Psychotherapy for interpersonal trauma in childhood

Interpersonal trauma is one of the most common issues of my clients who come to seek psychological help. Many clinical manifestations, such as clinical perfectionism, attachment issues, poor self-image and self-neglect, may be related to the clients’ traumatic experiences in relationships in childhood and adolescence. A healthy mother-infant relationship will facilitate the development of secure attachment style of the child. Mothers who sensitively respond to their infants’ signals play a central role in generating security of the infants. 

If the mother of the infant is inconsistent in responding to the infant’s signals, problems of attachment may be developed. For instance, if the mother responds to the infant’s needs with love and care only occasionally, and even exhibits hostility or harm towards the infant sometimes, disorganised attachment style may be developed. The infant may feel ambivalent as he or she wants to cling to the mother for love and support, while also feels frightened for the rejection or hostility of the mother by wanting to avoid her. This approach-avoidance conflict of the infant contributes to various types of psychopathology, such as Borderline Personality Disorder and Complex Posttraumatic Stress Disorder (PTSD), in one’s adulthood.

It is quite common for those with Borderline Personality Disorder and Complex PTSD to have poor self-image and low sense of self-worth.  Frequent criticism and rejection by the mother may undermine the child’s ability to develop core self-esteem. Especially for those children who experienced inconsistencies in their mothers’ responses to their needs for attention and recognition, core shame may be developed.  These children, in their adulthood, may have a sense of themselves being fundamentally unloveable, worthless, and defective.

In my clinical experience, those with core shame issue may persistently worry about others’ rejection or abandonment. For example, one of my clients frequently ruminates about her colleagues disliking her for giving even neutral comments on some issues at work. She is constantly evaluating her conversations with her colleagues retrospectively because she kept worrying she may say something that causes disapproval from them. She is also hypervigilant in detecting possible facial expression of sarcasm of others towards her. In fact, in many occasions, she later found out that the other party did not think in a sarcastic way towards her in these occasions.

It is very important for those with interpersonal trauma in their childhood to seek psychotherapy for their attachment issues and core shame. In the psychotherapy, a secure relationship between the client and the empathetically-attuned therapist must be developed, so that the client can experience a relationship that provide him or her a secure base. In the long run, this secure therapeutic relationship modulates the impact of the original traumatic relationship. Gradually, the client may overcome one’s attachment issues and start to develop healthier relationships outside the therapeutic setting. Though not easy and time-consuming, it is possible for a person with attachment issues and core shame to develop a healthier self-image and more secure attachment style with psychotherapy in a secure therapeutic relationship.

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