Author Archive: ACE Aware

Salutogenesis and ACEs, Part 1

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A few weeks ago, in the last part of our conversation with Henriëtte Markink, one of the topics we mentioned was salutogenesis. This is what we said about it: “This approach asks about the origins of health, leading to very different follow-up steps than western medicine’s more common ‘pathogenesis’ (the questions about the origins of disease). Salutogenesis is prospective (looking ahead – how can we maintain this?) and proactive (what does one need to stay healthy?) and searching from trust and confidence towards the good things in life. Pathogenesis is more retrospective (looking back – how did this problem arise?) and reactive (what can we do to solve the problem?) and working from avoidance (of risk factors). The founder of the concept, Aaron Antonovsky, described it like this: ‘Pathogenesis sees life as a river full of risks that you should not end up in. This view focuses on prevention (do not fall in) and treatment (do not drown, we will save you). Salutogenesis says that all of us are always in that river, because in life, anything can happen to us at any time. What to do…? Learn to swim!’ ” This week, we will take a closer look at this fascinating view on health.

Salutogenesis is a concept introduced by Aaron Antonovsky (1923-1994), a medical sociologist for whom two things were as plain as day: first, humans are always in interaction with the larger social context, and second, continuous change, disturbance, and deterioration are not the exception, but the rule. For that last process, he used the term ‘entropy’, which in sociology terms refers to ‘inevitable disintegration’. Humans are mortal. The road to the end of life is longer, healthier, and happier for one than for the other, but sooner or later we all take our last breath. That may sound like a pretty dramatic, pessimistic approach: is there nothing but misery, and are we all inherently flawed? What is the purpose of all our efforts? Strangely enough, the idea of inevitable disintegration is somehow full of compassion, full of softness and optimism: nobody is perfect; we are all vulnerable; each and everyone of us can fall prey to adversity; we all go through ups and downs and highs and lows on a daily basis. This, in full truth, is a realistic view on life that opens up a new perspective. It does not assume a smooth, linear life trajectory as the status quo. It leaves room to, without shame, be allowed to make mistakes, to experience things as difficult. This awareness connects us as humans with one another. To slow down the entropy, we can look for factors and processes that actively counteract the decline. We can, then, proactively strive for the things by which health (‘saluto-‘) is being created (‘genesis’), instead of nervously, incessantly preventing all that is dangerous and might threaten our health and wellbeing. The challenge, Antonovsky said, lies in learning to deal as well as possible with what life brings and make sure we can weather the storm… or the swell and surges, to stick with the image of the river.

In all of that, he did not view health as a dichotomy, a divide by which you can only be in one of two categories, in this case ‘healthy’ or ‘not healthy’. Antonovsky saw a continuum, a line on which people move back and forth: there are times they feel better and healthier than at other moments. Even if they go through tough times, however, they can still work towards maximizing wellbeing, given the circumstances. Even if everything seems to be working against them, people can tap into resources that bring light to the darkness. Even if you are really ill or heavily traumatised, comfort and reassurance can ease your fate.

Looking at health this way, the core question becomes: what do we need? How can we enjoy as long as possible the years we are given? What makes us feel happy and healthy and consider life as meaningful, even if there is disease or adversity? The interesting thing is that Antonovsky did not give a really concrete answer to these questions; he recognised that this can differ greatly per person, per context, and per life stage. He did develop a number of important ideas that do have a quite general validity and that are mentioned in the image above. We see, for example, above the upper blue arrow, the words ‘Generalised resistance resources’ (GRRs), resources and tools that can help you handle stress factors. Antonovsky described them as follows.

This means that these resources are effective to avoid or combat the stressors that life may bring to a person. What does that amount to? It can mean that you can breathe, relax, ease your mind and feel better again because you are physically able to go and do sports or take a long walk, because you have a sweet neighbour whom you can have a cup of tea with, because you live in a community where the atmosphere is good and safe. Those who have such resources available (and there are many others), will be better able to keep the faith and the courage when life hits hard, to pick up where they left off when things got rough.
Antonovsky’s work specifically asks us to pay attention to the positive things in life and go look for them very consciously, because they help us to swim through the river of life – or, put differently… to develop resilience.
When we translate all this to ACEs, we can see beautiful connections. We know, based on neurophysiological research, that the human brain is built and develops in response to the environment – the larger social context that Antonovsky took as his starting point. We can make an effort to organise society in such a way that we can optimally safeguard the positive influences on that development. Examples? Well-attuned, responsive adults are vital GRRs for a child. Teachers who see the child’s potential and support and encourage the child, create cognitive and emotional GRRs. A social environment that acknowledges children’s interests, forms a precious interpersonal and macrosociocultural GRR. A natural environment where people co-live with nature peacefully, stimulates (among others) physical, material and attitudinal GRRs.

