Trauma Therapy in Massachusetts and Rhode Island

You may not think of yourself as someone who has experienced trauma.

Maybe nothing in your past seems “bad enough” to deserve that word. Perhaps you had parents who loved you and did their best. You may know people who went through much worse. Or maybe the word trauma itself just doesn't feel like a useful way to understand your experience.

You don't have to decide whether what happened to you counts as trauma in order for us to be curious about how your experiences have shaped you.

In therapy, we don’t need to decide whether a particular experience qualifies as traumatic. What’s more important is understanding what happened inside you in response to it. Were there experiences that were too much to make sense of or stay present with at the time? Were there feelings you had to manage alone? Are some of the ways you learned to protect yourself then making it harder to live the way you want to now?

Those are questions we can explore without requiring you to adopt a particular story about yourself.

What do we mean by trauma?

Trauma can happen when an experience overwhelms our capacity to stay present with it—because it's too much, happens too soon, or goes on for too long.

Sometimes the experiences that overwhelm us are the ones we readily recognize as traumatic: abuse, violence, assault, accidents, sudden loss, or other situations in which we are frightened, helpless, or in danger.

But what we are able to handle also depends on the resources available to us at the time. An experience that an adult can make sense of and recover from may be overwhelming to a child who has no way to understand what is happening and no one to help them with it.

When we're overwhelmed, our minds and bodies find ways to help us get through. Those responses can be remarkably adaptive in the circumstances in which they develop. Sometimes, though, they continue long after the original circumstances have changed.

In that sense, trauma isn't defined simply by what happened. It's about how an experience affected you, whether it overwhelmed what you could manage at the time, and what you had to do to get through it.

What if nothing particularly bad happened?

Sometimes the difficulty isn't only that something overwhelming happened. It can also be that something important was missing.

Children depend on adults for much more than food, shelter, and physical safety. We need relationships in which we are noticed, responded to, comforted, delighted in, and helped to make sense of what we're feeling—and in which we're encouraged to explore, make mistakes, and discover who we are. Over time, these experiences help us develop the capacity to understand and regulate our emotions, trust our perceptions, feel connected to other people, and develop a sense of who we are.

This doesn't require perfect parenting. Children don't need parents who are endlessly available or who always understand what they need. But they do need enough emotional responsiveness—and opportunities for connection and repair when things go wrong.

When those experiences are consistently missing, there may be no single event to point to. You may have had parents who loved you and worked hard to give you a good life. You may have had a comfortable home, opportunities, family vacations, and everything you needed materially.

And you may still have grown up with a profound sense of being alone. If there wasn't someone who was interested in your inner world—who noticed what you felt, helped you understand it, and reflected back that your experience made sense—it can become difficult to trust your own perceptions, feelings, and needs. You may find yourself looking to other people to tell you whether what you're feeling is reasonable, whether what you remember really happened the way you think it did, or even whether you're seeing a situation clearly.

This is sometimes called emotional neglect.

One reason emotional neglect can be difficult to recognize is precisely because it is about what didn't happen. There may be no frightening memory that explains why you feel the way you do now—and nothing obvious to point to when you try to explain the depth of the loneliness, shame, or self-doubt you carry.

“Nothing terrible happened to me” and “I got what I needed emotionally” are two different questions.

What does dissociation have to do with trauma?

When what we're experiencing—or what we're missing—is more than we can manage, one way our minds and bodies may protect us is by disconnecting from some part of what we're feeling. This is called dissociation, and it can take many forms and degrees. Research has found that dissociation during or immediately after a traumatic experience is associated with a greater likelihood of developing PTSD.

But dissociation doesn't always look dramatic. Sometimes people don't realize how disconnected they've become from their own feelings, experiences, or needs. You may be very good at functioning, thinking, working, or taking care of other people while having much less access to what's happening inside you.

Sometimes we don't realize how much we've had to disconnect until we find a safe enough relationship in which it becomes possible to notice what's been waiting for our attention.

How can trauma show up in your life now?

Trauma doesn't always look like flashbacks or nightmares. Sometimes it looks like a life that works remarkably well on the outside but doesn't feel like yours on the inside.

