Therapy for relational trauma

The concept of psychological trauma originated as a medical metaphor comparing invisible injury to the mind to physical wounds to the body. While this comparison helpfully draws attention to the emotional and psychological impact of certain events, it also has distinct limitations. In physical medicine, trauma typically results from a visible, acute event such as a car accident, a physical assault, or a natural disaster. Because early psychiatric definitions borrowed heavily from this framework, trauma is still widely misunderstood as something caused only by sudden, catastrophic shocks.

Modern psychology has defined trauma less in terms of the types of event which tend to cause it, and more in terms of what happens in the nervous system in response. When we encounter danger, our bodies naturally mobilise through active survival responses like fight or flight. These are healthy, adaptive ways of coping. Psychological trauma occurs when these natural defences are overwhelmed or thwarted, and we cannot process and integrate the experiences which caused them, producing long-term physiological and psychological disruption. While this can lead to post-traumatic stress disorder (PTSD), responses to trauma vary between individuals and often do not sit neatly in a diagnostic box.

Given the importance of relationships in our lives, it is not surprising that adverse relational experiences can feel accutely dangerous and impact us as significantly as physical threats. While big events, such as verbal or physical attacks and significant betrayals of trust, can be deeply traumatic, so can repeated subtle misattunements. These include reaching out for connection and being ignored, or needing space and not getting it. These experiences can accumulate and overwhelm our ability to process them, resulting in relational trauma.

We are particularly vulnerable to relational trauma in childhood, when fighting or fleeing is either impossible or too dangerous given our dependence on others. When children do not receive what they need emotionally and physically from the adults they depend on, or find their actions frightening, they adapt in ways that are often helpful in that situation, but may have substantial drawbacks later on in life. This may manifest in particular relational patterns or becoming stuck in a trauma response. For example, anger can sometimes be a suppressed fight response emerging from earlier relational trauma, whereas emotional numbness and disconnection can be an enduring freeze response.

Both post-traumatic stress disorder (PTSD) and Complex PTSD refer to diagnoses based on experiences that people may have as a result of trauma. Someone who has PTSD may experience intrusive memories, either awake or in dreams, which feel as though a traumatic event is happening in the present moment. These memories may be fragmented, with only particular aspects of the experience being replayed. They may find things that remind them of an event distressing and actively avoid reminders of what happened. Those with PTSD may spend a lot of time feeling in danger and on high alert. It is worth noting that these experiences naturally occur immediately after a traumatic event and often resolve after a short time, so they are only considered PTSD after they persist for several weeks.

Those with Complex PTSD (or CPTSD) have the experiences associated with PTSD alongside issues with emotions, relationships and their sense of themselves. They may struggle to calm down after feeling upset or feel emotionally numb. Complex PTSD is also defined by having low self-worth and difficulty relating to others. These experiences are thought to be the result of repeated relational trauma: the nervous system's response to events which were overwhelming, inescapable and happened in the context of a relationship with another person.

Many people experience some or all of these issues with emotions, relationships and sense of self without having PTSD symptoms. For this reason, they would not receive a diagnosis of Complex PTSD. This does not mean that the experience did not cause relational trauma. Relational trauma has a wide range of long-term effects, not limited to those defined as Complex PTSD. A diagnosis simply describes a cluster of symptoms for medical classification; it does not measure the depth of someone’s emotional pain or their need for support. In therapy, the focus is not on whether you fit a specific label, but on understanding how your past relational experiences continue to affect your emotional well-being and relationships today.