TIFT #52: An Extraordinary Conference on Trauma

Today’s writing comes after attending a blockbuster online conference* organized by Tian Dayton, a psychodramatist, who spent 90 minutes with each of five leading thinkers on trauma: Bessel van der Kolk, Peter Levine, Stephen Porges, Ed Tronick, and Richard Schwartz. What made this conference so special was the psychodramatist’s point of view brought by Dr. Dayton.

In the past, I have often spoken about the inner child concept as a replacement for the idea of transference and a helpful and accurate way to bring compassion and understanding to the young ways we so often see in psychotherapy. The takeaway from this conference is that inviting younger parts into the room and addressing them directly can be even more effective. Too often, therapists try to show the client a more adult perspective, but don’t realize that they are talking to a child, who is not able to take in the wisdom we want to impart. This post is about ways to develop a direct relationship with inner children.

The old way to look at things

Traditionally, we think of the client as one person, an adult, who sometimes exhibits ways of experiencing and thinking that derive from long ago and cause trouble when applied to the present. The idea of transference sees a single, unified client as experiencing the present through the lens of the past. In CBT terms, the client holds erroneous beliefs and values. In both cases, the therapy consists of presenting contrary ideas as an antidote to erroneous views. The client is supposed to consider this new information, see how valid it is, and change their understanding. The problem is that we are often talking to the wrong “self.”

Today's more interactional version

A more modern view puts emphasis on the role of the affect and of the therapeutic relationship in healing and growth. Early in the evolution of the psychodynamic orientation, it was understood that timing of interpretations needed to be when the client was experiencing transference with affect. Along similar lines, Alexander and French described the corrective emotional experience in which the client encountered the emotional experience of early life expectations, which were contradicted by interaction with the therapist. Schema therapy had a similar idea that early life ways of understanding could come to dominate and needed to be brought into a more adult perspective. Today there is more emphasis on the healing power of a healthy, empathic relationship that somehow allows a transformative experience. But is yet further we can go to acknowledge and take advantage of the real presence of a childlike version of the self and the need to single out and relate to that version as separate from the adult client.

Identifying and relating to the childlike self

How can we do a better job of connecting with a young self that does not analyze, but relates? The influence of psychodrama on the five thought leaders at the conference was to focus on ways of engaging childlike versions of the self in direct dialog. Here, the therapist and the adult self act as partners in a compassionate and caring exchange with a younger part. Not surprisingly the one who was most clear about this was Richard Schwartz, founder of Internal Family Systems Therapy. Not only does Schwartz talk about wounded inner children and their young protectors, but he also reminds us of the sometimes invisible presence of a more objective adult persona he calls the “self.” This adult version is seen as carrying a more realistic view of the world but, at times, being overridden by younger versions, which we could call parts, inner children, ego states, states of being, or simply alternative “selves.”

In my experience, talking about the “inner child” is particularly helpful when a childlike state is clearly in view. What the presenters add to this is that less obvious manifestations of childlike thinking and experiencing can be coaxed out into the open and invited to enter into a direct dialog. Why is this more effective? First, without a clear split, what we get is a muddy amalgam of the adult trying to rationalize the presence of the child. We see attempts to compromise between childlike thinking and an adult view. It's an attempt to produce something acceptable to the adult client, who hopes to convince the therapist. The result is to obscure the pure logic of the child and to blunt our attempts to juxtapose old and new. 

Furthermore, even when the childlike experience is clear, speaking to such parts from an adult point of view does not work well at all. It’s no different from speaking to a child who doesn’t understand adult language or concepts. Even with some willingness to be compliant, the child simply cam’t take in this kind of information. One of my favorite illustrations of this principle is to listen to a pharmaceutical advertisement on television with the sound turned off and subtitles enabled. One has a remarkable feeling of one part of the brain taking in the smiling faces, while a totally different mind listens to dire warnings of deadly side effects. Children only hear the emotional part of the communication.

Another blockage that sometimes happens is that the childlike state is so powerfully triggered that no adult self is available to partner with the therapist in the emotional communication. I have seen cases where a child part is so dominant that any suggestion of an alternative point of view is consistently and forcefully rejected, even though the client is an intelligent, professional adult. All one may get is a compliant pseudo-adult who listens obediently but can't facilitate any change. Progress in therapy is blocked. In these cases, the adult may sometimes take over, but to little avail, as the adult client has no more influence on the childlike part than a therapist speaking in purely “rational” terms.

Working with childlike parts

The appearance of childlike responses is usually triggered by some circumstance that calls out old patterns. The therapeutic relationship is a powerful trigger, but family relationships, reminders of troublesome experiences, and a surprising variety of circumstances can give the same result. In the days of transference, one had to wait until the phenomenon appeared. As we become more alert to “who” is present in the room, we can be aware of triggers, and possibly invite the client to recall these in a way that purposefully energizes a childlike response.

How can we better work with the states or parts that come to light in psychotherapy? Empty chair exercises, “parts work,” and psychodrama each have something to offer. These modalities recruit the adult as an observer, but create a theater in which the childlike part is split away and is asked to represent him or herself in pure form. These are means of staging a divide between the young state or part and the observing self. They have the advantage of catching the child state’s attention and demonstrating the therapist’s genuine interest and respect. Tried for the first time, these techniques may seem awkward and artificial, but as therapist and client begin to enter into the drama, it can take hold and become fully “real.” 

