Why many people with complex trauma struggle to recognise healthy relationships

Are you surprised by what your clients don’t know about relationships?

I recall a very sensible adult client coming to a session and describing exploitative behaviour that they saw on a television show, and asking if I thought it was ok. (It was not ok!!) This person had suffered extreme relationship adversity during their formative years, and was now quite socially isolated as a self-protective strategy.

While we were exploring their question about the television show, I realised: this person had no confidence in their own judgments about people’s rights in relationships, and no sense of healthy interpersonal boundaries.

Have you had similar experiences with some of your clients?

Over the years that I’ve worked with people who have experienced complex trauma, I have realised that many people don’t have internalised models of healthy relationships. Some people come to treatment without having had much or any exposure to healthy relationships. This is one of the reasons why complex trauma training for therapists and trauma-informed therapy training are so important. We need to understand not only trauma itself, but also the relational knowledge that many clients never had the opportunity to develop.

That’s when I realised:

Knowing about healthy, respectful, reciprocal and safe relationships is a privilege.

Not all people have access to this knowledge. People who grow up deprived of healthy formative relational experiences grow up with internalised models of unhealthy relationships. Without healthy models for relationships, people often struggle to improve their social situation. They may miss out on developing healthy relationships because they don’t insist on them, and others develop bad habits with them. They may be drawn to the familiarity of exploitative relationships, or simply unaware that there are better alternatives out there.

In some cases, they struggle to identify unhealthy relationships, and don’t act self-protectively around unsafe people. In other cases, they avoid relationships altogether, feeling safer keeping their distance from all other people. This can result in chronic loneliness, which is a health hazard, and chronic re-traumatisation.

Healthy Relationships: A practical resource for clients and therapists

It is for these people that I developed my new course, Healthy Relationships.

The course is a comprehensive look at healthy relationships from a neuroscience and psychological perspective, and it’s full of self-help and practical wellbeing strategies.

For therapists, it provides a valuable source of relational psychoeducation to use in treatment.

For clients, it provides the information and skills needed to build internal models of healthy relationships, and to get clear about what is and is not ok in their relationships.

The course draws on therapy training grounded in neuroscience and offers practical insights that complement therapy skills for treating trauma and attachment difficulties.

What will you learn in the Healthy Relationships course?

In the course, I teach:

• Science of Healthy Relationships, with an accessible neuroscience lens, covering Polyvagal Theory, the Risks of Loneliness, Attachment Theory and how understanding your own temperament is relevant to relationship health
• A Practical Definition of Healthy Relationships, including a close look at social circles, trust and resonance, boundaries, rights and responsibilities, and the importance of showing up in relationships
• Recognising Unhealthy Relationships, understanding what distinguishes uncomfortable from dangerous relationships, and unhealthy from healthy conflict, learning about schemas, and recognising manipulation and danger signs
• How to Begin, Improve and Maintain Relationships, including self-care and self-regulation, communication skills, curating relationships and meeting people
• Self-Assessment of current relationships and social circles

For therapists interested in attachment trauma therapy training and therapeutic approaches for complex cases, the course also offers a practical framework for helping clients understand relationship health in a way that is accessible, compassionate and actionable.

Understanding healthy relationships through a neuroscience lens

Here are some details about a few key components of healthy relationships:

Understanding temperament and relationship compatibility

Perhaps it’s not obvious, but understanding our own temperament is a key part of having healthy relationships. Why? Because good relationships are about a good fit between ourselves and the other person. We need to know what we like, how we like to spend our time, and where we sit in terms of sensitivity and privacy so we can regulate ourselves well in relationships and choose people who resonate and fit well with us.

Some temperaments are well suited to a broad range of other people, and some temperaments are more sensitive and require a specific fit. Rather than shoving yourself into spaces that don’t fit you, it’s easier to figure out who you are and where you fit, and work with that to find good fits for yourself.

