Relational Depth

Relational Depth: Healing Traumatised Clients

Working with traumatised clients presents unique challenges and opportunities for counsellors and psychotherapists. Trauma disrupts a person’s sense of self and their ability to regulate their nervous system, often leaving them fragmented and disconnected. Building relational depth with such clients is essential for facilitating healing and reintegration. This article explores the importance of the therapeutic relationship in trauma work, drawing on concepts from polyvagal theory and embodiment practices to enhance therapists’ effectiveness.

Learning Outcomes

  • Understanding trauma: Trauma results in the disintegration of the self and dysregulation of the nervous system. Therapeutic goals focus on reintegration and regulation.
  • Relational depth: Relational depth between the therapist and the client can facilitate the healing and integration of traumatic experiences.
  • Embodiment practices: Techniques to enhance embodied presence can support the achievement of relational depth.
  • Polyvagal theory: Recognising the state of the client’s nervous system (social engagement, hyperarousal or hypoarousal) is crucial for effective trauma therapy.
  • Therapeutic challenges: Therapists must navigate complex client behaviours and their own emotional responses to maintain a secure, empathic therapeutic environment.

The Importance of the Therapeutic Relationship

Trauma can lead to profound disintegration of the self, and dysregulation of the nervous system. The therapeutic relationship is crucial in addressing these effects. Relational depth involves moments of profound contact and engagement between therapist and client, which can facilitate the reintegration of fragmented parts of the self and the regulation of the nervous system.

Cooper (2005, p. xii) defines relational depth as a ‘state of profound contact and engagement between two people, in which each person is fully real with the Other, and able to understand and value the Other’s experience at a high level’. This emphasises the significance of these moments in therapy. Such moments can happen anytime and are marked by a deep attunement in which time seems to stop, and a strong connection is felt.

Cundy (2017, p. 27) emphasises the importance of the therapist providing a secure base, which the client will experience as soothing and will internalise:

It is easier to internalise an experience that is repeated and predictable … and then when needed, he [the client] can call up on this new internal resource to calm and contain himself, to help him observe his feelings, impulses, and motives before acting, to create thinking space, and to challenge himself.

Key Factors of Trauma Affecting Relational Depth

  • Disintegration: Trauma causes disintegration of self and of nervous system regulation.
  • Triggers: Sensory triggers (smell, sound etc.) can cause clients to relive trauma.
  • Integration: Therapy aims to integrate these fragmented parts and to place trauma in the past.
  • Embodied presence: Your embodied presence can be enhanced through understanding polyvagal theory.

Embodiment Practices for Enhancing Presence

Embodiment practices are vital for therapists to maintain their presence and to support their clients’ healing processes. These practices include:

  • Posture and alignment: maintaining an upright posture to stay engaged and present.
  • Grounding techniques: feeling the feet against the ground or the back against the chair to anchor yourself in the present moment.
  • Breathwork: using breath to regulate the nervous system, such as full inhalations to increase energy, and straw breathing to elongate the out-breath and to engage the parasympathetic nervous system.

These practices help therapists to stay within their window of tolerance, a term developed by Siegel (1999) to describe the optimal state for relational engagement and emotional regulation.

Recognising States of the Nervous System

Understanding the polyvagal theory is crucial for working with traumatised clients. The theory outlines three key modes of being:

  • Coping with being seen as bad: being able to withstand and understand clients’ projections without becoming defensive.
  • Avoiding rescue tendencies: allowing clients to process their trauma without trying to ‘fix’ them.
  • Managing personal dysregulation: recognising and addressing your nervous system responses to maintain a stable therapeutic presence.
Final Remarks

Building relational depth with traumatised clients requires a deep understanding of trauma, effective embodiment practices, and the ability to navigate complex therapeutic dynamics. By recognising and responding to different nervous system states and maintaining a grounded, present therapeutic stance, you can support your clients in achieving integration and healing.

References and Further Reading

Cooper, M. and Mearns, D. (2005). Working at Relational Depth in Counselling and Psychotherapy. London: Sage Publications.

Cundy, L. (2017). Anxiously Attached: Understanding and Working with Preoccupied Attachment. London: Karnac.

Levine, P. (1997). Waking the Tiger: Healing Trauma. Berkeley: North Atlantic Books.

Schore, A. (1999). Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Abingdon-on-Thames: Routledge.

Siegel, D. (1999). The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. New York: Guilford Press.