Transforming Trauma host Sarah Buino facilitates an extraordinary conversation between trauma visionaries Dr. Laurence Heller and Dr. Gabor Maté centered on complex trauma (C-PTSD), the effects of adverse childhood experiences (ACEs) on human development, and their views on the future of trauma-informed care.
At the core of both Dr. Heller’s and Dr. Maté’s thinking on trauma is the understanding that trauma is not what happens to someone, it is what happens within someone. When asked to define complex trauma, Dr. Maté says, “For me, the essence of trauma is the disconnection from the self.” Complex trauma is characterized by its chronicity of disconnection. This disconnection to self and others can severely impact a person’s mental and physical health. As demonstrated in the current ACEs research, unresolved early trauma leads to various psychological and physical disorders, relational difficulties and social challenges.
Both Dr. Heller and Dr. Maté address the profound effects of disconnection and misattunement that lead to complex trauma. The clinical models they have developed over the course of their careers – the NeuroAffective Relational Model (Heller) and Compassionate Inquiry (Maté) – both focus on how using aspects of the self, like compassion and agency, can support the healing of attachment, relational, developmental and intergenerational trauma.
Dr. Maté points out that when someone is traumatized they have a negative view of themselves, lack compassion for themselves, and often attack themselves. Dr. Heller reiterates that the dynamic of not having compassion for oneself, as expressed through shame, self-judgment and self-hatred, stems from the need to survive early childhood developmental and relational trauma. While there is an adaptive wisdom to the way children internalize shame, fear and self-rejection, this does not support healthy growth. Developing self-compassion is an antidote to unresolved trauma. And Dr. Maté believes there are two experiences of compassion that are at the core of the healing process: the first being the compassion that comes from the therapist for their client, and the second being the client’s own developing compassion for themself.
Sarah mentions the challenges she has as a psychology professor in introducing her graduate students to the importance of their own inner world, and how they show up with their clients; or what is referred to as “countertransference” in psychology. Dr. Heller and Dr. Maté share the belief that in order to better support the healing of their patients’ complex trauma, therapists must be willing to explore their own unresolved trauma, and “do their own work”. This requires a process of self-inquiry and self-reflection.
Due to the deeply relational process of working with complex trauma, therapists can’t rely on just a set of skills and protocols, they must learn a deeper engagement necessary for relational healing. Dr. Heller and Dr. Maté both advocate for more relational, depth-oriented models, which are not well supported by the current movement toward evidence-based treatment. They describe that the training programs they have developed both have a strong focus on the relational process central to the resolution of complex trauma, focused on the therapists’ capacity to facilitate a “corrective relational experience” for their clients.
Sarah, Dr. Heller, and Dr. Maté address the gap in the mental health and healthcare fields with understanding C-PTSD (Complex Post Traumatic Stress Disorder). This means that many therapists are working with clients without fully comprehending the complex psychobiological patterns that leads to such suffering for their clients. As Dr. Maté puts it, “If I could pass a law…if you don't understand trauma, you’re not allowed to practice psychotherapy. You can coach people. You can be a friend to people. You can lend an empathetic ear to people. That's all therapeutic. But, if you don't understand trauma, there is no basis for you doing deep therapy with people.”
Both Dr. Heller and Dr. Maté share the intention of bringing their important work into the trauma-informed field, and to anyone suffering from unresolved trauma, so that we can address the unrelenting personal and social impacts of unresolved trauma. At the end of this lively discussion. Dr. Heller and Dr. Maté begin making plans for future collaboration.