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Book Review-Invisible Heroes: Survivors of Trauma and How They Heal

Trauma survivors aren’t heroes in the same sense that a first responder is.  We see the first responder at the scene of an accident, like a house fire, and see how their actions are protecting all of us.  We don’t get to see the hard work that trauma survivors do, because their work is internal.  That’s why the title Invisible Heroes: Survivors of Trauma and How They Heal makes so much sense.  The work is invisible on the outside – until the trauma victim reemerges transformed by the trauma.  (See Transformed by Trauma for examples.)

Predictable Pacification

Too frequently after a trauma, a person blames themselves.  They think that they somehow – often magically – should have avoided the situation.  Of course, in many cases, there is no way to see or avoid the situation.  It’s one of the random things that happen in life.  Even in those cases where we could have made different choices – and likely will in the future – there’s little reason to ruminate over the choices that were made.

This need for a sense of control – innate to all humans – drives us to take too much accountability for the things that have happened and how we might have made things turn out differently if only we had done something differently.  We fail to accept that we may not have done anything wrong or incorrectly.  We believe we had to have done something wrong, so that we can maintain our belief that the world isn’t random and that we’re able to predict it.

The degree to which we believe we can predict the situation influences the degree to which we feel peaceful.


One of the challenges with the unnecessary attribution of blame to ourselves from the randomness of life is that we can take on ourselves a sense of unworthiness.  That is, we believe that not only did we make a mistake (guilt) but that we’re unable to do the right things (shame).  We start with shame, but eventually we start self-punishing and self-isolating, perhaps progressing even to a place where we believe we’re irredeemable.  There’s nothing that can happen to make us worthy of interacting with other mortals.

Sometimes, this thinking style becomes so pervasive because of continued trauma and abuse that the idea of returning to what others would consider normal is uncomfortable.  It can feel weird and uncomfortable for people to treat you as a fellow human instead of someone beneath them.

The truth is that no one is irredeemable.  Everyone deserves to be treated as a human – even if that’s not their norm.


Substantial traumas often create a division in a person’s lifeline.  There’s a time before the trauma and a time after the trauma.  Often, traumas cause a major change of course.  One of the ways you can recognize that someone acknowledges their experience was one of trauma is that they’re able to acknowledge their life is different – in more than a tactical and mechanical kind of way.

With smaller traumas, or traumas that persist over a longer time, it’s harder to see this demarcation point, but it’s rare that trauma doesn’t cause us to change in some way or another.

Something that Happened to Me

With time, in the post-trauma space, it’s possible to recount the trauma without reexperiencing it.  Until we can establish an explicit memory of the trauma and come to some terms with what it does – and does not – mean, many victims reexperience the event while retelling the story.  With new traumas, it’s important to not push them to recount the events, because doing so may accidentally amplify and anchor the trauma in their mind.  Rather, we should let people share at the speed, detail, and level that they’re able to.  If we can create a safe space for them to process the trauma, they can move it to something that happened in the past.

It is even better when we can recognize that one trauma or even multiple traumas don’t define us.  Yes, there is that demarcation line where things changed, but it’s not the entirety of who we are.

Work is Hard and Necessary

I’ve never found anyone who would dare to say that overcoming and moving past trauma is easy.  Even those who are grateful for where they are today would neither recommend their trauma nor relish the work they had to get to their place of healing.  Victor Frankl in Man’s Search for Meaning explains his time at a concentration camp.  While he exposes some of the things that helped him and others survive, he doesn’t recommend it.

There’s a delicate balance of experiencing the event while replaying it at a level that’s safe enough but vulnerable and raw enough that it’s possible to make sense of the event.  Sometimes, the only sense of control you can get in a trauma is the extent to which you allow yourself to experience it and your insistence that it won’t define you.

Mastering the Waves

Trauma survivors will tell you that you’ll always experience triggers that connect you to the traumatic experience, but they change.  It can be likened to riding an emotional wave on a surfboard.  You are still moved by it, and you’ll likely end up in the water at some point.  In the meantime, you can stay above it, using the energy to propel you forward.  Surfers, even professional surfers, fall off their board, but until they do, they’re able to do some amazing things.

One way to make trauma better is to learn the skills that allow you to spend more time above the wave and less time being pummeled by it.

Internal Perception of Danger

One step is recognizing that, often, the danger and fear associated with the event are in the past.  It’s quite likely that the fear of that moment doesn’t continue into the current moment – or shouldn’t.  What we come to realize is that it’s our internal perception of danger that matters more than the objective measure of risk.

We can use a set of well-known techniques to shift our perception away from momentary and current danger to a sense of relative safety.  Some of those techniques are below.

Play Acting a Different Ending

It’s magical thinking.  It’s the domain of the two-year-old – but it works.  For Victor Frankl, it was imagining his wife.  He knew she might be dead, but hearing her speak to him transcended that actuality.  He was able to create a scene in his mind that he knew to be reassuring but also false.

One way that we can reduce the suffering associated with trauma is to replay the event in our mind with different endings.  We can know they’re not real but at the same time be comforted with alternate endings.

An Army of Heroes

One alternate ending that can be valuable is to call in for a hero you can trust – real or imaginary.  These heroes can stand with us in our mind’s eye of the moment.  For some, they have a single hero who can stand with them.  For others, it’s a cadre of heroes, each with their own special skills and protections to offer.

This stands in the fantasy land of the child and at the same time offers us healing.  The real heroes aren’t the Invisible Heroes of our imagination but are those who fight their way out of the wake of trauma.

Book Review-Reducing Secondary Traumatic Stress: Skills for Sustaining a Career in the Helping Professions

When you think about it, there are dozens of professions that are focused on improving society.  We think of first responders in terms of firefighters, law enforcement, emergency medical personnel, and 911 dispatchers.  However, we forget about our mental health professionals, teachers, child protective services, and dozens of other professions that are exposed to the traumas others are coping with.  Reducing Secondary Traumatic Stress: Skills for Sustaining a Career in the Helping Professions is designed to serve those who serve others by helping them learn to address the hardest parts of their jobs.


Early on, Miller speaks about burnout harking back to Freudenberger’s Burn-Out.  He incorrectly associates Maslach’s work with Freudenberger’s, perhaps because that’s the narrative that has been spun.  (I should say that Freudenberger’s book isn’t the oldest book on burnout: that distinction belongs to Professional Burn-Out.)

Miller, however, correctly identifies the key to burnout as feelings of inefficacy.  He challenges the notion that you’re burned out at the end of a long career and explains that burnout happens more frequently at the beginning of a career – not the end.  Of course, this is consistent with the research we did when building Extinguish Burnout.

Compassion Fatigue

Miller similarly pushes back against compassion fatigue.  He argues that it’s not that you’ve expressed too much compassion, but rather that you’ve closed yourself off to all feelings and empathy with the result of failing to express compassion for those you’re there to serve.  In Is It Compassion Fatigue or Burnout?, we speak about it from the perspective that professionals have failed to do their self-care.  The result is the same: you shut down, and it’s this shutdown that’s perceived as compassion fatigue.

Systemic Stress

Too many mental wellness programs are little more than herbal tea, soft lighting, and a once-a-month yoga session.  While these practices have some value, they’re often crushed by the onslaught of 50-minute sessions, crisis calls, and complex cases.  The physician that can’t find time for a bathroom break between 15-minute patient appointments won’t find what they need at the bottom of a teacup.  The paramedic whose sleep was just interrupted to respond to an accident doesn’t need soft lighting.

We can’t assume that we can put a band-aid on a gaping wound, and it will all be okay.  We have to match the care that we give to the need.

Feel or No Feel – There Is No Try

My apologies to Yoda.  You can’t selectively let in some feelings and dampen others.  You can’t decide to let joy through but block depression.  When we numb – either naturally or with pharmaceutical assistance – we block both the good and the bad.  This is part of Miller’s point: when we try to block out the struggles of empathy, we necessarily prevent the development of compassion.  We can either choose to open ourselves to experiences and live, or we can wall ourselves off from the world and from others.  If we choose that option, we disconnect ourselves from the broader community and their support for when we’re feeling low.

No Feeling is Final

What we know about feelings is that they change.  Even moods change over the longer course of time.  (See Emotion and Adaptation.)  It is hard to remember in the moment that the feeling will pass.  (See Capture.)  However, the only thing constant about feelings is that they do change.

There is something to be said for actively shaping your thoughts while accepting them.  One can work to hardwire happiness without preventing acceptance of other emotions.  (See Hardwiring Happiness.)  Too many people believe that feelings happen to you – and it can certainly feel that way.  However, we know that you can consciously influence your feelings by focusing attention on the emotions that you want to have.  Caution is appropriate here so that we don’t over emphasize what can be done, as Bright-sided and Happier? Are concerned about.

Removing Rumination

Rumination is the opposite.  It’s focusing on the same situation and the challenges associated with it without finding ways to resolve the problem.  Instead of problem solving, rumination catches us in a net of repetition.  (See Capture.)  If we want to break free from rumination, we must either seek to solve the problem, or we must learn to let go.

Miller proposes an ACES (Action, Concrete, Experiential, and Specific) model for problem solving.  You know it’s not rumination when you’re coming up with specific, concrete actions that are doable.  Problem solving doesn’t mean that you must solve the end problem yourself.  Even identifying the specific set of actions you’re going to do to ask for help is enough to allow your mind to let go of it.

It used to be that I’d be caught in a loop of trying to not forget something that I needed to do in the morning.  Now, I grab my phone, send myself a quick one-line email, and go back to sleep.  Knowing that I’ll see it in the morning allows me to let it go and move on to the important need for sleep.

Letting go of something is the other option.  It’s easier when you’re deferring it, but for some things that we ruminate on, we need to accept that we have no control of.  We can’t prevent something from happening or cause it to happen.  No amount of rumination will change the outcome.  As uncomfortable as it can be, sometimes we just must let the cards play out the way they’re going to play.