• Individual therapists can use an empty chair for the observer, while the occupied chair becomes the place of the embodied child. Therapist and client work together as the observing adult. When the therapist occasionally chimes in, Dr. Dayton calls it, “doubling” for the adult.
• In parts work, the therapist can attempt to relate and dialog directly with the childlike part, much as can be done in cases of Dissociative Identity Disorder. 
• Full psychodrama has an additional advantage, as Tian pointed out, that a group may be better able to engage a younger self than an individual therapist, not to mention the power of dramatic interaction.

When the child part is not tolerated

A very common variation is when the young part, who is trying (still) to solve an unsolved childhood problem is an object of shame. Often this blocks progress as the child is judged and rejected or even punished for being immature and needy. Do such judgments come from an adult point of view? Usually not. The objection is another early solution to a problem. The inner child’s neediness would inevitably have lead to yet more hurt and must be kept hidden. Consistent with the Inner Family Systems paradigm, the source of shaming can also be seen as a part. Schwartz calls them “managers” or “protectors.” In one case, the childlike self, a five-year-old, did not have the self-control to suppress neediness, which, in childhood had led to being attacked and humiliated by the parents. A slightly older part became adept at denying any neediness and rejecting any suggestion of it in the self. In therapy, healing of the wounds of the younger part could not take place as long as the older “tough” child was in charge, suppressing neediness and replacing it with a hard-edged defiant persona.

Schwartz has an interesting approach to this. Instead of arguing that it is no longer appropriate to feel shame or reject neediness, he simply asks the “protector” to step aside while he talks with the needy child. When approached as an equal, the protector or manager is often willing, temporarily, to cede control and allow the needy child to come on stage. Once again, addressing a child state with respect and understanding is far more effective than lecturing.

It can’t be overemphasized how often attempts to heal the anger and pain of the inner child are blocked by harsh values adopted to keep the child from further hurt. Once again, we may be used to calling them inappropriate values or identification with the aggressor, but it may be far more powerful to see these as belonging to a protective part of the self. These judgments and the shaming that follows need to be dealt with before healing work can proceed.

What happens next

When a childlike state of being is successfully invited to the party and comes fully to life, then magic happens. Pain, anger, and unmet needs are juxtaposed with the experience of a warm hearted and understanding adult in alliance with the therapist. This is the formula for healing and acceptance by both extinction and memory reconsolidation. Notice that, consistent with the mode of communication children are able to receive, this is not so much imparting intellectual information as the experience of a new and healing relationship. Being heard and understood is both a way to meet the unmet needs and a way of healing feelings of anger, injustice, and pain. The presence of a respectful, understanding, and compassionate others is largely sufficient, without having to impart much information. The relationship, itself, carries most of the antidote to old wounds. 

Some of the conference presenters also noted that explicit recounting of childhood traumas was not actually necessary. I’m sure that abstractions and affectless generalities are not sufficient to bring therapist and young client together. But the varieties of hurt are infinite and I think need to be communicated in a way that brings the therapist into the picture. Essential, in my view, is sufficient communication so that the witness has a real sense of the emotions that have been experienced and endured.

Healing of troublesome emotions

Along with bringing emotions into the room as affects, the necessary antidote is connection with another human who understands and is not overwhelmed. Under these conditions, pain seems to heal rapidly and automatically. Anger needs its own time. Once it has had its “day in the sun,” having been expressed and heard, there comes a point when the angry part is ready to let go. It can’t be hurried, but like the resolution of grief, the process must proceed naturally. At some point, anger can dissipate, leading to acceptance. Debts can be “written off.” This can be blocked by the hope of avoiding acceptance by seeking revenge. Unfortunately, as described in TIFT # 50, when some part is intent on revenge, acceptance usually can’t happen.

When pain and anger no longer carry energy, when the affect has died down, then something remarkable happens. The protectors and managers are no longer needed. When weakness or neediness is no longer so charged with anger and yearning those emotions no longer have to be suppressed. They no longer represent a threat so protectors and managers can, indeed, put down their swords.

The body and states of being

One final, but important note: In making a clinical switch towards relating to parts or states, we open the door to a greater appreciation of the body. Reminders that trigger the appearance of a part are often physical sensations and sensory inputs. Understanding may require listening to bodily sensations and being open and sensitive to the language of the body. We need to be open to communication on this distinct wavelength. Words can be evocative, but children live in their bodies and sense with their bodies. A bodily aware mode of communication may be the best or only way to connect with a young state of being. Just as with any child, physical contact may be the natural way to connect. The problem with this in parts work is that other parts may be listening and responding as well. They may be receiving very different messages. That is when harm can be done, and safety must take precedence.

Conclusion

Ultimately, my take away from this excellent conference is that relating to a child part as a real protagonist using direct communication on a wavelength appropriate to the child part can be significantly more effective than the best lecture or explanation.

Jeffery Smith MD

* The Body Speaks, sponsored by Collectively Rooted. https://www.collectivelyrooted.com/programs/the-body-speaks

Photo by Kyle Head, Unsplash