The clients I saw in my practice last week were typical of my ordinary caseload. There were couples in violent relationships, an internist who’d sexually abused patients and nurses, an agitated combat veteran just returned from Afghanistan, and a woman who’s spent nearly 20 years cut off from her family and friends because her abusive and jealous spouse keeps her completely isolated. There were also clients whose traumas were less obvious and dramatic but still shaping the way they handled the stresses and conflicts in their present lives. Whatever the differences in presenting symptoms, the common thread in almost all the cases I see is a legacy of complex trauma as a result of relational violence or severe neglect within a family.

Such cases have been the focus of my work over the past 35 years, a period in which the trauma field has seen the emergence of powerful therapeutic innovations like eye movement desensitization and reprocessing, Somatic Experiencing, dialectical behavior therapy, and Internal Family Systems, as well as many major advances in our understanding of the brain and the neurobiology of trauma. Clearly, we’ve made important strides in our ability to help overwhelmed and hopeless people overcome the stigma previously attached to trauma symptoms, learn new thinking and self-regulation skills, and even find a new sense of restored well-being—at least for the period of time that they’re with us in our offices.

But then they go home, and far…