by Lissa Rankin MD
It sounds weird to say that trauma is hot right now, but it doesn’t take much to recognize that after a year of personal and collective trauma, conversations about healing trauma are everywhere. For example, I’m delighted that Oprah Winfrey and Bruce Perry, MD have published their book about developmental trauma- What Happened To You? and Gabor Mate collaborated with the Science & Non- Duality community to release their documentary The Wisdom of Trauma. To have the conversation about trauma elevated out of the shadows of shame and into the illuminating light of the mainstream is nothing short of a miracle to me. In Healing With the Muse, we spent the better part of May and June diving into a trauma healing method NeuroAffective Relational Model (NARM), as well as deepening our work with Internal Family Systems (IFS) with IFS founder Dick Schwartz, as part of our community recovery process after the past year of personal and collective trauma. In a live demo with Dick Schwartz, I worked on the parts of me that are scared of reopening after the pandemic because I’m not sure which humans I can trust. (You can watch the demo Dick Schwartz did with me here).
I wanted to share with you some of the “Cliff Notes” I took from the book about NARM by Laurence Heller and Aline LaPierre- Healing Developmental Trauma. Many of us are aware of the impact of shock traumas like childhood sexual abuse, the death of a parent, being abandoned or put up for adoption, growing up in a war zone, or being the victim of violence- the traumas that add up to a high Adverse Childhood Experience (ACE score). But until recently, most people didn’t realize that developmental trauma can be even more insidious, hidden, and misunderstood. In fact, it’s possible to have severe developmental trauma- even if your ACE score is zero- and this kind of trauma can severely impact your ability to thrive, especially in relationships.
CHILDREN ARE DEPENDENT UPON MATURE ADULTS TO MEET THEIR DEVELOPMENTAL NEEDS
NARM is based on the understanding that children have five core developmental needs- for connection, attunement, trust, autonomy, and healthy connection between love and sexuality- and that if any of these needs are not met, a series of behavioral patterns arise. When these core developmental needs are met, kids (and later adults) develop core capabilities.
When those needs are not met, we grow up with certain predictable trauma symptoms and behavioral patterns, which we may not even recognize as trauma symptoms, making it hard to get them treated. The data linking developmental trauma and medical illness later in life is so strong that we invited Laurence Heller to join the faculty of the Whole Health Medicine Institute this year so he can help teach our health care providers and therapists a more trauma- informed approach to medical treatment.
The first year of life is supposed to be a time of normal, healthy symbiosis between the mother and infant, where boundaries blur and the baby cannot tell where mother stops and baby begins. This healthy symbiosis makes baby feel safe and connected, establishing a sense that intimacy is not only safe, it feels good and leads to core needs being met. Connection with the parent leads to a regulated nervous system that allows the infant to stay embodied, knowing that needs will get met and connection will alleviate distress if it occurs.
If the need for CONNECTION is not met:
- lack of affect
- feeling shame about needing anything from anyone
- communicate intellectual or spiritual superiority
- relate to others who did not get connection needs met and don’t challenge their need for personal space
- use interpersonal distancing as a substitute for adequate boundaries
- withdraw in emotionally disturbing situations
- tend to relate in an intellectual rather than a feeling manner
- seldom aware that they are out of touch with their bodies
- fear both being alone and being overwhelmed by others
- feel like a frightened child in an adult world; do not know how to deal with or appropriately manipulate their environment
- exaggerated fear of death and disease
- fear their own impulses, particularly anger
- fear groups and crowds
- intense ambivalence: deepest desire for contact is also the deepest fear
- yearn to fill emptiness and fear fulfillment at the same time
- strong need to control self, environment and other people
- difficulty tolerating intimacy
- want to know reason why; transcendentally or intellectually oriented
- because of their failure to embody, often have access to esoteric spiritual states
- drawn to therapies, meditation, and spiritual movement that reinforce dissociation
Those whose connection needs don’t get met have shame- based identifications: shame at existing, feeling like a burden, feeling of not belonging. They also may have pride- based identifications: pride in being a loner, pride in not needing others, pride in not being emotional.
