Healing from Trauma is a Developmental Process

To explorers in general and mountaineers in particular it is a well-known fact that each successive attempt at the solving of a problem makes that problem easier of solution. Few great mountains have been climbed, a few passes crossed, at first, second, or even third essay.
— Eric Shipton & H.W. Tilman, Nandi Devi

Healing from trauma is typically described as a process of steps, but not necessarily developmental steps. I believe that the primary reason that healing from trauma has not been discussed in developmental terms is that there is a fear that it will make it sound like a long term process (which no one wants to hear) and it will make the people going through the process feel like they are being called “babies or children.” Both are reasonable concerns, but I think there is so much to be gained from understanding healing from trauma as a developmental process.

The first benefit if we can locate healing from trauma in a developmental frame, is that we have at our disposal decades of developmental research and theory to support us in this journey. There exists a consistent, yet somewhat malleable process of growth that organisms follow from the smallest cell to the largest community.

What I have noticed in twenty years of working with adolescents and adults who have experienced trauma, or who are in need of treatment, is that the standard protocol of treatment often starts ahead of where they actually are in a developmental sense. I worked for many years in residential treatment facilities and hospital adolescent inpatient units, and the standard treatment in these programs is cognitive-behavioral therapy (CBT). For the record, let me state that I have nothing against cognitive behavior therapy, and consider it, at the appropriate times, to be a very successful form of treatment. I believe, however, that the ‘evidence-based’ research in treatment is skewed toward CBT because it is the most easily researched—it follows a routine protocol and is often time limited.

As someone who has spent a lot of time in graduate school I can attest to the fact that the things that get researched the most are the things that can get researched in shortest period of time. Graduate students want to graduate, and they want to graduate as quickly as possible. They drive a lot of the research that gets done in academia. So, while what gets promoted as ‘evidence-based’ does mean that there is evidence that it works, but it’s often what has worked in a time-limited framework. I have always wondered what ‘evidence-based’ parenting would look like.

On the inpatient or lock-up units, the teens were required to state why they misbehaved, what feelings triggered the episode, and what they could do differently in the future. What became apparent is that the teenagers really couldn’t do this task: what they learned to do was parrot answers that they heard other kids say, or that the staff gave them. They would state, “I was angry and so I ran away. Next time I will talk to staff or a peer.”

This all sounds reasonable except that these kids didn’t actually know what they were feeling, and they didn’t trust anyone enough yet to talk to them when they are upset, so the solution was not yet a possibility. This is the developmental equivalent of expecting a toddler to type an apology note for his last tantrum. Because we get literal about developmental stages, and get hung up on their chronological age, rather than their developmental age, we ask the impossible from people who are trying to heal.

What the kids on the unit needed to realize was that they were cut off from their feelings. When the adults on the unit asked them what they were feeling, quite often they said “nothing.” This actually was the accurate answer—and it would have been a better starting point of honesty than trying to tell them what they were feeling and have them repeat it.

What is difficult about this discussion is the problem of definition or labels. In fact, I think that this alone has kept us from meeting people where they are. Fearing the implication that they are ‘behind’ or ‘young’ or ‘delayed’ we treated them like ‘adults’ with a standard of treatment and an expectation of recovery-- and everyone acts as though this will work. In therapy the client will engage dutifully and complete the sentences and say what they are supposed to say—but it isn’t actually connected to where they are so they aren’t learning about themselves. Then, when a stressor hits, they revert to what they always do because the ‘new learning’ hasn’t made any real connection.  And everyone is frustrated—therapist, client and the people who live with the client.

Our American ideals of equality probably hinder us in our ability to discuss developmental difference. We tolerate it with skill level. We have all sorts of assessment tests for various activities that test our skill level: beginner French, intermediate piano, or advanced algebra. No one likes being in the lower skill level, but we also know we can’t just jump in to algebra if we haven’t learned fractions.

We have compassion and understanding for the types of brain injuries that wipe the slate clean altogether—for stroke patients who lose the ability to speak or to walk. No one expects them to leap out of bed, or begin speaking in full sentences. When the damage to the brain, and the emotional systems is less obvious, or when the trauma interfered with how the brain developed over time, then we have no current way to understand the problem, and no easy way to  ‘let the person off the developmental hook.’ It is a reasonable question to ask how one would make a developmental diagnosis, or who would be in charge of doing it, and of course, what would it mean if someone did.

In a very real way we understand the damage a stroke does to a brain—and we can quantify it and name it—damage to the language or motor centers. But neuroscience research is now letting us see the damage that trauma can inflict—it can shrink the hippocampus, the center of memory, and it can shrink parts of the limbic system, center of attachment, and create lesions in the the amygdala, the fear and warning center. These are only some of the brain centers affected by trauma and they need time and new learning to heal. The brain must re-develop capacity.

Part of the problem lies in language—as development is growth over time, and to be further back in development makes one ‘younger’ or ‘immature.’ We simply don’t yet have language for this problem. In the language of countries, we have language for ‘developing nations’ that has nothing to do with the chronological age of the nation. Cambodia is a third world country, and a developing nation, and the United States is a first world country and a developed nation despite the fact that the Khmer civilization had temples and irrigation canals and libraries and science centuries before the United States or Europe had any of these things. In the taxonomy of countries, we assess based on economy and resources and label the country accordingly.

When we think of development we most often think of cognitive development in its most obvious forms: speech, learning, intelligence. When we have mastered the basic elements of development: standing, walking, talking, reading, school, driving, working—we feel like we have moved ahead.

We have no common language or understanding of emotional development or cognitive development in the mean-making, or understanding sense.  My motivation to write this blog in language that clients can understand, rather just for therapists is an attempt to jump over the need for someone else to tell you your developmental level—but instead to give you some understanding and compassion and information and help you state where you think you are starting this journey of healing. What are your capacities, and where are your deficits? Where are you starting? What do you need?

© Gretchen L. Schmelzer, PhD 2015