Synthesis in Trauma Therapy

visualization of synthesis in trauma therapy

Synthesis work in trauma therapy is a natural mental action and an automatic process of linking related aspects of an experience and differentiating (personifying, realizing, presenting) between them in such a way as to establish a coherent and cohesive memory.

In synchronous synthesis, we create our phenomenal self moment by moment, i.e., every two seconds, over and over again. Diachronic synthesis, in turn, links all past syntheses together and creates the perception of a linear time axis along which our phenomenal self moves.

Thus, a successful synthesis establishes our phenomenal self (the sense of I-ness) at all levels of perception:

  • visual, auditory, kinesthetic, olfactory and gustatory senses (VAKOG)
  • nociception (pain sensation)
  • vestibular sense (balance)
  • proprioception (body sensation / depth sensitivity)
  • autonomous nervous system (sympathetic, parasympathetic)
  • all action tendencies/clusters (daily life, danger defense, bonding, sexuality, caring, belonging, food intake, relaxation, etc.)
  • the resulting ego states as integrated and conscious personality parts with their respective feelings (intensity, simultaneity), thoughts (memories, expectations, perceptions), behaviors and impulses

A coherent synthesis can be disturbed by traumatic experiences or persistent social or emotional stress or neglect in childhood and adolescence, because integrative capacities are low and linking and differentiation in the situation does not occur or occurs only partially. This leads to – according to the intensity of the traumatization – double, i.e. co-conscious synthesis of injured parts, up to sequential, i.e. fragmented synthesis (DIS) with mutually amnesic parts. Thus, the ability to synthesize represents the dissociation continuum (PTSD, cPTSD, pDIS, DIS) and can be understood as a survival strategy due to the overwhelmed ability to integrate, as dissociation ensures survival (there & then). In this process, de-personalization, de-realization, identity insecurities and amnesias can occur, whereby the injured/fragile parts draw attention to themselves through intrusions, flashbacks or other, different secondary symptoms (depression, anxiety, panic, compulsions, aggression, somatizations, etc). They seek integration, while we continue to avoid and struggle to maintain dissociation, i.e. the desire to protect one’s life (here & now).

Dissociation as a result of trauma

In structural dissociation (DIS), the different parts have no awareness of each other and are amnesic regarding the respective experiences and sequential syntheses of all other parts. At least two personality parts exist, each with associated injured parts. An example would be wondering where the oranges in the kitchen came from that you don’t like at all. One personality part bought them, another wonders and cannot remember going to the supermarket. Here the first step would be to come out of the dissociated ego perspective of the individual parts bit by bit into a perception of WE, to explore the inner system and to make all parts known to each other, whereby this should be practiced primarily in everyday situations before traumatic material is processed.

Only when it is possible that all parts are co-aware and there is a willingness to cooperate in the system, is coherent synthesis then possible. This necessarily takes place fractionally, i.e. in small steps, also called titration. Important here is the regulation with the help of metaphors as dosage helpers, so that slowly (and according to the integration ability of all parts) can be advanced, in order to avoid a retraumatization by too fast and/or too intensive synthesis. This means that pieces of memory (fragments synthesized there and then) are collected like pieces of a puzzle and then put together piece by piece to form a coherent picture. Here it is important to note that we like to overestimate ourselves and want to achieve a lot quickly once avoidance has been overcome and curiosity prevails, as we do not yet fully remember or realize the extent of what we have experienced (personified/presentized).

As soon as our perception for other parts, as well as the perception of the parts among each other is more permeable and co-aware, it is especially important to promote self-reflectivity and perspective-taking and at the same time to always address all parts. The different parts usually have their own goals, which can also be contradictory, so that mutual compassion, understanding, witnessing and democratic interaction (cooperation) are the basis for a coherent synthesis. The question: Who wants what for what? is inevitable to get step by step from the 3PP over the 2PP into the 1PP and from the WE to the realization “This is all ME”. The more we can take to ourselves, the more the hurt parts are relieved and the symptoms disappear. When the hurt parts realize that the traumatic situation is over (there & then), they are safe (here & now) and they receive the missing care and perception, the adaptation of the pathological survival strategies into adequate and timely action tendencies can succeed.

The trauma therapist works here as a coach and helps, especially at the beginning, to show through model learning how care, compassion and recognition for the injured parts can succeed, so that this integrative work can be increasingly managed independently. Since trauma therapy requires a high degree of mental energy, it is extremely important to ensure sufficient stabilization before the integration phase, to make people aware of resources and experiences of success, so that there is sufficient positive counterbalance (mental energy) for holding and accepting the traumatic experiences.