Energy Management

The narratives around burnout, compassion fatigue, and secondary traumatic stress are collectively focused on a false dichotomy.  They generally believe that your energy is drained or consumed at work and refilled at home.  The expectation is that work grinds you down, and your home life is fulfilling and life-giving.  However, for many people, this isn’t the case.

At work, they feel effective and fulfilled in their role.  They know what to do and how to get good results.  At home, they’re in a constant struggle with their spouse.  Their teenage kids don’t listen to them and are downright hostile.  They don’t know what they did wrong or what it will take to fix it – but they know they don’t like it.

More often, it’s in the middle, where some things at work build and renew a person – but there are times of exposure to trauma and tragedy.  At home, they find both love and challenge.  It’s not about the place but rather about the moment-to-moment environment that defines whether someone is receiving more energy than they’re giving.

Driving with the Brakes On

If you’ve ever had the experience of having a car brake caliper freeze up, you quickly have discovered what it’s like to drive with the brakes on.  (Hint: it doesn’t end well.)  A less eventful situation might be what happens when you forget and leave a parking brake on.  Unfortunately, that’s what happens with too many people.  Their sympathetic and parasympathetic systems get locked into a fight, and they get stuck or oscillate.  If we want better results, we’ll find a way to either have the brakes on or put our foot on the accelerator.

Generally, when the parasympathetic system (brakes) is engaged, the sympathetic system shuts down – but not always immediately.  With patience and practice, it becomes easier to downregulate and recover more quickly when we do become triggered.

Blessin’ or Lesson

Miller quotes a Southern saying that “everyone you meet is a blessin’ or a lesson.”  In other words, they’ll either attempt to bring you good or bad.  Either way, you must learn to work with them.  Knowing ahead of time which one they are is one step towards Reducing Secondary Trauma Stress.

Book Review-Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal from It

When Paul Conti’s brother, Jonathan, killed himself with the handgun that his father had been issued in the Korean War, his life changed.  It wasn’t simply that he experienced the loss of his brother, but it also caused his desire to focus on understanding trauma and why he couldn’t see the struggles his brother was facing.  In Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal From It, Conti tries to expose the internals of how we process trauma so that we can learn to see it and process it.

For Generations

One of the often overlooked aspects of trauma is that it has a ripple effect that expresses itself across generations.  In Why Zebras Don’t Get Ulcers, Robert Sapolsky shares not only the research from the adverse childhood experiences (ACEs) study but also the work on fetal onset of adult disease (FOAD).  To clarify, the stress of the mother can have a negative impact on the health of the fetus.  More broadly, we’ve begun to learn that it’s more than genetics that leads to health outcomes, it’s epigenetics.

That is, our genes are activated and deactivated by our environments.  While two identical twins start out with an identical set of genes and gene expression, through different experiences, they can end up with different gene expressions – and therefore different outcomes.

The implications of this are that a traumatic event or set of traumatic events can send ripples across time into future generations.

Marshmallows of the Future

In the person themselves, trauma changes things.  It makes the world a bit less stable.  It causes us to believe that our dreams and aspirations aren’t possible.  They’re not real.  Irrespective of the facts, we insist on staying in the here and now so that we aren’t disappointed when the future disappears.  This has a negative impact on our ability to hope.  (See The Psychology of Hope.)

When Walter Mischel tested preschoolers to see how they could handle delayed gratification, he didn’t realize what he was measuring.  (See The Marshmallow Test for a full explanation.)  Ultimately, the test was about whether children would sit with a sweet in front of them for a short time without eating it, with the promise of more if they did wait.  (It wasn’t always a marshmallow that Mischel used.)  Retrospectively, it seemed that those who could delay longer did better in life.  However, what’s more interesting are the strategies that the preschoolers used.  Some could clearly see the value despite the future, discounting what Daniel Kahneman explains in Thinking, Fast and Slow.  Other research, including Paul Tough’s in The Years that Matter Most, leads us to understand that those who have the most trauma have the hardest time trusting in future gains.

More tragically, trauma can leave us questioning our self-worth and our gifts.  We begin to consider life in terms of some sort of grand karma.  If we’re really good and worthy, then trauma wouldn’t happen to us.  Of course, that’s not fair, but it doesn’t stop the evaluation.  As The Halo Effect explains, life is probabilistic, not deterministic.  Bad things do, in fact, happen to good people.  While Thomas Gilovich explains in How We Know What Isn’t So that we have a bias towards believing better of ourselves than we should, trauma can reverse that wiring, so we believe we’re not as good as we are.

Presumed Control

If you speak with an abused child before they’re removed from the abusive situation, you’ll often hear that they believe the abuse they receive is their fault.  They believe that if they’re just a better child, their mommy or daddy won’t hurt them.  This illogical conclusion is the one that their minds are forced into, because the alternative is more painful and tragic than believing that they can, with their behavior, prevent the abuse.

If the abuse has nothing to do with how good or bad they are (or their behavior at all), then it’s unpredictable and unstoppable.  They must believe that the abuse and pain will continue forever – and that’s not something they’re prepared to do.

We all do this throughout our lives, not just in childhood.  We try to take control of the situation, so that we don’t have to fear it.  (See Compelled to Control for more.)

Inciting Illness

One way that we see this same dynamic in adults is when they believe that the trauma they experienced is their fault.  From the automobile accident that they blame themselves for to the cancer that couldn’t have been prevented, people believe that it’s their fault.  The result is shame – “I am bad” – driving the sense that they need to punish themselves.  Somehow in the punishment, they’ll equal out the scales of justice.  There are two key problems with this.  First, the sources of the traumas are almost universally external to the person.  Second, no amount of self-flagellation will even the scales.


Brene Brown calls it “enough.” (See I Thought It Was Just Me (But It Isn’t).)  It is the feeling that we’re not “good enough.”  We’re not “doing enough.”  We’re not worthy of what we have or even of being on the planet.  It’s the less extreme form of impostor syndrome that too many people routinely feel.  While inadequacy can be a powerful drive to cause people to strive to do more and be more, it comes at a cost.  The cost is both the happiness of the person and, sometimes, their life.  In Perfectionism, we learned the psychic toll that perfectionism – or inadequacy – brings.  When we believe we’re not enough, we can never get a break from ourselves.

The Costs of Survival

We celebrate the survivors of trauma of all kinds.  We admire their strength and their courage.  However, we never ask ourselves what it took to get there.  We celebrate the war hero who walked his team out of the firefight, and we don’t ask what he had to do.  We don’t want to know about the prisoner or little kid he had to kill to survive.  We don’t want to know how deep that trauma goes.  We fail to notice when we try to celebrate them, and they squirm away.  It’s more than being shy.  It’s a deep sense that if people knew what they had to do, they wouldn’t celebrate their return home in the same way.

Computers and Chainsaws

Both computers and chainsaws are tools with immense positive potential.  They’re also tools through which someone can inflict suffering.  With both, if we learn how to operate them safely, we can prevent trauma.  The unfortunate reality is that anonymous forums lead to mob-like or gang-like behavior where people become worse than they’d be on their own.  (See Going to Extremes and Delinquent Boys for more.)

Protecting people from unsafe spaces is, in part, requiring that individuals be held accountable for their comments – or, at the very least, having their name attached to them.

Not Mine

Whenever there’s a negative outcome, it’s appropriate to ask to what degree your behaviors influenced the outcome.  What could you have done differently?  What should you do next time?  These are healthy questions that can take an unhealthy turn we if decide that we need to not only own our own dysfunction in the situation but the dysfunction of others as well.  A wise friend once explained that “that’s not my shit.”  She explained that sometimes you’re not responsible for the negative outcome – or certainly not responsible for all of it.

It’s important to take responsibility for your part – but equally important that you not take responsibility that’s not yours.

Facts and Fallout

The law is concerned (ostensibly) with the facts.  They want to assign guilt and blame.  They are not equipped to help trauma victims cope with the fallout.  The penalties that are assigned to criminals are used as a deterrent to prevent their own and others perpetrating the crime in the future.  There as some crimes – like murder – for which there is no compensation.  Criminal trials aren’t concerned with that.  Civil trials are, but only a small fraction of trauma-inflicting events are the subject of a civil suit.

Criminal trials are themselves sometimes more trauma-inflicting than healing.  It can be hard to confront the person who injured you and hard to defend yourself against the questions and implications of their attorney.

Pre- and Post-Trauma

When people have a single, defining trauma, there seems to be a bright line between the before and the after.  The trauma created a change in the person (that may still be evolving).  That change can be seen in the pre- and post-worlds.  Sometimes, people speak of recovering or returning to the place before the trauma, but the place no longer exists.  We must build a new place with new awareness – and that isn’t always easy.

Given that it’s estimated that 90% of us will experience trauma in our lives, it makes Trauma: The Invisible Epidemic.

Book Review-Fighting Fires: How Emotional Trauma Sparks an Inferno

For many first responders, firefighters included, the idea of mental health is for the other guy.  It’s a tough job and you’ve got to “man up” and be tough.  However, at the same time, the things that first responders see, hear, do, and not do, are unforgettable.  They’re confronted with the worst that humanity has to offer.  It’s the most suffering, the most cruelty.  It’s also times of greatest compassion.  Fighting Fires: How Emotional Trauma Sparks an Inferno is David Lewis’ journey through trauma that he experienced outside of the job, inside the job, and through life.  No question he experienced trauma through his work as a firefighter, but that wasn’t the only trauma he experienced in his life.

Fire and Smoke

Lewis describes mental health as the pillar upon which life is built.  It’s a sound argument, since the life we experience is the one that we create.  Incognito shows us just how much of our lives and what we think is reality is made up.  Life is really what we make of it – and it can be filled with fire and smoke, or it can be fresh air.

Lewis uses the analogy that fire is the traumatic events that you see, hear, do, or experience.  Smoke is the problems as a result of that fire.  He properly places the focus on the fire portion, recognizing that smoke is a result of fire.