Next week, we will look at the core of Antonovsky’s work: the Sense of Coherence, the confidence that your internal and external environment are predictable and reliable, and that somehow all will be well.

From Childhood to Life Happiness – our questionnaire, Part 2

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In last week’s blog, we made a reminder note and started to look at the first insights from our questionnaire – ‘From Childhood to Life Happiness’. After dedicating some thought to certain interesting demographics, we talked about how people tend to perceive and remember their childhoods, what makes childhood a favourable or rather a more sad experience overall, as well as which specific events or periods of time seem to weigh most heavily in the long-term. This week, we are following on that thought, asking ourselves what links do people identify between their childhoods and current selves, between their past and present. 

To begin with, all but one of the respondents identified a clear connection between their childhoods and the main current themes of their lives. The picture seems clear and powerful. Loneliness and a lack of connection in childhood seems to be linked to a burning desire of belonging and integrating into the surrounding social circle. Constant insecurity and lack of safety seems to lead to a persistent feeling of doubting one’s actions, immature reactions to daily stressors and seeking safety in the presence of others. Sometimes, people become painfully aware that their childhood trauma somehow leads them to recreating around their children the exact same sense of insecurity that was so difficult for themselves. A lack of recognition and space to show themselves might lead people to feel a lower state of energy in life, and a sense of ‘being too much’ around others, hence a tendency to close inside more often than not. 

Consistently, these themes are reflected in the daily life difficulties that people find themselves in. What our respondents mentioned with regard to this, is: not having faith in oneself or others and finding it hard to let go of people; experiencing fear of failure, insecurity and trouble in setting one’s boundaries in relation to others; having a generalized lack of confidence and not feeling good enough; or feeling a sense of depression. Sometimes, such difficulties either turn into or are accompanied by their first-grade cousins: bad habits. So far, it seems that bad habits can be put into two categories: socio-emotional habits; and substance-related habits. From the first category, people tend to ‘draw a wall around’ them and ‘play nice weather’, avoid hard situations in the workplace by quitting and fleeing ‘out of the blue’, panic easily, act too defensively, or are not able to handle critical feedback well. From the second category, ‘same old, same old’ – a lot of smoking, alcohol or drugs, used either recreationally or abusively, often starting at a young age and later on falling back into old patterns. A common thread across all of these? A reminiscent echo of insecure attachment.

 

Still, as we move towards the end of our questionnaire, the air in the room seems to change a bit. It becomes more fresh, more light, more positive; it brings hope to the table. It reminds us of a central pillar across all of our work and other ACE-related work: resilience. People often find unexpected sources of strength to survive, and hope is hard to beat. Despite the difficulties and life stories described in a nutshell above and last week, people generally report a state of ‘okay’ health, some better, some worse. It is true that chronic illness seems to have often settled in (once again strengthening the reported link between ACEs and chronic conditions), and feeling ‘ok’ is not really an ideal scenario of how we would hope someone to rate their health. Even so, people find sources of happiness and meaning, whether it is one’s children and grandchildren, dogs and other pets, the process of creation, being in nature, reading, enjoying music, cooking, volunteering or other forms of helping others and sharing one’s knowledge, connecting with people and sharing their stories, or the realisation that one has the power to break a ‘destructive family chain’. People go through (often long, complex and difficult) processes of healing. In one form or another, whether it involves therapy of any sort or not, people learn to develop strategies to live with chronic conditions. They find peace of mind somehow, and use their abilities to reach a fulfilling life. It does not always work and the road is tough, but these stories brighten our day and mind greatly. 

