The Limits of Trauma Work

We’re currently living through a revolution in our understanding and treatment of trauma. New concepts and techniques have allowed us, as a field, to offer far more effective approaches than ever before, and millions of people are benefiting. One could hardly be more pleased. And yet, a word of caution.

At its best, effective trauma work can heal deep pain within an individual. But on its own, does it have the power to transform someone’s personality, their basic character structure? I don’t think so. On its own, will it cure addictions or permanently stop abusive, grandiose behaviors? I see no evidence to support that. On its own, does it teach individuals essential relationship skills—how to assert oneself lovingly, how to negotiate, the steps of repair? Not at all.

And yet, some therapists—actually, nowadays it seems to be many therapists—think it can.

Proponents of IFS are perhaps the most explicit in offering such claims, asserting that once the individual is “unburdened” of trauma, Self instinctively knows how to be intimate—no teaching of skills necessary. But all kinds of practitioners also overreach in terms of what they think trauma work will effectively accomplish alone.

As both a trained addictions expert and a practicing couples therapist for decades, I find claims that trauma work will stop addictions, dissolve grandiose traits, and even halt offensive behaviors to be wishful thinking. And in psychotherapy, wishful thinking can do harm—not in what we offer, but in what we tell ourselves, and our clients, we no longer need to offer.

The Sex Addict

William was, as many of the men who call me are, a “wife-mandated referral.”

About 18 months ago, Miranda, Will’s wife of over 20 years, stumbled upon piercing emails between her husband and no fewer than four women—flirting, arranging meetings. She closed Will’s laptop and called a lawyer. But 20 years and two teenagers together—this was not such an easy life for Miranda to walk away from. Besides, Will pleaded. Will promised. Will began therapy. Slowly, the hurt began to recede and Miranda started breathing again—until she stumbled onto Will’s “burner phone.”

Three weeks before he called me Will had spent 16 months in three-day-a-week intensive therapy, looking deeply into the roots of his “silly behavior.” Silly because he never actually “went through with anything,” he claimed.

In an early session I asked him, “How many ‘flirtations,’ as you call them, do you keep going at any given time?”

Will stretched, yawned. “Oh,” he confessed, he’d have “a line out” to maybe four or five “girls” at a time.

“How long has this been going on?” I asked.

Will stopped to think this one over. Finally, he shrugged. “Uh… I guess… always.”

Although he’d gone through 48 therapy sessions, he hadn’t once heard the term sex addict. I told Will he was one, and let him know that many sex addicts don’t particularly love sex itself. The buzz of “intriguing” anticipation, seduction, fantasy, “euphoric recall”—any one of these was enlivening enough to self-medicate the loneliness such measures, paradoxically, only increase over time. As was true for so many of the men I treat, for Will intensity and gratification had taken the place of intimacy.

Along with workaholism and the salve of success, his drug of choice was two-thirds adoration and power, one-third pure erotic charge.

“Maybe,” Will allowed. But hey, he was “sober” now. He’d learned his lesson. He was happy to go back to talk therapy, which had done nothing for him the first time, but Miranda was having none of it. Neither was I.

In addiction work, one quickly learns that “white-knuckle sobriety” is rarely enough. The question is: Does your client have appropriate supports around them to keep them sober?

In no small part to help Miranda step back from the ledge, I proposed that Will attend a weeklong intensive program with the express agenda of helping him see the need for continued support—either Twelve Step work, harm reduction, or both.

He accepted. But to my chagrin, a week later, Will’s primary therapist in the program sent a congratulatory report announcing that Will, after a week of deep trauma work, had uncovered the roots of his acting out and was all better. No need for further anything—which, of course, was music to Will’s ears.

I never heard from him again.

I did, however, receive a brief note from Miranda about a year later informing me of their imminent divorce. A third tranche of hidden emails proved too much for her.

Confronting Destructive Entitlement

Relational Life Therapy (RLT) is designed in three phases—particularly helpful, I believe, when treating grandiose or addictive clients.

One: Loving Confrontation. This is what you’re doing. This is the likely outcome unless you change. This is available if you do. Will you let me help you?

