Decisive Resolution of Trauma in Brief Therapy

by Stephen Lankton, MSW, DAHB

[Please note: this article and the ideas it describes are intended to be read by mental health professionals with Masters and Doctorate level training post graduate training, credentials and licensed for practicing in their respective disciplines. It is, however, of interest to anyone in the public, as an aid in better understanding how therapy operates. Reading this article does not constitute proper training for the use of these techniques and they are not to be used by non-professionals to attempt treatment of others. Please seek proper medical and psychological aid from licensed practitioners in your local area.]

This paper focuses on helping therapists decisively resolve traumatic reactions for many clients in very brief, often one session, therapy. Such resolution of the traumatic effect does not constitute complete therapy, but rather makes the additional required therapy more accessible.

Victims of trauma can suffer in several largely different ways before ever seeking therapy. They can be recent victims who are primarily experiencing a great deal of anxiety and disorientation, as is often the case with victims of automobile and public transportation accidents. Or, victims may have suffered for years from the effects of earlier life trauma and present themselves in therapy with defense mechanisms that limit their experience in terms of joy, sense of self, intimacy, security, livelihood, and more. These two extremes illustrate vastly different clients and problems and illustrate that total recovery from the effects of trauma, for many people, will not happen in one session. This paper is not about solving all of a client’s problems which may have resulted from trauma. It is not about resolving the grief from loss. It is not about relearning new habits and perceptions to fill learning deficits and it is not about the social changes which rehabilitation may require. This paper is about overcoming the major limitation to growth that trauma creates. It is about the most decisive technique for getting on with growth and learning in the case of both mild and severe traumas. In some cases, especially those with recent traumas which have not become part of a life-style, this intervention may comprise the majority of the therapy. In other cases of long-standing trauma, it will serve as the groundwork to make the journey to more pervasive growth, grief, and change possible.

The techniques listed in this paper have to do with a complex association and dissociation paradigm the author has developed and used for years. Since the literature on trauma often suggests that therapists must assist victims in some type reliving and abreaction, an explication of the similarities and differences between association/dissociation techniques and techniques of reliving/abreaction is offered. The following chart lists 21 areas of therapeutic results and the comparison or contrast between “Assoc/Diss” and “Abr” in the columns on the right. Perhaps a global comparison is needed first to clarify the major differences in the approaches.

Consider that you have come to therapy due to the continued tension and anxiety you have experienced since you were on an Amtrak train which de-railed and killed many persons and from which you narrowly escaped with some minor medical problems, all of which are corrected and healed. The therapist you visit has two major ideas for your therapy to center upon.

Reliving and abreaction requires that you mentally, emotionally, and experientially return to the disaster. You would be encouraged to verbalize and release your emotions freely for all aspects of the incident. You will be expected, encouraged, and supported in the expression of fear, anger, shock, confusion, panic, helplessness, sadness, dependency, and so on, as the explication of the scene is relived and verbalized. Perhaps you might also be a candidate to express anger and other types of aggression. The major goal of this emoting is to help you rediscover your true feelings and adaptive response mechanisms, to own the emotions you concealed and to grow in ego strength gained by acquiring previously denied parts of yourself. The success for some of these goals depends largely upon skill the therapist provides. There will usually be some major resistance to this approach on the part of the client, primarily the general reluctance to show emotions before the therapist and the reluctance to actually feel the unpleasant incident all over again.

Abreaction can produce a corrective emotional experience, attitude change, redistribution of psychic energy, and will most likely result in an increased focus on the past as it encourages regression and reduces use of denial. There is an unfortunate risk of re-traumatizing the client during the reliving. More worrisome, perhaps, is the possibility of increasing reliance on the therapist, and if he or she encourages, becoming alienated from the family of origin (in the case of family created trauma) or actually reconstructing a past of false traumas in the process of “therapy.’

With association/dissociation techniques, by contrast, you can still experience a corrective emotional experience and attitude change but the focus is on the present and future of your life. There is no risk of re-experiencing the trauma or increasing dependency on therapist. You can build additional adaptive defenses, learn to use the parts of yourself lost in the trauma, and increase your self-support and personal resources.

In either case these interventions are not being suggested as the only necessary intervention for a full and complete recovery. They are being used as the major intervention for regaining the ability to cope, function, be creative in living, and to recognize that the trauma is behind you and you are improving radically. This association/dissociation model is being offered as an effective, viable, and preferable alternative to abreaction methods.

Comparison Between Dissociation and Abreaction

Therapeutic Incident Assoc/diss Abr
Corrective emotional experience can can
Attitude change(s) yes can
Focus on past no yes
Focus on present/future yes no
Redistribution of energy can can
Encourage regression no yes
Reduce denial can yes
Risk pain of re-trauma no yes
Build additional defense yes no
Learn to accept part of self can can
Learn to use part of self yes no
Intra-psychic no yes
Inter-social yes no
Risk distancing family of origin can yes
Risk distancing self can no
Increases stress on current system no can
More likely to be resisted no yes
Builds self-support yes no
Risk increased reliance on therapist no yes
Construct the reality of the past can can
Connect with personal resources yes yes
Three categories of trauma impact in my model

The wide range of results from trauma are divided here into three discrete categories. These are intuitively logical groups that are all inclusive and, for the most part, mutually exclusive. These three categories dictate three types of increasingly complex interventions, one of which constitutes the bulk of this paper. These categories are “type 1 – simple,” “type 2 – complex,” and “type 3 – state bound” traumatic reactions. Discussing clients who have psychological and sometimes physical results of trauma requires that we differentiate levels of severity or hurt that might have come from the event or events of the past. A continuum from “type 1 – simple reaction” to “type 2 – complex reaction” to “type 3 – state-specific reaction,” facilitates this process. Two of the approaches are discussed below and the complex association/dissociation “type 2” is illustrated with a case. While the personal impact of traumatic events is obviously unique in every situation, the general limiting effects of trauma have some recognizable similarities.

