The Hidden Driver That Makes Complex Trauma Difficult to Treat

When the Nervous System Intertwines Safety and Threat

I tend not to think of things primarily through the lens of attachment styles when working with clients, because they can overemphasize a sense of stable categorization that doesn’t fully capture how dynamically state-dependent1 relational organization2 actually is. While these frameworks can be useful for understanding relational patterns, behaviors, and dynamics, they are better understood as strategies an organism relies upon to maintain connection, regulation, and self preservation. These strategies are, however, sensitive to shifts in perceived threat, levels of intimacy, and internal capacities—such as access to boundaries or the ability to reach toward another—whether with an intimate other or within a therapeutic container, and this variability becomes especially evident during trauma processing, when activation of specific memory networks can shift relational organization and capacity in real time.

Under conditions of increased threat, particularly when relational support is simultaneously needed, some individuals will exhibit forms of disorganization—by which I mean a temporary breakdown in bottom-up processes when attachment needs and threat responses are activated at the same time—even if they would not typically be categorized as having a disorganized attachment style. In these moments, the system reflects competing and contradictory tendencies under conditions where attachment figures are simultaneously experienced as sources of threat and potential regulation, producing an unstable form of continuity rather than coherence3.

In my clinical experience, there appears to be a set limit by our primitive system4 to what trauma can be processed outside of a relationship, which I paint out in my Relational Corrective Capacity Model (RCC). And by processed, I mean genuinely resolved rather than managed or understood. Although reframing, reparenting, self-compassion, and spiritual practices can be needed and helpful, they rarely lead to resolution for the fragmented self on their own, as the needs of a younger, less developed and more vulnerable self often require something relationally external. Unfortunately, I think this is profoundly misunderstood in mainstream mental health discourse, which often overestimates the capacity of self-directed practices to resolve trauma leading to a slew of confusion, mental noise, stagnation, and failures in therapy for many people struggling with complex trauma.

Back to tracking disorganization. I think of it less as a static trait and more as an emergent state that becomes visible when attachment and survival systems are simultaneously activated and bound together under relational pressure. In chronic presentations, this state can be so persistent the client does not recognize the persistent background fear, bracing, and anticipatory vigilance they’re managing and enduring within the relationship to the therapist. Clinically, this makes moment-to-moment tracking essential, because disorganization can easily be missed when it is embedded within the client’s habitual relational strategies. And if it’s missed, the therapeutic relationship can inadvertently begin to organize around the same push–pull dynamics, rather than offering a secure alternative to them.

I remember a practitioner I worked with long ago, in earlier stages of my own treatment, praising my increased capacity to tolerate physical touch and relational closeness in the presence of overt fear and panic. What was overlooked throughout my treatment was that the panic and fear was fundamentally relational in nature—my system was simultaneously orienting toward connection as a source of regulation while registering that same relationship as life threatening. In that state, I was continuing to move toward the relationship while a survival response remained fully active, distorting perception, meaning-making, and gatekeeping any possibility of trust, while receiving positive reinforcement for remaining in proximity to it.

This created a long arc of reenactments of an early relational environment in which closeness and threat were one in the same, and in which proximity to the attachment figure required enduring terror in order to maintain connection, leading to unnecessary destabilization, confusion, and disorganization. Over time, this added additional layers to my early wounding that connection, care, and nourishment are accessed through tolerating escalating internal threat, even in therapy. In this way, the therapeutic container came to calcify the preexisting disorganization as the pathway toward resolution, quietly holding the lofty expectation that “healthy attachment” or “safety” existed on the other side of it, something I later realized is impossible to access within those conditions.

I’ve seen this disorganization within the therapeutic relationship more clearly over the years in my clinical work. Clients will need relational support from me, while simultaneously experiencing a background and often hidden anticipatory fear about me—what I might do to them, how I might hurt them, or reject them. A client might reach toward me for something to hold onto and report some initial relief from the fear, but when I dig deeper and track it carefully, another fear will pick up speed right behind it, arising from that same contact they initially reached for. This does not tend to reduce the reaching; instead, it often intensifies it.

The need for me increases at the same time as I become more psychologically dangerous in their internal experience, creating a bind in which they are pulling toward me for support while also bracing against me as a source of threat. This often leads to a tightening grip on the relationship—more contact, more checking, more urgency—while the fear escalates in response to the tightening, rather than soothing. The system becomes caught in a negative feedback loop where the very act of using the relationship for support adds more fuel to the threat system, making the relational support they’re reaching for even further out of reach, until the growing pressure is relieved through stagnation, collapse, relational rupture, or a lateral discharge of activation that breaks the loop just enough to move it elsewhere before the cycle starts again.

In my view, this is the crux of complex trauma and what often makes it so complex in treatment. The very thing clients need to access in order to integrate their fragments is also the same thing that fragmented them in the first place, relationships. And the more dependent and helpless the individual was when these events took place, the more they’ll need to rely on the relationship to reenter these traumatic memories, while less able to discern the practitioner from the threat-induced relationship that initially hurt them. Without addressing this properly, this will often lead to a profound futility in treatment, and at times in life, as it keeps someone stuck in a psychological purgatory that can’t be resolved or escaped on their own, and has them reaching for something that should help, but never truly does.

I often wonder how much this phenomenon contributes to individuals with significant complex trauma struggling to heal in therapy, or seeking out alternatives that de-emphasize the therapeutic relationship while emphasizing self-reliance or a detached fervor towards spirit. Or how the very thing our biology is wired towards is being misattuned, missed, or diverted to a different source due to the training, culture, or countertransference the therapist or facilitator inhabits, further leaving a client isolated in their process. Because even if there’s disorganization in the reach for more closeness or relational support, there’s still a genuine need waiting to be met underneath it.

I continue to be struck by how frequently this pattern is present with clients who have explored years of therapy prior to stepping into my office, including somatic and psychedelic approaches, and how often it remains untracked or unaddressed in therapy and trauma-informed trainings. In my view, this remains one of the most under-recognized mechanisms in complex trauma treatment, and I hope to shift that through articles like this and a workshop I’m currently developing. In a time when human intimacy and attachment seem to be increasingly undervalued, outsourced, feared, or avoided—as I’ve seen reflected in cultural patterns and technology like AI attachment surrogates—I find it even more crucial that people can identify and seek out trustworthy connection that is not tainted by the fear of their relational history.

I believe identifying this pattern, and determining what conditions need to be in place for connection without disorganization to become available falls on the shoulders of therapists and practitioners, not clients. We should be relying on our clinical expertise to recognize it, and to find a way to build a different relational template they can move toward. Our role is to offer something that can be taken beyond the therapy room, shaping how connection is experienced, created, and sustained in their lives. Because some clients will not know another option exists until they experience it within a relationship, and that first relationship may be with you.

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1State-dependent: memory that is most easily accessed when the same internal state in which it was formed is reactivated.

2RelationalOrganization: the internal structure through which a person experiences and navigates relationships.

3Coherence: the capacity for experience to remain sufficiently assembled across affective and sensory channels, allowing presence to experience even under high activation.

4Primitive System: the non-conscious survival systems of the organism, including autonomic, affective, and implicit memory processes through which internalized relational models of self and other are automatically organized and enacted