Two: Trauma Work. Where in your childhood did you learn these things, and can you form a corrective relationship with these younger parts of you now?

Three: Skills. No one taught you the sophisticated tools it takes to create and sustain intimacy. Let’s teach you how.

I believe it’s the combination of all three—loving confrontation (particularly of grandiose behaviors), trauma work (to reduce flooding), and skill building (teaching the art of interpersonal effectiveness)—that produces relatively quick, transformative change.

Addictions treatment can get someone sober. But I believe intimacy keeps people sober.

RLT’s core belief is that we’re born to be relational; it’s what we as a species are designed for. Intimacy fulfills and sustains us. Disconnection is what ails us, and reconnection—to all parts of ourselves, to others, to nature, to Spirit—is the cure. What we self-medicate is the pain of not being intimate. But you can’t be intimate from a state of either one-down inferiority or one-up superiority.

We’ve all heard the bromide: You can’t love another until you love yourself. It turns out that’s true. Intimacy demands self-esteem work. In RLT we say, “We want the weak to stand up and the mighty to melt.” Intimacy demands democracy.

For half a century, we as a field have grown ever more adept at helping people come up from the one-down of shame. But we’ve offered little to nothing to help people come down from the one-up of grandiosity. Instead, we speak of “trauma reactions.” Rage, lying, irresponsible, selfish behaviors—we may not have bad parts, but we surely have parts that behave badly.

The conventional belief that so-called narcissistic traits and behavior are always a compensatory escape from shame turns out to be true only about 50 percent of the time. Many grandiose-based people simply believe they are superior. For centuries, women under patriarchy have found themselves more empathetically attuned to their male partners’ disowned vulnerabilities than the men are themselves. “If I could just get under my partner’s bullying and love up the hurt boy inside, all would be well,” they tell me.

Good luck with that.

These days, many therapists take the same tack. Heal the “underlying” wounds and selfish, addictive, even abusive behaviors will dissipate. No wonder it’s commonly held that so-called narcissists can’t be treated. They certainly can’t be helped like this.

I’m the son of a depressed, violent man, as was he. Looking back, at least part of what moved me to become a therapist was a need to understand my father enough to avoid becoming him.

When I first started working with men in the early ’80s, the field was split. Some Twelve Step programs, domestic violence programs, and certain feminist therapies held men’s feet to the fire. But no one would call them overwhelmingly empathetic. Ninety percent of the rest of therapy for men was then, as now, compassion, understanding, nurture. Unfortunately, few therapists spoke of male privilege or how much damage damaged men can do.

I needed a way to hold particularly grandiose, difficult men like my dad accountable and yet lovingly at the same time.

The key came through one of my mentor Pia Mellody’s insights—that there isn’t one form of abuse, but two. When we think about trauma, we turn toward disempowering abuse—making a child feel small, unworthy. But there’s also false empowerment—artificially pumping up a child’s superiority or neglecting to check it, as parents must. Disempowerment leads to shame. False empowerment leads to grandiosity.

Children who have been falsely empowered—hero children, substitute spouses, a parent’s confidant, even incest victims—often are told, and feel, that they’re special. But false empowerment is not a gift. It’s a burden. I ask such clients: “’What is the most destructive phrase a child can hear from a parent?’ The answer is: ‘Honey, you understand me better than my spouse.’”

Healthy self-esteem—rare in this culture—means that my essential worth is neither greater nor lesser than anyone else’s. It’s fine for parents to praise accomplishments and address problematic behaviors. But they must also teach that there’s a firewall between the ups and downs of circumstance, behavior, even traits, and one’s unchanging essential being.

Our shame-based clients deserve to rise into intimacy. Our grandiose-based clients deserve to come down out of entitlement, open their armored hearts, and discover love. But first, and above all, abuse of any kind must stop. No addiction. No perpetration.

What current trauma work seems to miss is what family therapy pioneer Ivan Boszormenyi-Nagy called “the multigenerational transmission of destructive entitlement.” When we think of trauma reactions, we tend to see them as responses to injury. In RLT we say, “Show me the thumbprint and I’ll tell you about the thumb.” You had an intrusive mother. You defended yourself with thick walls that you now bring into your marriage. But these automatic responses are also fueled through modeling—identification with the aggressor.