Type 1 trauma

“Simple trauma” refers to the unavailability of resources in certain needed situations. In a simple trauma an individual has been inhibited from learning certain experiences. Consider that the aim of a healthy person is to be able to associate to needed experiences and resources in each unique life situation. However, in the course of suffering a trauma in growth, the victim can not organize or associate to or retrieve experiences needed in certain situations. For instance, experiences commonly called confidence are needed (or at least very useful) in public speaking. A “simple trauma” has occurred when a specific event prevents experiences of confidence being vividly remembered (or experienced) in the context of public speaking and the person is still able to operate in some other area of his or her life with confidence and even sometimes amble through events that call for public speaking. Public speaking is not impossible for victims of this simplest kind of trauma, but the act of public speaking would result in considerable distress if it could not be avoided. There is not a significant loss of muscle flexibility, there are no significant attitudinal alterations about the world, and the person is likely to be resourceful enough to be quite successful in almost all areas of his or her life.

Type 2 trauma

“Complex trauma” refers to outcomes which constitute developmental learning problems. In these situations the effect of the traumatic situation was sufficiently severe to render the person impaired over a specific developmental area of coping which would seem to otherwise be within the behavioral repertoire of the person. The client with this type of trauma will usually show fairly severe use of denial, have many attitudinal and perceptual changes related to avoiding, and have much tension which is used to prevent the breakdown of defenses such as reaction formation and denial. There may be frequent outbursts, child abuse, or anxiety attacks as efforts fail to maintain defense mechanisms. For example, a person may be unable to be in a position of speaking to the public and would arrange things so that this situation never happened. It would not merely be uncomfortable, public speaking would be such a threat that even the thought of it would cause severe panic attacks. More usually, the events are such things as avoiding sexual experiences, machinery, travel, love, and other major commitments and responsibility.

Coping skills may be diminished, defensive attitudinal disposition may become a major problem that results in the person moving away from choices in life, intrusive memories break into consciousness, and the person may experience major loss of certain muscle groups (such as sexual organs). The panic which can be felt is often handled by alcoholism, avoidance of family members, occasional collapse, institutionalization, etc.

Type 3 trauma

“State learning” refers to situations in which the troubling mind-set is very persistent. Being immersed in a state from which one can’t recover is often referred to as state-specific and this is consistent for severely traumatized individuals. A person who experiences this type of reaction to trauma is severely limited by compartmentalized ego-states. There are problems for these individuals in nearly all areas of development which follow the traumatic event(s). They may show excessive fear, may have amnesia for large areas of their past, and they usually feel helpless, not just in the area related to the trauma, but for life in general. They often use the defense of identification with the aggressor that may result in self harming long after the traumatic events are over. Musculature, perception, attitude, emotional growth, and social skill are all impaired. Severe war traumas and severe child abuse trauma, including seeing siblings murdered, for instance, are the type of traumas which may give rise to this reaction.

Solving the effects of trauma

The goal of brief therapy is to promote increased functioning as soon as possible. To accomplish this, clients need to look at present and future goals, become involved with loved ones and other support, and to replace doubt and worry with permission to feel positive. Therapy needs to associate current resources to future tasks, reframe perceived failures, provide post-session suggestions for future success, and train clients in self-image thinking to reassess their skills and strengths.

Successful therapy identifies strengths and stimulates attitude change. In addition, it will increase self-nurturing by retrieving safety, comfort, rehearsal, self-talk, and self-acceptance by helping the often disowned self cast off shame.

Finally, there will be an ego-strengthening which comes from grieving, building new boundaries, and developing feedback loops to become self-sustaining in many ways. Other dynamic problems and social problems might also be solved especially when it can be seen that personal or social situations have been limited by the historical impact of the trauma or that the client, originally troubled in these areas, was in some ways presupposed to the traumatic effects that they suffered.

Therapists should use all the interventions they can for the most decisive changes but this paper will deal with only two major interventions: “simple associations/dissociation for Type 1 trauma and “complex association/dissociation” for Type 2 – complex trauma. The “simple association/dissociation” paradigm will be briefly discussed, outlined, and “complex association/dissociation” will be illustrated with an outline and a case example of the complex variation of this intervention. The severity of Type 3 trauma and the equivalent decisive intervention is better left to face-to-face and professional group training workshop and will not be addressed in this article.

“Simple dissociation” paradigm for Type 1 trauma

Rationale: The goal in simple trauma is to return the person to a state of functioning in which resources are available in the context in which they are needed. To accomplish this the person generally needs to have an inhibiting no-choice experience become less prominent in awareness. That is, the person would naturally build a creative personal response of success in a desired situation if he or she did not automatically recall the threatening and unpleasant learning from the original trauma. The outline below illustrates the steps generally followed in the paradigm.

Outline of steps for “simple dissociation” paradigm

The following outline provides a foundation to discuss complex association/dissociation. Many of the steps in this preliminary paradigm are self-explanatory and will only be discussed briefly.

1. Establish a safe environment

The importance of establishing a safe environment for the client can’t be underrated. It is of utmost importance that this step be accomplished before continuing. The safe environment can be established by any means and may have to be heightened by the use of internal absorption where concentration on the here-now context, relaxation, respiration and so on, can be maximized.

2. Teach or create a heightened internal concentration to facilitate a conscious frame-break

As mentioned above, this step may need to occur first in some cases. It is an important step for helping people to limit their awareness to the secure resources they require for protection during the intervention.

3. Retrieve sufficient creative resources to add to the safe and secure experience

These may come from memories of such times or from the future anticipation of life which will come after therapy is complete. The attitude and presupposition of the therapist is crucial to success. The client and therapist may combine their creativity to determine what resources might be preferable to those limiting experiences which were learned. That is, the person who was severely shamed or embarrassed before an audience in a trauma that lead to fear of public speaking will add to the security and safety by accumulating experiential memories of resources like “alert,” “warm,” “intelligent,” “prepared,” “confident,” and so on. The actual experiential referents for words such as these will vary with each unique client, of course, but the strategy for the intervention process will be standard despite unique client situations.

