Why Change can be Difficult
As we encounter a New Year, many people take this as an opportunity to make new goals and habits to improve their lives. A recent study indicated that 25% of people included mental health as a facet of their wellbeing that deserves attention. People with a history of unresolved trauma, however, may find themselves making new resolutions to improve their health and struggling to attain these goals despite their best efforts. Today we will look at the “why” behind the difficulty in changing.
Contemplating well known terms like “treatment resistant depression” and “chronic relapse” (albeit outdated and stigmatizing), it is important to understand some of the driving factors behind these treatment outcomes that help to dispel labeling outcomes as “failures” and people as “hard to treat”. Our brains are brilliantly designed to protect us, and in the case of complex trauma, those protections grow more elaborate and elusive. What some may label as “failure” or “resistance” should be reframed as protection and survival. We know that treatment of dissociation is not commonly taught in graduate school or medical school, and therapists trained in this type of treatment are more of an exception. If dissociation is not adequately addressed in treatment, a whole world of untapped parts will likely remain as an effort to preserve their sense of safety.
Using Internal family systems (IFS)/Ego State work and Eye Movement Desensitization and Reprocessing (EMDR), we can take a sort of back door into the subconscious and reveal how “staying stuck” is actually serving us in some way. We know all behavior either produces some level of reward or allows us to avoid uncomfortable or painful outcomes. The job of “parts” (different aspects of our psyche that have a specific function to protect us) is to “not know” or dissociate to protect us from realizing (or knowing) that painful events actually happened to us and the meaning behind these events. For example, in childhood people often develop a part that hold the pain of “it’s my fault”, which actually protects them from thinking that something might be wrong with their caregivers. To a child, if something is wrong with them, they can create defenses or parts to mitigate this fault through perfectionism, competitiveness, or arrogance, etc. If something were truly wrong with their caregiver, however, the child would not have any means to control their safety and their entire existence would be in question, (ie “Will I survive?”).
These parts do an excellent job protecting us in childhood. The issue arises, however, when we transition into adulthood and the protection mechanism may no longer fit our current surroundings (assuming we have been able to remove ourselves from traumatic situations to some extent). Trauma, in general, often creates a need for control and being able to predict the outcome of new situations. Change, then, can be overwhelming to a system that needs to know how things will play out.
The following are a list of common fears and obstacles clients hold toward change:
1. Procrastination- People often perceive procrastination as being lazy, but this is not actually the case. Procrastination can usually be broken down into two types of fears, including fear of failure and fear of success. If we have experienced a great deal of perceived failure in our lives, we may be highly motivated to avoid any new situations in which we may not be able to meet our own or others’ expectations. Not starting at all means it is impossible to fail as we never even tried. Fear of success is similar except that success does not align with how a person views themselves and this discomfort drives the stand still behavior.
2. Comfortable being Uncomfortable- The best way to describe this is to look at the nervous system. When we have unhealed trauma, our nervous system is usually ravaged and remains in the flight, fight, freeze, or fawn (sympathetic) responses most, if not all, of the time. While this feels “uncomfortable” and client express the desire to move into the “rest and digest” (parasympathetic) response, they are so used to being in a hypothetical war zone that to stray from this feels even more foreign and uncomfortable. We see those with long histories of trauma unconsciously being pulled back into situations and relationships that continue this ongoing experience of their childhood.
3. Flight/Fight/Freeze/Fawn- There are specific parts who hold protective functions in clients. We know in the wild when an animal is being hunted, freezing helps the potential victim to go undetected and buys them precious time while the predator either loses interest or walks away all together allowing for escape. Similarly, a child may have a part that is design to freeze and get as small as possible to avoid conflict or being noticed. In adulthood, freezing occurs in situations the brain perceives as similar and prevents the adult from moving into action. Fawning (or people pleasing) is a function children develop to anticipate the needs of unpredictable care givers to prevent undesirable outcomes. In adulthood, people pleasing prevents clients from being able to be their authentic selves and from being able to express their wants and needs (which often coincides with depression and anxiety because needs never get met). They may also believe their feelings and needs are insignificant as they were not valued by their caregivers. The fight response often is physically protective in childhood, but in adulthood can lead to fractured or non-existent relationships and potential for legal issues. Finally, the flight response, which does work in the interim as one can avoid uncomfortable situations, actually increases anxiety around discomfort as clients do not develop the skills to increase frustration tolerance. Long term avoidance teaches the brain that the perceived danger is actually even more dangerous than it was to start with.
4. Fear of Rejection- Social anxiety is a common experience, particularly among those struggling with addiction, and is increasing with the pandemic as people are out of practice being in social situations. The part holding this fear is often trying to protect us from perceived abandonment and the fear serves as a deterrent to putting us in the situation where the abandonment potentially occurs. This keeps people isolated and without social support.
5. Internal phobia. Depending on the degree of dissociation, internal parts are not always aware of each other. When they are aware of each other, often they are phobic of other parts and their job is to protect against other parts whom they feel are a threat. A common example of this is having a fear part protect against hope. The fear part might believe that every time they have allowed a glimmer of hope, these glimmers have been snuffed out by tragic events and therefor hope is not safe. Hope would be difficult to access because it has been exiled and not allowed to be part of the team of parts.
6. Internal Overwhelm - I often hear the statement “If I start crying, I will never stop”. When clients have avoided feeling or dissociated for years, they often believe they do not have the capacity to feel deeply, or it will flood them with emotion. Further, parts may not trust other parts to be able to handle what have been deemed as difficult emotions.
7. Introjects- Clients often develop parts (introjects, persecutory parts) that emulate their critical, neglectful, or abusive parents. These parts can take on the role of adult abusive relationships as well. These parts protect the child or adult while in the abuse by being able to anticipate what the abuser might say or do and being able to act accordingly. Once out of the abuse, however, these parts continue the only role they know and continue to internally abuse, thereby retraumatizing the other parts.
8. Ongoing current Traumatic Events- When we continue to face circumstances reminiscent of childhood trauma in adulthood, parts understandably will be more resistant to change, as circumstances have not. Helping clients to set emotional & physical boundaries, reduce stress, and remove themselves from situations that are threatening, creates emotional and physical safety and the system is more open to change.
9. Payoff for Staying Unwell. Another unconscious reason to stay the same is that a person might only get attention in childhood for being unwell. The phrase “negative attention is better than no attention” speaks to a whole range of protective behaviors kids take on to get their attention and attachment needs met. These behaviors become the life raft for this people and the thought of letting it go is terrifying due to the fear of potential loss of connection to others. This is a realization that people often come to when exploring dissociation and requires internal healing of attachment to allow parts to believe that it is safe to behave in new ways and that connection will not be lost if they do.
Lastly, this list is not meant to be exhaustive or negate times when there is a need for concurrent medication, TMS/neurofeedback/brain therapies, or other clinical and medical intervention. May this list provide direction to clients who struggle with hope that they can heal, and for therapists who might want more insight into why clients may get “stuck”.