I use the word trauma a lot. It’s a loaded word, and for many people, it makes them think of war, abuse, or catastrophic accidents. So when I say to someone, “You’ve experienced trauma,” they are often unsure what I mean.
Their reaction makes sense. The DSM-5-TR — the Diagnostic and Statistical Manual of Mental Disorders — is the guide used by psychologists and psychiatrists to diagnose mental health conditions, and reflects most people’s understanding of trauma. It defines trauma narrowly as exposure to actual or threatened death, serious injury, or sexual violence. This is the definition used in diagnosing Post-Traumatic Stress Disorder (PTSD). It’s specific and based on one-off events, and focuses on extreme external threats.
But in therapy, that’s not what I usually mean when I use the word trauma. My understanding of trauma is grounded in contemporary trauma theory, based on the work of Bessel van der Kolk, Stephen Porges, Peter Levine, Allan Schore, Janina Fisher, and others.
This understanding includes what’s known as relational trauma — the kind of trauma that happens within relationships over time, rather than from a single extreme event. The DSM focuses on one-off events that are clearly life-threatening or extreme, like accidents, assault, or natural disasters. Relational trauma, on the other hand, is often subtle and chronic. It happens when a child’s emotional needs go unmet again and again, or when the people who were meant to provide safety and care were inconsistent, critical, or frightening.
These experiences might not look dramatic from the outside, but they deeply shape a developing nervous system. The child learns to adapt to emotional danger rather than physical danger — by disconnecting, pleasing, staying small, or shutting down parts of themselves to stay attached and survive.
Common forms of childhood relational trauma
In my practice, the most common forms of trauma I work with include:
- Emotional neglect — not being seen, soothed, or understood
- Chronic criticism, shaming, or rejection
- Parentification — needing to care for a parent’s feelings or wellbeing
- Unpredictable or inconsistent caregiving
- Conditional love or approval based on behaviour or achievement
- Growing up in an environment where it wasn’t safe to express anger, sadness, or need
There are many other pathways to trauma, but these are the ones I most often see creating people’s adult struggles.
Dissociating to survive
At the time, dissociation was intelligent. Dissociation simply means the mind and body separate from overwhelming feelings, sensations, or memories in order to cope. It’s the brain and body’s way of saying: This is too much right now — I’ll hold it somewhere else until it’s safe to feel.
The problem is that those feelings don’t disappear; they just go underground. They wait for a time when it’s finally safe enough to surface — which often happens decades later, when the body senses safety that wasn’t there before.
As adults, these unprocessed fragments — the split-off parts of self — continue to influence our emotional world. They surface as symptoms such as:
- Anxiety or chronic tension
- Emotional numbness or shutdown
- Shame, guilt, or self-criticism
- People-pleasing or fear of conflict
- Difficulties trusting or maintaining closeness
- Strong reactions that feel “bigger than the situation”
Healing
In therapy, the goal isn’t to relive the past — it’s to integrate what was too painful or frightening to experience as a child. That means gently accessing the dissociated parts, allowing the feelings that were once unbearable to come into awareness within safety and connection.
The next step is to allow the body to do what it couldn’t do at the time: to cry, assert itself, run, fight back, or protect oneself in imagination. As this happens, the nervous system learns that the danger has passed. This is often described as completing the interrupted defensive response.
Finally, therapy helps you meet your unmet needs — variations of being protected, loved, or valued. These reparative moments happen within the mind. The previously split-off parts of the self can reintegrate, and the system can return to wholeness.