4. Aid in constructing a dissociative review

a. Review traumatic situation in words and pictures only.

Basic instructions must be stressed: the secure and comfortable client needs to review the past in words and pictures only (see illustration #1). If, at any time, the client begins to be pulled into undesirable feelings during the review he or she is to stop the review and reestablish the security gained in steps “1,” “2,” and “3” above. From this distance the client should be instructed to view the events in a collapsed time frame – that is, a few minutes can allow a view of many hours, days or weeks of historical time. Therapists should consider having clients review events in reverse order as this exercise will heighten the dissociation of previous tensions and emotions from the cognitive stimuli that have triggered limiting experiences since the trauma.

1) Gain a new understanding of it.

2) Recognize that the frightened child survived.

3) Recognize that any decisions made by the child or younger self of the past had occurred due to the limited resources that were available in the past.

b. Establish groundwork for integrating the dissociated part.

1) Establish communication between all parts.

2) Nurture the “child” or younger part and accept the self represented by it.

Therapists have a unique opportunity at this point in the therapy to suggest positive interpretations and attributions to clients for them to “pass along” to the younger self. This is a context therapy has created so that clients realize it is possible to recall needed resources and at the same time recall events that actually kept them away from those resources since the trauma(s) they experienced. Suggesting self-talk statements will provide nurturing internal communication in the context of thinking about the past (when client’s often have been less than kind and self-nurturing). It will also provide an opportunity for ideas on how to cope and how to understand the behavior of the self as an adequate attempt to cope in the past. These are referred to in illustration #1 as attitude shifts about the past with coping strategies, learning dialogs, and self-nurturing comments. All of these will be needed in the complex paradigm that follows.

3) Trade resources between parts for a more creative adjustment between parts as in the illustration below (illustration #2).

4) Practice the occurrence of the cognitive and emotional resources happening at each step until they are easily available to the client.

c) Integration strategies to conclude review

1) Create a visual or other sensory symbol of a combining and blending.

2) Create a participatory action with aids such as using hands coming together.

3) Auditory imagination – hear the voices in the scene blend together.

4) Continue holding the fantasized parts in the above manner while feeling an absorption and settling of the experience of integration.

5. Link learning to future uses

a. Keep the desired integrated results constant in feelings and in fantasy.

b. Do self-image scenarios training for progressively more difficult encounters.

The following illustration (Illustration 1) depicts the arrangement outlined in the above steps. It is crucial that the client begin only after secure resources are retrieved and stabilized. It is also essential that therapist stress the importance of literally only seeing and hearing the events from the past.

Illustration 1

Swapping resources paradigm

Illustration #2 concerns the swapping or trading of resources between the separated parts which are in communication. This is needed to understand the complex association/dissociation intervention which follows it. The illustration suggests that some “power” from the younger self is moved up to the older self as experiences of protection are made available to the younger self. As this happens there are a number of changes which can also be facilitated in the cognitive, and emotional experience of the client. These are shown as words describing the trade. Specifically, each part will gain needed resources as the client can have several experiences simultaneously which were not previously possible (such as feeling safe while remembering the trauma, for instance). There is a good opportunity for framing the younger part of the client as positive when this might have seemed negative to the client due to parental attribution. The therapist can help the client notice or create somatic or other internal signals to concentrate on in the future and which will symbolize these cognitive and emotional gains. This awareness process will stabilize new positive associations very quickly or with just a few repetitions in more horrifying cases. Some examples of the wording which may be used to swap resources between parts of the self will be seen in the transcript below.

Illustration 2

“Complex association/dissociation” paradigm for Type 2 trauma

The rationale for this paradigm is that the conscious mind is capable of noticing representations of internal communications and changes which can remain mostly out of awareness. Therapists merely need a way in which this communication and those representations can be set up. Most people will immediately accept a metaphorical framework of “talking” to other, usually younger, parts of the self. This is due to the commonality we all have of family and community and the ability to use that metaphor to sort our experience in terms or our age and size. Once established, this metaphor of dissociative review makes it very possible to associate to other needed resources of cognitive, perceptual, attitudinal, and emotional experience. Therefore, accepting the metaphor of older self talking to younger self, clients will have needed resources occurring in their experience as they think about and remember bits of traumatic memories. That is, they will have experiences which used to be eliminated in the context of recalling bits of their traumas. The detailed outline for establishing and conducting this intervention follows and are depicted in Illustration 3.

Outline of steps for “complex association/dissociation” paradigm

Complex association/dissociation: if clients can not recall the known trauma or resource or if it is an extremely “volatile” memory

1. Establish a safe environment.

2. Retrieve necessary resources.

3. Ask the client to imagine a “grown self” out before himself or herself in the room.

a. This self is usually a representation of the current aware and resourceful self.

b. This self is usually the same age and has the same characteristics.

c. In some cases this representation will be of a self from the future, at such a time that the problem is all solved. The future self may be presupposed to be years or only hours into the future. This occurs in the case transcript.

d. This self is conscious and knows what the conscious mind knows

1) Presuppose a position of observation toward the conscious mind

2) This conscious mind of the client will communicate with this part of the client

3) Client imagines communication taking place between this part and him or herself in an unspecified manner (it may be feeling, words, etc.)

4) Ideo-motor signaling is established for the therapist to continue with more intricacy. This is usually a head nod from the client indicating agreement has occurred between him or herself and this resourceful part.

4. Ask client to ask the projected part to further dissociate.

a. The projected part (part 1) is asked to see another part (part 2) which is younger.

b. This second part (part 2) is often not seen by the client.

c) Part 2 represents the more unconscious self and can communicate via the ties with part 1. This part is also usually chosen from all possible younger selves because of some special strengths or resourcefulness.

d) Part 1 and part 2 therefore become buffers between any memories created by part 2 and the real client.