Curating social circles for relationship health and wellbeing

Curating refers to selecting, organising and looking after something, and curating the people in your social circle is key to having healthy relationships. Social circles exist across different levels, and it’s important that we have the right people in the right spots.

Assessing your social circle and how you feel about it is important to ensure that the right people are in the right spots for you.

If you realise that you need to move some people out or you have vacancies, this is an opportunity to make helpful changes to your social circle.

Recognising unhealthy and problem relationships

This is such an important topic for so many complex trauma survivors, and can be what puts people off relationships in general. If we act as if everybody is safe, or as if everybody is dangerous, then we are failing to recognise problem relationships.

In reality, most people are safe enough to at least be acquainted with, but a minority of people are not safe to connect with closely. To socialise healthily, we need to recognise the people who may cause a problem for us.

Introducing DARVO (and, why recognising manipulation matters!)

I am so grateful to Jennifer Freyd and her Centre for Institutional Courage for all their great work, including coining the term and researching the phenomenon of DARVO¹.

This concept is extremely valuable in helping us identify problem relationships and we all need to understand the concept, because it’s hard to see what we don’t have a concept for.

DARVO is an acronym. Its letters stand for a description of the behaviour of people who manipulate others when a problem is raised with them.

The manipulator will:

• Deny the other person’s account, regardless of whether it’s based in fact
• Attack the other person either directly or through reputational damage
• Reverse
• Victim and
• Offender, to switch themselves from the offending role to the victim role, making out the person raising the complaint as the offender and themselves as the person being attacked

These are some of the concepts I illustrate and work through in my course, Healthy Relationships.

Building healthy relationships after trauma

For many people who have experienced attachment wounds, adversity or complex trauma, learning about healthy relationships is not a luxury – it is foundational to recovery.

Understanding trust, boundaries, temperament, social circles and relationship safety can help people build healthier internal models of relationships and create more meaningful connections with others.

If this resonates with your practice, whether you are looking for practical resources for clients, wanting to deepen your understanding of neuroscience and therapy practice, or seeking continuing education for mental health professionals, my hope is that the Healthy Relationships course helps more people develop healthy internal models of relationships and build safer, more connected lives.

These are just some of the concepts explored in Healthy Relationships. To learn more about the course and explore the curriculum, please visit:

1. With credit to Freyd, J.J. (1997). Violations of power, adaptive blindness, and betrayal trauma theory. Feminism & Psychology, 7, 22-32. ↩︎

Why EMDR basic training doesn’t answer every clinical question

Do you sometimes run into obstacles applying the EMDR Standard Protocol?

You’ve done your EMDR Basic Training and off you go to use it with your clients, excited and daunted by this powerful new tool in your kit. Some of your clients go so well with EMDR, but you realise you also have questions about the process of EMDR.

For instance:

• How do I know we’ve arrived at the right negative and positive cognitions?
• How do I decide whether to do resourcing, and how much resourcing is needed?
• How do I use cognitive interweaves?
• How fast should the BLS be?

With other clients, you run into problems, such as:

• A client gets overwhelmed and becomes phobic of EMDR
• Another client presents with trauma symptoms, but they have no conscious memories of trauma – so how could you treat this with EMDR?
• Another client becomes vague and non-responsive when you discuss working on memories (and you are not sure what to do)!

These questions and challenges are common in the phase after doing your Basic Training. Here are some tips that helped me get started applying EMDR in the complex trauma presentations that make up the bulk of my work.

EMDR for complex trauma practitioners: Understanding negative cognitions

Using survival responses to identify the right negative cognition

Do you wonder if you’ve got the right Negative Cognition, and how you would know if you did?

I found this so confusing until I had some consultation with Andrew Leeds. He taught me something really valuable: focus on their physiological symptoms, not the words they are using.

When you understand which action system of survival drives the symptoms, you can frame the intervention around that, and you’ll know it’s correct because when they say it to themselves, the action system comes online, and they feel their distress.