You may have put enormous energy into surviving, achieving, taking care of other people, or keeping everything under control—and built a remarkably successful life in the process. But at some point, you realize you don't really know who you are beyond the roles you've learned to play and the things you've learned to accomplish.

The career you worked so hard to build may no longer feel meaningful, but letting go of the success, identity, or financial security it provides feels terrifying. You don't know how to relax. Maybe you don't even know what you would want if you stopped doing what you've always done.

Or the place where you feel stuck may be in relationships. You might feel painfully alone even when the people closest to you are right there. You may long for intimacy and also find yourself protecting against it. You may be stuck in an unsatisfying marriage or long-term relationship and unable to figure out whether to leave—or how.

You may want an erotic life but feel alienated from your own body, or find yourself using sex to escape from yourself rather than to connect.

Sometimes the past shows up in things you desperately wish you could simply stop doing: working constantly, binge eating, trying to control everything, losing your temper, or agreeing to things when you want to say no. Maybe you can't sleep or concentrate. You may understand perfectly well that the pattern isn't helping and still find yourself unable to change it.

And sometimes the past shows up in especially painful ways. You may hear yourself saying something to your child that sounds just like your own parent and feel flooded with shame: I promised myself I would never do this.

None of these experiences necessarily means that trauma is the cause. But sometimes things that look like separate problems begin to make more sense when we understand them as ways you learned to protect yourself—and ask whether some of those protections are still responding to circumstances that have changed.

How does trauma therapy work?

If an experience was too much to be with when it happened, what makes it possible to be with it now?

One important part is the relationship we build together. Research consistently finds that the quality of the therapeutic relationship is associated with how much people benefit from therapy. If relationships themselves have been a source of hurt, danger, or disappointment, we don't need to rush or decide in advance what our work together should look like. We can pay attention together to what feels possible, what doesn't, and what helps you stay connected to your experience without becoming overwhelmed by it.

Part of what makes a relationship healing is that we don't have to regulate entirely on our own. When you're with someone who can stay grounded and present while something difficult is happening, it can become easier for your own system to stay present, too. This is sometimes called co-regulation, and it's something we can draw on throughout our work together.

Having that support can make it easier to stay connected to yourself when something difficult comes up. And that means we can approach painful experiences differently than you may have had to experience them originally—not all at once, and not alone. If something was once more than you could manage, it doesn't make sense to try to heal it by overwhelming you all over again. Instead, we can approach difficult experiences in small, manageable pieces, continually paying attention to how much you can be with at any given moment.

This also gives us the opportunity to notice more than what you think or understand about an experience. You may already understand extremely well why you feel the way you do. But intellectual understanding doesn't necessarily change the emotions, sensations, impulses, images, or protective responses that arise when something touches an old experience. Our work can include paying attention to those forms of experience, too. In a sense, we're learning to speak to your system in the languages it already knows.

You can read more about how I use Somatic Experiencing (SE) in therapy.

Will I have to talk about everything that happened?

No. You don't have to do anything here. You control the pace of our work, including how much—or how little—you want to tell me about what happened.

The approaches I use for trauma generally require surprisingly little narration of the original experience. We may need enough information to identify what we're working with—a feeling, belief, image, body sensation, or particular moment—but I don't need a detailed account of everything that happened in order for us to work with its effects.

Sometimes, particularly in Internal Family Systems (IFS), a part of you may eventually want its experience to be witnessed. But being witnessed doesn't necessarily mean telling me the whole story. I can help you stay with and listen to that part without knowing the details of what it's showing or telling you.

At other times, we may talk enough about an experience to notice what happens as you remember it, and then shift our attention toward sensations, emotions, impulses, images, or movements rather than continuing to narrate the story. Some kinds of trauma work, including Deep Brain Reorienting (DBR), may require very little information about what happened at all.

The goal isn't to get you to tell the story better or in greater detail. It's to help you have a different experience of something that was once too much to be with.

Interested in working together?

If some of what you've read here feels familiar, we can talk about what's bringing you to therapy and whether working together feels like a good fit.