Therapists virtually ignore modeling as a shaping force, though social psychology focuses on it quite a lot. Grandiosity is often passed on this way. When my father beat me, I was disempowered. But he was also modeling for me what an angry man looks like. Yell, hit, throw things? Sure. That’s normal.

Wounds get passed on from one generation to the next.

So too does entitlement.

As a field, we have been dealing with half the issue—and either ignoring or excusing the other half.

Grandiosity feels good. Dominance can feel good—even sadism. By framing all difficult behavior as various forms of “trauma reaction,” as if this description alone were sufficient, we run the risk of minimizing, and sometimes even rationalizing, offensive behavior.

Look at the debacle surrounding Jeffrey Epstein. Both the delusion and the seduction patriarchy offers is dominance. To the victor go the spoils.

Patriarchy protects perpetrators.

So does psychotherapy.

We seem more and more to deny or explain away any unsavory aspect of our humanity. The urge to dominate, sadistic impulses, the thrill of vengeance and retaliation—these have largely disappeared from our discussions and case reports.

As everyone takes a number and stands in the trauma-victim line, one wonders where all the perpetrators have gone. Are we all victimizing ourselves? As AA says, “Hurt people hurt people.”

Beyond the Trauma-Victim Line

As a field, we have become adept at healing injuries. But what are we offering perpetrators—or the perpetrating parts in all of us—to prevent injuries from occurring in the first place? We will heal your wounds but offer little to help take the sword from your hands.

Sigmund Freud wrote, “The first person to hurl an epithet instead of a rock was the creator of civilization.” That civilizing force is called restraint. Are we unaware that we now live in a cultural moment that, for many, can be characterized as an almost giddy throwing off of constraint—a celebration of the shameless overthrow of social norms?

Surveying the social landscape—not just in the U.S. but across the globe—I confess to an urge to grab our community and say: Please, look around. This is not the time to declare grandiose perpetrators untreatable. Nor is it the time to mollify, rationalize, or excuse difficult and ultimately self-destructive traits. The patriarchal dominance model rips through our psyches in chronic loneliness, hunger, and insecurity. It rips through our marriages and families. And it threatens the very bulwark of democracy itself.

The father of family therapy, Gregory Bateson, exhorted us to wake up from humankind’s “epistemological mistake” of placing ourselves above nature and to realize instead that we live within our biosphere—that it is in our own enlightened self-interest to care for the ecological context upon which our own well-being depends.

Learning to think relationally and becoming ecologically wise turn out to be the same thing. In our marriages, in our relationship to ourselves, in our relationship to Mother Nature, we must shift from one-up, one-down dominance to interdependence and cooperation. When we see our relationships as our ecosystem, the question “Who’s right and who’s wrong?” becomes irrelevant. The real question is: How are we going to operate as a team to make this work for all of us?

Are we, as a field, helping our clients understand this? Do we empower the one-down enablers to stand up and find their voice? Are we helping the one-up fighters realize that bullying does not truly serve them? Are we encouraging the walled-off fleers to risk engagement?

Along with the blessed work of healing old wounds and bringing nurture to unloved parts of ourselves, are we also helping clients face the truth about how they are handling themselves right now in the world? Do we offer guidance and practical alternatives so that the legacy of injury inside us is dealt with rather than passed along?

Healing early wounds is wonderful—critical even. But it’s a step along the way, not the whole journey. Over the years, I’ve seen countless individuals go off for intense trauma work, have extraordinary, revelatory experiences, and return home unchanged in their relational immaturity.

Are we equipping those who turn to us with the skills to be fully intimate? Fully relational? Ecologically wise?

And if we do not, who will?

Nurture is necessary—but not enough.

My nightmare is that 10 years from now we’ll all be replaced by endlessly gratifying AI companions who, as has already occurred, nurture their “clients” unto death—perhaps taking our overheated planet along with them.