The Charlatans

Early on in Lewis’ attempts to get better, he describes running across an “internet guru” that claimed to have the elixir that Lewis needed to be “fixed.”  All it would take is a credit card.  The free materials seemed good, so Lewis parted with hard-earned money only to realize that the content behind the pay wall wasn’t really worth it.

The real problem is it’s easy to make things look like they’re good when it’s shallow; it’s hard to make sense of it when it’s deep and it matters.  I cannot count the number of burnout books that I’ve read where the authors had no breadth or depth in what they’re saying.  They saw the opportunity to make a buck selling some books and consulting, and they dropped right in.  (Even Maslach’s latest book, The Burnout Challenge, is woefully under-researched.)

Even professional mental health providers rarely read research or use evidence-based techniques.  Too frequently, they just do what they think works, leading to Science and Pseudoscience in Clinical Psychology and The Cult of Personality Testing.  Even in an area where the public is supposed to be protected through licensure, we’re confronted with the need to carefully screen people, as Lewis points out later in the book.

Coloring in unicorns may be fine for an eight year old, but it’s not appropriate for a professional firefighter – or most other adults, for that matter.

Buffalos and Cows

For the most part, cows and buffalo seem like similar animals.  They’re both mammals.  The buffalo burger is leaner but is similar in taste to a hamburger.  (Why “hamburgers” come from cows not pigs is a mystery.)  However, they have some different behaviors.  One is how they cope with the stress of a storm.  They react like people react.  Buffalo charge into the storm, while cows walk away from it – even when they’re in the midst of the storm.

The subtle change of moving into or away from the storm has a profound effect on how long the animal is in the storm.  The buffalo will spend much less time in the storm than the cow, because the storm passes over quicker.

As humans, we often turn away from our challenges expecting that we can escape them – but rarely is that effective.  Sometimes, the right answer is to face the storm and walk into it.


When the mental anguish becomes so strong that you’re fighting intrusive thoughts, there are many strategies that one may employ in an attempt to retain balance.  Unconsciously, there may develop a tendency towards obsessive compulsive disorder (OCD), including ritualized approaches to common activities.  We can deceive ourselves into believing that these activities protect ourselves and our families, when in reality they deprive us of the resources that we need to heal.

A more common and more socially acceptable approach is to become a workaholic.  (See The Globalization of Addiction for more.)  After all, being a workaholic means that you’re providing for your family.  However, the dark side is that work becomes all-encompassing, leaving little of the person for themselves or their families.  It’s common to believe that if you just work harder, you can block out the feelings and memories.  However, doing so deprives you of the very resources you need to live – and to recover from the pain and trauma.


As Compelled to Control clearly points out, we all love the illusion of control.  The illusion protects us in a random and ultimately unpredictable world.  It calms our consciousness as we confront the challenges of the world.  If we’re in control, then we don’t need to fear the world.  We can feel safe.

Some would say that we can control ourselves but not others.  However, in some ways, we’re so influenced by our environment, and we respond so instinctively at times, that it’s hard to convincingly say we’re even in complete control of our own reactions.  (See Thinking, Fast and Slow for more about how we lie to ourselves.)

Defined by Our Responses

It’s not the tragedies and struggles we’ve faced that define us.  What defines us is how we respond to them.  Problems, struggles, and challenges are the substance of life.  We can’t escape life without problems.  In fact, sometimes when we believe we’re helping animals, we’re dooming them, because they need the struggle.  (See Beyond the Wisdom of Walt for more.)

There’s no shame in being injured – if we can heal.  If we need help to be able to heal, then we should ask for it.

Worst Case Scenario

Sometimes, we’re so afraid of playing the worst-case scenario game that we won’t play it at all.  Other times, we won’t play the game fairly.  In a bit from a comedian friend, he speaks how his mother moves from how he isn’t overly responsible through owning dogs to having a child that dies of neglect.  This wholly illogical chain of thinking is the way that too many people think about worst-case scenario.

Instead of looking to the things that can happen and reasonably evaluating their probability and impact, we focus on the case where the Earth is impacted by an asteroid – something that’s both always a possibility and something that we have no ability to prevent or mitigate.

By avoiding the game, we trap ourselves into a set of beliefs about a threat or stressor that aren’t realistic.  Like a large shadow from a small person or animal, we magnify the size of the problem, because we refuse to look at it directly.

The Balance of Life

In a state of suicidal crisis, it’s possible to lose all sense of scale.  Lewis explains how buying a toy for his son and dying by suicide seemed to be of the same magnitude.  Somehow, he thought that the scales of justice would be even.  Reflecting on it, Lewis can see how “jacked up” his thinking was – but in the moment, the evaluation of the balance of life was such that it had no special meaning.

The research and reflections seem to validate Lewis’ experience that life and the possibility of hope aren’t given their due significance.

Focus Forward

Trauma, whether acute or chronic, is a tragedy.  It’s something that each of us must learn to process, to come to terms with.  We can’t run from our challenges, and we can’t pretend they don’t exist.  Eventually, they’ll add up to a point where they compel us to address them – and by that time, they’ve grown fearsome.  If we get the choice, we should want to pick smaller fires when we’re Fighting Fires.

Book Review-Trauma Therapy and Clinical Practice: Neuroscience, Gestalt, and the Body

A common experience in trauma is dissociation.  One of the clinical therapies most focused on grounding and being present – the opposite of dissociation – is Gestalt.  The intersection of these two opposites is an interesting space for healing.  Trauma Therapy and Clinical Practice: Neuroscience, Gestalt, and the Body walks in the middle of the experiences and shows how one might connect the two.

If you need a definition of psychological trauma, please see Trauma and Recovery.

Living in an Uncertain World

The heart of the problem with trauma is some event that shatters our beliefs about the world.  Psychological trauma is an event – something you’ve experienced or done – which cannot be integrated into your beliefs.  Too often, the belief that’s called into question is the one about the world being predictable.

Many people see the universe as a big clock with gears spinning and whirring.  Everything has the mechanical precision of cause and effect.  There’s no room for chaos theory or Lorenz’ tornado-causing butterfly.  (See Facilitating Organization Change.)  It is this predictable world that we live in, because it’s a place of safety.  If we believe the world is probabilistic, then we’ve got to accept that bad things can happen to good people, and that’s not okay.

Still, we know that probabilities exist.  We watch batters swing and miss at the baseball plate.  We play the lottery and expect to win – knowing that the probability is very small.  We spin the wheel and roll the dice but keep for ourselves a separate thought about the safety of our world.

The first thing to accept about our world is that it’s random and impermanent.

The Disconnect

Central to Gestalt is being in contact with oneself.  This is a conscious, and non-judgmental, assessment of the body and mind.  This includes feeling our breathing, our heartbeat, the state of our muscles, and so on.  It also includes an assessment of our emotions and whether they appear to be influencing bodily processes.

In some cases, trauma victims believe that exploring these sensations is dangerous, because it will bring back the traumatic event or that, once experienced fully, they’ll not be able to contain them.

Expanded Choices

A sign of trauma is constricted thinking.  Some things are, quite literally, unthinkable.  So, one sign that someone is recovering from – or healing from – traumas is the capacity to consider other options.  Capture explains how thoughts can sometimes enter downward spirals.  In Trauma Therapy and Clinical Practice, the statement is about the barriers to escaping those cycles.

The reality is that we always have choices.  Instead of the tightly coupled idea that someone or something “made you” do something, the more accurate statement is that you reacted to their action.  Emotion and Adaptation explains there’s a gap between stimulus and response, and that gap allows us to respond rather than react.  We can, in fact, choose our responses, if we decide we want to and we practice it.

Regulated Arousal

Much of the work on psychological trauma resolution is on increasing our capacity to process the event.  This can mean increasing our resources or decreasing the impact of the event.  Much of that is finding ways to regulate our arousal as we consider the event.  If we can reduce the emotional responses, including fear, to a more manageable level, we can better process the event.

On the surface, it sounds simple, but it requires a set of techniques like desensitization, building safety, and the core work of Gestalt, grounding.  These tools and others allow traumas to be processed and thereby stop their intrusive nature.  (See Trauma and Memory for more.)

Between Too Ordered and Too Disordered

Live is about making decisions.  It’s selecting the right choice or option for us at the current moment.  Much has been written about how we make decisions – and the consensus seems to be that there’s an optimal range for people to operate.  (See Decision Making and Sources of Power for more on how we make decisions.)

Gestalt views this from the lens of being too ordered – or too disordered.  You wouldn’t expect that even creativity is helped by some bounds, but that’s what Creative Confidence says about how to be creative.  So, despite getting a bad reputation, constraints can be helpful.  Simultaneously, they can be too restrictive and can choke off both creativity and joy.

Sometimes the traumatized person has added constraints to their world (by themselves).  It’s important for them to determine whether those constraints are too much – or if they need to add some healthy boundaries and limits.

Hovering at the Thresholds of Tolerance

Flow is a highly productive state that lives in the narrow band between challenge and capability.  (See Flow, Finding Flow, and The Rise of Superman for more.)  In this gap, research finds 5x performance gains and real growth.  It’s not hard to imagine how hovering around the edge of our tolerance might be a powerful way to learn to process trauma.  In fact, this is the core of desensitization: keeping people safe while moving them progressively closer to something that triggers them.

By hovering at the edge of tolerance, at the edge of safety and our capacity, we expand that capacity and make it more likely that we can process trauma at some point.  It’s critical here to celebrate the progress, because it can seem painfully slow when you want a solution now.

They Can’t Hurt Me, I’m Not There

Dissociation is a natural response to an overwhelming event.  When the event is very close to the threshold for processing, it may be that it’s only compartmentalized.  That is, we’re aware of it, and we can’t process it, but we’re still present and connected.  At the other end of the continuum, there’s severe, clinical dissociation.  Dissociation is a process of distancing ourselves from an event to protect ourselves from it and its impacts.

