The impossible dilemma
BACP Children, Young People and Families, September 2023

Imagine you are hungry, lonely, frightened and desperately seeking safety. You hear the familiar voice of the guard in the distance; you move towards the sound. The guard has historically sheltered, fed, cared for and protected you. As you get closer, your body stops you in your tracks as you remember that the guard has an identical twin. There is no way of telling them apart as they are indistinguishable in every way. 

The twin, however, is not protective. Historically they have hurt you, frightened you, denied you food, and left you alone in terror when you needed comfort. What do you do? If you initiate contact with the guard, you may be harmed; but if you don’t, you will perish. This is an impossible dilemma and tragically one that many children face at home every day.

Unlike many other species, human babies are born completely reliant on others to survive. The baby requires years of nurturing to develop into an independent being. It is intriguing, when humans have weathered so many evolutionary storms, that we produce such fragile offspring. We are born with a disproportionately large head to accommodate a brain with a large and sophisticated prefrontal cortex, that affords us skills that other species do not possess. To add further challenge, human babies must develop a strong enough core to support the body on two legs, as opposed to many other species who have a more even distribution of weight over four. Evolution did not see these challenges as a problem because humans are pack animals; as such, there were others in the pack to join parents in the role of protecting and raising their babies. Sadly, this is why human babies are so vulnerable, as without primary carers and the support of the pack, they are unable to survive.

So, why are parents drawn to protect their babies, what draws them to each other, and what happens if something goes wrong? During labour, the hormone oxytocin is released, which increases bonding between mother and baby. Skin to-skin contact further simulates the release of oxytocin, known as the ‘love hormone,’ creating, what we hope will be, an almost unbreakable bond. Other primary carergivers might be invited into this bond to form an attachment with the baby, thus creating a circle of protection and love that will encompass them and ensure that they survive and thrive. The primary carers become attached to the baby, and the baby to the primary carers through this process of bonding. Each time the baby becomes hungry, bored, uncomfortable, tired, startled or has other emerging needs, they become dysregulated. They send a cue to their carers through body language, facial expression or crying that they have a need, which the primary carers must attune to and meet. During the baby’s early years, they will repeat this cycle thousands and thousands of times. As the baby develops into an infant, they will learn that people are safe, predictable and caring, and that they are loved and lovable. Each time the pattern of dysregulation occurs and the carers meet their need, the process of co-regulation develops. The primary carer remains regulated, filtering the dysregulation the baby is experiencing, and feeding back regulation. These repeated, predictable patterns of serve and return develop into the ability to self-regulate. Often, as therapists, we may be seen as having ‘magical’ skills in our capacity to pick up on what the client is feeling transferentially. What we are actually doing is what humans are designed to do – attune, notice the felt sense and respond – skills we are taught to develop in our training and practice.

If the dysregulated baby is met by a dysregulated, harmful, or neglectful parent, they will not experience the co-regulation described above, and the capacity for self-regulation will be significantly impaired.

Survival

Developmental trauma is a pervasive form of trauma that occurs in the relationship between primary carers and the infant. Instead of the infant being treated with love, affection, safety and warmth, it is marinated in an environment of violence, anger rage and harm; where basic needs may be intermittently met, but integrated into a confusing mix of care, harm and neglect. The baby knows that they need to gain the attention of the primary carer and initiate them into action to get their needs met, but simultaneously they experience terror as they know that initiating attention may result in being harmed. The baby is caught between two opposing drives – engage the primary carer to stay safe or disengage from the primary carer to stay safe. This is the impossible dilemma.

We are designed to survive. As well as the attachment drive, we have a safety drive, which activates when we are faced with danger, so that the body goes into fight, flight, freeze or flop. In these states, the primary goal is self-preservation. This primitive system served us well as historical hunters, and enabled us to maximise our resources and survive against predators.

The baby has an innate drive to seek attention from the primary carers to enable them to survive. When this source of survival is also the source of danger, the baby has an impossible dilemma. Its safety drive, which is also innate, instinctually draws the baby away from danger, at the same time that the attachment drive draws the baby towards the primary attachment figures. Imagine if the baby needed milk, but the only way they were fed it was mixed with salt. What it needs to survive would also be its biggest threat to life. For a baby in this environment, there is no time to switch off and relax as they must be on high alert. The only respite from this state of high arousal is dissociation.

Dissociation

If we cannot escape physically, we can escape psychologically. Similar to the fight, flight, freeze response that protects the body, dissociation is the protective system of the psyche, when faced with overwhelm through terror or pain. Dissociation enables us to psychologically exit the body, almost as though we are on the outside looking in. From this position, the pain or fear is significantly reduced. Sometimes, we can completely cut off psychologically, so that the experience, and memories of the experience, are held in suspension from conscious awareness. As the infant grows, the mind’s capacity to dissociate as a means of protection further advances. Dissociation may take them to a land full of endless sweets, with a milk chocolate fountain and no people to hurt them, just a pet lion for protection.