As one of our respondents put it, by managing to “break the cycle of trauma (and go through) a lot of work on myself, I am finally being able to understand my past and accept it”. Understanding, accepting, healing – not a bad way to put it.
Let us end on that note, with the awareness that we can all facilitate our fellow humans going through these stages if need be, by nurturing connection, by showing compassion, and by building the courage to listen to those life stories, as hard to hear as they may be. Noone is ‘beyond repair’, beyond any degree of healing. Our sincere, non-judgmental curiosity and understanding can create exactly that space for personal authenticity that people felt was lacking in their childhoods. If, through connecting with compassionate others, they can finally reconnect to themselves, if we can stimulate people’s perception that they do belong, they can finally grow towards feeling that deep sense of belonging in their own lives. 

From Childhood to Life Happiness – our questionnaire

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For this week’s blog, we would like to have a first ‘dive’ into the initial responses to our ACE Aware NL questionnaire ‘From Childhood to Life Happiness’, that we introduced in this blog and that can be found at any time here. With this occasion, we would also like to reach out to those of you who didn’t have the chance to see it yet, because we think it offers both a very good opportunity to reflect for any of us, as well as a valuable source of interesting data for research around ACEs.

With an average age of 45, our respondents are both from within the Netherlands, and outside, both raised here, and not, and both settled in the region for generations, as well as second generation Dutch citizens or expatriates. In other words, we are in for a treat – a properly mixed participant pool.
Is that so? One interesting detail is that so far in our small sample, 100% of our respondents are women. What might that tell us? Is our audience mostly female, or the ACE-science in general reaching more women? Are women more willing to talk about personal issues? Are the men in today’s society (at least in the Netherlands) taught to play ‘tough’ and avoid disclosing emotional stories that are sometimes deeply rooted in childhood? Or is it just a coincidence, so far? We don’t know yet, and we will have to see along the way as the responses come in, but we find it an interesting element to ponder upon nevertheless.

As we dive in a bit deeper, things start to get…well…messy. A first glance at how people remember their childhoods gives a strikingly troublesome image: neglect, abuse, bullying, loneliness, complicated family relationships, loss of a dear one, problematic sexual experiences, lack of safety, lack of emotional support… and the list goes on. It’s almost like reading a presentation on ACEs, or a description in a trauma-informed manual. Except, these are not book descriptions – they are real life stories that we read first hand. Immediately, the question comes to mind – is this a skewed representation, meaning that people who are interested in our material tend to be more involved in or oriented towards this topic and implicitly tend to have lived more troublesome childhoods? We are aware that painful experiences may be why our respondents participated in the questionnaire in the first place, so that their stories may be heard at last. Or, is this a hint indicating, as others have pointed out, that unhappy, traumatic childhoods are much more common than we dare or can bear to imagine? Again, we don’t know, and we will have to keep analysing more data as more people start to fill out the form and share their narratives with us. This first impression, however, once more feeds our curiosity for the topic; it also strengthens our compassion for all those among us who, often invisibly, carry with them the scars from their early days. What should be a carefree life stage, a happy past nourishing a fruitful future, is clearly still a triggering and often unsettling present for many.

And then, what are the threads, the moments, the experiences that leave the strongest marks, and stick in our memories and bodies forever? What are the defining characteristics of childhood that are formative for the development of a person? What do people point out first, when ‘caught off guard’ and opening up in their vulnerability? Well…it depends. Sometimes, it is a one time event, like the birth of a sibling, the death of a parent, or an illness in the family. Other times, it is a transitional period, like learning how to breastfeed, figuring out how to deal with strong feelings and life challenges, or even the time spent in the mother’s womb. Sometimes these events also play a role in making the perception of our childhoods good or bad, joyful or traumatic, a pleasant dream or a nightmare. Often, a common narrative seems to be, perhaps not surprising at all, the emotional environment in which the child grows up, the quality of parent-child attachment: a toxic relationship, a perceived lack of love, persistent bullying at school without any buffer at home, or, moving to the other side of the spectrum, making a parent enjoy your milestones, feeling emotionally understood and listened to, a good ‘life energy’ being instilled from the start. Whatever the case may be, one thing becomes clear – life stories cannot and should not be considered a mere collection of consecutive events to be treated as numbers in a statistical pool – they are much more than that. It matters how people feel all the way through their life journey, starting in early childhood. These are biopsychosocial processes doing their neurophysiological work: they have the worrying potential to build a road from a lack of feeling safe and secure in childhood to a difficult life in adulthood.

