One of the clinical populations I specialize in working with is survivors of trauma, as well as family counseling Chevy Chase, MD trusts. As with all my clients, I feel privileged that they choose to share their stories with me. I am especially impressed by the courage and strength that survivors of trauma demonstrate by seeking help and daring to heal. They are massively diverse in age, race, gender, ethnicity, religion, nationality, and sexual orientation—and their experiences often defy category as well as imagination. Working with survivors has offered me some insight into the interpersonal and intrapsychic impact of traumatic experiences, as well as how to ease the pain and make room for healthy growth.
Not every person who has experienced traumatic events wishes to be labeled or defined relative to their trauma—which is understandable. It can often feel like an unflattering designation—implying they are weak, pitiful, or damaged—or one that simply does not fit who they are now. Maybe the traumatizing event occurred when they were a child and now they are grown up. Maybe when the trauma occurred they were powerless and marginalized, but now they are poised, powerful and imposing in their everyday life. Maybe they have gone on to hurt other people in some way, and they are interested in fixing who they are now instead of attending to who they were then.
Traumatized individuals often do not see themselves as victims, or survivors, or patients with an invisible wound: they just are who they are, and what happened is just what happened. In my practice, I have found that it is rare for someone to come to therapy because they are a survivor of trauma. Instead, they come for some other reason—problems with intimate relationships, low self-esteem, poor emotional regulation—and as the therapeutic process unfolds, we slowly start to uncover how the patterns of behavior that cause trouble for them in the present stem from traumatic experiences in the past.
Trauma can be colloquially defined as “a deeply distressing or disturbing experience.” Traumatic experiences take many forms, including abuse, neglect or abandonment in childhood, witnessing or suffering violence of any kind, displacement, and deprivation or poverty. Importantly, not every person who has experienced these or other traumatic events will react the same way: reactions are as diverse as the survivors themselves, and they vary most widely based on a survivor’s access to solidarity and support among family, friends, community, and other proximate institutions.
Unsurprisingly, therefore, traumatic events tend to have the most painful and lasting impact when survivors do not receive solidarity and support. When the “safe” people and institutions in their lives fail to understand, comfort, and protect them, a survivor’s initial pain is compounded by shame and isolation. Shame, because their pain is seen as a weakness or failing in them rather than a wound that has been cruelly and unfairly dealt; isolation, because if a survivor believes, or realizes over time, that sharing their story only leads to more hurt, they will avoid sharing it at all—and continue living with the belief that if other people knew the truth, they would shame, ignore, or abandon them as well.
Survivors of trauma develop defensive—or, more accurately, protective—measures to help them function during and immediately following traumatic events. These habits, attitudes, and beliefs look different for everyone, but there are two common themes that I notice frequently: first, survivors of trauma tend to exhibit hypervigilance about, and sometimes overreaction to, physical or emotional danger; second, survivors of trauma often find it challenging to practice self-compassion and self-validation.
Individuals who have not experienced trauma will find it difficult to relate to and appreciate the protective measures of trauma survivors, and understandably so: these protective measures comprise thoughts and behaviors that do not make any sense in a safe environment. In the context of trauma, however, a survivor’s protective measures make a lot of sense: they may be self-effacing or even self-endangering, but in the context of trauma they are functional and adaptive. This is as evident with behavioral protective measures—i.e. self-harm, substance abuse, or withdrawing—as it is with thought-based protective measures—i.e. “bad things happen to me because I am bad,” or “I cannot trust anyone to take care of me.” Unfortunately, survivors of trauma frequently continue enacting their protective measures long after they have they have outlived their usefulness.
Particularly for high-functioning survivors of trauma, their self-worth tends to be conspicuously out of pace with their accomplishments: they may work hard and succeed, but they consistently perceive themselves as inadequate in some way—or they cope with consistent feelings of inadequacy by compulsively seeking external validation. While working in the Maryland state prison system, I encountered many survivors of trauma who would be technically considered “low-functioning”—although many were exceedingly crafty survivalists. In contrast to high-functioning survivors, they tended to demonstrate capacity that was out of pace with their accomplishments: they may have been gifted artistically or analytically, but their personal and professional lives were beleaguered—held back in part by the belief that their painful pasts have rendered them unworthy of satisfaction or success.
Both for better and for worse, trauma is not a stagnant reality: it follows a survivor through every stage of life, squeezing its maladaptive beliefs and behavior into every new setting. So, how does healing happen? The first step for clinicians—as well as for partners, other family members, and friends—is solidarity and support. Even if it has been decades since the traumatic experiences occurred, solidarity and support is always appropriate, and it can take a number of forms: making time and space for the survivor to tell their story, believing them, crying together, validating the choices they have had to make to protect themselves, telling them how impressive and strong they are to endure what they have, and many more. Even decades later, solidarity and support have the power to impact the survivor in a tremendously positive way. Once a survivor receives support and solidarity in therapy—from the clinician as well as any partners and families present—they can learn to identify, challenge, and eventually replace the maladaptive beliefs and behaviors that stem from past trauma.
Thank you to friends and contributors at Lindsay Hoskins and Associates for their insight into therapy and trauma.
 Dr. Alexandra Solomon, Instagram, https://www.instagram.com/dr.alexandra.solomon/p/BoxwzE3nnaX/