Trauma theory emphasizes working with the deadening of affective consciousness by this other bodily-based survival defense, dissociation. Clinicians are learning to differentiate the two and recognize the latter.

But, yes, the idea about disruptions and repairs came out of the developmental data and was incorporated into my modern attachment theory. My writings emphasize that rupture and repair, both in the developmental and psychotherapeutic contexts, involve important opportunities for interactive regulation of dysregulated affective states.

At the most fundamental level I’m interested in the mechanisms of change, especially in the early developing right brain self system. To use an earlier language, what I’m exploring is how the object relational sequences between the mother and the infant shape emerging psychic structure. In more modern terms these are investigations of interpersonal neurobiology. An interpersonal neurobiology of human development enables us to understand that the structure and function of the mind and brain are shaped by experiences, especially those involving emotional relationships, and to understand how brains align their neural activities in social interactions.

The tie in from my developmental work to my clinical work is that the same right brain to right brain social emotional processes that are setting up between the mother and the infant later play out in the therapeutic alliance. The model links the right brain growth in early development with later changes in the social/emotional context. And as you pointed out rupture and repair are potential contexts of emotional growth. So I’ve paid attention to the work of other developmental psychoanalytic researchers like Beatrice Beebe and Ed Tronick and Karlen Lyons-Ruth, who are also studying ruptures and repairs.

In my most recent writings I’ve focused on the essential role of these repairs in re-enactments of attachment trauma, which really is at the heart of the therapeutic change mechanism. I’m describing how both patient and therapist co-construct both the rupture and the repair, and that these ruptures are not technical mistakes, but literally—

AS: Beautifully put. Enactments represent communications of previous ruptures that triggered negative affects so intense and so painful that they were dissociated and banished from consciousness. As the therapy progresses and the attachment bond in the therapeutic alliance strengthens, there is enough safety for the patient to dis-assemble the dissociative defenses and let the affects come online more frequently. And then, what has been buried and packed down underneath dissociation surges into bodily awareness in the presence of a regulating other, now offering a possibility of interactive repair.

Jung, who studied dissociation, described how the enduring emotional impact of childhood trauma “remains hidden all along from the patient, so that not reaching consciousness, the emotion never wears itself out, it is never used up.” He also stated the trauma may suddenly return: “it forces itself tyrannically upon the conscious mind. The explosion of affect is a complete invasion of the individual. It pounces upon him like an enemy or a wild animal.”

In my model of “relational trauma” I’ve suggested that it’s not just mis-attunements that lead to the traumatic predisposition. It’s also the lack of the repair, and that repair and interactive regulation requires a very personal, authentic response on the part of the therapist. Attachment trauma was originally relational, and so the healing must be relational, a mutual process. In Sullivan’s words, the therapist is not neutral and detached, but a “participant observer.”