Next week, we are going to address exactly that, the link between childhood and adult life, between the past and the present. These links only come to light because of your insights and stories, that we appreciate deeply. Therefore, until then, if and whenever you see fit, feel free to have a look at our ‘From Childhood to Life Happiness’ survey and know that we welcome you to fill it out. Thank you in advance for doing so or for sharing the link with others who may be interested!

Professionals and ACE-awareness; Episode 2 – This time: Henriëtte Markink, Part 3 (final)

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Last week, we spoke in detail about the diverse aspects that Henriëtte sees as the essence of her work. Inextricably connected to that, for her, is the importance of a childhood during which babies and young children can be gracefully little and playful on the one hand and in which, on the other hand, not all things hard and complicated are kept away from them. As we have learned, experiencing and understanding intense events will prepare you for what life has to bring. “I regularly notice that ill family members, for example, are hardly or not at all talked about, about what their illness means for all involved. There can be a lot of grief in life and I often think: ‘Go ahead, deal with it!’ Do not allow children to give these things a wide berth, but let them go straight through it, obviously with the support of a stable adult. You don’t have to be rich or highly educated to do this, as long as everything can have a place. Sometimes it seems as if everything in our society has to go well. I speak with people who are mourning and they say that in our present-day communities they have no place to go to with their sorrow. After three months, they say, you just have to get back to ‘business as usual’ and I recognise that – supposedly, things are only allowed to go well for us.”
I ask her whether she thinks that the concept of ‘toxic positivity’ plays a role here. This is a form of excessive positivity that minimises or invalidates authentic and tough emotional experiences of others.
Henriëtte: “Yes, I think that we often make things seem too positive; maybe everything around the lockdown is interesting seen in that context. Now, it feels very legitimate to say you are not doing so well or that things are hard on you.”


Related to this, we speak about toxic stress, a resulting form of chronic stress. She speaks about how she uses the work of Peter Levine to address this stress through bodily exercises and how she has started to read in Stephen Porges’ book on the polyvagal theory: “A client of mine spoke about that, and is very excited about the fact that we now do exercises based on that theory.” The polyvagal theory explains how important our sense of true safety is for the parasympathetic part of our autonomous nervous system. “When I explain to people that the effects they feel due to their lack of security are purely biological, they are often very relieved. Many keep hearing from others that they are strange or that they do everything wrong, if they do not succeed in going through life with more peace of mind.”

We return to a little detour we made before about the influence of survival strategies from childhood, how they can be effective initially to keep it together, but become disruptive and sometimes even self-destructive in the longer run: because of psychological trauma or ACEs, people often lose the connection to themselves and experience a deep division within themselves. I mention the idea of loss of authenticity following the lost connection to self. “Hmmm… I don’t know about that… in my experience, many of the people I see really rather have their own character, but they are often quite unstable ánd quite sturdy, sturdy in their instability. That is the ambiguous part: there is also a lot of strength in the vulnerability of trauma. People can be so lost to themselves… they get all tangled up in their history and no longer know where their roots are, where they come from. Everything that happened, has become one big knot that together we then try to unravel.”

I listen carefully and somehow get the feeling that regarding ‘authenticity’ we are having two different conversations. I explain that in this context, trauma expert Gabor Maté speaks about the coherence between the innate urge to connect with others on the one hand and the need for self-expression on the other: attachment versus authenticity . His position is that if a child has the feeling that their unique personality can not be shown, because one way or another it does not fit with what is comfortable for the parents, that uniqueness will lose out in favour of the attachment relationship. After all, a child cannot survive without the parents, so there only seems to be one way out: suppress the authenticity and be seen a little less (as discussed last week),  be less enthusiastic, dedicate less attention to personal interests or development… anything to make sure that the attachment relationship is not (further) disturbed.

