Navigating the Unseen and Inter-being: Working with Complexity and Trauma

Something repeatedly brought to reflective supervision and therapeutic spaces are the impacts of trauma and disempowerment. There can be confusing, enraging or even frightening ways that humans, and the systems we create, perpetrate and respond to trauma and injustice. And sometimes there are compassionate and authentic pathways of connection that support understanding and repair. Workers often talk about complexity and trauma, and there are great guidelines often in place around trauma-informed care in many of our services systems. But it's still common to hear stories from workers, teams and services where people can feel overwhelmed and confused. One of the things that might emerge is that intentions to help or get care, don't always lead to experiences that are reparative. In fact, they can sometimes lead to repeated disappointment, invalidation, iatrogenic harm or exclusion.

Understanding Complex Trauma

When faced with pain, overwhelm and powerlessness, it is a human impulse to move to safer ground. When pain and disempowerment are expressed or felt, there are myriad ways and means that humans and systems enact to get our selves to 'there' - a safer place that is not the fearful 'here'. The intention is a protective one, motivated to reduce a perceived source of threat and suffering. Sometimes, it's an impulse that results in the opposite of what was hoped for. Or perhaps a temporary reprieve that outlives its purpose. Tragically it can be an impulse that saves us but has far reaching unforeseen consequences. In "My Year of Living Vulnerably", Australian writer Rick Morton uses autobiographical essay mixed with research to explore his lived experience of Complex Post Traumatic Stress Disorder (CPTSD). It's a rich and moving account of his journey to understand traumatic childhood events that shaped his life, and the ways he grapples with the 'long tail' of its impacts:

"It is hard to really understand the cost of shrinking yourself to escape pain... A way of looking at CPTSD that makes the most sense to me is this: that boy is a ghost with unfinished business, hanging around the corridors of my soul banging on my interior with desperate warnings about imagined future hurt extrapolated from those torturous days and nights of years before. He is a boy out of time, employing lessons that are no longer relevant to scenarios he has never visited."

A ghost is intangible - fleeting in its visibility, but very much felt and lived with. It haunts us as it makes itself known, and in the anticipation of it coming back. Morton's metaphor brings to life the neuromotor and sensory processing patterns that can emerge in human defensive systems after trauma. It made me think about transgenerational trauma too. We can be haunted and embody within us - through epigenetics or implicit learnings - the ghosts of traumas past, inherited from our ancestors.

When we meet and reckon with complex trauma, there can be a dance not unlike shadow boxing, dodging and weaving amongst ghosts. And because of the nature of CPTSD and its sequelae, this shadow boxing can also be taking place with the material realities of more corporeal threats to safety and empowerment in the here and now. Working between 'safe' and 'not safe', 'real' and 'not real', 'here' and 'there' with choices about what movements we might do in response is part of the work. But it requires bringing those ghosts and parts of the self that are lived with into consciousness with compassionate awareness. There is grief, loss, fear, anger and pain in reckoning with such important and protective parts of the self. Mortons words poetically weave neuroscience and lived experience to make such acts visible:

"If you think deeply enough about what it means to rewire a brain from a trauma that has frozen parts of it in time there is an inescapable conclusion. To undo that lasting code you are in effect removing the last real world form of a distant and threatened self. In my case there really was a ghost in the machine and his name was Rick...I must unwrap his little fists from the cords of my amygdala and cut him loose. "Thank you", I might say, unsure if this is truly an end or just a beginning."

At times, our human neurological systems and our human service systems can lead workers to act in ways that don't always support complex trauma. It can inadvertently activate, sometimes in subtle and sometimes in pronounced ways "fight or flight" responses. We are confronted with things that can feel overwhelming. In the case of helping professionals, that can activate our "fixing" or "controlling" proceedural pathways of action - sometimes for therapeutic or supportive benefits, and sometimes not - depends on the impact and consequences. While neuroscience and cognitive research has done much to help us understand the nature of trauma, relational and socio-political frames offer valuable tools for exploring and supporting the process of working with complex trauma.

The Importance of Sociological & Political Perspectives

Engaging with complexity requires an openness to the multi-dimensional nature of experiences. Trauma is often linked with systemic issues, personal histories, and community dynamics - all things rife with the intersections of power and subjectivity. Two research projects I worked on some years ago evaluated mental health service interventions, but with different populations. One involved young people and carers in the Out of Home Care system and the other resettled refugee young people and their families from Iraq and Syria. I don't want to conflate these two very different experiences or suggest either group was homogenous, but I was struck by the shared descriptions at play in human experiences of trauma, adversity, poverty and disempowerment. People described interpersonal violence, grief, loss and displacement. Many were having to navigate in real time ongoing symptoms of trauma with repeated barriers to welfare systems and community participation. In qualatative interviews through both projects, two red threads stood out to me: 1) the importance of recognising the impact of sociocultural and political determinants at play in experiences of past and ongoing trauma and disempowerment, and 2) the importance of relationships, community connection, citizenship, identity and belonging. A mental health lens focusing on individuals symptoms and symptom resolution was not enough.