When you work this way, you only have to hold three things in mind, and you listen for these in the presentation and the history:

1. Fight or Flight symptoms of fear or anger, meaning: I am in Danger
2. Freeze symptoms of numbness and immobilisation, meaning: I am Helpless
3. Submit symptoms of shame and overwhelm, meaning: I am all Alone, I don’t Belong

Choosing the right resource for danger, helplessness and belonging

When you work this way – looking for signs of physiological over-activation of a survival response – it’s also clear whether and what you need to resource.

It’s not necessarily just about a Calm resource, which is the appropriate antidote to a Fight or Flight, or Danger-based trauma.
If, however, you are working with a Freeze, or Helplessness-based trauma, then the antidote you need is Empowerment: a mobilisation of their body with its capacities to cope and self-protect is the antidote.

If you are working with a Submit action system, an injury to the sense of Belonging and Connection, then the antidote you need is a felt sense of loving connection and belonging.

I have noticed over my years of working this way that it’s often easier to begin with Danger and Helplessness symptoms, rather than Belonging ones.

Why? Because Danger and Helplessness tend to be simpler to resource and resolve, and they often process in a straightforward way using the EMDR Standard Protocol.

Injuries that affect Belonging, however, are often developmental injuries, and they often run deeply into our attachment systems, our sense of self, and the EMDR Standard Protocol may need some adjustment to be effective.

How do I use cognitive interweaves more effectively?

I used to find this so confusing, tying myself in knots about which type of interweave to use and what exactly to say, and I would get stuck with my clients.

Then I realised what an interweave does: it builds a bridge (with as few words as possible) from where your client is stuck (the trauma meaning: Danger, Helplessness, Aloneness) to where they need to be to heal (Safe, Empowered, Connected).

Once you see it this way, things are so much simpler – just ask a question or make a statement that activates the healing, adaptive meaning in their body.

So simple! 😉

Finding the right bilateral stimulation speed

The guidance to keep in mind is: fast if you’re reprocessing trauma, including doing installation, and slow if you’re laying down a resource.

I see BLS speed as a matter of attunement with your client – as fast as they can tolerate and stay in their window of tolerance, slower if they are struggling with things that are emerging.

What to do when EMDR processing gets blocked

EMDR Standard Protocol has several suggestions, including cognitive interweaves, but sometimes these aren’t enough.

How come?

Because some of our clients have dissociative structures that complicate processing.

Can you use EMDR with clients who dissociate?

But wait! You can’t use EMDR with people who disassociate, right?

Wrong!

I, like many of you, learned that you should avoid applying EMDR with people who dissociate. The problem for me was that when I learned EMDR, I had a whole caseload of people who dissociated.

Working with dissociative structures in EMDR therapy

So, I learned to understand a person’s internal world, map it out to understand their symptoms, and foster internal collaboration, with the help of many dissociation theorists like Richard Kluft, Sarah Krakauer and Kathy Steele and colleagues.

I have a foundational course on this work: Complexity to Clarity

I also have a course teaching how to formulate this way: Parts Work Formulation – How to Make a Map

And I have a course looking at advanced topics in this area: Clarity is Complex Again –
Advanced Parts Work Skills for Trauma-Related Dissociation

Working this way gives you possibilities to break complex presentations down into manageable, bite-sized symptom clusters, and to apply EMDR therapy in a progressive way.

The Progressive Approach to EMDR Therapy for complex trauma

EMDR practitioners including Jim Knipe and Dolores Mosquera pioneered the Progressive Approach to EMDR Therapy.

It’s based on a profound insight from Jim Knipe that bilateral stimulation does basically two things:

1. It decreases dysfunctional positive affect
2. It spreads activation through meaning networks, recruiting healthy adaptive networks to resolve the traumatic meanings

Using bilateral stimulation in strategic doses

Knipe then realised that you can use it progressively; in small doses, to ‘loosen the system’ that blocks access to a network, or process a smaller blockage to prepare a client for the EMDR Standard Protocol.

Dolores Mosquera has contributed to this approach in various ways, showing us how useful it can be to use strategic doses of bilateral stimulation to resolve symptoms that are life-interfering in complex and disorganised clinical presentations.