Her face lights up: “Aaaah, yes! Explained that way, I see what you mean! That also explains the loyalty to parents after incest experiences, for example… at least you remain attached somehow that way. Wow, this is beautiful!” I recognise her eagerness, as I had a similar feeling when I read about the importance of prosocial behaviour as described by anthropologist Sarah Blaffer Hrdy. As humans, we are so wired for connection and attachment that we do not passively wait for it to happen, but that already as babies we actively seek out contact: the nicer people think we are, the bigger our chances for survival.
Therefore, Blaffer says, like Frans de Waal and Rutger Bregman (two authors on empathy research), that the idea of innate egotism is a myth. The problem is, however, that it is truly very hard to remain prosocial if you are on guard the whole time due to the experience that sooner or later, you will be ‘spit out’ again, as we also discussed last week. The sympathetic (‘fight-or-flight’) system will then take the upper hand at the expense of the normal functioning of the parasympathetic (‘tend-and-befriend’ or ‘calm-and-connect’) system that calms us down again. The last two, with the oxytocin hormone as one of the leading actors, are under severe pressure these days, because many people experience only a minimal amount of positive social interaction. Thus, levels of stress hormones remain higher, with short tempers and lack of patience as a consequence. Clearly, positive interaction is also crucial in childhood. Sometimes a child has to turn down their authenticity; a child cannot get away from the family system (without severe repercussions) and can only try to make the best of life within that constellation. If you have to become a little ‘invisible’ to earn your mother’s love, then that may seem the best way to survive. After the first 1000 days, such behaviour can already be strongly internalised – a very sad situation with great impact in the long term.

Henriëtte has been listening closely: “Really, this is terrific. This is something I can explain to my clients; then we are back more or less, with the psychoeducation we discussed before. Really, I think this is going to be the future, much more attention for the parasympathetic system: how can we activate that part of the nervous system and what do we need to achieve that? That also includes lifestyle and doing things you really like. I started a vegetable garden, for example, and with it, I have already been able to inspire several of my clients: they get a lot of energy from having their own!”

The ‘calm-and-connect’-system activated: secure closeness

We laugh out loud together when I say that her remark reminds me of something again: “Not another book, no?!” It is such a treasure to see how we mutually provoke further thoughts and ideas. This time, the concept of ‘salutogenesis’ comes up. This approach asks about the origins of health, leading to very different follow-up steps than western medicine’s more common ‘pathogenesis’ (the questions about the origins of disease). Salutogenesis is prospective (looking ahead – how can we maintain this?) and proactive (what does one need to stay healthy?) and searching from trust and confidence towards the good things in life. Pathogenesis is more retrospective (looking back – how did this problem arise?) and reactive (what can we do to solve the problem?) and working from avoidance (of risk factors). The founder of the concept, Aaron Antonovsky, described it like this: ‘Pathogenesis sees life as a river full of risks that you should not end up in. This view focuses on prevention (do not fall in) and treatment (do not drown, we will save you). Salutogenesis says that all of us are always in that river, because in life, anything can happen to us at any time. What to do…? Learn to swim!’

Henriëtte smiles enthusiastically: “If you would ask me now what the essence of my work is, I would say: learn to swim together… and sometimes maybe to be a cheerleader on the shore, to encourage the swimmers!” Many people can do with some positive encouragement, she says. “Many people are so lonely; there is a lot of pain and people often are very accusatory and punitive towards themselves. Often, they had a difficult place or role within their family of origin and often they suffer from disorders and complaints that make you wonder: ‘If only one person would have taken a close look at this story, it would have been clear that this is not normal and that there must be much more behind it. Temporary blindness, a sudden stutter, behaviour like pulling plants from their pots… we cannot keep looking away from things like that only because we do not know how to handle them. We have to study them much more closely. That also leads to the question: ‘How to approach parents who have given you the impression that they are not creating a secure base for their children to grow up in?’ That is difficult, because there, too, a punitive approach is probably not going to do any good.

I ask which policy changes she considers necessary and where she sees opportunities to create them. “I think that the increased attention for psychotrauma is a positive point. Finally, it can be mentioned. I am well aware that I may be in my own bubble when I think there is no way to escape books and tv programmes that deal with this topic and that all of it is already obvious to everyone… it is probably not yet completely obvious, but I really do see progress. There is a lot of knowledge to share, but I feel I am also never done with knowledge collection, as there is always so much left to learn! I remain curious, for more knowledge, but also towards the people I see. In listening to them, it is all about pure attention. And the most important is to give that attention without judgment. People are often very judgmental towards themselves and if you as a professional don’t judge, they can have a more compassionate and less judgmental look at their own history and learn to understand it.”

