Dr. Karen Treisman writes about the therapeutic relationship:
The relationships are the glue and the magic that make the strategies meaningful, purposeful, and therapeutic. This is in line with the sayings ‘Relational trauma requires relational repair’ and ‘Relational repair requires safe hands, thinking minds, and regulated bodies’. Without the relationship to anchor to, the strategies are empty and tokenistic, and they lose their essence and intention.
The interpersonal safety trauma survivors need is summed up in these three things: safe hands, thinking minds, regulated bodies. We need to take a closer look at what it is supposed to mean to understand why it is a good way to evaluate relationships, and not just those with helpers.
Safe hands
Safe hands stands for safe behaviors. It can literally mean what people do with their hands, since hands are involved in all physical/sexual abuse. The way people touch us or refrain from touching us is important. We often react with fear to unexpected or fast movements with the hands. It is important to see, feel and realize that the hands of another person are safe for us and that can only happen when they are in fact safe.
In a broader context, ‘safe hands’ includes other actions, like respecting our boundaries, not exposing us to overwhelming difficulties or protecting us when needed.
Language that doesn’t include triggers is important to learn trust. The best trauma therapists know how to use words to avoid a confrontation with trauma content. If we have to expect a triggering word in every sentence we will not feel safe and we will be busy bracing ourselves or staying half dissociated at all times to protect ourselves. Unsafe language gets in the way of every therapeutic intervention without having any helpful effects. It is not how desensitization works. If Ts can’t even protect us from their own words, how can we let our guards down?
Safe hands means not acting like abusers. Tools like force, blame, judgment, isolation or punishment don’t belong in a therapy setting. That is especially important when we experience situations where we lose control, like in dissociation or flashbacks. I often see force and blame used with helpless patients and it is an absolute no-go. Helpers cannot mistreat patients and expect to be seen as safe partners in therapy.
To offer safe hands, it is necessary to make connection more important than other goals so that the relationship does not depend on achievements. Ts need to be tangible, real and present, engaged and willing, to counter the neglect in our past. Imagine what it would feel like to be in the presence of safe hands and how that differs from our experiences of neglect and abuse. That is what we need therapy to be.
Thinking minds
Thinking minds are able to hold information and the whole person in mind at all times, while interacting with that person and during the time between interactions.
The foundation of the thinking mind is education and expertise. Helpers must have adequate training and know what they are doing. It is necessary to have specialized knowledge when treating DID (even in bodywork). Without the theoretical foundations, the interventions will be ineffective or even unsafe. Internal systems function in specific ways and it is necessary to understand these interactions to be able to offer what ‘thinking mind’ really means. I cannot count how often someone told me that they are ‘not going to work with parts’, missing the fact that they were talking to a host, who is just a part. Statements like that are signs of a tiny thinking mind that show that we are not really safe with a person because they haven’t understood the most basic things about how we function.
The rest of the thinking mind builds on this basic understanding of our inner life. It means getting to know us, remembering things about us and holding this knowledge together in one’s mind in an integrated way. What is helpful, what to avoid, which part is which and the action systems we operate in, what to expect, what is important to us, what we need, where we tend to neglect ourselves, how we think, what we believe, personal resources and positive experiences that can be used for regulation, triggers, topics we tend to avoid, relationships and inner dynamics…
A thinking mind is interested in getting to know us and is able to keep most of that information in mind when interacting with us. If we have to explain things over and over it increases a felt sense of falling apart and getting lost. Ts usually manage to hold their normal patients in mind like this and it only gets more complex with a DID patient because there is a lot more going on and most of it is invisible. Everyone who is not fronting needs to be kept in mind too. That is why knowing theoretical foundations helps to systematically learn and remember details. Thinking minds grow with time and experience. When a T can hold an integrated picture of us in their mind it helps us to feel more like we belong together. You could say that our own integration starts in the thinking mind of our therapist.
Helpers with a good thinking mind and the ability to use it will give us a sense of being known, seen, understood, protected, cared about and connected. We usually grew up with caretakers who managed none of that, and the corrective experience of being held in a thinking mind is very much life-changing. It means we are real and we are somebody.
Regulated bodies
The moment two people get in contact with each other they are co-regulating, usually without conscious awareness. Our bodies notice how regulated or dysregulated the other one is and both sides shift a little (or a lot) to match the other one. Since we as patients are either chronically dysregulated or easily dysregulated, we need someone with a stronger and more regulated nervous system for co-regulation to be helpful.
I have had helpers get chalk white and almost faint or dissociate with amnesia when I shared things because their nervous system crashed in response to my trauma history. Needless to say that this isn’t therapeutic. Our therapists need to be able to regulate their own stress responses when they show up. It is normal for their stress levels to rise a little when we get stressed. Ts just need the resilience to calm themselves and then help with co-regulation.
As patients we subconsciously scan how regulated our therapists are and compare them to abusers. We learned that hyperarousal is a sign of danger and so is someone trying to hide their tension behind a neutral or friendly face. Some of us got incredibly good at telling when tension is appropriate in a situation and when it means someone is trying to hide their motives. It becomes an unspoken signal of danger when we notice that our therapists are unable to regulate themselves.
Some hide behind still faces because decades ago they were taught not to show any emotion in response to our histories. That is outdated and today science knows that still or neutral faces will be read as cues of danger by traumatized patients. There is no hiding from us. We can sense dysregulation and emotional responses. That is not a problem and it will even help us to trust when we see that we can cause a response in someone. The most important part of it is that we can observe our therapists as they regulate themselves. Knowing that they can manage themselves strengthens the therapeutic relationship. We will not become the victim of their dysregulation. They won’t hurt us because they lose control. Having a regulated body sets them apart from abusers while it is also the foundation of much needed co-regulation. To get out of chronic dysregulation we need our Ts nervous system as a guide and touchstone. Regulation is learned through co-regulation.
Trust
Trauma patients have trust issues. That might even be the biggest problem we have. Processing trauma is so much easier than learning to trust someone. Safe hands, thinking minds and regulated bodies all reflect essential abilities that create a fundamentally different relationship than what we had with neglecting or abusive caretakers. Being safe with someone, being known and cared about and being able to rely on co-regulation when we are vulnerable are keys to learning how to trust. These are all the things we didn’t get at home. It might look like very high standards but it really is a matter of practice and time. There is a deeper level of corrective experience happening within the relationship that goes far beyond therapy tools and techniques. It represents the relational repair that is needed to heal. In a world where trauma recovery has to be quick and efficient the healing of our ability to trust can sometimes get overlooked.
Beyond relational repair
Safe hands, thinking minds and regulated bodies will make every intervention easier and more effective. Therapy doesn’t happen in a relational vacuum. Without trust, we will try to control the situation, hold back or keep silent about important details because of shame. Relational repair is by far not the only thing that is needed to heal, the techniques and tools are important, and it is also more crucial than we are made to believe when we are introduced to techniques.
That is why we look at these 3 cornerstones when we engage with professionals. It can help us to see what we can expect and how we want to interact. Nobody will be perfect and especially the thinking mind does not have a limit, it can grow all the time and it usually does. It is rare to find helpers who are good at everything. We just need to be careful when someone is exceptionally bad in one area because it will limit how good they can be in others. Someone who cannot regulate themselves will not be able to use their thinking mind properly. Without enough knowledge one might not even know what kind of safe actions are needed. It is impossible to act unsafely and offer co-regulation at the same time. You can look at this model as the foundation for deeper work and successful trauma therapy. It is the standard professional helpers have to live up to. And it can sometimes help to examine our friendships in this light as well.
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