If you conceptualise your interventions from this perspective, you can apply EMDR in small and strategic doses, and EMDR becomes a much more versatile tool in your hands.

Advanced EMDR training for complex trauma

If you work with complex trauma presentations and find yourself running into these challenges, you’re not alone.

These are common questions that emerge after EMDR Basic Training and are often the reason clinicians seek further professional development trauma training.

My upcoming two-day workshop explores these topics in depth and provides practical approaches for applying EMDR therapy to complex and dissociative presentations. For more information (and early-bird pricing) please visit EMDR for Complex Trauma.

If you are looking to strengthen your EMDR skills, deepen your understanding of complex trauma, or expand your therapeutic approaches for complex cases, my hope is that this training helps you use EMDR with greater confidence, flexibility and effectiveness.

With thanks to:

Gonzalez, A. & Mosquera, D. (2012) EMDR and Dissociation: The Progressive Approach. First Edition, Revised. Self Published. Info@itradis.com

Knipe, J. (2015) EMDR Toolbox. Theory and Treatment of Complex PTSD and Dissociation. New York: Springer.

Do you have clients who are so convinced they are unlovable that nothing you do seems to make a difference?

Perhaps you will recognise this from your clinical work. A client presents for treatment. They are delightful to be with in the room – engaged, polite, socially skilled. They ask how you are. They seem warm and easy to connect with.

As you get to know them, you are surprised to discover that their reason for seeking therapy is low self-esteem and chronic feelings of worthlessness!

When you explore their concerns more deeply, they tell you they fear what would happen if anyone were to really get to know them. Why? Because then they would be exposed as they believe they truly are – flawed, ugly, unwanted, utterly unlovable.

How can we make sense of this?

It is especially challenging when you already experience them as worthwhile and likeable. When you begin working to help them see this, everything you attempt seems to be blocked, minimised or dismissed.

Understanding these dynamics is central to attachment trauma therapy training, particularly when we are considering strategies for managing resistance in therapy.

Is self-worth really worth it?

This may seem like a counterintuitive question, but it can be a very useful one.

What if the client has unconscious reasons to maintain low self-worth?

What if their survival systems implicitly know that if they begin to feel they matter – that they deserve dignity, voice and choice – they may lose something that has felt essential?

The developers of Coherence Therapy (an approach grounded in the neuroscience and therapy practice of memory reconsolidation) have written about this1¹. Look through the list below, derived from their work, and notice whether you recognise any of the dilemmas your own clients may be facing.

Unconscious reasons to maintain low self-worth

• Maintain a connection with one’s parents to avoid:Realising that one is alone and invisible
• Maintain an illusion of empowerment to avoid: Realising the extent of past powerlessness
• Preserve safety from further abuse to avoid:Realising injustice and experiencing associated anger
• Avoid awareness of betrayal to avoid: Realising betrayal and feeling its pain
• Avoid awareness of living out only a small portion of potential to avoid: Experiencing grief
• Safety from criticism and rejection to avoid: Awareness of risks of criticism and rejection
• Avoid the weight of existential responsibility to avoid: Awareness of existential responsibility
• Maintain a ‘Good World Hypothesis’ to avoid: Existential crisis of accepting a not-so-good world
• Quest for accountability to avoid: Acceptance of wellbeing despite lack of acknowledgement of harm
• Quest for owed nurturance to avoid: Grieving unmet childhood needs
• Quest for owed childhood to avoid: Grieving the lack of a carefree childhood
• Pseudo-penitence to avoid: Adult struggles with authenticity and integrity
• Disidentification to avoid: Shame associated with identifying with an abuser
• Preservation of the familiar to avoid: Being immersed in the unfamiliar

When we view low self-worth through this lens, resistance begins to make sense.

What appears as a therapeutic blockage may actually be an attempt to preserve psychological balance.

Shame as a regulator in attachment trauma

When we look at these patterns more closely, we often find that shame plays a central organising role.