Obviously, if there’s physical trauma, dissociation doesn’t prevent that physical trauma from happening.  It does, however, separate the processing of physical trauma.  For instance, someone in an accident may see the scene from outside (and often above) their body.  They don’t feel the pain associated with physical trauma, because their consciousness is separate from their body.  It’s this dissociation that led more than one trauma victim to say, “They can’t hurt me, I’m not there.”

A technique recommended in the book when speaking with people who may be dissociating is to ask them what percent “in the room” they are.  It’s a continuum between wholly present and not present at all.  Often, the person you are speaking with – when prompted – can judge the degree to which they are currently dissociated, providing clues about whether it’s time to add more safety to the conversation or whether it’s safe to press on.

Relationships for Healing

Healing happens in relationships.  When you look at the factors that most impact outcomes in psychological care, the number one answer is called the “therapeutic alliance.”  (See The Heart and Soul of Change for more.)  It is the relationship between the therapist and the patient.  It’s much more important than the actual techniques in use.

In difficult work with substance use disorder (SUD) patients, Motivational Interviewing starts with engaging the patient, because without a relationship – even a professional relationship – nothing else matters.

While this book is focused on clinical applications, we know that we are most likely to influence the people with whom we have a relationship.  In fact, Everett Rogers in Diffusion of Innovations believes that it’s the only thing that can change someone’s attitude – and ultimately their behaviors.

Disorganized Attachments, Trauma, and Cults

Perhaps the most disturbing thought from Trauma Therapy and Clinical Practice is the way that trauma creates a disordered attachment style where none existed before.  Terror, Love, and Brainwashing explains that it’s disordered attachment that makes cults possible.  Often, the cult leader induces the trauma – but it’s also possible that a recent trauma could make people more susceptible to cult leaders, because they’re already partially or completely in a disordered attachment style.

I don’t believe you need to be a clinician to find ways to help people who have experienced trauma reconnect, and Trauma Therapy and Clinical Practice may have the tips to make that easier and faster.

A Week of Trauma Processing

If you’ve ever faced trauma in your life – of any kind – please share this to take a stand against continued suffering.

We never teach people how trauma affects us or what we can do to better process trauma.  It’s the stark realization after reviewing hundreds (if not thousands) of hours of training materials, books, articles, and webinars.  We know so much about how trauma – including secondary trauma – changes us, sticks to us, and harms us, but we don’t teach how to process it.  We don’t teach how to move to the other side of trauma, to release compartmentalization and move to processed trauma.

We’re so honored to change this.  We’re going to be teaching a workshop on how trauma impacts first responders and what they can do about it.  We’ll talk about how to avoid PTSD and how to move towards post-traumatic growth (PTG).  We’re going to share simple techniques that first responders can use for themselves and share with their peers.

To celebrate this work and to ensure that the resources that we’ll be providing in class are freely available, we’ll be posting a book review for a trauma book every day from November 27th through December 1st.  Be on the lookout for the tools that you can use to address the trauma that you’ve experienced.  Estimates place the number of people who will experience in their lifetime over 90% – effectively all of us will experience trauma.  We’re hoping that you’ll know what to expect and what to do when it happens – or learn it now so you can process trauma no matter how old it is.

Here’s the list of the trauma books that we’ve already reviewed along with those publishing this week.  (The links will automatically start working when they’re posted at 8AM EST each day.)

Book Review-Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship

What does it mean to have our development interrupted by trauma – and what do we do about it now?  These are the questions that Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship answers.

If you need a quick introduction to what trauma is before understanding what you can do about it, see The Body Keeps the Score or Transformed by Trauma.

NeuroAffective Relational Model (NARM)

The book is focused on a model called the NeuroAffective Relational Model (NARM).  The model is concerned with how our development may or may not lead to dysregulations, disruptions, and distortions.  These lead to difficulties in living our lives and ultimately reduce our ability to thrive.

The model suggests that we have five biologically-based core needs:

The model further suggests that if these needs aren’t met, they will need to be addressed, because they will create barriers to a fulfilling life.


Our bodies are amazing machines that allow us to achieve wide ranges of self-regulation.  From the mundane regulation of temperature, oxygen status, states of arousal, and the rest to the more complicated regulation of our emotions, we’re wired to achieve stability.  Of course, there are limits.  You can’t keep cool when you’re in intense heat.  However, overall, our systems are widely effective at the process of keeping us in states of homeostasis – relative balance.

When these systems are impaired, we experience it as a barrier.  Commonly, people who have been exposed to trauma have difficulty regulating emotions.  To be clear, as Jonathan Haidt explains in The Happiness Hypothesis, emotions are really in charge.  (See also Switch.)  Our ability to regulate our emotions is just an attempt to understand them and shape our responses.  Haidt’s model of a rational rider on an emotional elephant makes it clear that the elephant always wins when it wants to.

I prefer to position the work of regulating emotions as the perspective of the relationship between the elephant and the rider.  The degree to which our emotions are responsive to the requests and influence of reason can be harmed by early developmental trauma.  While Healing Developmental Trauma describes managing our emotions, I believe that this is too strong of a statement based on what we know about neurobiology.


NARM calls for mindfulness as a technique.  However, as they use it here, mindfulness is a catch-all term for a variety of approaches including more formal meditation techniques.  (See Altered Traits).  One of the specific approaches recommended is Somatic Experiencing (SE).  Somatic Experiencing is an approach developed by Peter Levine.  Healing Development Trauma and the NARM approach pulls key techniques from this work, including grounding, orienting, titration, pendulation, and discharge.  (See In an Unspoken Voice for more.)

Another component that is included in NARM is gestalt, which is a therapeutic approach developed by Fritz Perls, MD.  It’s focused on being aware of the current state – particularly, the current state of the body and what sensations are being felt.  This, too, is a part of the broader family of mindfulness.

Cognitive Distortions

“Cognitive Behavior Therapy (CBT) does not address the nervous system imbalances that drive cognitive distortions.”  It’s a problematic statement for me, because it’s not well supported in the rest of the text, and it’s not precisely true.  CBT does have some aspects of reality grounding in the overall suite of tools.  But the more challenging aspect of the statement is should it?  Cognitive distortions are just a separation of our perception from reality.  Some of these distortions are adaptive.  For instance, we know that depressed people have a more accurate – and negative – view of the world and their capability to impact it than non-depressed individuals.  Thus, non-depressed individuals see the world more positively than they should – but it’s adaptive.  (See How We Know What Isn’t So for more.)

Some cognitive distortions allow people to maximize their capacity for hope and self-agency.  (See The Psychology of Hope for more about hope.)  We shouldn’t limit those cognitive distortions.  We should be concerned about those distortions and those adaptations that are no longer working.

For Another Time

Each of us picks up a series of quirks about the way that we interact with the world.  They are adaptations and accommodations that we make either because a human in our life requires it from us or because the way that we see the world requires us to adjust.  We see this in the stereotypical differences between men and women in the way that they interact.  (See Radical Candor and No Ego for more.)

These adaptations and accommodations can be positive for the time that we adopt them.  It can be that they’re incredibly effective at helping us navigate the world.  However, over time, these may get progressively less effective or even become harmful.  They can begin to limit our growth as adults and our ability to navigate in the world of today.  That’s why we need to be aware of these adaptations and evaluate whether they’re still appropriate.


Sometimes those adaptations deprive children of their childhood.  Chaotic lives and parents who fail to plan sometimes find children creating the structure, organization, and planning that is necessary for the children to get what they need – like food and shelter.  (For some examples, see The Years That Matter Most.)  The problem this causes is that the child doesn’t feel safe allowing others to be themselves and often results in over controlling in their adult lives, because to not do so is too dangerous and scary.


Too frequently, we believe that if we share our entire selves with someone else, they’ll stop loving us – or they’ll leave us.  Too often, we hear about people who believe that others don’t know who they are and wouldn’t like them if they did.  (See How to Be Yourself for more.)  It’s one thing to do that with others – to deny a part of ourselves – but it’s a different thing when we do it to ourselves – hiding or limiting parts of who we are to become acceptable to others and to ourselves.

In No Bad Parts, we learned about the Internal Family Systems model, which explains that we have exiles (parts of ourselves that we deny) and protectors (parts of ourselves that are over expressed to protect us from harm).  In trauma, we find dissociation, which can cause the creation of the exiles and the protectors.

Degrees of Dissociation

In my reviews of The Body Keeps the Score and In an Unspoken Voice, I spoke of dissociation, but Healing Developmental Trauma identifies the gradations of dissociation.  Specifically, they use the analogy of a switch.  Some people dissociate with a dimmer switch, turning up their degree of numbing or muting their experience.  Others have a breaker switch, where they shut everything off completely and often experience the situation as if they’re outside their body.

So, the trick when working with people who have had trauma is to look not just for the complete dissociation but also the self-numbing that may be maladaptive.

Holding Framework

NARM proposes that “emotions are experienced and contained.”  I’d call it a holding space.  (See more in my review for Alone Together.)  A holding space is an environment that is capable of holding the emotion.  The goal is to create a space that is sufficiently safe, calming, and reassuring that the person is able to gradually experience the emotion without becoming overwhelmed.  You can see how I recommend this for small groups in my post, Small Group Safety Rules – Before, During, and After.

The key – as with Peter Levine’s approach in Somatic Experiencing – is to allow people to move into the experience and emotion to the degree that they’re capable of doing it and feeling safe.  (See In an Unspoken Voice for more.)

Unleash the Kraken

For some, the process of creating a holding space and offering a place for them to express their emotion is like asking them to unleash the kraken.  They fear that they’ll never be able to put their emotions back in a box.  They’ve been taught that emotions aren’t safe, and they’re not sure how to dance with experiencing emotions without being overwhelmed.  However, that’s what the holding space is for – to make it safe enough to experience the emotions and to learn that they don’t have to be overwhelming.

If you’re ready to help others – or yourself – work through your trauma and move forward with it in the past, start the process by reading Healing Developmental Trauma.