COMMON PHYSICAL & MENTAL HEALTH SYMPTOMS for those whose CONNECTION needs go unmet:
- Digestive problems
- Irritable Bowel Syndrome
- Environmental sensitivities
- Chronic fatigue
- Panic attacks
Babies need attuned caregivers who mirror their experience, ground them, and help them feel their emotions, tolerate intense feelings, and normalize difficult experiences so they know they are not alone when their nervous systems become overwhelmed. Dr. Dan Siegel says, “When we attune with others, we allow our own internal state to shift, to come to resonate with the inner world of another. This resonance is at the heart of the important sense of ‘feeling felt’ that emerges in close relationships. Children need attunement to feel secure and to develop well, and throughout our lives we need attunement to feel close and connected.” When we get our attunement needs met, we grow up able to know what we need and to recognize, reach out for, and take in the abundance that life offers.
If the need for ATTUNEMENT is not met:
- difficulty in sustaining energetic charge; they get excited about new projects but have difficulty finishing them
- longing for their needs to be met without expressing them
- clinging in a covert way
- like to talk; getting attention is equated to getting love
- often describe an emptiness in the belly
- periods of elation at the beginning of a relationship or new, exciting project without the ability to follow through
- do not reach out for what they want because of low energy and fear of disappointment
- expression of anger is weak; tendency to be more irritable than angry
- relationship to love object is self- oriented: “I love you…I take care of you…you have to love me.”
- encourage others to depend on them
- pick up strays- animals or people
Babies who don’t get their attunement needs met learn to limit their needs to match the amount of nurturing available, ignoring their own needs and often prioritizing the needs of the parent over their own. These babies become little caregivers, often of a dysregulated mother. Many grow up to become caregivers of others who neglect their own needs. Doctors, therapists, nurses, teachers, and any kind of “carer” may fit this profile.
Those whose attunement needs don’t get met have shame- based identifications: needy, unfulfilled, empty, undeserving. They also may have pride- based identifications: caretaker, pride in being the shoulder everyone cries on, make themselves indispensable and needed, pride in not having needs.
Children need to be able to trust that love is unconditional and that they are free to become themselves. If children cannot trust their caregivers to let them become their own person, they struggle with the ability to trust others, foreclosing trust and healthy independence, giving up their authenticity in order to be who the parents want them to be (best friend, straight A student, gifted musician, sports star, good little Christian child, etc.) These children are rewarded for selling out and they feel pressured to fulfill their parents desires, not their own. Trusting and depending on others becomes conflated with being used and betrayed (as they were used and betrayed by their parents.) As adults they expect betrayal and may betray first. They seek power and control and prioritize “getting to the top.” At the healthy end of the spectrum, they can become visionaries and empire builders. On the unhealthy end, they can be ruthless, manipulative, and self- absorbed, doing whatever it takes to win at all costs.
If the need for TRUST is not met:
- underlying feelings of impotence and powerlessness
- fear of failure
- feeling of emptiness for always playing a role
- displacing of blame; always make it someone else’s fault
- not being able to depend on others, they feel alone
- projective identification making others feel small, weak, stupid or helpless
- inflated self- image
- always needing to be “one up”
- always wanting to be the best, the winner
- empire builders; when healthy, they can be visionaries
- deny the reality of their bodily experience
- act “as if”
- appearance of commitment to others, but in reality self- serving
- good at reading other people, particularly their weaknesses
- become anxious when they cannot avoid or deny
- when the idealized self image fails, they may become self destructive, prone to substance abuse or other high risk behaviors
- paranoia: life is a jungle- survival of the fittest
- turn the tables: “I have lived with fear; now I’ll make you afraid,” “I don’t get ulcers; I give ulcers,” “I’ll never be betrayed again- I’m the betrayer”
Those whose trust needs don’t get met have shame- based identifications: small, powerless, used, betrayed. They also may have pride- based identifications: strong and in control, successful, larger than life, user/betrayer.