Understanding the function of shame is invaluable when working with pervasive feelings of being unlovable. In my own learning – influenced strongly by Janina Fisher – I came to appreciate shame as a powerful emotional regulator (and have written more about that here: Resolving Shame and Self-Loathing).

Shame can act like an ice bath or a wet blanket on experience.
It dampens emotional intensity.
It freezes connection.
It narrows possibilities.

But what is its purpose?

I like Jim Knipe’s2² definition. He describes shame, for the neglected child, as the lesser of two evils. The child may take on self-blame – ‘it is all my fault’ – because this creates an illusion of control.

‘If I become better, then they will love me’.

This protects the child from an even more devastating realisation – that they are without power or options, and are profoundly alone.

For many clients with attachment trauma, this pattern continues into adult life. As therapists, we may therefore need nuanced strategies for managing resistance in therapy rather than assuming that insight or reassurance alone will shift entrenched beliefs.

Building self-compassion little by little

One helpful starting point can be introducing clients to gentle self-compassion practices.

I have created a guided meditation designed specifically for people who struggle with shame and self-criticism. It offers a compassionate framework for understanding how experiences of powerlessness and neglect can shape self-concept.

You can access it here:

Small experiences of safety and kindness towards the self can gradually support deeper therapeutic work. Approaches such as EMDR for attachment trauma can also provide structured ways of working with the implicit memory networks that underpin these patterns.

When informed by contemporary social neuroscience, EMDR can help clients gradually process the experiences that made self-worth feel unsafe, rather than trying to persuade them cognitively that they are lovable or worthwhile.

Supporting clients to move from complexity to clarity

Over time, as traumatic material is integrated and emotional regulation improves, clients often begin to experience subtle shifts:

• Increased capacity for self-reflection
• Greater tolerance for positive relational experiences
• Emerging compassion for earlier versions of themselves
• Less rigid defensive responses

These developments are rarely dramatic or sudden. More often, they unfold gradually as safety and integration deepen.

As part of my commitment to continuing education for therapy practitioners, I share practical ways of working with these dynamics – particularly when therapy feels stuck.

If it’s a challenge that resonates for you, this resource will be useful:

Deepening clinical skills in attachment trauma therapy

If the themes in this article resonate with your clinical experience, you may be interested in further developing your skills through focused attachment trauma therapy training.

On May 22, I will be offering a workshop exploring practical EMDR-informed approaches for working with shame, resistance and entrenched low self-worth in attachment trauma presentations.

In this training, we will look at:

• Conceptualising resistance through a trauma-informed lens
• Integrating neuroscience into clinical formulation
• EMDR strategies for working with protective emotional systems
• Supporting clients to move from entrenched survival patterns towards greater clarity and self-compassion

You can also join my newsletter (scroll to the signup at the bottom) for ongoing clinical reflections, resources and training updates.

1. Ecker, B. & Hulley, L. (2019). Coherence Therapy: Practice Manual and Training Guide. Published Online: Coherence Psychology Institute LLC ↩︎
2. Knipe, J. (2018) EMDR Toolbox: AIP methods for treating Complex PTSD and dissociative personality structure. Workshop Presentation. Mooloolaba, Aug 3-5, 2018. ↩︎

Do you feel like your interventions are all over the place with your complex trauma clients?

If you work with people with histories of complex trauma, this is probably a familiar feeling. Some clients present for therapy with so many distressing symptoms and current challenges that you don’t know where to focus your energy. Each session can slip away as clients share their difficulties, without you making headway on anything. This often leaves both you and your client feeling demoralised: how will they ever start to feel better with all this going on? Many therapists describe this sense of scattered focus when first developing therapy skills for treating trauma, and it’s a core issue addressed ineffective complex trauma training for therapists.

How do you balance all the needs complex trauma clients present with?

