The Trauma Triangle in Therapy

It is well researched that the most important factor for change and healing is the therapeutic relationship.  When a person feels that their therapist is not only capable and knowledgeable, but also attuned, warm and present, the conditions of relational safety are met  and healing is possible. 

There are times though, no matter how skilled and empathetic a therapist is, the client still is distrustful, cautious and unable to fully reveal themselves.  “You’re paid to do this so this you’re just acting like you care.”  Underneath that distrust lies the question of safety.  Do you really see me?  Am I really safe with you? 

The role of the therapeutic relationships

I frequently say that with complex trauma, the wounding happens in relationship, therefore the healing also must occur in relationship, in connection with another.  The therapeutic relationship for an adult offers the closest experience to the unconditional positive regard and attachment of the caregiver relationship.  When there has been relational trauma though, the place of healing also becomes a place ripe for the trauma triangle to be re-enacted. 

Last week, I discussed the typical roles that are developed in response to trauma: the victim, the persecutor, and the rescuer.  These roles are enacted internally and externally.  When an individual who has experienced trauma, particularly complex relational trauma, comes into a therapy office, without a doubt this trauma triangle will be alive and active in the therapy session, making its presence known.

Re-enactments in therapy

If a therapist is not experienced and well versed in recognizing the tricky manifestations of this trauma triangle, there is a strong probability that they will be caught in these re-enactments, responding and reacting to the client rather than offering an invitation to engage differently.  These re-enactments can be so subtle, that even the most skilled therapist can unwittingly walk right into these dynamics.  To illustrate, I’ll use a piece of my own story as an example.

I experienced postpartum depression with my first child.  It was horribly difficult and painful to experience the opposite of joy and connection those first few months of my daughter’s life.  While pregnant with my second child, I started to experience the same emotions and overwhelm.  I decided to be proactive and found a therapist.  I was overwhelmed. My negative self talk was through the roof and I was filled with anxiety. In the midst of everything that was happening inside of me, I was having a hard time feeling comfortable with my therapist.  I was keenly studying their non-verbal responses, and I felt uneasy.  The question of safety has not been fully answered. I decided one session to bring up what I’d been experiencing with my therapist, only to be told by my therapist that they were known to be highly empathetic and that I was “very difficult to work with.”  My attempt to gain safety in the therapeutic office came to a screeching halt. 

What happened in that therapy session can be a typical experience for trauma survivors and is related to the trauma triangle, the ways that we learn to survive in relationships. 

During that period of my life, I was highly fearful of judgment.  My inner voice was so full of judgment against myself that I was on high alert to any hint of that in my therapist.  When my overactive nervous system perceived possible judgment in my therapist, I placed myself in the persecutor (protector) role, deciding to address and bring to the forefront (challenge) what I was sensing from my therapist.  I went the direct route and told my therapist “I think I’m triggering you.”  Unfortunately, this direct approach from me elicited the persecutor (protector) role in my therapist.  She reared her head back, visibly moved her body back in her seat and told me she was known to be highly empathic and that the issue was me. I was the difficult one to work with.   She was right and I was wrong.  My response to that was simultaneously in the role of protector and victim.  I defended myself outwardly, responding to my therapist’ anger.  Inwardly, I was shrinking away, shutting down vulnerability.  I decided at that moment her response proved my point.  I was right, she was wrong and therefore not safe.  Our work together ended shortly after. 

I have sat and thought about that experience, attempting to understand what was happening in me, between the two of us, and what we created together.  There’s no simple right or wrong.  There was activation that occurred in both me and in my therapist.  That’s the nature of relationship trauma.  No one, therapists included, are immune to relationship dynamics and triggers.  The triangle roles show up in every area of life, even in (and maybe especially in) the therapeutic relationship. 

Working with the trauma triangle

Both therapist and client play a role in relationship dynamics.  It is the therapist’s role to be mindful and aware of these relationship dynamics.  The attuned therapist looks for those subtle micro exchanges that speak to these relationship fears and patterns, gently inviting an opportunity to experience relationships differently.  On the other hand, it isn’t just the work of the attuned therapist.  No matter how skilled and empathetic a therapist may be, the invitation must be accepted by the client.  It is a “both and” dynamic.  The therapist recognizes the relationship wound, attends to, acknowledges any role they may play, and invites the client to join with them in creating a new experience.  The client must decide to either engage, to take a risk of vulnerability, or to continue the trauma triangle role.  Take for example a client who is used to presenting in the victim role, looking to elicit the caretaker role from the therapist.  The attuned therapist who offers understanding and presence while maintaining the appropriate boundary, offers an invitation to the client to step out of the victim role.  This healthy response from the therapist may just be experienced by the client as “not caring,” precisely because of the victim role they are in and the desire to be rescued.  This is what makes trauma work tricky.  It is not just addressing the trauma that occurred.  It’s noticing and moving away from the trauma roles and responses that keep people stuck.  It’s difficult work, for both therapist and client.  When a therapist and client are able to dig into the messy, sticky work of relationship fears and wounds though, the opportunity for healing is present. 

The container of safety

In order to create a container of safety for your healing, it is necessary for your therapist to be attuned to your process.  Part of that attunement is a willingness to address the relationship dynamics that are occurring between the two of you, with your therapist taking ownership for their role, offering repair and/or an invitation to stretch outside of these familiar protective patterns.   As the client, you also play an active role.  Will you take a risk?  Will you step into vulnerability?  All your therapist can do is extend the invitation: the questions must be answered by you.  In therapy, these questions are repeatedly asked and answered.  How your therapist engages with you is important.  Each time you lean into the mess, you are changed.  The beauty is in the process.