5. Have the client ask part 1 to ask part 2 to review the traumatic events from a comfortable distance. Part 2 would see the trauma happen to a third part, part 3.

a. Suggest that only by means of dialogue or signaling (such as seeing the “head nods”) from the imaginary part 2 to part 1 and then from part 1 to the client should the client know what is occurring to part 3 in the mind or memory of part 2.

b. Conduct a careful elaboration of part 2 reviewing the scenes about part 3 and sharing with part 1 only that which it is safe to share. Have part 2 communicate the review to part 1 by ideomotor signals so that part 1 can report the communication to the client and, likewise, the client can report to the therapy (all by ideomotor signals such as head nods).

c. This presupposes that the memory of the trauma to part 3 exists and is known to some part of the self (at least to part 2).

d. The client’s conscious report of “not knowing” is not unexpected. In this way, even poorly recalled traumas (to part 3) can be reviewed by the dissociated part 2. In fact, forgotten traumas can presumably be reviewed and overcome in this manner.

6. Repeatedly review and communicate with self from past.

a. Continually request and guide the client to instruct part 1 to ask part 2 (only) to review the trauma which occurred to the younger part 3 with words and sounds only. Thus part 2 continues to be at a distance from the trauma which is being seen to happen to the younger part 3.

b. Help the client instruct part 1 to instruct part 2 to accomplish (essentially) a simple association/dissociation with part 3. Part 2 should watch the events, see them take place in speeded up time, watch them unfold in chronological sequence, even watch them unfold in reverse order – and all the while verify that part 1 and part 2 and the client are safe and secure during the process.

7. Remove the intermediate parts gradually and integrate the learning and resources.

a. It is possible for parts 2 and 1 to be gradually removed after the client accepts the presupposition of the safety and security and other desired resources occurring as the traumatic memory is reviewed.

b. The client must repeat the above steps until it is presupposed that he or she can handle the awareness and have the resources – and possibly even use the bits of memories as signals that desired resources are available and can be experienced and used.

c. As each part collapses into the neighboring part one at a time the client eventually creates the situation of the client in a simple association/dissociation.

8. Finally, there can be a merging of the secure part with the youngest traumatized part.

In doing this the secure client can be directed to reassure and nurture that younger part. This constitutes a reframing of the role the client has played to the role of self care-giver, non-victim, resourceful and empowered. The client, in this way, learns a role that generates strength and maturity any time the traumatized self is remembered in this way. It should also be said that the chances of the client taking this empowered role in the future are quite high because there has been no other adaptive role mapped out for the client since the trauma. Therefore, this intervention will represent a decisive turning point for the client’s growth.

9. Conduct post-session associations for the client to find and use these learnings and resources in the future.

It will be especially important to help the client to think through possible future times that might have resembled the traumatic event or might have been avoided due to the old traumatized self image.

Illustration 3

After this intervention is used – usually a full one or two-session event – therapy can proceed to deal with any other issues that have arisen for the client. These might include changes in family life, recreation, self-care, grieving, intimacy, sexual functioning, educational or occupational goals, learned awareness of physical pain, and so on. Each client will have unique needs in these areas. It is most likely that clients for whom the trauma was recent will have few mal-adjustments to correct and clients for whom the trauma has been long standing will have far more difficulties that have arisen during years of avoidance, excuses, lower self-esteem, and so on.

The following case illustrates the actual wording for setting up this intervention. This case was a single session intervention and is useful as an example in that it demonstrates this intervention in isolation and since it shows how to follow the outline while still modifying it slightly in some creative ways to accommodate the client’s unique situation. Specifically, this client reported no self in the present or past who was without the fear of crossing bridges. Therefore, the representation of the self (part 1) was constructed as a presupposed self from the future who was expected to be free of the anxiety. Likewise, the most distant self (part 3) was never revealed to the therapist by the client. The client did, however, indicate the existence of part 3 with head nods and later comments about her many parts and her connections to the past. Her head nods indicated the recognition of part 3 to part 2, if not to her, and an agreement with the swapping of resources and attitudinal self-nurturing comments to part 3. Commentary is added to facilitate understanding the flow of therapy as conceived by the therapist throughout the session.

Case example of complex association/dissociation

This session was conducted with a volunteer subject as an example of brief therapy at the 1993, Orlando, FL Brief Therapy Conference (Lankton, S., 1993). Her problem is real and she agreed to participate before an audience of about 800 mental health professionals. The session does not include hypnosis or the induction of hypnosis and it is of greater value dues to that fact. It illustrates how therapist who are not trained in the use of hypnosis can still greatly benefit from the techniques outlined here. Commentary about the session for the purpose of this paper has been placed within indented boxes between paragraphs. Speakers are identified in the following way:

S: refers to Stephen Lankton, M.S.W., D.A.H.B.

C: refers to the client, Mary.

S: I’ve asked for a volunteer for the demonstration based on very little information about what we’re up to here. You’ve volunteered. And, so if you could acquaint me with what you hope to gain, we’ll talk about that a bit and find out whether or not there is some kind of dialogue that results in something useful for you.

C: Going over bridges of any kind makes me very uncomfortable and it is not that I don’t do it — I go ahead and do it, but I am aware that my heart rate speeds up, it — just the whole situation is terribly uncomfortable. I like stop breathing for the time it takes me to go over the bridge.

S: Mmm.

C: I have the urge to close my eyes which I don’t do. (laughter)

S: Pardon me for laughing…but… not closing your eyes will keep you from finding out how you went over the edge of the bridge at least (observers laugh). Can you say how old you are?

C: 31.

S: 31…and how long have you had the difficulty – that you’ve known of?

C: I don’t ever remember not being apprehensive about going over bridges.

S: Uh-huh. Do you remember when the first time was? Don’t , you don’t have to feel apprehensive right now — but can you ‚ how long back can you remember having it in your experience?

C: Ummm.

S: Do you remember being ten …?

C: Late teens is when I became acutely aware of it. I was living in Texas.

It seems as if there will be no “past” resource part which will be useful to this process since all of her past memories of her self are those of a person who is frightened. One viable option at this point would be to use a “future” self as the first cognitive resource for stabilizing her strengths.

S: Uh-huh.