Some people have lifestyle difficulties that create dysregulation, like problems sleeping, exercising, or nourishing themselves. Some are out of work or overworking, creating barriers to accessing and engaging with therapy. Others have social challenges that range from total isolation to entanglement in unhealthy relationships, and these feel important even when they’re not stated treatment goals.

Some clients present with so many different symptoms of dysregulation that you don’t know where to begin. Others have severe difficulty establishing collaboration with you, or engage in risky behaviour that jeopardises their safety.

Where should your focus be?

How to focus therapy in the midst of complexity

Therapeutically, I work from a neurobiological perspective. This means I understand wellbeing as a process of regulating the body. Regulation means learning to work with ourselves as social mammals, with bodies that have needs, limits, preferences, and a requirement for care, rhythm and connection with others.

One of my core approaches to therapy comes from this neurobiological understanding. I often call this to mind:

No frontal lobes, no therapy.

You can’t work on self-understanding or developing new skills and knowledge if you’re triggered or distracted. This means the first focus of therapy is to enhance frontal-lobe functioning, to teach the client to become present and oriented in the therapy room, and to be able to recognise how they feel while relating with you.

I normally support this by teaching:

• Grounding skills to be present
• Containment skills, to set aside what feels too overwhelming right now

This builds capacity in the observing self and provides a foundation for future change.

Grounding and containment are core therapeutic techniques for trauma and are essential therapy skills for treating trauma in complex trauma therapy.

Therapy is a process (and it has phases)

You will recognise this in the treatments you already offer.

In the early phase of treatment, you are figuring out what’s going on for the client: assessing needs, clarifying goals, learning how best you can work together and developing a therapy plan.

Later in therapy, you’re implementing that plan and the client is acquiring skills to address therapeutic goals. You then assess progress and make adjustments to keep moving forward.

In the final phase, you’re reassessing mental health needs as goals are met, developing relapse-prevention plans and preparing for regulation in life without therapy.

Recognising which phase of therapy you’re in is an integral part of organising intervention and knowing what to focus on in each session. 

This is a core competency typically developed through advanced therapist professional learning online and supervision.

Keeping the arc of trauma therapy in mind

When treating trauma, there is a method to resolving traumatically stored material in the nervous system, with an overall arc of therapy and defined tasks in each phase. When you keep this arc in mind, interventions follow a structured path.

You can ask at the beginning of each session:

• What phase of therapy are we in?
• What progress have we made on this phase’s core tasks?
• Is the client grounded enough to work on these tasks?
• What is preventing skill acquisition right now?
• Are we ready to transition phases?

These focused questions keep therapy moving along its arc while allowing flexibility to respond to current stressors – an essential balance in complex trauma work.

Prioritising safety in complex trauma therapy

Anything that poses a risk to a client’s current safety is always the first priority. The client cannot make use of therapy if they come to harm. Grounding them into this reality naturally focuses work on resolving immediate risks.

Once risks are addressed, focus returns to the tasks of the current phase you are in.

The three phases of complex trauma therapy

Phase 1: Safety, symptom reduction, skill building, preparation

The client learns to ground into the present, establish safety internally and externally, and develop self-regulation skills that enable trauma resolution.

Phase 2: Integrating trauma

Traumatic content is resolved using an evidence-based trauma-focused therapy.

Phase 3: Integration and rehabilitation

After trauma resolution, the client’s mental health needs are reassessed. Any grief work and further skills acquisition are addressed.

In practice, these phases are not linear. It’s common to complete tasks of one phase and return to earlier phases in new contexts. Working this way is invaluable for keeping complex trauma interventions organised, focused, and effective. 

Confidence in navigating these phases is a core element of high-quality complex trauma training for therapists and a hallmark of the best therapy workshops for trauma clinicians.

Developing focused trauma therapy skills

If these challenges resonate for you, I share practical strategies and resources for clinicians working with complex trauma through my newsletter and offer therapist professional learning online.

I’ll also be sharing a free webinar on this topic next month (Friday 20 March 2026).

Join the mailing list via the signup form below to receive the webinar invitation and future resources on complex trauma therapy.