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  • Elle Stübe

RELATIONAL TRAUMA: misunderstood, misdiagnosed and the missing link

The subject of ‘trauma’ is currently experiencing a wave of unprecedented popularity and interest.


While for decades, trauma was a fringe subject relegated to a small group of pioneering therapists and those with a forward leaning interest in neuroscience, now through social media, trauma has gone mainstream - empowering people the world over to recognise and better understand trauma in themselves and others.


Despite this, the discourse on trauma mostly continues to focus on the more tangible forms of traumatic experience and to overlook the single most common form of trauma that humans experience – ‘relational trauma’.


And with good reason. Of all forms of trauma, relational trauma is arguably the most hidden form of traumatic experience. Occurring interpersonally, in relational trauma it is the relationship itself that is the vehicle of traumatisation – where the nature of the interpersonal interaction alone is sufficiently unsafe as to result in the same kinds of long standing impacts on a person, as physical or event based traumas.


Where many traumas involve an ‘explicit’ or outwardly visible aspect, relational trauma occurs in the ‘implicit’. The implicit is the subterranean realm of facial expression, eye gaze, tone of voice, posture, emotion, nervous system arousal and other information conveyed back and forth in human connection. As a result, overt evidence of relational trauma is often invisible – even to many therapists.  

Relational trauma is an overarching term under which there are many sub-categories of trauma. Relational trauma can occur between parents and children in early life and can thus include childhood trauma, adverse childhood experiences, complex trauma, developmental trauma, or attachment trauma. 

Relational trauma can also occur between adults and include trauma arising from narcissistic abuse, coercive control, bullying, stalking, verbal abuse, financial abuse, emotional abuse and so on. 

Relational trauma causes immense damage to people, for the way it hijacks our fundamental human need for connection and wreaks havoc in our most vulnerable selves. Precisely because safe relationship holds such a vital place in human development, relational trauma doesn’t just impact our mental state, but also devastates our emotional, physical and relational functionality and wellbeing.  


In this way, the many varied symptoms and outcomes of relational trauma can be easily misjudged, misunderstood or misdiagnosed in many mental health approaches - leaving clients with relational trauma frequently missed.


As a newly trained psychotherapist starting out in private practice, I could never have been prepared for the frequency with which I would encounter relational trauma in my clients. Trained to identify the physical, emotional, mental and relational signs of relational trauma, I soon realised that the issues my clients initially presented with, were often simply the long term outcomes of a far deeper root cause.  


Whether presenting with anxiety, depression, mood disorders, eating disorders, self harm, suicidality, addiction, relationship problems, parenting struggles, chronic health complaints or many of the myriad experiences we think of as ‘mental health issues’, what many of my clients shared was a history involving some form of profoundly unsafe relational experience.


Fifteen years on, I have now worked with hundreds of humans whose pain we would come to understand together as being primarily informed not so much by the things they may have originally thought were the problem, but by other less obvious yet formative experiences in their relational life.


Throughout the therapeutic process, clients go on to form brand new understandings of how certain relational interactions in their past, constituted potent experiences of abandonment, rejection, abuse, neglect, manipulation, violation or terrorisation. Over time we notice together, how those experiences have been laid down in their bodies, written into their nervous systems, crafted their sense of Self and informed their core beliefs.


Traumatic relational experiences are often something a client is entirely unaware of and where that trauma occurred in the first few years of life, there is no explicit memory of the experience. Identifying relational trauma therefore, requires a ‘whole of person’ approach in which all aspects of the client’s subjective experience are examined, including their bodily experience, emotional experience, mental experience and relational experience - not only in relationships outside the therapy room, but also paying careful attention to the moment to moment embodied relational interaction between us as therapist and client.


Throughout the therapeutic process, my clients come to understand that their experiences of relational trauma were not mere moments relegated to the forgotten past, but have lived on within them and come to pervade and inform every aspect of their selves and lives.


Frequently, identifying the impact of relational trauma on their development and wellbeing is the missing link my clients have searched for in a lifetime of struggling to understand themselves. Long confused by their own reactions, patterns of behaviour, recurring relationship issues, physical health crises, pervasive emotions and dominating desires, many clients with histories of relational trauma have sought support from a wide range of helping professionals, only to feel pathologised or even retraumatised by the experience.


Through using a ‘relational trauma informed’ approach, a new and more compassionate perspective can slowly emerge in which the client’s innate drive for safe and meaningful connection, is revealed as the fundamental through line in their life. Tracing this through line, we are able to develop a whole new appreciation of their intolerable inner pain, their inbuilt need and valid longing for connection and the adaptive ways they have spent their lives seeking out developmentally vital yet missed relational experiences.


Due to the complexity and depth of relational trauma’s impacts, working with relational trauma requires a distinct clinical paradigm. Firstly, it demands an embodied and somatic approach in which the bodily aspect of relational trauma is included in the work. Secondly, it demands an attachment theory informed approach in which the complexity and depth of relational trauma is understood in human developmental terms. Thirdly, relational trauma requires an understanding of interpersonal neurobiology – the specific neuroscience of human relationships.


Fourthly and perhaps most importantly of all, working with relational trauma requires a relational or ‘two person’ psychoanalytically informed approach – in which the therapist makes themselves authentically available to the client in a reliable, safe, empathic, attuned and consistent connection.


Ultimately, it is the therapeutic relationship itself, that over time becomes the transformational training ground, in which a client with relational trauma may at last experience relationship in positive and reparative ways - confirming that as with all trauma, with the right practitioner, recovery is within reach.






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