A client, whom we will call Doris, was 50 when she first came to see me. She brought with her a long list of ongoing issues—chronic dissatisfaction, simmering anger, ruptured relationships, sexual dysfunction, depression, anxiety and low self-esteem.
Doris first presented as confident. She had a wicked sense of humor that would sometimes cross the line into personal attack and cruelty. Doris explained that she began seeing therapists in her early 20’s with no measurable difference in her depression or anxiety. She was quite surprised when I mentioned trauma during our intake session. She said that the word “trauma” had never been mentioned in her 30 years of treatment.
As we talked, I recognized that, in the past, Doris’ story would have tugged on my own childhood adaptation to “make things better.” But experience and the wisdom of the AIP model have taught me that attempts to soothe, manage or fix the pain provide only temporary relief—a “state” change. When the relief fades—as it inevitably does—clients like Doris find themselves wrestling with the same issues they sought therapy to address.
I believe that Doris had been experiencing, at best, that temporary relief during her 30 years of therapy. There had been work on specific problem behaviors or feeling states and attempts to ease her pain without ever recognizing or addressing the real problem—her childhood experience of trauma and neglect. What Doris needed, I thought, is a “trait” change—the kind of healing transformation EMDR therapy can provide.
Listening for the Truth Underneath the Symptoms
I once read that disowned feelings are like strangers living in your house—except for the food they steal, the furniture they leave out of place and the mud they trail down the hall. Disowned feelings are a product of unprocessed trauma. The trauma buries our emotions alive and that's where the suffering starts.
As I listened to adult-Doris’ long list of struggles, I could envision child-Doris, attempting to please her parents, making herself small, asking for very little—just trying to survive in a home where she was not seen, valued, or loved. I believed that the symptoms on Doris’ list were the psychological, behavioral and emotional manifestations of problems with deep roots in attachment wounds where she was hurt and there was no repair; where developmental milestones didn’t get met and neglect denied her the kind of attention and support all children need.
As an adult, the things Doris did to survive when she was a child; the sense of self she never developed; the unprocessed grief for the neglect she experienced at the hands of her parents; the inability to relate to other people authentically all contributed to her present pain. Even Doris’ body screamed at her for years with chronic health issues and pain—clues that the painful emotions stored in her body were unhealed and blocked from her awareness.
When Doris came to me, she felt discouraged and overwhelmed by the persistent pains and problems that plagued her. I, on the other hand, was hopeful. Why? For many years, I’ve had clients with histories of ongoing childhood abuse and neglect. And I’ve learned that I can help those clients by using the AIP model for case conceptualization and treatment planning along with EMDR reprocessing. I believed that Doris and I could collaboratively transform her pain into a life worthy of her.
AIP Is My North Star
I want to pause here to say a few things about using The AIP Model—something that I believe has made me a better therapist. I call it my “North Star” because that’s the only star in the night sky that remains stationary. And just as the North Star has guided astronomers and navigators for centuries, the AIP model is, for me, the certain and dependable starting point for mapping a way through the rough waters of trauma work.
EMDR’s AIP model helps me zoom out and conceptualize the larger clinical picture instead of getting caught up in the details of a misery list. It helps with mapping out a treatment plan that leads to true and permanent healing. It provides the frame that frees me to ask: What do the symptoms tell me about this client’s problem?
Doris’ Childhood Experiences
In Doris’ case, the AIP model allowed me to be curious with her about her childhood experiences and the ways she learned to act in response to them—behaviors that cause problems for her now as an adult.
Doris’ childhood experiences of brutal criticism, absence of parental attunement and connection, profound neglect and on-again, off-again sexualized attention from her father left her starving for affection and willing to accept morsels as a full meal.
The message she received from her parents was that she didn’t matter. What mattered was whatever her parents needed in the moment. She gave up “Self” in the service of a mother who was never going to see her or delight in her presence and a father who had looked her way only when he was in need.
Onward to Permanent Healing
These childhood experiences help explain Doris’ vacillation between submission and fighting; appeasing and resentment; pleasing and devastating sarcasm. It also helped us make sense of her emotionally barren marriage which replicated her own family dynamic.
The AIP model made clear that the necessary work was to help Doris develop a sense of self, separate and apart from what she saw and didn’t see in her parent’s eyes. The goal was for Doris to become a fully authentic adult.
Doris came to understand that making herself small was a once-necessary survival strategy to maintain any shred of an attachment bond with her parents, but it left her fighting to be seen, resistant and, at times, shocking to others when she was desperate. Doris was also able to see how her childhood adaptations left her depleted and enraged in her adult life.
AIP case conceptualization delivered the framework of understanding that helped free Doris to reprocess those childhood experiences—both the acts of commission and more importantly, the pervasive acts of omission.
The AIP-informed treatment map gave Doris the hope and courage to identify and reprocess many present triggers that had memory networks of their own. Most importantly, the reprocessing of the past and present finally allowed her to grieve the significant losses her symptoms helped her avoid. It also revealed the developmental deficits we needed to address. For example, she needed to recognize her own needs and learn how have them met, rather than assume that others would know, leaving her chronically disappointed. She needed to learn how healthy relationships work and what it takes to nurture them in her life.
Thanks to the AIP framework, the North Star that guided me in this and all my cases, Doris has claimed who SHE is. Her current friendships are healthy. She responds authentically. Her life is increasingly fulfilling and her capacity for intimacy continues to grow. She has even developed compassion for her parents— particularly her mother. It’s been a long journey, but the family legacy of complex trauma now stops with her.
As you can see, I rely on AIP as my guiding light, my North Star. I trust the fact that we can always find direction and map out a path to healing with this brilliant model that’s built on the belief that our systems and brains will always move toward health and healing when given the chance.
How great is that!