The Incredible, The Amazing, Lithium!Laurie Kahn, MA, LCPC, MDA is a pioneer in the field of trauma treatment and the author of  Baffled by Love : Stories of the Lasting Impact of Childhood Trauma Inflicted by Loved Ones Love). For more than 30 years, she has specialized in the treatment of survivors of childhood abuse and has trained hundreds of clinicians through her Trauma Consultation Training Program.

It feels like so much of the work that you write about doing with patients is based on relationship skills. With such a relational approach, how do you not get totally wrapped up, how do you have boundaries?

I see boundaries as part of healthy relationships. And I think of mutuality as being about a relationship that works for both people; both people have to feel like their boundaries are respected, known and articulated. I really don’t think there’s any way to do this work without being deeply invested, but that doesn’t mean you give up your life or more time than makes sense for you.

It’s such an act of courage for the client who has been abused by people who professed to care about them and love them to walk into therapy . I think they’re often terrified of their own tender feelings toward their therapist, as well as their anger and their fear. The relationship itself can be extremely daunting.

There are a few times in the book where you write about making mistakes or doing something that triggers the patient. How do you approach mistakes in therapy?

It’s not a trivial question, and in some ways it’s part of what’s at the heart of this book for clinicians who read it.

When people are abused as children, there is no accountability. Very seldom does someone abuse a child and acknowledge it or acknowledge the impact the abuse  had on their development, feelings or psyche. It mostly goes unacknowledged, with no expression of regret. So as I look through the lens of my clients having experienced a traumatic experience of love, I want to create a very different emotional experience.

To me, mistakes are an opportunity. There’s no way to work with people and not make mistakes. Mistakes  are inevitable. Mistakes are part of human relationships. There’s a difference between unintentional mistakes and malicious mistakes. There’s also a difference between hurting someone and not taking responsibility for it and hurting someone and expressing regret and doing repair. To me, acknowledging mistakes, taking responsibility, having our clients watch us reflect on what we did wrong or how it injured them and then making repair in a way that they feel deeply understood and heard deepens the trust and sense of connection.

To me, what happens after a mis step  is a really important moment. . Acknowledging mistakes and making repair is one of the ways we get to teach different models of relationships.

They’re an opportunity to show that I want my clients to know that conflict does not have to be dangerous, but that in a good relationship it can deepen people’s ability to understand each other. These are some of the most extraordinary moments I have with clients.

One of the core themes of your new book, “Baffled by Love” is betrayal blindness. Can you talk a bit about what that is and how it shows up for people in therapy?

 Before I can explain betrayal blindness, you need to understand something about betrayal trauma, a theory developed by Jennifer Freyd.

Betrayal trauma occurs when a trusted person, someone the child depends on, abuses them. For a child or infant, attachment equals survival and abandonment equals death. Children resist the knowledge that their primary caretakers are dangerous or abusive because it is psychologically unbearable. Children, and later on as adults, will transform malevolence into love and even idealize those who injured them. This not knowing, or denial, is what we understand as betrayal blindness.

Betrayal blindness impairs children’s ability to accurately perceive danger in relationships, making them more vulnerable later to abusive behavior by their lovers and partners. This is what I see over and over again. The bad choices many of my clients make is a result of their inability to assess danger and to identify people who are not trustworthy. They dismiss, ignore or are blind to the red flags that warn about danger or about relationships that are likely to lead to bad outcomes.

One of the cruelest truths about childhood trauma is the way it revisits its victims when they are adults. People who are victimized as children are more likely to be victims of interpersonal violence and/or abuse as adults. It is heartbreaking, and it is a result of  a child’s traumatic experience of love.

On the topic of mutuality, you wrote in the book, “True mutuality requires that the therapist be willing to be ripped open on occasion, to sometimes feel humiliated, baffled and horrified.” What does that look like when it happens in a session? How does a therapist experience an intense reaction without compromising the relationship?

Our clients often show us what they can’t tell us. In some ways, even feeling humiliated is how we get to experience their wordless experience. We have to be prepared to feel a range of feelings that our clients are going to unconsciously and  nonverbally fill us with.

In a session, we can be aware of our feelings and reflect on them, but not act them out. A simple acknowledgment of feelings, such as saying “Wow, that really scares me when you say that” can be really useful, because early on, often times clients will be numb from the horrible things that happened to them. Sharing our own feelings in this bite-sized, digestible way can help give the client a different perspective on the unspoken, horrifying experiences that they had to find a way to manage even when they had no one to help them get the words for what was happening.

As for our own triggers, it’s an ethical responsibility for us to know ourselves, to stay aware of those triggers. It is the therapists disowned or disavowed feelings or experience that can unintentionally cause harm.

It’s not reasonable to expect people who have had such hurtful and twisted experiences of love to know the norms of relationship. Our clients  were not given a blueprint for healthy relationships, quite the contrary. They have often witnessed or experienced toxic and abusive relationships.

In the book, you talk about how interpretation can be a way that a therapist exerts power and I really thought that was interesting. Can you talk more about what you meant by that?

A woman named Constance Dalenberg wrote a book called “Trauma and Countertransference.” As she interviewed trauma clients for the book, they told her that when they spoke about traumatic things, like their abuse or the horrible things that happened to them when they were children , if the therapist gave an intellectual or distancing response, they felt more humiliated.

They want connection, compassion and empathy, not an interpretation or distancing disconnection.

How can a therapist understand a traumatic experience of love and how that shows up?

Our clients have been injured in the context of what are supposed to be loving relationships and this often gives them twisted ideas about relationships and love. Their beliefs from their early experiences go with them in relationships, both inside and outside of the therapy relationship. As therapists, it is our job to understand the nonverbal enactments within the relationship that are part of the client’s untold story.

The most common presenting problem in my clients who have experienced really horrific child  abuse is that they want to be loved by someone and it’s going very badly. The loss of their ability to understand and connect in a loving relationship is one of the more profound damages of child abuse.

 Like you say in the book, many assume that the capacity to love is intuitive, but it is not.

I hope that what people will get from the book is a better understanding of how this kind of trauma shows up and how it gets repaired. In the book, I tell the story of when a client came to see me and I said, “I’m really glad to see you,” and that expression of warmth was terrifying to her because the people who were warm and tender with her were also the people who abused her. This horrible pairing of tenderness and abuse is just so confusing.

As therapists, you have to allow for an experience which includes respect, accountability and tenderness. You have to be someone who is willing to express authentic commitment to your client’s well-being and to take responsibility if you fail or hurt them. You also have to invite them to do the same, and that’s part of how the subtext of therapy can teach new models of love.

For more about Laurie Kahn, check out her new book Baffled by Love: Stories of the Lasting Impact of Childhood Trauma Inflicted by Loved Ones .