Book Review-Trauma and Memory: Brain and Body in Search for the Living Past

There’s a complex relationship between Trauma and Memory: Brain and Body in Search for the Living Past.  This is in no small part because traumatic memory isn’t in the past – it’s a part of the current reality of those who have been traumatized.  It’s also in part because traumatic memories are different than our regular, explicit memories.  Trauma and Memory is by Peter Levine – the same one who wrote In an Unspoken Voice.  In fact, he mentions he’ll be focusing on this work immediately after that one.

I won’t go into what trauma is here; you can see Peter’s other work or Transformed by Trauma for a basic understanding of trauma.

Traumatic Memory is Memorex

In my review of Mistakes Were Made (But Not by Me), I included a heading that explained that memory isn’t Memorex – that is, identical to the original event.  That’s true of our explicit memories – those that have been processed.  However, unprocessed memories, those of a traumatic nature, are in fact immutable, exact copies of the experience of the moment.  They’ve not been processed through Broca’s area of the brain to be made explicit and are therefore somehow immune to the natural shift that happens as we recall memories.

Memory Formation

The actual formation of long-term memory is a complicated process.  It can be disrupted in several ways.  First, most memory consolidation and conversion happen during sleep.  If we interrupt sleep at the wrong moment, we can effectively prevent learning.  (See How We Learn for more.)  We can also disrupt learning by creating an event that is too emotionally charged.  This creates a situation where critical portions of the brain are not active when they should be, presumably due to overactivity in other areas.  Broca’s area is commonly thought of as the linguistic processing portion of the brain, but that’s not the complete story.  Broca’s area is responsible for syntax – in other words, ordering and orienting – and appears to play a key role in conversion of physical sensations into meaningful explicit memories.

To understand the mechanics that cause areas of the brain to reduce activity, it’s important to recognize that there’s a maximal rate of glucose (power) transfer across the blood-brain barrier.  When we engage our brains most fully, we necessarily create a power deficit, and the brain responds by taking components offline.  (See The Rise of Superman for more.)

As I mentioned briefly in my review of The Body Keeps the Score, traumatic memories overload the emotional centers of the brain, and this causes the breakdown of the conversion process.  The problem is that the brain will continue to attempt to reprocess these memories repeatedly until it finds an acceptable way of integrating them.

To Predict

Inside Jokes proposes that the primary function of consciousness is prediction.  To perform its function, it processes input and uses it to create models that are then used to predict future events.  Gary Klein in Sources of Power shares his experience with fire captains who couldn’t articulate the way they were making decisions.  The theories at the time were along the lines of Decision Making, where decisions are made slowly, thoughtfully, and sequentially.  What he observed was that fire captains weren’t doing this – and they couldn’t articulate how they were making their decisions.  (See also Seeing What Others Don’t for Klein’s work in this area.)  The discovery was that they were building models of how the fires work, including all the variables necessary to predict the source of the fire and the factors feeding its growth – or inhibiting its growth.  They built this model by integrating their experiences from hundreds of other fires.

Because these models are so important to navigating the world, our brains will continue to try to make sense of – process – experiences until they complete their work of integration.  This means that unprocessed traumatic memories will intrude into daily life.

Memory Types

Before continuing, it’s important to note that there are different kinds of memories.  They are:

  • Explicit
    • Declarative
    • Episodic/Autobiographical
  • Implicit
    • Emotional
    • Procedural
      • Learned Motor Actions
      • Emergency Response
      • Response Tendencies: Approach/Avoidance

The knowledge management discipline sees these slightly differently but does acknowledge the array of memory types.  (See Lost Knowledge for more.)


We use our explicit episodic memories to help us orient in time and space.  We use them to help us understand where we are and where we’ve been.  However, this requires the conversion into explicit memory, which is missing for traumatic memories.  As a result, traumatic memories are quite literally experienced as if they’re happening in the present moment.  Our brains cannot tell the difference between a traumatic memory and currently occurring facts.  It’s no wonder that people with traumatic memories feel overwhelmed and unsafe – because, to their brains, they are.

Erasing Memories

It’s the subject of science fiction, but too few people realize that it is a scientific fact.  The study was testing what would happen if a key protein needed for memory retrieval was blocked at the time of memory recall.  Mice were trained with classic conditioning to fear a sound.  The protein inhibitor was injected, and the sound was played.  They, predictably, didn’t experience fear.  The memory was blocked.

However, the spooky result was that they no longer feared the sound even after the protein inhibitor had worn off.  Somehow, accessing the memory at a time when the protein to allow for retrieval wasn’t available had caused them to unlearn the behavior – permanently.


It’s not clear the total implications of this; some researchers and clinicians have observed children exposed to trauma in their preverbal time to repeat or reenact the traumas they experienced even without conscious knowledge of the trauma.  Even mice taught to run a maze seem to pass along that memory of the maze – at some level – to offspring, as was demonstrated with a creative experiment where mice were taught a maze in Australia and then offspring were presented with the same maze (pattern) in New York.  The offspring were statistically faster than they should have been at solving the maze.  The same thing happened when the pattern was reversed – it wasn’t just the city that made them faster.

This was further validated experimentally by using a cherry scent to precede a shock.  Great-great grandchildren of the original mice in the experiment had a stress reaction to the scent – even though they had not themselves been exposed to the scent or the training.

For all the things that we know about Trauma and Memory, we don’t know enough yet.

Book Review-Posttraumatic Growth: Theory, Research, and Applications

It didn’t start with the name “posttraumatic growth” (PTG).  It started at the dawn of man, when countless of our ancestors faced challenges, setbacks, and tragedies and then grew from them.  Posttraumatic Growth: Theory, Research, and Applications may be the latest codification of the concept that Tedeschi and Calhoun labeled “posttraumatic growth,” but that doesn’t mean that it didn’t exist before.  Nearly three decades after their original work, this work reports on the concept as well as the misconceptions that have attached themselves to PTG since the original publications.  This isn’t my first foray into reading Tedeschi’s work.  I’ve previously read and reviewed Transformed by Trauma, which shares stories of those who have experienced growth.

PTG Summary

To provide some context, posttraumatic growth is “positive psychological changes experienced as a result of the struggle with traumatic or highly challenging life circumstances.”  It is a framework consisting of five domains:

  • Appreciation of life
  • Personal strength
  • New opportunities
  • Relating with others
  • Spiritual change

For the most part, PTG is about the internal experience of the person rather than the externally observable, tangible results.  This is important because as is often addressed in therapies and groups, the circumstances surrounding the struggle may not change – but the response to it can.

Heroes Journey

Joseph Campbell spent a lifetime researching myths.  From his research, he discovered patterns that emerged in all epic myths across countless cultures.  That pattern he called the hero’s journey.  When Bill Moyers sat down with Joseph Campbell for a PBS series, the extended cut of their conversation ended up in the book The Power of Myth.  It highlights some of the interesting parallels between cultures and how heroes change over the course of their stories.

The key is that heroes face adversity and challenge.  They face loss and trauma.  Then, they grow.  The hero rises to the occasion and moves their personal mission forward.  They find focus and ultimately save their groups.  This indicates that, for centuries in cultures across the world, we’ve seen PTG as the best thing.  It’s the way that heroes behave, and don’t you want to behave like your favorite hero?

Posttraumatic growth doesn’t draw out this parallel in its pages, but it’s one that I couldn’t avoid as I evaluated how PTG has been a part of humanity through the ages.

Relationship to Resilience

Much has been made of the concept of resilience in modern media.  However, so much has been made of it that it has lost its meaning.  People have lost touch with the fact that resilience returns something to its original state after a challenge or stress.  While this initially seems desirable, it’s not long before you realize that the better response would be for things to become better.  Antifragile lays out the framework and conditions for how stress and challenge can make things better.  We have examples in our everyday worlds, like those who exercise literally break down their muscle tissue only for the body to rebuild it stronger than the last time.

Wouldn’t a better response to stress, trauma, and tragedy for us to find ways to be better because of it?  Of course, that is the goal, but how do you tell the mother or father who has just lost their child that they’ll be better off for it?  In deep loss and grief, it’s impossible to see that growth is even an option.

The difference is that, for PTG, the goal is greater than where things started.  Instead of returning to normal, we’re looking for a new, better normal.


It’s a natural, but overly simplified, perspective to see posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) on opposite ends of the spectrum, but to do so prevents the reality that PTG and PTSD can coexist at the same time.  (See Traumatic Stress for more on PTSD.)  It seems counter-intuitive that you’re experiencing growth at the same time as being imprisoned by recurrent memories that refuse to be integrated into our core narrative, but one doesn’t preclude the other.  We can adjust our basic assumptions about the world and thereby achieve growth while simultaneously being unable to fully integrate the memories into our internal autobiography.

In short, they are associated with two different aspects of the trauma experience.  PTSD is associated with the recall of the event, and PTG is associated with the resulting need to adjust beliefs.  People can, and sometimes do, accomplish one without the other.

Fundamental Beliefs and Basic Assumptions

In Trauma and Recovery and Traumatic Stress, I used the language “fundamental beliefs” to refer to the basic set of assumptions that we have about the world and the way that it works.  These terms are – in effect—the same thing, and under both is the assumption that they’re hidden.  In both cases, the implication is that the thing at the heart of trauma is the way that we see the world.  It’s more than the loss and the threat.  It’s the fact that it changes the way we see the world.

This reorganization is not without its challenges, but it also creates opportunities that didn’t exist with the previous view of the world.  Does the reconstituted set of basic assumptions and beliefs create or allow for a new appreciation of life, new opportunities, better relationships, or a spiritual awakening?  In some cases, it seems that the answer is yes.

The Weakness of Thriving

As a term for PTG, “thriving” has some issues.  It means to prosper or flourish – but how do we measure that in human terms?  Happiness might be one answer, but happiness is notoriously hard to measure and predict.  Some, like Barbara Ehrenreich in Bright-sided, criticize the push towards happiness, while Barbara Fredrickson in Positivity argues that being positive has its own rewards.  Desmond Tutu and the Dalai Lama agree in The Book of Joy.  Sonja Lyubomirsky focuses on The How of Happiness.  Conversely, Daniel Gilbert in Stumbling on Happiness cautions that we’re bad at predicting what will make us happy.

