Self as a constellation of inner self-states. Each self-state, or sub-identity, carries its own individuality, character and purpose. The therapist’s goal is not to unify the parts but to help the client harmonize them. Note: this view involving a multiplicity of selves describes normal development and should not be conflated with Multiple Personality Disorder, a pathological condition.
Cognitive and behavioral techniques have earned their place in the pantheon of effective psychotherapeutic theory and practice. A preponderance of neural pathways—neural pathways being unidirectional—originate in the limbic system, the emotional center of the brain, and deliver messages to the cortex, often associated with cognition. Clearly the emotional center has enormous influence on the ‘upper’ region, the cortex. Given that the limbic system is thought to have evolved approximately 500 million years ago and the cortex only 5 million years ago, this makes sense. Research findings indicate that decision-making, planning, as well as meta-cognition—thinking about thinking, thinking about feeling—are not only under pervasive influence of emotion; but that emotion effectively trumps cognition as the pathway to psychological healing. The felt-sense, the incipient wisdom of the body, outweighs the cognitive realm as a portal to restoring health. And this sea change in perspective, once again, is spearheaded through clinical applications innovated from within the trauma field.