Working with PTSD

Working with PTSD
Sunday October 25, 2009


Dear Alice Miller,

I am writing to you for two reasons. One to thank you – for your marvelous work, which has helped both me and my clients so much; and two, to bring your awareness to my subsequent work on childhood trauma and Complex PTSD, at my website, All of my articles on the subject are downloadable there for free, and I am attaching one that derives partial inspiration from your life-saving [to me] book, The Drama of the Gifted Child. It is entitled “Codependence, Trauma and the Fawn Response.”

I hope you will find it worthwhile, and that perhaps you would choose to link to my website. Many of my clients, students, website readers have noted the compatability of my work with yours. More than one client has said to me that I am the only one they have found besides yourself who is unabashedly on the side of the child.

I hope this finds you well, and thanks again for how much you’ve done to bring light into the darkness of cultural denial and minimization of parental abuse and neglect. One excellent American traumatologist, John Briere, recently said that if we could somehow end childhood abuse and neglect, the 800 page DSM [Diagnostic & Statistical Manual of Mental Disorders] would be shrunk to a phamplet in two generations.

Best Wishes,PW

Codependency, Trauma and the Fawn Response

Pete Walker, MFT, [925] 283 4575

In my work with victims of childhood trauma [and I include here those who on a regular basis were verbally and emotionally abused at the dinner table], I use psychoeducation to help them understand the ramifications of their childhood-derived Complex PTSD [see Judith Herman’s enlightening Trauma and Recovery]. I help them understand that their extreme anxiety responses to apparently innocuous circumstances are often emotional flashbacks to earlier traumatic events. Sometimes a current event can have only the vaguest resemblance to a past traumatic situation and this can be enough to trigger the psyche’s hard-wiring for a fight, flight, or freeze response . Examples of this are as follows: a fight response has been triggered when the individual suddenly responds aggressively to someone/thing that frightens

her; a flight response has been triggered when she responds to a perceived threat with a intense urge to flee, or symbolically, with a sudden launching into obsessive/compulsive activity [the effort to outdistance fearful

internal experience]; a freeze response has been triggered when she suddenly numbs out into dissociation, escaping anxiety via daydreaming, oversleeping, getting lost in TV or some other form of “spacing out”. Many trauma victims over time develop an ability to use varying comb- inations of these responses depending on the nature of the triggering circumstances.

A fourth type of triggered response can be seen in many codependents.[Codependency is defined here as the inability to express rights, needs and boundaries in relationship; it is a disorder of assertiveness that causes the

individual to attract and accept exploitation, abuse and/or neglect.] I have named it the fawn response…the fourth ‘f’ in the fight/flight/ freeze/fawn repetoire of instinctive responses to trauma. Fawn, according to Webster’s, means: “to act servilely; cringe and flatter”, and I believe it is this response that is at the core of many codependents’ behavior. The trauma-based codependent learns to fawn very early in life in a process that might look something like this: as a toddler, she learns quickly that protesting abuse leads to even more frightening

parental retaliation, and so she relinquishes the fight response, deleting “no” from her vocabulary and never developing the language skills of healthy assertiveness.[Sadly, many abusive parents reserve their most harsh punishments for “talking back”, and hence ruthlessly extinguish the fight response in the child.]

The abused toddler often also learns early on that her natural flight response exacerbates the danger she initially tries to flee,[“I’ll teach you to run away from me!”], and later that the ultimate flight response, running away from home, is hopelessly impractical and, of course, even more danger-laden. Many toddlers, at some point, transmute the flight urge into the running around in circles of hyperactivity, and this adaptation “works” on some level to help them escape from uncontainable fear. This then, is often the progenitor for the later OCD-like adaptations of workaholism, busyholism, spendaholism, sex and love compulsivity and other process addictions.

The toddler that bypasses this adaptation of the flight defense may drift into developing the freeze response and become the “lost child”, escaping his fear by slipping more and more deeply into dissociation, letting it all

“go in one ear and out the other”; it is not uncommon for this type to eventually devolve into the numbing substance addictions of pot, alcohol, opiates and other “downers”.