Part of the challenge is separating persistent happiness – or joy – compared to moment-to-moment happiness.  Mihaly Csikszentmihalyi’s concept of flow points out that people are generally happier if they’ve had more time in flow.  (He documents flow in Flow and Finding Flow.)  Some would call it “persistent joy,” as Mattheu Ricard explains in his book, Happiness.

In short, we have a problem defining happiness in any meaningful way, and therefore we can’t use happiness as a measurement for thriving.  Sometimes people fall back on external, materialistic measures, but these fall well short of the inner experience that people who experience PTG have.

Pain as Necessary

There are stories embedded into both Buddhism and Judeo-Christian tradition about the necessity of struggle.  We’re reminded of the struggles of Job.  We’re encouraged to find mustard seeds from people who’ve not known death and pain.  We’re reminded that pain isn’t optional.  Judeo-Christian beliefs are that we live in a fallen world.  The painless world that was created in Eden isn’t available to us.  Buddhists believe in both the impermanence of life and in that life is suffering.

More practically, we know that helping chicks during the hatching process – bypassing the struggle to escape the shell – may be a death sentence.  They need the hatching process and the struggle it entails to transition.  Sea turtles that are helped to the sea after birth are hopelessly disoriented and tend to swim in circles instead of swimming in lines.  (In addition, touching a sea turtle is a federal offense, so don’t do it.)  Across nature as well as religion, struggle is necessary.

In many traditions, it’s struggle by which we achieve wisdom (or enlightenment).  The desire to develop wisdom has challenged philosophers since the beginning of written history.  It has equally been associated with struggle and pain.  Those who have been declared wise men almost universally achieved this title through struggle.

Vulnerability and Strength

People who have been through traumatic experiences and have developed PTG often reveal a strange dichotomy.  On the one hand, their experience taught them that they were vulnerable in ways or to degrees that they didn’t believe – or couldn’t believe.  They also will say that they discovered the strength they had.  They admit to never knowing their own capabilities and only through the struggle did they realize what they’re capable of.

We often say that where we are now is great, but we would have loved to get here without struggle.  We realize that this isn’t realistic, but still, the pain and struggle isn’t fun – even if the results are worth it.

PTG as a Process

Much like trauma, which can refer to an event or the reaction to the event, PTG can refer to the outcomes – the changes.  It can, however, also refer to the process through which people grow.  While outcomes are static and finite, the process of PTG can go on for a lifetime.

In twelve-step groups, participants are encouraged to always see themselves as recovering rather than recovered.  (See Why and How 12-Step Groups Work for more.)  This has a certain fatalistic attitude attached, but only if you don’t allow for the perspective to change.  Experienced participants realize that the struggles and vulnerabilities continue to shrink over time.  Similarly, you can continue to grow from trauma throughout life – but it won’t be the same as today.

The Role of Creativity and Flexibility

Since the outcomes of PTG are obviously better – there’s growth in the name – there’s a desire to understand what influences who will and who will not experience PTG.  How do we find factors that reliably predict who will achieve PTG?  The answer seems like people who are more creative are more likely to experience PTG.  If you don’t feel like you’re creative, I’d encourage you to develop your Creative Confidence.  Everyone is born creative.  We’ve learned to be less creative and to conform to society – but we can buck that trend and be our own person.

More than what we traditionally think of as creativity, it may be that cognitive flexibility holds the key.  The ability to accept that both the pain and torment of the tragedy and the peace from PTG come from one thing is an important dialectical perspective on the event – and in general, this may be what drives us to grow.  It could also be that those with greater cognitive flexibility are those who are more readily able to reevaluate their basic assumptions and change them.  This may explain why some research shows that growth is more likely to occur for those who are younger.  It may be that the degree of fixedness in old age becomes a barrier.

The Role of Disclosure

You’re only as sick as your secrets.  It’s a common phrase for those with substance use disorders – and anyone who finds themselves in a twelve-step program.  We recognize that many of the challenges that we have in life are about where we lie to ourselves and others.  Leadership and Self-Deception particularly challenges the things that we do when we’ve stopped being honest with ourselves.  It speaks of the ways that we interact with others and the kinds of challenges that these patterns cause.

While disclosure is risky – and you’ve got to be judicious about who you share with – ultimately, the more open, honest, and transparent you can be about the trauma, the better off you’ll be in the end.  (See Trust => Vulnerability => Intimacy, Revisited for more on trusting others and the impacts.)

Self-Efficacy and Social Supports

Another big question about PTG is whether it’s more important to have self-efficacy or social support.  The answer is self-efficacy in the long run.  It’s a journey, and like any journey, no one else can do it for you.  The best case scenario is that you have people supporting you and rooting for you, but ultimately, it’s you who has to make the move towards Posttraumatic Growth.

Book Review-Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society

Traumatic experiences have the capacity to change us at a genetic level.  We can be so burdened by our traumas that we’re unable to appreciate the gift of the present.  Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society is a journey into what trauma is, how it impacts us, and what we can do about it.  One of the editors, Bessel van Der Kolk, is the author of The Body Keeps the Score and a friend of Gabor Mate, who wrote The Myth of Normal.  In short, it’s edited by people with huge respect in the trauma space.

Legitimate PTSD

Labeling is a problematic space for psychology.  On the one hand, experiments have shown that labels can have a negative impact on our outcomes.  (See The Psychology of Hope and A Class Divided for more.)  However, on the other hand, a label gives us something to call our struggles and creates an opportunity to come together around a common challenge.  (See The Deep Water of Affinity Groups for more.)  Traumatic circumstances that have debilitating consequences have had several names over the years, but it wasn’t until DSM-III in 1980 when the post-traumatic stress disorder (PTSD) moniker got its foothold.  Now for many it serves as a way for people to identify and understand what’s happening to them.

This comes with a risk.  Despite the idea of post-traumatic growth (PTG), some people believe that PTSD is a life sentence.  (See Transformed by Trauma for more on PTG.)  People are told that the flashbacks that interrupt their world today may become less frequent, but they’ll always be subject to a relapse and therefore can never be totally healed.  This reframes them as broken and, in some ways, a perpetual victim of their trauma.  This isn’t helpful.

It’s true that there is always the chance the trauma will come back up again, but recovery isn’t about resolving the symptoms forever.  It’s about resolving them most of the time and providing better coping skills when they do intrude again.

The Meaning of Trauma

In my review of Trauma and Recovery, I explain that trauma is our inability to process what we’ve seen or done.  This is echoed here – with the twist that the magnitude of the problem is bigger over time because of the reinforcement that happens.  A memory intrudes, it’s disruptive, and you take “evasive action” alongside the fear that the situation will overwhelm you; as a result, the memories are reinforced and can become even more scary and overwhelming the next time.

Because the body becomes biologically aroused for something that is no longer a threat, we attempt to disconnect our bodily sensations with the rest of our world – treating them as hostile and unreliable witnesses to reality.  However, this disconnection process leaves us ill-equipped to sense that an episode is on the horizon or is coming.  It also provides us with insufficient warning to consider our response rather than just react.

Richard Lazarus in Emotion and Adaptation explains that there is a gap between stimulus and response.  We can use it to thoughtfully respond, or we can ignore the gap and simply react.  The goal in teaching people how to cope with greater degrees of trauma without becoming traumatized is helping people develop the space between stimulus and response.


Anyone who has met a boy in their early twenties has met someone invincible and invulnerable.  At least that’s the way that many see themselves at times.  They can do amazing feats that others cannot.  Surely, they cannot be harmed.  They look at their parents with their aches and pains and wonder without knowing how they could have ended up that way.  (For more on our delusions of grandeur, see How We Know What Isn’t So.)

Trauma has a way of piercing the illusion of invulnerability, whether it’s for you personally or just someone you know.  The trauma signals to some part of you that you are vulnerable, you can get hurt, and that’s world-altering.  We build our world based on our perceptions and the rules that we define for how our world works.  Jonathan Haidt in The Righteous Mind explains that we have six fundamental pillars of morality, the first of which being care/harm.  If we believe that we’re in a world that is benevolent, then bad things shouldn’t happen to good people.  Another pillar is fairness/cheating.  We want to believe that the world is fair – like us – so trauma shouldn’t happen to good people.  In short, the foundations of morality speak against our ability to easily cope when our perceptions are altered by trauma.

It’s often these changes in beliefs – triggered by something we saw or did – that represent the harder part of recovering from trauma.  We must define limits under which our beliefs function – or redefine them from scratch.

Rewriting History

I can remember the negative reaction of a professional counselor friend when I told them I was rewriting memories.  It was a sense of shock and horror – how could you tamper with your memories?  My answer is a bit different.  My memories are going to be tampered with.  Every time they’re brought to memory, they’re corrupted by a bit of the current sense of that moment.  My goal is to direct or shape the direction of the bias instead of letting it happen randomly.

Instead of allowing reinforcement of resentment, I decided to actively consider compassion – much like Buddhist monks recommend.  (See Emotional Awareness for more.)  I decided that I was going to take positive, warm feelings of the current moment along with curiosity and allow those things to reshape my childhood memories.

In Mistakes Were Made (But Not by Me), I shared that we know normal memories are not unchanging recordings; instead, they’re altered each time we recall or process them.  (I also address this in White Bears and Other Unwanted Thoughts, Intertwingled, and The Progression of Parental Alienation.)  This is the case for most of the episodic, semantic, and procedural memories that we have.  Knowing memories can be changed, we can enhance the memory – you can savor it.  It can make the memory seem more negative.  Somehow, the Sun just didn’t shine as brightly.  However, we can also be grateful for what we had and what we learned.  We can make the Sun seem to shine just a little more brightly.  Rarely do we consider this a conscious process, but it’s at the heart of the process of helping people to heal from trauma.

