making connections

Cain returns to session with data, indicating the importance of informal, ongoing evaluation by the therapist. People change over time and documenting that is imperative for success. He presents an argument he got into with his girlfriend a few days prior. In it, she accused him of betrayal in a barrage of harsh language. He got defensive, tensed up and raised his voice. A few moments into the fight, he noticed the knots in his stomach, which prompted him to remember the assignment—make a note every time his trauma surfaces between sessions.

Physiological fight-or-flight activation is indicative of sympathetic nervous system hyperactivation, not necessarily a trauma response. However, we’re creatures of habit and each one of us is behaviorally conditioned to respond in a specific way when attacked. Some people freeze and go mute. Others respond aggressively. Rarely do people respond gently and with compassion.

Our conditioned response to an other’s aggression is primarily genetic (Blair, 2016; Panksepp, 1998). Some people are simply more aggressive than others. They’re born that way. Not all of our behavior is accounted for by genetics, however, about 40% of our conditioned responses are learned (Plomin, DeFries, Knopik, & Neiderhiser, 2016; Turkheimer, 2000). This is precisely the nature of Cain’s homework assignment, to study how he responds when provoked.

When he found himself in this conflict with his girlfriend, he noted his behaviors and brought them to therapy. Upon further inquiry, it was established that he didn’t betray her, that her accusation came from an underlying insecurity. This isn’t to excuse Cain having raised his voice, but to clarify the nature of his behavior. Why would he become aggressive at being falsely accused of cheating? Why not respond with empathy and comfort her?

Cain confirmed that he wants his girlfriend to trust him, and that he wants her to feel safe. However, his behavior in light of her insecurity had the opposite effect. This is the core feature of maladaptive schemas. They often perpetuate conflict and trauma instead of supporting a person’s efforts at fulfilling their psychological needs.

Let’s consider sex as an elementary example. When a young man wants sex and his partner rejects the advance, how attractive will he appear if he throws a temper tantrum? Will his partner be more likely to want to have sex with him if he pouts or throws a fit? Probably not. His efforts to meet his own physiological and psychological need for sex are self-sabotaged by childish and underdeveloped personality characteristics.

Psychological development is the crux of psychotherapy. 

There are numerous other examples to highlight how maladaptive schemas have unintended consequences. In Cain’s case, he wants to repair their emotional connection and develop more of a secure attachment with his partner, but he can’t help but get defensive and raise his voice when she’s feeling insecure. This pushes her away and creates more distance in the relationship.

According to Cain’s trauma timeline, pushing people away and creating distance is something he learned two decades prior to therapy. Violent aggression became a tool he used to take control in unsafe circumstances. When he was threatened or attacked, he’d rush in and establish dominance. This worked well with other males in the streets and behind bars. It doesn’t work at all in intimate relationships.

The therapist helps Cain make the connection between past trauma and present behavior, and encourages Cain to continue monitoring his behavioral patterns and thought processes, especially when the “knots” in his stomach are activated, thus continuing the evaluative process. Assessing present-day social functioning and developing productive self-awareness are the primary targets at this stage of the therapeutic process.