A final scenario describes the incipient codependent toddler who largely bypasses the fight, flight and freeze responses and instead learns to fawn her way into the relative safety of becoming helpful. She may be one of the

gifted children of Alice Miller’s Drama Of The Gifted Child, who discovers that a modicum of safety [safety the ultimate aim of all four of the 4F responses] can be purchased by becoming useful to the parent. Servitude, ingratiation, and forfeiture of any needs that might inconvenience and ire the parent become the most important survival strategies available. Boundaries of every kind are surrendered to mollify the parent, as the parent repudiates the Winnecottian duty of being of use to the child; the child is parentified and instead becomes as multidimensionally useful to the parent as she can: housekeeper, confidante, lover, sounding board, surrogate parent of

other siblings, etc. I wonder how many of us therapists were prepared for our careers in this way.

All this loss of self begins before the child has many words, and certainly no insight. For the nascent codependent, all hints of danger soon immediately trigger servile behaviors and abdication of rights and needs. These response patterns are so deeply set in the psyche, that as adults, many codependents automatically and symbolically respond to threat like dogs, rolling over on their backs, wagging their tails, hoping for a little mercy and an occasional scrap; [Webster’s second entry for fawn: “(esp. of a dog) to behave affectionately.” I find it particularly disturbing the way some codependents can be as unceasingly loyal as a dog to even the worst “master”.

I have had considerable success using psychoeducation about this type of cerebral “wiring” with clients of mine whose codependency began as a childhood response to parents who continuously attacked and shamed any self-interested expression on their part. I work with such clients to help them understand how their habits of automatically forfeiting boundaries,

limits, rights and needs were and are triggered by a fear of being attacked for lapses in ingratiation.

Elucidation of this dynamic to clients is a necessary but not sufficient step in recovery. There are many codependents who understand their penchant for forfeiting themselves, but who seem to precipitously forget everything they know when differentiation is appropriate in their relationships. To break free of their sub- servience, they must turn their cognitive insights into a willingness to stay present to the fear that triggers the self-abdication of the fawn response, and in the face of that fear try on and practice an expanding repertoire of more functional responses to fear.

Real motivation for surmounting this challenge usually comes from the psychodynamic work of uncovering and recreating a detailed picture of the trauma that first frightened the client out of his instincts of self-protection and healthy self-interest. When the client remembers and feels how overpowered he was as a child, he can begin to realize that although he was truly too small and powerless to assert himself in the past, he is now in a much different, more potentially powerful situation. And while he might still momentarily feel small and helpless when he is in a flashback, he can learn to remind himself that he is in an adult body and that he now has an adult status that offers him many more resources to champion himself and to effectively protest unfair and exploitative behavior.

I usually find that this work involves a considerable amount of grieving. Typically this entails many tears about the loss and pain of being so long without healthy self-interest and self-protective skills. Grieving also tends to unlock healthy anger about a life lived with such a diminished sense of self. This anger can then be worked into recovering a healthy fight-response that is the basis of the instinct of self-protection, of balanced assertiveness, and of the courage that will be needed in the journey of creating relationships based on equality and fairness.

To facilitate the reclaiming of assert- iveness, which is usually later stage recovery work, I sometimes help the client by encouraging her to imagine herself confronting a current or past unfairness. This is often delicate work, as it is sometimes akin to therapeutically invoking an emotional flashback, and therefore requires that a great deal of trust has been established in the therapy. When the unmastered, threatening situation has been successfully reinvoked at non-flooding levels, the client has an opportunity to become more aware of how fear arises, and to practice staying present to it and its associations. This then sets the stage for the deconstruction of internal and external self-destructive reactions to fear, as well as the continued grieving out of the pain associated with past traumas.

Finally, I have noticed that extreme emotional abandonment also can create this kind of codependency. I believe that the continuously neglected toddler experiences extreme lack of connection as traumatic, and sometimes responds

to this fearful condition by overdeveloping the fawn response.

Pete Walker

AM: We don’t create any new links because we receive too many similar requests but we publish your informative letter that can inform our visitors about your work.