Closeness Under Threat

After the 9/11 terrorist attacks, there was a surge in patriotism in the US.  People came together in ways that hadn’t been seen in a generation.  It fulfils something that social scientists already knew.  When people are faced with a threat, they tend to band together.  (See Change or Die, Bowling Alone, and Our Kids for more.)  However, this expectation of closeness can be a hinderance to healing from trauma.

One of the challenges that sometimes happens when someone is faced with a trauma, something that overwhelms their internal coping capacity, is they reach out for support to friends, family, or community – but that support is missing.  In addition to dealing with the trauma itself and the foundational beliefs directly associated with the trauma, they must question their belief that others will be there for them when they need it.  They can feel as if their trauma separates them from the rest of the world, and that’s why they were unable to get the support they needed.

Ironically, those people who have an internal locus of control did better in a study of trauma recovery than those with strong social support but no internal locus of control.  That is, those people who believed they could recover themselves did better than those who expected their network of support would help them cope.  It’s not clear why this happened – but it exposes the fact that there are limits to external support and it reinforces the need to develop an internal locus of control.

This is fundamental to effective techniques like Motivational Interviewing.  It’s about supporting people until you can enable them to operate on their own Willpower and Grit.

Victims and Survivors

It’s seen as empowering to call living victims of a disaster “survivors.”  That is, of course, literally correct, but it denies the fact that they were almost certainly powerless in their victimization.  By changing to a happier label for the circumstances, we simultaneously deny part of their experience – further alienating and separating them from the “normal.”

It’s important to recognize that victims aren’t responsible for their trauma.  They weren’t asking for it or punished for being bad.  (See Trauma and Recovery for more on this concept.)  Bad things happen to good people – whether we like it or not.  We also need to empower victims to take back control of their worlds and, importantly, their recovery.  In Hurtful, Hurt, Hurting, I explained that no matter who hurt you, it becomes your personal responsibility to heal – no one else can do it for you.

Traumatic Memory

Traumatic memories are different than the regular memories that we can rewrite.  They’re stored in terms of their emotional impact.  Because they’re disconnected from the rest of our memories, they’re also fixed and unchangeable.  If we want to move past a trauma, we must find a way to integrate those memories.  That means finding techniques and tools to minimize the chances that we’ll become overwhelmed while processing them.  Strategies like desensitization and building overall feelings of safety can make it more tolerable to consider even awful things.

If the memories can’t be integrated, then they exist outside of time.  In other words, even though the circumstances of the trauma no longer apply, that doesn’t stop the experience of those memories.  Because they can’t be positioned in the larger autobiographical narrative, they appear to be happening in the moment even if the conditions are from years ago.

Traumatic memories are also frequently triggered by only peripherally associated experiences.  We’ve all heard someone say something that reminded us of a book, movie, or music.  What happens with traumatic memories is that sometimes the connections and triggers that create the memory are “turned up,” so relatively unrelated situations that share even rough resemblance to the memory cause it to be triggered.  Of course, this might be adaptive if it’s a situation that you want to be reminded of – but in today’s world, it’s rare that this amplification of the connection process is helpful.

In fact, the continued recall and the continued inability to process a traumatic memory may be debilitating.  It has the tendency to amplify the somatic and emotional effects and make it harder to deal with the memory in the future.

Memory Without Memory

One of the odd observations about trauma is that sometimes the memories of the trauma don’t have to surface to the conscious level to dramatically impact behavior.  Daniel Kahneman was clear in Thinking, Fast and Slow that we spend most of our time in System 1 – that is, not consciously considering what we’re doing.  We rely on templates, patterns, and expectations to guide us and only engage System 2 – higher-order thinking – when System 1 doesn’t seem to be working.  Traumas sometimes operate completely in System 1 and remain undetected.  Mysterious ailments on anniversaries of the trauma are common.

It’s also tragically common that a person who was victimized will reenact their trauma either by inviting the conditions for themselves or on others in similar circumstances.  This is one of the sources of generational trauma that is so difficult to stamp out.

Can’t Force Memory

Some people believe that you can force people to recall – and thus integrate – memories about an event.  However, the powers that we have to direct our thoughts are more limited than we realize.  (See White Bears and Other Unwanted Thoughts.)  Anyone who has struggled to remember the name of a person, the name of a song playing in their head, or that thing they walked into the next room for knows sometimes we just can’t remember no matter how hard we try.

We know from knowledge management work that some knowledge is tacit, and this tacit knowledge may not be something that we can recall.  (See Sharing Hidden Know-How.)  In fact, information architecture and anthropology both actively find ways to get to knowledge and understanding without simply asking people to explain the way they think.  (See How to Make Sense of Any Mess for information architecture and The Ethnographic Interview for anthropology.)

The goal is trauma recovery – integration of the trauma in a way that is autobiographical.  In an ideal world, we’d integrate the memories and be done.  We’d never have to worry about it again.  However, much like a bone that’s been broken, has become weaker, and needs to be protected, we’ll need to be aware of similar situations to prevent repeat traumatization.  In most cases, we’re unable to collect and integrate every aspect of a trauma and instead must settle for having integrated as much of the experience as we can.  This leaves free-floating bits of the trauma still in our psyche, and sometimes those random bits can arise again – and cause us to be back in the heart of struggling with the trauma.


One of the facts of life today is that we’re in a constant state of information overload.  (See The Organized Mind.)  The question is only the matter of degree that we’re currently experiencing it.  Our psychic defenses gradually decrease the amount of information that makes our conscious awareness to prevent from overburdening our resources but this can operate too slowly.  The result is that we can become overwhelmed when the information we’re taking in jumps dramatically.  However, a more serious problem is the one encountered by people with trauma when the system that performs this filtering process, the reticular activating system (RAS), suddenly starts flagging the irrelevant as potentially relevant.  (See Change or Die for more on the RAS.)  The result is a potentially debilitating level of information that becomes too much to process, and we start to engage other defenses like isolation.

It makes sense that, when impacted by an unexplainable trauma, our mind would begin to adjust parameters and try to find a combination of adjustments that allow the trauma to “make sense.”

Death and Belonging

Somewhere in the rubble that accompanies trauma is often the threat of death.  It may be that the trauma as the result of death itself – or a near miss where death was a possibility.  It may be that others died, and you became aware or watched helplessly.  As The Worm at the Core and The Denial of Death explain, death is one of the core fears that most people can never shake.  It’s natural that seeing someone else’s death or injury would remind us just how frail our lives are – and how little we can do to prevent harm at times.

In some kinds of trauma, the death card is quite hidden from view.  Instead, the focus is on a sense of belonging.  When there’s a sexual assault, it’s possible that there’s a direct fear for one’s life, but also that the experience alienates you from others.  There’s the sense that you are now separate from others either because they’ll never believe you or because you’re alone in your experiences.  In historic times, this kind of separation – or excommunication from the group – would be a death sentence.

Another variation is the damage that the trauma causes to our sense of control of our environment.  This is particularly true with sexual trauma, because in that, we can’t even control our own bodies.

Preparation and Control

Traumas are – by their nature – something that you’re not really prepared for.  Even in high-risk careers, we don’t believe that the losses will happen to us.  In fact, early on, we may want to try to assert control over things that we can’t assert control over.  We want to believe that, even if bad things happen, we’ll be able to control them.  However, control is the last great illusionist.  We believe we have high degrees of control and forget other confounding factors, particularly if they don’t line up in our favor.

The woman that we adopted as my grandmother survived The Great Depression.  Her struggle was real and difficult.  As we cleaned out her home after her death, we found multiple sets of sheets that she had horded, because she remembered a time when she wasn’t able to buy them – either because of shortage or because she didn’t have money.  We found all sorts of these stashes of things that you didn’t need more than one of – but that she felt she might not be able to get.  We also found old, broken coffee makers and other devices in minor disrepair, which she apparently kept in case they weren’t available and she needed to repair them in the future.

This is the impact of trauma who felt ill-prepared for The Great Depression.  She began to prepare in ways that most wouldn’t expect.  She wouldn’t tell you that she was preparing for the next one directly.  She’d simply state that there might be a time when they would be difficult to get.  We’ve all seen people who are holding onto things for no rational explanation.  It’s possible they’re still reliving a prior trauma of scarcity.

Control is, unfortunately, an illusion.  We believe we have control of much more than we really do.  (See How We Know What Isn’t So.)  We want control.  (See Compelled to Control.)  Because we want to be able to predict the future (to keep us alive), control is the easiest way of ensuring our predictions are accurate.  (See Mindreading and The Blank Slate for more on our desire for predictability.)  While control seems like the best solution, it is not real.  We only have control of ourselves – and then only in most cases.  We don’t control others, the environment, or the circumstances we find ourselves in.


One of the hallmarks of trauma is the protection mechanism of dissociation.  When the event becomes more than we have the capacity to address, dissociation creates artificial distance to help us defer the processing until a later time.  It’s the last resort for our psyche in defending itself.  A high degree of dissociation is correlated with PTSD.

People respect the role of compartmentalization in allowing people to continue doing their jobs even if the events are traumatic.  We need the military, firefighters, police, paramedics, nurses, and doctors to do what they’re trained to do in life-threatening situations.  We can’t have them running away when they’re needed most.  However, compartmentalization has its limits.  If you push it too far, there are consequences to be paid.

Similarly, the use of numbing can be an adaptive response if it’s being used to moderate the impact of the traumatic event and create opportunities to process it more effectively.  Too much numbing is a problem, as it prevents the processing of the events.  A glass of wine or a beer occasionally is fine.  When it becomes a constant need to prevent intrusive thoughts, then it’s crossed over the line and is maladaptive.

The experience most associated with dissociation is the sense that you’re watching from a third-party position.  It’s like you’re floating above the situation and seeing it as not you that’s suffering – but at the same time recognizing that it is you.  Moving into this state sometimes feels like you’re losing sensations in your body.  It’s like you know your body is there, but at the same time, you can’t really feel what’s happening to it.

Disassociation, like compartmentalization and numbing, can be adaptive for the situation because there are no other options – but that being said, it means that things are – or at least were – pretty bad.