Trauma is not exclusive to marginalised groups, but it does increase the risk of occurrence and the impacts are likely to be more profound without resources and support. Additionally people who experience CPTSD can have experienced acts of violence or harm at the hands of someone or a group of someone's in a position of power over them. This is important to recognise when we ask people to engage with services or workers who might hold a position of 'authority'. In their book on Cognitive Analytic Therapy (CAT) and The Politics of Mental Health, Lloyd and Pollard emphasise the importance of staying alive to the politics inherent helping or healing. They urge examining the histories and limits of psychological interventions and service system logics that avoid overt sociopolitical engagement by 'bringing politics out of the shadows':

"...Psychoanalysis and Cognitive Behavioural Therapy (CBT) have located causes of individual distress (and by implication the fault) in the mind of the suffering individual... what goes on 'inside peoples heads' is very much a function of what is going on in the world around them. Therefore it is a delusion of great folly to imagine that whatever context we work in, what we do as therapists can ever be untainted by 'politics'."

Tools that enable greater visibility of the intersections of power, identity and privilege can give us sign posts for what we don't see on our own. One potential benefit of CAT's contextual reformulation strategies are how it supports workers to name and map out the impact and consequences of socio-cultural and political forces in personal and systemic responses. As Lloyd and Pollard illustrate in their book, it is not uncommon for workers to feel a sense of overwhelm by the forces and factors outside of their sphere of influence or personal awareness. In fact, that is often a common theme to emerge in reflective practice and supervision sessions when it comes to working with complex trauma. Putting ourselves as workers and services 'on the map' - paints our own actions, needs and responses into the picture, as we are working within service constraints in real time. This reveals where and how we are operating and coping within systems of power. When we have a means of not just understanding 'the other', but also contextual factors and reflections of ourselves, we can be more authentic and potentially supportive and supported in the 'here' and 'now'.

Importantly, Lloyd and Pollard don't suggest that CAT, despite its origins as a socially democratic model of therapy, is free of the risk of becoming problematic. Rather it offers potential and tools so long as it, the practitioner and the context are held up to be seen and we remain critically engaged. Power, resource privilege, and perspective bias are real, permeating and shaping experiences of our selves, others and the world. Understanding who and what gets left behind, or unacknowledged and finding ways to regularly reckon with this is important to working accountably with complexity and trauma.

Relationally Engaging with Complexity and Trauma

"We can't exist by ourselves alone. We can only inter-be. I am made of only non-me elements, such as the Earth, the sun, parents, and ancestors. In a relationship, if you can see the nature of interbeing between you and the other person, you can see that his suffering is your own suffering and your happiness is his own happiness. With this way of seeing, you speak and act differently. This in itself can relieve so much suffering." - Nhat Hanh, How to Love

Integrated relational and systemic approaches can open up the opportunity to see ourselves, others and reflections of inter-subjective experiences. They provide lenses that support understanding of the felt impacts of interpersonal trauma and the intersection of internalised and external systems we exist within and between. Trauma often results from overwhelming experiences that disrupt our sense of safety and well-being - within bodies, within a sense of self, in relationships and in the world. Relational and systemic approaches help us to engage in a therapeutic process that encourages sharing experience with connection rather than disconnection or isolation. Building trust and safety for the expression of lived experiences where there is complex trauma is an ongoing process. Tools to attend to the therapeutic or working relationship are valuable to support maintenance and repairs for safety and trust. Questions that can prompt this work are: who, what and how do I imagine I'm helping, but importantly how is that experienced by the other in this context? Our experiences and responses to trauma are influenced by our relationships and communities, and so are our pathways to repair.

Relationally reflective spaces can enable us to bring together more than one persons perspective to unpack and shed light on our actions as workers. It is the collective act of challenging and expanding what we think we see, feel and know with others that builds possible pathways of understanding to integrate experiences of complexity and trauma. Both have elements that can lead to chaotic effects. Reflection needs to be aided by tools, frames and supportive structures that bring awareness and accountability to invisible or unnamed phenomenon as it emerges. It helps to be guided by some questions like: What parts of our own selves, parts of others, or parts of systems might we be shadow boxing or dancing with? When I've had the benefit of being part of such groups, it is a chance for workers to see themselves and to be seen as individuals and team members with their own experiences and responses to experiential knowledge of pain and disempowerment, and its shadowed sides of safety and empowerment. I've seen people in leadership often think the answer is more technique, policy, advocacy or information about what should be done. These are useful and important things. However they have limits on the capacity building of human workers and services to regularly respond to complex trauma. No matter how experienced, resourced or skilled - its ongoing work that is a process requiring supportive connection with oneself, with others and with the world as it is in the 'here' and the 'now'.