While they are psychologically in this place, the child is one step removed from the atrocities that exist in the body and environment at that present moment. The psyche may identify parts of the mind that can shut off feelings, or problem solve, while the rest of the mind remains in an amnesiac state. The mind of the frightened child may compartmentalise their experiences and store them in the unconscious, in an attempt to protect them from psychological overwhelm.

Developmental trauma

As the infant grows from a dependent baby into a child, they develop autonomy and the emergence of a sense of self. They begin to express preferences, likes and dislikes, and develop the art of saying ‘no’ if they do not wish to do something. They delight at the things they enjoy and can identify their favourite clothes, songs, books, toys and games. All these things, and many more, are key parts of the development of the child’s identity, and it is well recognised that the first five years of life are the most critical in terms of development. The baby’s world is only as large as themselves and their primary carers. Their world view grows with them as they begin to explore their environment. If their primary relationships are abusive, the baby experiences the world as abusive. If their primary relationships are neglectful, the baby experiences the world as neglectful. If their primary relationships are violent, the baby experiences the world as violent. If the baby experiences a combination of violence, abuse and neglect, they learn that the world is unpredictably terrifying.

Vital developmental stages and milestones are significantly impaired if the baby does not feel safe enough to explore the world because they are preoccupied with survival. If they are subjected to neglect or abuse from the primary caregiver during this period, this is experienced as a threat to life. Bessel van der Kolk argues that because the infant’s brain is so malleable, and because they are completely reliant on primary caregivers to survive, the impact of developmental trauma is distinct from other forms of trauma.¹ It interrupts development and has a significant impact on the emerging sense of self.

Trauma informed care

There are a range of key areas that we need to consider when counselling children who have experienced developmental trauma. These can be explored through the DARTS² five pillars of developmental trauma model, which I designed based on many years of working as a therapist in the field of developmental trauma. The model comprises of five pillars: Dissociation, Attachment, Resilience, Trauma and Shame. Integrated into all the pillars is relationship, as this is the ‘glue’ that holds the whole therapeutic process together.

As counsellors, it is important that we recognise and understand developmental trauma when working with children who have experienced abuse from primary care givers. Because the abuse occurred in a close relationship, the impossible dilemma is likely to continue at some level within the counselling relationship. Many children and young people who have been subjected to developmental trauma find it difficult to trust. It could be argued that they have good reason not to, as their historical blueprint gives them every reason to draw this conclusion. The therapeutic work can take time and they may need to test you as part of that process. They will be wondering: Will you let me down? Are you tricking me? Do you really care? Why would you care about someone like me? All these questions, whether expressed verbally or not, are attempts to keep themselves safe and should be respected.

The way that the child responds in the therapeutic relationship, and other relationships, needs to be considered in the context of how their understanding of relating was formed, and how they needed to adapt their attachment strategies to survive a world that was not meeting their needs. I do not view children as having attachment disorders; if the physical and emotional environment for meeting the infant’s needs was disordered, children adapt to the disordered environment in an effort to get their needs met. 

If a child’s needs are not met, they may attempt to become self-sufficient and learn not to rely on anyone else. Alternatively, they may attempt to stimulate the inattentive primary caregiver’s awareness by initiating any strategies that might get them noticed. In the most unpredictable and unsafe environment, a blend of both strategies might be used, resulting in the child presenting as chaotic and as unpredictable as their environment. These adaptive strategies are then repeated in other relationships beyond the primary carer dyad.

Working with shame is an important part of the process. A child whose needs have not been met is left with a sense that there is something wrong with them, and that they are the problem. Young children are egocentric as they do not have the need to empathise, and, in fact, empathy may be unhelpful. Imagine a baby that could empathise, as they lay in the cot pondering if it is fair to wake their parents for the third time that night when they have had such a busy day and looked so very tired when putting the baby to bed. That baby wouldn’t cry out for the milk it needs to grow and survive. The lack of empathy we need to survive as young infants is also a key reason to why we internalise experiences from a young age as being our fault. It is important that we explore and understand the shame our clients carry, and are willing to work with it as part of the process. 

The capacity that children with developmental trauma have to survive their earliest experiences of neglect and abuse demonstrates incredible resilience. I do not see resilience as purely a personal trait or skill set to be taught. The very fact that these children are able to enter the therapy room is testament to the adaptive strategies they have deployed to enable them to survive. Just as a sunflower changes direction to lean to towards the light, these amazing children and young people have done all that they can to adapt to an environment that did not meet their needs. As therapists, we can be part of the team that helps the child to accept that those strategies worked. Now that they are in an environment that is safe, we can plant new seeds to grow alongside the others, so that they do not have to rely on the original adaptations alone. Trauma is healable, not a life sentence, and hope is a reality.