Internal Family Systems

One of the key factors in the internal family systems (IFS) model, as explained in No Bad Parts, is the idea that our traumas cause us to exile aspects of our selves, and protectors begin to seek to protect us from further trauma – sometimes quite ineffectively.  Dissociation is the part of this process, where a part of us is exiled because it’s perceived to be the source of the trauma.  The healing process, defined by IFS, is the process of reintegrating the exiled parts of our personality and reintegrating them into our core.

Sequential Stressors

It’s one thing to have a traumatic experience once, but what if it happens repeatedly?  What if it happens over the years – or even worse, it’s a result of your career choice?  Multiple traumatic events, even if they’re smaller, have a cumulative effect.  Abuse of any kind once is problematic; continued abuse – particularly after having notified someone it’s happening – is even worse.  However, first responders, military, and law enforcement all encounter potentially traumatic events repeatedly in the service of others.  In these cases, too, the traumas can build up, but unlike other traumas that can be avoided, these keep coming as long as you have your job.

Dealing with sequential stressors if you’re not in service to others means making the trauma stop.  If you are in service to others, you’ll have to learn to get good at processing trauma and not allowing it to build up.  That’s much easier said than done in cultures that are built on toughness and competition.  Admitting that the last body you fished out of the water really bothered you can make you the target of ridicule.  Please don’t misunderstand: it’s wrong.  It’s just what happens.  Even if the ridicule isn’t out loud, it’s something that people will probably look down on you for.

Luckily, this is shifting somewhat with the world’s greater understanding of mental health and realizing it’s not a weakness.  However, cultures are often stubbornly resistant to change, and it may be hard to stand up in your service and say that you need better support and better skills to cope with the things you see and do.

The Benevolence of Humans

As I mentioned above, Jonathan Haidt in The Righteous Mind lays down what he believes are the foundations of morality, and the first is care – not harm.  Said differently, we have some belief that we’re supposed to all be benevolent with one another (at least in our tribe), compassionate, and maybe even altruistic.  This is a subject of much conversation and debate over the years, starting with The Selfish Gene, flowing through The Evolution of Cooperation, and continuing on to SuperCooperators and Does Altruism Exist?  Regardless of how it got started or whether we’re really being selfish when we’re being altruistic, most people believe that the world is a generally good place.  This is one of the biggest challenges after a trauma.

It’s been framed as “How could God let this happen?” but there are other similar thoughts about how bad things happen to good people.  The answer is randomness, but since that doesn’t allow us to predict, it’s unsettling.  In the end, we reach the level of acceptance (or delusion) that is discussed in Change or Die.  Sure, an asteroid could hit the Earth, but what are the odds?

It’s when traumas are inflicted intentionally by others that it causes us the most concern.  You can’t accept randomness when you know people like Timothy McVeigh (Oklahoma City Bombing) or Ted Kaczynski (Unabomber) are humans on the planet, too.  Even companies like Pittston Coal, which was responsible for the Buffalo Creek, West Virginia Disaster, make it hard to believe in the common decency of man.

Our first responders, military, and law enforcement see people doing awful things to other people too frequently.  It’s too easy to lose your faith in humanity, and so difficult to keep it in the face of biased – but overwhelming – evidence that humans can do horrific things to one another.

Trauma Doesn’t Define You

The Grant Study is a very famous study of Harvard students followed for over 75 years.  The results have provided insights into all sorts of parts of human behavior, including the impact of trauma.  One of the most interesting things about the study from a trauma perspective is that one of the most traumatized participants became very successful.  In fact, most people know that John F. Kennedy was the president who was shot, but few know that he scored very high for trauma in the Grant Study.

Here’s the message.  Your trauma d”esn’’ have to define you or limit you.  Few would say that JFK wasn’t a good president or that he wasn’t successful.  You don’t have to believe that you can’t succeed or be a part of society because you’ve been traumatized.

Capacity to Trust

One of the tricky areas of trauma is that it seems to impact our capacity for trusting.  It’s tricky, because we need to rely on others to guide us through the healing process, and because trust is essential for our lives to be fulfilling.  For a basic understanding of trust, see Understanding Trust.  It is understandable that trust would be impacted by prior negative experience – trauma.  At the same time, it’s tragic that the people who need to trust most are those for whom it may be the most difficult.

Differentiating Grief and Trauma

There are often two co-occurring situations in the wake of trauma.  First is the grief response to loss.  Second is the post-trauma processing of the event.  Grief is about processing the loss and what it means to us.  It’s a natural response to a loss at any level.  Many books, including Finding Meaning, The Grief Recovery Handbook, The Grieving Brain, On Death and Dying, and Option B, discuss the grief process and how to navigate the process of grieving.  This intersects and overlaps with post-trauma processing of the event in the evaluation of what the loss means to the person personally.

The post-trauma processing is that meaning process – not just for the loss but for the broader meaning to life as well.  One can be processing the grief of losing a loved one and simultaneously processing the threat to their own lives and the way they view the world.  Losing a child to violent crime involves the loss of the child, the recognition of the external threat of death to ourselves, and a challenge to a core belief that the world is a fundamentally helpful place.  The process of separating these different concerns creates greater probability that we can find our path through grief and trauma.

Special Uprooting

Some trauma comes in the form of uprooting.  This can be a literal refugee from a country of origin, a conscious immigrant to a new land, or a psychological uprooting due to the termination of familial relationships.  The uprooting kind of trauma is particularly challenging because of two additional factors: an inability to orient in a new world, an increased workload.  (See Man’s Search for Meaning for more on the impact of uprooting.)

One of the first goals in a cognitive assessment is to assess a person’s ability to orient.  Knowing when it is (date), where they are (place), how they got there, and often a commonly known fact like who is president, tells a responder that a person has a basic connection to reality and the ability to understand their place in the world.  Uprooting someone often disrupts the ease at which they can orient both in the quick assessment perspective and from the perspective of how they can compare their perceptions with their beliefs.

The increased workload that people face is a natural response to being uprooted.  In the physical space, it’s necessary to find new people for healthcare needs, appropriate vet care, and a number of other services.  In the psychological space, it can be that you’ve depended upon others for a particular kind of help.  Maybe you asked your mother for recipes or your father for car advice.  A sudden disconnection from can leave you partially disoriented as you must either develop this knowledge yourself or find someone else that you can offload it to.

Suicide research confirms this difficulty, as A Handbook for the Study of Suicide indicates.  Immigrants are at higher risk than the general population for dying by suicide.  There is good discussion about how this may be impacted by lack of belongingness – and by a constrained ability to orient.

Progressive Re-exposure

In helping people to recover from trauma, there are four key ways of helping make the traumatic event sufficiently safe that it can be fully processed and integrated.  They are:

  • Experience Shaping – Creating situations where the triggers to the traumatic memory are managed so as to occur slowly over time in a way that doesn’t overwhelm the person.
  • Desensitization – Bringing the person progressively closer to the impact of the trauma to normalize it and reduce the build-up of residual emotion.
  • Safety Building – Explicitly working on the overall safety context of the person so that they believe their world is more generally safe.
  • Grounding – The development of skills of being connected to the present moment and to bodily sensations to help the individual feel the traumatic memories less intensely.

The Role of Informal Support

While much is made of the professional support and resources for supporting people suffering from trauma, there is an awareness that much of the efficacy in any therapeutic relationship – professional or not – comes from therapeutic alliance.  “Therapeutic alliance” is a fancy way to say relationship.  (See The Heart and Soul of Change.)  Consistently, social supports – in the form of family, friends, and community – have been proven to be powerful tools for recovery.  They’re more available and more trusted than professionals.

In building trauma-resilient communities, we cannot ignore the fact that improving community responses has a powerful and durable impact on outcomes.


In my review of Opening Up, I exposed some of the problems with Critical Incident Stress Debriefing (CISD) and Critical Incident Stress Management (CISM).  Both effectively encourage people to discuss a potentially traumatic incident soon after it occurs.  These debriefings are not generally scheduled by the exposed parties but are rather timed to meet the needs of the trauma or crisis team.  The research on the efficacy of CISD/CISM is mixed.  Some studies indicated small to moderate positive impacts, while others indicated negative outcomes.  The metareviews are careful to indicate that the individuals doing this work may have a big impact on the outcomes, and poorly executed CISD/CISM can lead to worse outcomes.

Some of this may have to do with the concept of psychological safety as discussed in The Fearless Organization by Amy Edmondson and The 4 Stages of Psychological Safety by Tim Clark.  CISD/CISM is frequently used in first responder situations where there is often a low degree of psychological safety.  Most professionals in this space avoid vulnerability to their peers, because of a fear of lack of confidence or teasing.

An analogy about CISD/CISM is appropriate.  CISD/CISM is like bereavement counseling for someone who has lost a spouse.  It’s a good idea to offer it.  Conversely, it’s bad to force it upon the spouse the day that they learn of the death.  It’s too soon, and they may not be ready.  This in and of itself may be enough to explain the negative outcomes.

Trauma Compensation

One of the biggest challenges with trauma is that it’s contextual to the individual.  Nuances and tiny differences in the experience can mean a big difference.  Of two sisters caught in the Buffalo Creek, West Virginia Disaster, one is relatively unaffected, while the other is nearly paralyzed by fear.  The individual experience of seeing the wall of water and the girls’ mother swept away was enough to create completely different experiences for the sisters.

In addition, exposure to something today may trigger an unresolved trauma from the past.  This leads to the question how much of today’s trauma is from the current event and how much should be assigned to the previous one.  These issues and others make people wary about claims of trauma.  There’s always the concern that someone is claiming trauma to get a payout.  As a result, we often dismiss legitimate trauma that people have, because we cannot understand how it was traumatic and/or we believe they’re just trying to get a trauma related payout.  While there is no doubt that this happens, it’s difficult to separate legitimate need for assistance from those who are looking to score.

Perhaps the best way to deal with trauma is to find a way to avoid Traumatic Stress in the first place, but that’s easier said than done.

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