C: And somewhere between ‚ Lubbock where I was living in Dallas you had to go over a very big bridge ‚ and it’s kind of hard to hold your breath for that long.

S: Yeah, that’s for sure. And you live around bridges now I mean is this an issue which is actually a problem, or…?

C: Little bridges but it just creates some conflicts — it’s not a major problem, as I say it doesn’t keep me from doing it. It would just be nice to be able to do it with a greater comfort level.

This case appears to be an example of the simple “type 1” trauma. The client is able to function very well in a number of areas of her life and she is even capable of getting through situations where she experiences the results of the trauma if necessary, although, with reduced creativity and coping options. Since this is a public demonstration, however, a variation on the more complex association/dissociation will be provided for the client’s added security and emotional safety. There generally never any harm in using a more protective intervention, of course.

S: Yeah. Do you know what you need in order to succeed in going across bridges besides maybe a scuba tank? (client laughs) You haven’t thought about it that way?

S: And, this situation here is a little bit uncomfortable for you a bit I guess in that you’re not fully prepared to encounter certain things perhaps. So I don’t want you to be uncomfortable here. Is there anything you can do now to make yourself more comfortable? And I have no idea what direction were going in at this point but I would like to try to pinpoint something and then develop from that basically a little bit of a broader understanding of the contract, which as I understand it, is to be more comfortable going across bridges, (humorously) making it possible for you to move to Florida, where you have a lot of bridges). So, if you haven’t thought about it much – you’ve just realized you had this anxiety and thought “wish I you didn’t have the anxiety.” It may have not been enough to bring you to therapy under other circumstances, right?

C: Correct.

S: But having the opportunity you said “what the heck.”

C: Correct.

S: Umm. If you were asked, and I’m not asking you to do that now, but if you were asked to think about going across bridges, even in this situation, would that be enough to generate anxiety for you?

C: Um-hmm.

S: So we could have some measure of success by the fact that you won’t have anxiety when you think about it at the end of the session, you could report on that.

I presuppose that the client will succeed by the end of the therapy and discover that she also can relate to the presupposed possibility that therapy will result in change. This can be seen by her affirmative answer which follows.

C: Yeah.

S: Maybe we could just move there now – to the end of the session…and you can…

C: That would work…

S: Yeah, well close your eyes shut there for just a second — that would accomplish a couple of things. One thing, you won’t have to keep finding me looking at you and you don’t have to —

C: …that’s all right…

S: …realize you’re in front of this audience and…

C: …I’d rather look at you than them.

S: …then you can picture yourself at the end of the session – that’s where I really want you to go. So really, close your eyes for a second and imagine yourself at the end of our session here. And when you do that, do you — keep them closed and answer for me because I don’t want to disrupt the image. I want to build upon it if you don’t mind. Do you see yourself in the picture at the end of the session?

Here we co-create the image she will see with her conscious mind throughout the session. This is the image she invented to represent herself at her most successful – and it happens to be an image from the anticipated future. Since she is nervous about being in this demonstration as well as having anxiety from the memory of the trauma I decided to use the complex association/dissociation paradigm for the more severe trauma of “Type 2” instead of the simpler paradigm for the “Type 1” trauma.

C: Um-hmm.

S: You do? That’s great. And do you see yourself walking off stage and giving a sigh of relief or something?

C: Off stage.

S: And how are you feeling – in that picture?

C: Relieved.

S: (Pause), one part of me wants to know whether or not you’d prefer to sort of go now – and that be it on this as you are. Would that feel better? It’s okay to do that, you know, you don’t need to be a forced client in a demo here, you know.

C: Um-hmm.

S: Well, examine that image for a minute or have a little chat, you know, if you want. What do you call yourself when you speak to yourself?

At this moment I check for the existence of the image. We must have created it successfully or she would not be able to call the self in the mental image by any name! Next we find that she calls herself by a name from childhood.

C: “Girl Child” usually.

S: You call yourself what?

C: “Girl Child”.

S: “Girl Child”? Kind of an affectionate little nickname, huh?

C: Um-hmm.

S: So talk to “Girl Child” there and ask her if she would rather just stop in this now and not continue.

I am establishing a communication with this “part” of herself. She must imagine dialoging with herself in order to continue talking to me.

C: (Shakes her head right to left slowly) No.

S: No? What do your friends call you?

C: Mary.

S: Hmm. So this “Girl Child” is a real private thing that we have now let the cat out of the bag about apparently?

C: Mmm.

S: Anything else coming to mind. You seem to be some — quite — somewhat absorbed in that. What else are you thinking about?

C: I’m thinking about being able to go over bridges without the image of the bridges.

S: Um-hmm. So, as you see it now, the Mary that is looking back at you from 45 minutes from now, is she looking different or standing different in any way? Or is it a very subtle internal thing?

C: A little more aware of herself.

S: More aware? What is she more aware…what is she more aware of? Can you say?

C: Just her physical presence.

S: Any particular part of her physique that she is more aware of? Her face or her shoulders or something of that nature? Her overall height perhaps? Examine it or step into the picture and be her and discover whether you can notice.

C: Just the whole presence.

S: A little more centered or self-aware of, in a balanced sense apparently, not in a self-conscious sense, is that correct?

C: I think perhaps it’s a little bit of both. The discomfort is okay because of greater comfort for being able to go over bridges.

S: Um-hmm. Hmm. I’ll tell you what, let’s keep working with “Girl Child” there – if I can use her name myself for a moment. And ask her to move that image up a little closer so that — well I don’t know that we need to move it closer — but I want you to be able to see that Mary pretty well, that 31-year-old Mary standing there. And ask her if she would help you. Let’s pretend we had a dialogue, pretend we had a communication back and forth with this imaginary representation of another part of you – if you don’t mind. And ask her if she would nod her head or keep talking to you as facilitation for this next few minute demonstration. And if it’s okay with her, ask her to keep you focused-in and keep you centered-in on that self-awareness that seems important and precious to you that she represents when you see her – at all times. And wait for a head nod from her or a yes or something from her, and let me know if you receive it; that she is willing to help you be embraced by those experiences throughout.

