Holistic Depth Psychotherapy - Nicole Ann Ditz, MA CMHC

The Invisible Faces of Complex Trauma

"the buddhists say there are 149 ways to god. I'm not looking for god, only for myself, and that is far more complicated."
~ Jeanette Winterson

Divided face


"People often say that this or that person has not yet found himself. But the Self is not something one finds, it is something one creates."

~ Thomas Szasz

Growing a Real Face:

I know now from years of personal and professional experience that it is possible to create an authentic and robust sense of Self in adulthood. As devastating and disfiguring as complex developmental trauma can be, human resilience and the capacity for recovery and self- growth can be stronger still. More recently cutting edge research in the fields of trauma and neurobiology have discovered that it is possible, due to human neuroplasticity, to generate significant neuronal cell growth and the creation of new complex neural pathways in the adult brain. Researchers and clinicians have discovered that a sense of self is a socially embedded construct amenable to change and development even later in life. This process, however, tends to evolve very slowly at more advanced developmental stages, requiring longstanding and corrective interpersonal experiences.

In my world of psychotherapy, growing a genuine 'face' is an intricate and deeply relational process. Survivors of complex trauma often have pervasive and diffuse damage in their internal operating systems that run defective programs throughout their self-organization: cognitively, physically, psychologically and emotionally. Intensive and integrative trauma oriented therapy can lead to a substantial self renovation if the person is willing and capable of engaging in this rigorous process, typically over many years. This type of therapy involves a million micro moments of providing reparative experiences that help build new psychological capacities and ways of relating to self and others while simultaneously deconstructing maladaptive patterns of thinking, perceiving, and experiencing. The dismantling process is as time consuming and challenging, if not more, than the actually rebuild and both processes continuously overlap, one contingent and interdependent on the other. It is an absolute labor of love.

Blindfolded person


"For years, copying other people, I tried to know myself. From within, I couldn't decide what to do. Unable to see, I heard my name being called. Then I walked outside."

~ Rumi

Change that is this substantive requires not only a new and enriched relational growing environment that supplies steady empathic attunement, compassionate presence, and skillful responsiveness but also an endless stream of psychoeducation, interpretation, reframing, confrontation, and experimentation with a plethora of new psychological, emotional, cognitive and interpersonal skills. Long entrenched characterological defenses are stubbornly rooted structures that need to be pared away extremely carefully while a new self foundation is being laid down. Many of these defenses have been the only existing scaffolding supporting the person's ability to function and handle the challenges of adult life so they must be met with an ongoing respect while new bones within the self's substratum grow, mostly imperceptibly, underground.

Developing a 'real face' thus seems to be a process that is significantly additive and subtractive. It involves slowly shrinking and weeding out false self adaptations that no longer serve the person's well being while, at the same time, filling gaps in self-structure with patiently cultivated new seedlings. A few examples of seedlings would be growing a capacity for self-reflection; learning how to translate internal sensations, emotions and thoughts into meaningful language; separating one's perceptions/truths from dysfunctional familial and cultural messages; learning how to self-regulate and soothe intense emotions; clearly establishing and reinforcing flexible yet solid interpersonal boundaries.

There is digging to be had in growing a true face, but what is unearthed in the trauma survivor does not seem to emerge as a preexisting gestalt but rather as fragments. These self- fragments can gradually resolve trauma wounds, can learn to be self-aware and self-supporting, can grow more genuine aspects to fill chipped contours, can be elaborated to become richly nuanced, and then can be juxtaposed with other pieces to form a more complex composition of Self. Defensive shards that are no longer needed can be extracted and reconfigured. I see the therapeutic process as helping to support the growth of a Self Mosaic-in-Evolution: materials of the original temperament and personality are mixed in with new features to create an expressive, integrated and multidimensional face.

Clients sometimes, in distress, talk about wanting to "get rid" of their habitual identity. I believe in a gentler, more inclusive modification that involves helping characterological defense styles to adopt more productive roles within the self-system. Certain false self adaptations once directed in unhealthy ways that caused suffering can actually be recycled and healthfully re-purposed in the self collage. My obsessiveness has been put to good use to fuel my passion for excellence in my field. Another person's defensive detachment can be reformulated into a meditative observer part of Self. Masochistic anger at the self can learn to point outward to confront real injustices in the world. A person's caretaker survival strategies can refocus its patient dedication toward nurturing and supporting oneself as the priority.

Nicole Ann Ditz, MA CMHC, Holistic Depth Psychotherapist

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

Serving Rhode Island and Southeastern Connecticut