Talking about one’s childhood is an important question in the context of how therapy works, particularly in helping patients move from addiction to recovery. At Encore Outpatient Services, one of our key focuses is trauma therapy in VA. The simple answer is that who we are today — our behavioral patterns, likes and dislikes, relationship behaviors, coping mechanisms, and other aspects of our personalities — is formed based on our early experiences. And it’s not just our personalities that take shape in our early years. Our brains are also formed as we grow, with early experiences significantly contributing to how neural pathways are created.
Trauma’s Role in Addiction
A 1995 study found that childhood trauma affects the child’s neurological development. Epigenetics indicates that even with a biological predisposition, psychological and social risks and protective factors can significantly impact how we develop both physiologically and neurologically. Because of the way our brains respond to trauma, including how new information is organized and internalized, a child who has experienced trauma can likely have neuropsychiatric symptoms that can take form in maladaptive traits.
Trauma does not always look the way we think. For example, a family that places a significantly high value on success or mental toughness to the degree that it supersedes emotional needs and precludes individuals from processing losses can cause trauma in a child. An experience such as this can become a part of unresolved trauma that carries on into adulthood. Essentially, trauma is what happens when you are unable to process what happened to you. Experiences that were challenging that remain unprocessed and unresolved may neurobiologically still with be with you and can impair your relationship with yourself and others.
The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends a regular screening using a checklist such as the Adverse Childhood Experiences (ACE) Study Score Calculator to identify stressful, traumatic experiences given that such factors may lay at the root of addiction and other issues. Multiple studies have found that higher ACE scores indicated higher risk for substance abuse.
ACEs can disrupt a child’s relationship with others generally and caregivers more specifically, resulting in the child having challenges with building and maintaining trust across different types of interpersonal relationships. Children may react this way to defend themselves, and then over time, lacking trust for adults in general may become the default. That is to say, all behaviors have histories behind them. Humans are wired to adapt and survive. So what looks to the untrained eye as simply difficult dysregulated behavior is something that at one time got this individual through life. Take shame, for example, which is also an attempt to protect the self from further abuse, to demean the self first before others do.
Resolving the Trauma
Healing can happen when patients get to know the parts of themselves that developed these neurological patterns of thinking, feeling, and behaving. Becoming aware of these parts helps us to better understand what our underlying need is rather than simply trying to eradicate what appears on the surface to be problematic or damaging behaviors or decisions. By developing a trusting patient-therapist relationship and offering a space in which emotions can be safely felt and expressed, the therapist guides the patient in a process of resolving the trauma. As patients start to understand and accept that they dealt with their trauma as best as they could at the time and adapted, they are given the opportunity to see their behaviors in a different light. Now, they have an understanding that the adaptations that worked to deal with traumas no longer serve them, and they can start exploring other options and opportunities for growth and change.
For example, in a psychotherapy model known as Internal Family Systems (IFS), the underlying paradigm is that all of us have subpersonalities that are developed overtime to help us deal with unresolved trauma and that these parts take on specific roles. When a child experiences distress or trauma and is not supported in processing it fully, it can cause one or more parts of the personality to take on an extreme and/or destructive role. The child cuts off the parts of their personality that carry the emotions, memories, and sensations connected to those experiences.
IFS as well as other therapeutic models and modalities conceptualize the self in the same way. What IFS has done is to identify and describe the sub-personalities that are common across most people. Those parts of the personalities that are cut off, as described in the IFS model, are the exiles. Exiles are then protected by two other parts, managers and firefighters. Managers attempt to control our experience, usually in socially acceptable ways, to protect us from ever connecting with the exile. And when the threat of connecting with the exile feels too great, firefighters step in. Addictive behavior is a firefighter.
While IFS is one of several modalities we use at Encore Outpatient Services for our trauma therapy in VA, what sets IFS apart is its recognition that addiction is not a moral failing but rather a way to deal with circumstances that otherwise could have overwhelmed the child who experienced them. It also provides a framework for therapists to use to treat unresolved trauma and allow the patient to help the firefighter parts let go of the destructive survival tool that is addiction and take on new and healthier roles. The patient can honor the parts of themselves — the managers and firefighters — that coped with harmful experiences and took care of the core self. The patient can shift into new ways to behave with the recognition that those coping mechanisms are no longer needed and the core self can emerge whole, healthy, and aware and lovingly connected to all the parts.
The person who emerges from treatment and into recovery can look at themselves as someone who is oriented towards safety and growth, who is capable of change, not because they shame or berate themselves into it, but because they have new ways of being safe and can embrace new ways of relating to themselves and to others as well as living their lives. This allows for real and lasting change.
Trauma Therapy in VA
Encore Outpatient Services
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