C: Yes.

S: And without really having the need to do something formal or ceremonious, you will find that you will become increasingly more absorbed in your own internal experience as you watch her. So feel free to let that develop into any degree of relaxation or comfort or security or safety, or joy, that you wish. To any degree that is necessary, tune me out and any other extraneous information or possibly hopefully use some of my words as a stimulus or guide to help you and that Mary think about things that are important to solving that problem and have that relief at the end of the session that stays with you.

I’m using the established dissociation to develop the added absorption that can aid in her relinquishing any belief that she can’t succeed. This will make her concentration on her own goals easier as she loses the normal reality orientation to the cameras, and the group of observers.

But in the meanwhile what I would like to suggest, then, is that you ask that Mary, that’s 31-year-old, to picture out in front of her, so that you don’t even have to see it if you like, was it that 10-year-old that we spoke of or that 14-year-old that we spoke of earlier, who was crossing those bridges back in Texas, I believe you said. And just change my words to the right ages and places if I’ve made an error in that. And I really don’t want you necessarily, Mary, only if for some reason you want to, but preferably don’t you even bother to see that, let’s say 14-year-old Mary back there in the distance. Just let the Mary who is done with the session see her. Ask the “Girl Child”…is that what you call her, “Girl Child”?

Now Mary is asked to create an image that will be seen by the “future” Mary represented in the first image. This second image may or may not be seen by Mary herself. But she does not need to see more than simply the representation of the first image “in communication” with this 2nd image.

C: Um-hmm.

S: Ask — is it okay for me to use that name too?

C: Um-hmm.

S: Ask “Girl Child” if she will make in her mind’s eye a picture of that younger “Girl Child” out there back in adolescence if she can remember from her vantage point of now being comfortable that she is past the problem, and nod her head when she can see that adolescent Mary in her mind.

(pause)

S: And then ask that Mary who is 31-and-one-hour older to pass along to that adolescent Mary that she can see the communication that she is from the future, that she has succeeded in getting past the anxieties of driving over bridges. And that she is going to help her and be there for her. And that the four of us will figure out how that is going to go in the next few minutes. But we want very little out of the adolescent, we just want her to stay in communication, if she would. And ask the 31-year-old Mary from our future to nod her head as a signal to you that the 14-year-old understands and is willing to participate in that way. (C: nods.) It sounds like, from that laugh that you had, that maybe there is a little bit more contact the two of you would like to — or the two of them — would like to make with one another. So, empower the Mary from 45 minutes in our future to tell the 14-year-old some of the other things that you have learned as a woman over the years.

Some of the skills and transitions and risks and outcomes and confidences and prides and let that 14-year-old know through your translator from our future that she is going to have all those things about her as she grows. And be frank, tell the 31-year-old from our future to be very frank with the 14-year-old that (pause) she is an important part of you. That while of course you treasure her as a “Girl Child” and you really want her to know that she can treasure who you’re going to have become. (pause) And back then she was a passenger and now you’ve learned to be a driver and that has a lot of meanings in different ways. (pause) (C: nods.)

In the above section I have initiated a nurturing dialog between her younger self and her as the client.

And for the sake of experiment, perhaps you would like to ask the 31-year-old from our future to tell Mary from your past and demonstrate, and pass along the feeling of relief, that the Mary you’re looking at feels, having overcome the difficulty of anxiety. And once she feels the feeling of relief being passed along this pipeline, have her inform the 31-year-old you’re watching so that she can inform you, and you can give me a head nod to inform me, that that 14-year-old has experienced that relief and can hold onto it. And let her know she doesn’t have to know how to get the relief or — just you would like her to feel that degree of safety and relief and confidence in her future.

Now maybe we can ask the 31-year-old from your future to ask the 14-year-old from your past to pass along some of that feeling that she currently is experiencing to an even younger Mary out there that the two of you have forgotten about or weren’t thinking about, so that a sort of bridge can be made all the way back to the past, where…(pause) standing a little taller and being a little more self-aware…(pause), gains a continuity of experience throughout your life, back in the back of your unconscious Marys, that you’re not even fully aware of and the 14-year-old is marginally aware of, and the 31-year-old from your future can only understand by the head nods from the 14-year-old. (pause)

This modification of the complex association/dissociation will possibly be sufficient with only 2 images represented. However, a 3rd image is offered for a more deeply associated set of changes. If Mary indicates that she accepts the suggestion a completely designed complex association/dissociation would be in process and a change that might be somehow metaphoric to the presenting problem would be in the process of being solved by Mary. A trading of resources, as mentioned above, is initiated by the above comments.

And of course there may be a number of places where that can kind of seep in and permeate. Because you know, even the tension in a person that is like concrete will absorb confidence, and pride, relaxation, self-awareness. My garage has a cement floor and it absorbs moisture right through it. And as it absorbs moisture it settles, takes the contour of the land. And it is not a problem that little fissures break. In fact they’re expected that there will be little cracks in concrete every so many feet. I’m not just sure what that is but an engineer will tell you it is built that way to endure that sort of thing.

I have now begun a metaphor that concerns moisture, concrete, sitting comfortably and so on. This will evolve into begin comfortable in incremental steps leading to, obviously, seated in an automobile driving on concrete pavement over water (wet roads or bridges over water).

There is a maximum distance, even in concrete, that we can expect that the shifting contour of the earth will result in little bitty cracks in the concrete. And, of course, water seeps up in that just like confidence can seep through the greatest degree of tension. And so the longer expanse of tension you can find in the continuity of Mary’s life, the greater the chance will be that you will find those cracks through which confidence can seep. So I hope you find a number of little flaws in that tension that will allow that confidence to seep in. You might even ask the 31-year-old Mary from the future to ask the 14-year-old if she can think of anything that she thought was a flaw in her conduct, or that she thought that younger Mary still had some flaws in. And tell them through your translator, that you are glad to find those little bitty flaws here and there so that some confidence can seep in that structure. And then let it seep right on through.