By now, a few weeks have passed. Through e-mail and telephone, we have been in touch about the blog texts and we both look back at our conversation with great delight. Shortly, I will visit Henriëtte and interview a colleague of hers for still more fascinating stories!
A few days after Henriëtte’s visit, Stephen Porges’ book was on my table, a tip she gave and one of the titles that had been on my reading list for a long time. I have started reading it by now and will dedicate a blog to it in the near future!

Professionals and ACE-awareness; Episode 2 – This time: Henriëtte Markink, Part 2

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Last week, we discussed Henriëtte Markink’s start of her work with people with trauma. Today, we travel on with her, on our way to more ‘value-ful’ insights of her discovery journey.

I ask about her workplace and she tells how, as a nurse practitioner/trauma therapist, she presently works in a small organisation for mental health. “In the smaller practice where I work right now, we strive for short communication lines and also for short waiting lists. Someone who had had to wait for a long time once said to me: ‘I had a terrible winter. I could easily have been dead.’ That person was very angry with me, and I understood that, even though I had done my utmost to get that client their turn as soon as possible.”
I look at her and try to read her body language. “It sounds as if for you, there is an ethical component to those waiting lists…?”
She nods with a fierce look on her face: “The waiting lists for psychotrauma treatment, sometimes up to three quarters of a year, are really a big and nation-wide problem and I most certainly consider that an ethical issue. I do suspect, however, that behind those waiting lists, there is a political game related to health insurers and their conditions towards health ‘buyers’ [organisations that contract health care – the way this works in the Netherlands], but I do not know enough about that, so I’d better not venture an opinion on that.”
She holds her hands alongside her face in a gesture of wearing blinders: “At a certain point, I decided to maintain a proper distance from all those political and policy issues, to no longer get all frustrated about them, and to only work from a patient-oriented perspective.”

This brings us to the essence of her work; I explicitly ask how she would define it. “The essence of my work…” She looks thoughtful and thinks in silence for a bit. “Yes, that I find a tough question… there are many things that come to mind… Of great importance in working with people with childhood trauma is to give them hope, to deguiltify them, to give them the space they themselves do not take up… but in the end, the essence is careful listening, because people have a chronic need to be heard and seen. That applies to everyone, of course, but if you have been ‘pulled from the clay’ [as the Dutch saying goes] in a nice way, if you have been raised well, there will not be this incessant need in adulthood to be both seen and not seen at the same time.”

We continue to talk about ‘not wanting to be seen’: “This morning, I had an online group treatment session with a colleague and we asked everyone to stand still and pay attention to how they felt, how things were right now. For many, this was very confronting. Some said: ‘I want to LEAVE!’ Someone else said: ‘This was a HORRIBLE hour!’ This person hardly made it through.” I ask how that was visible, now that so much has to be done with the help of computer screens. Henriëtte breaks open in a big smile: “Oh, that was very clear!” She turns her head and averts her eyes, looks at the ceiling, to the left, to the right, at her shoes: “This person was constantly looking around and it was very clear that the theme we discussed, was a topic to be avoided. That is very hard to notice, because finally there is a group where people do listen, but then this person cannot find the courage to be heard, because they failed to be heard all throughout their lives. These people are so hit and hurt and harmed by all that happened to them, that the confrontation with their pain in a loving, attentive environment is almost too much for them. That is why I always strive to listen to people with compassion and without judgment. You have to teach them to feel that they really deserve to be heard. So often, these people have not been listened to in the most dreadful ways…”

We get to the question of how trauma is defined in her work environment. She indicates that they stick with the description of the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders. For PTSS, this comprises among other issues sexual abuse, physical abuse, witnessing a sudden death, and their effects, such as nightmares, avoidance and mood swings. She differentiates between situations where a person is or is not well supported after serious events; this support, she says, can make the difference between developing trauma or not. This reminds me of the description of trauma by Gabor Maté: ‘‘Trauma is a psychic wound that hardens you psychologically and that then interferes with your ability to grow and develop. It pains you and now you’re acting out of pain. It induces fear and now you’re acting out of fear. Trauma is NOT what happens to you. Trauma is wat happens inside of you as a result of what happens to you.’