While healthy infancy requires symbiotic connection and attachment to the mother, toddlers need to separate from this enmeshed early relationship, often by testing and practicing limits and boundaries in the “terrible two’s” and beyond. Some self- absorbed parents interpret this healthy individuation as rejection or rebellion and squelch the child’s attempt to separate from the symbiotic attachment to mother. Teenagers go through another phase of individuation, and by the time the child leaves home, autonomy should be fully established. Parents who do not let their kids individuate wind up with enmeshed, compliant, pleasing adults who have not fully broken up with Mom and Dad and are infantilized and stunted in their attempt to become fully functioning, sovereign adults. Because their parents didn’t teach them healthy boundaries and respect healthy limits, these people have trouble saying no, setting limits, and speaking their mind without fear or guilt.
If the need for AUTONOMY is not met:
- ambivalent, paralyzed by their internal contradictions
- often complain of being stuck or in a morass
- fear of losing their independence when they become intimate
- choose to please others over themselves and then feel resentful
- will- based, stubborn identity based on efforting
- fear of their own spontaneous expression
- fear of being rejected or attacked if they are openly oppositional
- global fear of guilt, inappropriately apologetic
- superficially easy to please
- covertly feeling spite, negativity, and anger
- passive aggressive, self- assertion and access to healthy aggression is limited
- secretive about their pleasures for fear that they will be taken away
- feel their only choices are to submit to authority or rebel against it
- strong fear of humiliation
- often complain of being “stuck”
- forceful in defending others but not themselves
- will avoid or distance themselves from a situation rather than confront it
- projection of authority onto others
- believe that others have an agenda for them; imagine it even when not true
- want to know what is expected of them so they can do the opposite
- pressure themselves constantly while imagining the pressure as coming from the outside
- continual self- judgment and self- criticism
- confuse their unwillingness to stand up for themselves with flexibility
- use the pressure of waiting until the last minute before a deadline as a motivating force to break through their paralysis in order to complete tasks about which they’re ambivalent
Those whose autonomy needs don’t get met have shame- based identifications: angry, resentful of authority, rebellious, enjoys disappointing others. They also may have pride- based identifications: nice, sweet, compliant, good boy/girl, fear of disappointing others.
LOVE & SEXUALITY
As children grow up, they need healthy modeling to connect the open heart to a loving, open sexuality and relationship to their blossoming body. This allows them to connect an open heart with a vital sexuality in a loving relationship with a partner. If a child’s natural curiosity about their body is shamed, if education about sexuality is terrifying to a young adolescent, if the healthy sexual awakening is not supported lovingly, teens grow into adults who have compartmentalized the heart from sexuality and can split off. This leads to adults who are highly energetic, attractive, and successful- the beauty queens, sports stars, actors, and cheerleaders- but deep down, they feel insecure, they become perfectionistic about their bodies, their self esteem becomes based on superficial beauty or outer achievement, and their sexuality is often disconnected from the heart. They may be open- hearted but have shut down their sexuality, or they are highly sexual but disconnected from their hearts.
If the need for a healthy connection between HEALTHY LOVE/SEXUALITY is not met:
- perfectionistic and critical; impossibly high standards for self and others
- hard on themselves when they fail to live up to their high standards
- continually oriented towards self- improvement
- drawn to working out, plastic surgery, wanting to make their hard bodies even harder
- mistake admiration for love
- difficulty feeling heart and sexual connection together; tendency to shut down sexually when the heart opens
- difficulty maintaining relationships
- sexually acting out- or moralistic, prim, and prudish
- self- righteous, judgmental, stiff with pride
- driven, compulsive, rigid, black and white thinking
- orientation towards doing rather than feeling or being
- sex is their primary way to be in touch with the body
- seductive, then rejecting; will tend to reject first
- base sense of sexual desirability on sexual conquests
- afraid to open the heart
- fear of surrender- difficulty allowing vulnerability in love relationships
Those whose love/sexuality needs don’t get met have shame- based identifications: hurt, rejected, physically flawed, unloved and unlovable. They also may have pride- based identifications: rejects first, perfect, does not allow mistakes, “seamless,” having everything together.
~ NARM’s five core needs and their associated core capacities.