I have now introduced the possibility of the full complex association/dissociation paradigm by giving suggestions for Mary to have the 31 year old see the future Mary, viewing the 14 year old “girl – child” viewing a yet younger Mary. I used the phrase that the younger one might have tension and a “flaw” – a concept from the metaphor that suggests a way for tension to leave and yet a play on words to suggest that the younger child was not perfect. Thus, this is a reference to a possible problem with her younger Mary being less than perfect in the eyes of others and a reference to performance anxiety. Both of these ideas are verifiably seen even in this adult woman who has performance anxiety in the demonstration and in crossing bridges in the non-symbolic sense.

I kind of rather enjoy walking on concrete that has become a little bit damp with my bare feet, especially in Florida here. It brings a certain coolness to the body that is refreshing. When you walk around a swimming pool and you have some wet concrete, it is so nice to get off that hot pavement and stand on the cool concrete. And any time I am around a body of water and there is concrete there I always look for the damp spots so I can walk barefoot across those. And I find myself straightening right up in the sunshine at those times. (C: straightens.)

(pause) And I don’t know if the 14-year-old and younger Marys, that you’re not thinking about particularly, ever used to swim and have that same experience, but I’m sure that the 31-year-old from your future knows about the comfort of being near concrete that has been damp and how that feels very good on the bottoms of your feet. (C: nods.)

So pass that information along down to the 14-year-old to pass onto the little “Girl Child” that she is thinking about – along with the understanding that not only will she stop in the puddles of water alongside the swimming pools in the course of her life, but there will be a lot of other places where she will be able to find, perhaps even a metaphoric meaning to the fact that, there will be some moist places around concrete that will be fun to just stomp her little feet in. (C: smiles.) And then I will tell you another secret that you can pass onto the 14-year-old. And that is that once I have gotten myself comfortable on that concrete wherever it is damp, I like to plant myself firmly in a seat so that I can keep my bare feet off the hot pavement for a longer period of time in the event that the water that I was splashing in starts to evaporate in the sunlight and just simply become hot pavement below me around the swimming pool. So I really enjoy being comfortable in the seat and letting the sunlight reflect up -warming and relaxing my limbs.

A while ago you were mentioning driving. I guess I wished that my lounge outside my home had a seat belt in it so I didn’t have to jump up and answer the phone, I can say, “Oh, I can’t undo the seat belt until the plane is fully landed and the pilot has turned off the fasten your seat belt sign and come to a safe and complete stop at the terminal. I will just have to let that phone keep ringing and sit her comfortably in my seat with the sunlight warming me, reflecting up from the pavement.” I’m just looking off at the swimming pool water rippling in the sunlight. (pause) Maybe there is something in that which is how come the Mary at the end of our session was feeling so comfortable about driving.

Maybe she made some metaphoric translation that comes from ideas like that. Why don’t you ask her in your mind’s ear quietly to tell you anything else she might have listened for and felt for and looked at that was important to her in the course of ignoring what I say and having your own experiences while you had your eyes closed that day on that stage that left her feeling so capable of driving across bridges at the end of the session. Maybe she just forgot all about the fact that the problem has always been there. If so, maybe she won’t know how to answer you.

Now I begin the process of integrating the parts in a way that will give continuity for the strengths of the various resources of each of the 4 parts of Mary: the real person, the future person, the 14 year old and possibly the younger girl who has not been consciously identified by Mary.

And in that case maybe you should have a little dialogue and tell her that “I am glad you are feeling comfortable about not crossing in the same old way, the way you crossed before, but you know there are a lot of other things I will be crossing in this new way. I don’t want to trouble you, Mary, now that you have already succeeded in crossing bridges comfortably to do even more for me but since you are from the future, you know, there will be some other bridges I cross, I guess, and I sure would like to do those comfortably as well.” And ask that Mary to project the “Mary from the future” still that you haven’t seen perhaps is crossing a number of other bridges, bridges of relationship, financial bridges, other kinds of moving that she will need that seat belt for. And this time maybe you could ask that Mary from 30 minutes from now to reach back to the continuity of all those “Girl Child’s” that you have been thinking about connecting with and connecting all those bridges together right through that “Mary into the future” and a couple of the other “Marys in the future” beyond that.

During this integration I use the image of the “Mary from the future” in an image I am using to post-session suggest her continued growth and integration of these learnings of comfort crossing (metaphorical) bridges.

Wouldn’t it be interesting if one of the Marys we can’t see is the “Girl Child” that goes to one of those Disney tours around the planet when they have that capability of just putting us on an orbital craft for one of those hundred dollar tours around the planet at orbital distance for one loop, crossing the moon. Think of the romance of the moon from the standpoint of being so far removed from the earth’s surface. (C: smiles.) Wow, there is a bridge to cross. (C: nods and smiles.) Make sure you hold the hands of all those younger “Girl Childs”.

When we were at Disney recently I held my daughter’s hand. She was very pleased to have one to hold onto. But every time the ride shook just a little too much for her, her old man father, she was just so happy to be on the ride that was shaking her bones like that. So you have to kind of smile and go along with those younger Marys and say, “Oh that ride was just terrific, darling. I really did like getting my bones shaken, my head banged and my back bruised just a teeny bit, that is okay, as long as we got to see Back to the Future like that, right in our face, getting eaten by a dinosaur, dropped down a volcano…” It is funny how children enjoy things a little differently than grown-ups do. And so when you think back to the nickname of “Girl Child” for all those Marys of the past, you might ask them what they are going to call the Mary from the future. Maybe you will become informed of some new little idea that you didn’t know you were hatching in there.

Back to the Future is one of the suggestions to reorient to the present.

These were some of my ideas that I was thinking about. And I wonder if it would be a good idea for you to bring back some of the Marys from the future into the Mary from our more immediate future and let her release some of those Marys from the past in her imagination so that three of us can just relinquish the complexity of all that imagination for a moment. And then let that Mary from the future stand by for your future use if you wish. And as that plane flies beyond us (a plane can be heard overhead) and your awareness of the room may come back to you. Open your eyes for a second and let’s talk about what you’re experiencing.

