Holistic Depth Psychotherapy - Nicole Ann Ditz, MA CMHC

The Invisible Faces of Complex Trauma

"That ain't me, that ain't my face. It wasn't even me when I was trying to be that face. I wasn't even really me then; I was just being the way I looked, the way people wanted." ~ Ken Kesey



"Stop masking your pain for it will bleed through somewhere else in your life"

~ Sherna Benjamin


The weeks, months and sessions turn their pages. Kate begins slowly to reveal more accurate snippets of her childhood: a depressed, detached mother; a father prone to sudden verbal outbursts directed at his wife; the oldest child, Kate, taking on a parentified role for her siblings and parents at a very young age. Despite this, she still sometimes justifies her parents' behavior as an understandable result of being overly stressed by their high demand jobs and efforts to give their kids all the finer things in life. At these times she rattles on about how well provided for she was growing up. Hers was a house where all the kids wanted to spend time because they would be free to do as they pleased with little to no adult supervision. She tries valiantly, in moments, to reflexively refashion her emotional neglect into a fairytale of a "pretty great childhood".

We begin to work with secondary elaborations of complex trauma: her chronic anxiety alternating with numb shutdown states, Kate calls "being zoned out"; her periods of dysthymic blues, Kate attributes to her menstrual cycles; her somatic issues such as migraines, which she fears is a sign of her being a hypochondriac; her episodes of dissociation during which she feels spacey and unable to focus well. Kate is hard on her self about these symptoms and interprets them as a sign of "weakness, laziness, a lack of mental discipline". This is a sharp contrast to her compulsive drivenness and severe self-imposed restrictions. She rarely allows herself to relax and when permission is briefly and reluctantly granted, she still tries to do something "productive" to justify these scant moments of repose.

We begin tackling other sequelae of childhood trauma such as social anxiety and preoccupation with people's disapproval and rejection. The latter results in overextending herself to please others followed by depletion, withdrawal and avoiding returning phone calls. She berates herself for being "a horrible friend" and then forces herself to give until exhaustion sets in and once again she collapses and retreats. Kate reveals struggles with food and her body image resulting in her cycling between episodes of overeating sugary snacks accompanied by emotional self-flogging, followed by periods of very restrictive eating which leads to fleeting feelings of relief and the illusion of being "in control". Despite her obvious physical beauty, Kate often refers to herself as "plain" or even "homely" with an expression of disgust wrinkling up her face.



"There is a face beneath this mask, but it isn't me. I am no more that face than I am the muscles beneath it, or the bones beneath that."

~ Steve Moore

We spend a great deal of time focused on relational issues, particularly those involving her husband. Kate oscillates between solicitous caretaking, contorting herself to fulfill his wishes while sacrificing her own needs and then emotionally detaching from him while feeling secretly hurt and resentful. She inhibits expressing her anger directly toward her spouse, waiting to open her complaint files in her sessions with me. Kate's most common conclusion is that it must have been something she did to "provoke" his disrespect and dismissive attitude toward her desires, ideas and feelings.

While I address Kate's myriad symptoms and issues, I am aware of observing extensive post traumatic compromises to her self-concept manifesting as a shame based identity, low self-esteem, self-blame, an external locus of reference, weak boundaries with enmeshment, and a disowning of her right to have and express needs. Kate is unplugged from her insides. She is hazy and confused about what she truly feels, values, and wants. Her persona cycles through various masks adopted long ago as unconscious strategies to survive developmental trauma. These masks are aimed at detouring further interpersonal assaults and abandonment while trying to procure phony substitutes for love such as social applause and being "valued" for how well she attends to others' needs.

Kate's masks appear and reappear one after the other upon our therapeutic stage. There is the pontiff who preaches about how she "should be"; the diverter who aims to keep us in shallow waters; the sergeant who demands she toe the line; the martyr who sees self-sacrifice as holy; the designated driver who always volunteers to be responsible for others' welfare; the rationalizer who may try to convince you that even Hitler's motives were reasonable; the minimizer who could look down at a shattered limb and calmly say: "Oh, a sprain"; the caretaker who would be so pleased if I would allow her to bring me a chai tea to every session.

And then again sometimes there is the professor who presents me with cerebral lectures about her problems; the heroine who single handedly strives to save the world while she leaps away from herself; the magician who tries to persuade me of her presence while she psychologically slips out the door; the chameleon who changes colors according to what she thinks I expect from her; the toughie who believes she should pick herself up alone by her own bootstraps; and the masochist who blames herself not only for her own trauma related symptoms, but also, if given half the chance, for global warming and warfare.

Nicole Ann Ditz, MA CMHC, Holistic Depth Psychotherapist

Voice Mail: (401) 573-6396  Email: info@holisticdepththerapy.com

Serving Rhode Island and Southeastern Connecticut