Henriëtte thinks along: “That is a beautiful description! What I find problematic is that neglect and bullying are not in the DSM, although they have a huge impact. Still a lot has to change there. And at the same time, the word ‘trauma’ also seems to have become a ‘waste bin’ category for all kinds of problems. When something doesn’t work out, people sometimes say: ‘It gives me a trauma!’ On the one hand, you make it too simplistic that way, but on the other hand this might be a sign of this topic slowly but surely getting more attention from society. When I became a sociotherapist, almost no one wanted to work with traumatised people. Do you know the book by Judith Herman? It was my ‘bible’, and in fact it still is. Wholeheartedly recommended.”

Why Judith Herman’s book is still her ‘bible’, is because it is still very current: “Herman explains how the question of whether or not trauma can be discussed, is very closely related to societal trends regarding the topic. Somehow, you know, all of us do NOT want to know at all those appalling things that have happened. We do not want to know about sexual abuse, about physical abuse, about parents who do that or let that happen. We do not want to be able to imagine all that – it is too painful. Now that we have more treatment options, it seems as if there is more room to discuss these issues. Despite all that, the work with traumatised people is still highly complex and if you are not transparent and ‘down to earth’ towards your clients and you harbour a hidden agenda, then things get out of hand. You will get friction and people will start looking for the boundaries. They are very good at that, because they have had to do so all of their lives. Then you get into this atmosphere of: ‘I will try and see whether I can really trust you or not. When will you, too, spit me out again, because you are fed up with me?’

We look at each other and let the intensity of such a primal perception sink in. “Some people are so damaged… their whole lives, they have not experienced anything different than that. Because we know more about neurophysiology now, it is a bit easier for therapists to understand what happens if people show behaviours that are hard to deal with and, to then sit and lean back and not become personally triggered. It happens… I’m human, too, and then I realise they have touched upon my own vulnerabilities … (she laughs), but with more professional experience it is much easier to return to and to establish or restore the connection. Connection… that is also part of the essence of my work. It may take a long time before that needed connection is there, but when it’s there, it’s there!”

We talk about what gives Henriëtte most satisfaction in her work. “The progress, the growth, the fact that people learn to see how powerful they really are, how much strength they have. Many of my clients feel extremely vulnerable, despite their apparently normal lives, with families, jobs and studies. I always try to point out how powerful they are, because otherwise they would never have been able to make it until here, straight through all of the misery. Many people with childhood trauma have comorbidities: numerous issues intermingle, but they are not always being linked to trauma. Then people sometimes get a message that more or less says: ‘Well, sorry, but your problems are too complicated; we cannot treat those with method X or Y.’ People are often given the runaround… In many places, there is still a need for much more psychoeducation to make sure that both in healthcare and in society at large, we call come to understand much better why people turn out and behave the way they do, about how their personality has been shaped.
That childhood plays an important role in many problems and disorders, and should get much more attention, is a true fact according to Henriëtte: “I wish that children would be much better listened to, also in youth care and social services. When thinking of all the adults I see, I’m not so sure I would be able to help them if they were children. I think I might feel too overwhelmed, too afraid of a bad ending. The adult clients at least survived until now! It really makes me sick, to see what children and young people have to go through right now due to the lockdown. Overall, I think child wellbeing is not given priority in our society; there is too much focus on achieving, even when they are still babies. Sometimes, at the age of three months, it seems they are already supposed to eat vegetables…” She wiggles to and fro on the couch and lets her head fall from left to right and to the front: “Spin… spin… spin…” We laugh about the sad image of a baby who cannot sit yet, but from whom so much is already expected. “Just let them be babies!”

That is a great motto: give babies the space to just be, with all needs attached, while simultaneously being aware of the fact that in all of their vigour and vulnerability, babies are full-fledged humans with rich emotional lives. When we respect their needs and feelings, we help them to view themselves and the world with compassion.
Next week, we will continue our journey with Henriëtte and we will, among other topics, address security and authenticity.