You are the Mary from the little bit of the future now. Last time I saw you, you were the Mary from the recent past. What were you able to come up with so far that might be useful and helpful?

C: Connections.

S: Connections?

C: Mmm-hmm. I’ve got a lot of different Marys in there.

S: Uh-huh. All different facets of the same life hologram, huh?

C: Um-hmm.

S: You might need to pick up your microphone so the others can hear as well while you are speaking. What have we accomplished so far that is useful towards our goal?

C: I don’t know.

S: Hold it a little closer. Especially when you have doubt because it will be useful to doubt loudly.

C: I don’t know.

S: You don’t know. Geez, I’m tempted to say that you can know if you wait just a few moments here. So I will wait while you think of something.

(laughter from the audience)

S: I don’t have any right answer that you need to hunt for or anything, you know. So. You looked pretty comfortable while you were doing that.

C: Very comfortable.

S: Uh-huh. Do you have some of that comfort with you now?

C: Um-hmm. Right up until you asked that question.

S: Ah-hah. I see, so. Well let me retract the question, then, and tell me about your experiences instead. Okay? How’s that?

C: Umm. There was a very strong sense of going back and making a connection at a younger time and carrying strengths I have now that I didn’t, I wasn’t necessarily aware of, at that point, and not as strong in this moment as with all the other moments to come. I’m not sure that that makes any sense to you, but it makes a lot of sense to me.

S: Do you want to have them stronger in this moment or is that okay?

C: It’s okay.

S: So it’s just a kind of intuitive grasp perhaps that that strength is just going to keep growing?

C: Um-hmm.

S: It sounds pretty good.

C: Um-hmm.

[A few sentences with Mary talking to the audience were deleted here for brevity.]

S: Could you do that little test in your imagination some way like you were thinking and validate or measure for us?

C: It’s not an image that introduces and positive feelings but it doesn’t – didn’t cause my breath to quicken either.

S: Would you like to introduce some positive too?

C: Positive is good.

(laughter)

S: A lot of people like it. So…(explaining the laughter) It is an understatement is what they’re chuckling at, “positive is good.” Um,…joy is a good positive feeling in lieu of some other specific one. You have some here, see. Why don’t you do something for that Mary that is going to be walking offstage. Hold that feeling, close your eyes and pass on to her the feeling of joy, not just relief.

C: (closes here eyes, smiling.)

S: And then you can help one another. And if she has time, ask her to pass that joy on back down the bridge that you built all the way into those pasts. And when you do that, you may hit upon a whole bunch more joy because you may find that joy is kind of logarithmic.

(pause)

S: And take it into the future. And tell the whole lot of them there are going to be people watching her when she has joy sometimes. And that will just have to be okay with them, even if those people are kind of depressed and sad, maybe they can just get a little bit of – make them just say “hey, there goes Mary, whew I wish I had as much joy as she did” or whatever people say, at moments like that. Sometimes I get the impression that children have more joy than their parents are capable of experiencing comfortably. And parents not knowing what to do with a child that has joy often teaches, inadvertently perhaps, the defense mechanism so the child cannot show their joy. And a very smart child learns how to protect those other people from some discomfort.

[Some material was deleted here about not protecting parents from a joyful daughter. The client nods her head affirmatively throughout this portion.]

And then before we’re done, once as you have a sense of the continuity of that, to the degree necessary and sufficient to proceed, ask the Mary who’s walking off stage with the ability to have confidence going across bridges, to be relieved going across bridges, to take some of this joy with her too – as a gift back for help she gave you and the Girl Childs from the past. And see those various stages of you as a woman crossing bridges in the future with joy. Not just relief, but joy!

And some of those other bridges that weren’t actually across water, see her taking some joy as she crosses those bridges too. And there are a lot of them and it has meaning in different ways for parts of your mind that will yet reveal itself to you, no doubt.

In these last few paragraphs I continue to help her integrate the parts of herself, this time with the more “aggressive” feeling of joy. Joy is stronger than the feeling of comfort, offers a sense of expression, and requires more alertness and self-awareness than mere comfort. So, her connections or associations can be to joy by again swapping resources to all parts of her in the dissociation. And post-session suggestions could be made to link these associations to further events beyond those of just physically crossing bridges without fear – but crossing bridges in a metaphoric sense.

[At this point there is a reorientation to having eyes opened.]

S: When you fantasize now about bridges does it seem like you’ve just broken even or does it seem now that you also have a good feeling with you?

C: A little ahead. I feel a little ahead.

S: A little ahead, huh (laughing). Well, great we are making a some progress then.

C: A lot of progress!

S: We should stop quite soon and let you begin.

C: Thank you.

S: Well, thank you!

This demonstration ended at this point with Mary walking off stage having a sense of confidence, joy, and comfort. She had probably only suffered from a trauma of the more simple type (Type 1) but still she benefited from the use of the more elaborate complex intervention this paper concerns. It is always better to use the more protective intervention than to use a less protective (simple association/dissociation) and wish the client had retained more security. In the privacy of an office setting the simple intervention might have served perfectly, but whenever there is any question, this paradigm will prevail.

Total therapy for Mary or for any client reacting to a trauma might require several more sessions. Future sessions would concentrate on social, occupational, self-image issues, and other areas where learned limitation had taken a toll over time. However, this intervention was absolutely pivotal in the change process as it supplied the means for the client to keep her desired experiences in the foreground so she could begin to function immediately in the real world. It also allows clients the increased capability to become more creative and responsible for themselves in the remainder of therapy work.

After this treatment intervention has been used, most clients describe more energy, greater availability of resources, good reality orientation, more self-support, an integration with earlier emotional strengths, and adaptive, creative behavior. The process is not resisted and defensive mechanisms are replaced by adaptive mechanisms.

Decisive Resolution of Trauma in Brief Therapy

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