Communication-Focused Therapy® (CFT) and Trauma

Haverkampf-C.-J.-2020.-Communication-Focused-Therapy®-CFT-and-Trauma.-In-Communication-Focused-Therapy®-CFT-Vol-IV-pp.-300-319

Communication-Focused Therapy® (CFT) and Trauma

Christian Jonathan Haverkampf, M.D.

Communication-Focused Therapy® (CFT) has been described for several mental health conditions. This article gives a brief introduction to the application of CFT to trauma. Meaningful communication is at the heart at understanding psychological dynamics, and trauma usually causes a significant rupture in the meaning world and communication web of the individual. The objective is not to reverse the effect of trauma, but to integrate it into the communication space and world of meaning of the patient so that the patient can develop interactions with others and oneself that lead to a greater perception of meaning in the world and reduce the effect of the trauma in the present.

Keywords: trauma, communication-focused therapy, CFT, communication, psychotherapy, psychiatry

Table of Contents

Trauma. 4

A Disconnect. 5

Prophylactic Communication Patterns. 7

Change Through Communication Patterns. 8

Communication Structures. 17

Meta-Communication. 19

From New Meaning to a New World. 21

References. 23

Trauma

Trauma is when something happens that has a more then temporary and negative effect on a person. It can also be a psychological injury which can change how a person interacts with themselves and with their environment. Thus, trauma often not only leads to flashbacks, dissociative states, anxiety, avoidance, emotional and affective instability and other symptoms, but also to a change in personality, and how the individual is integrated into the web of communication with the environment. Since personality is about how an individual communicates with others, changes in personality after a more severe trauma also correspond to changes in communication patterns and styles (Haverkampf, 2018a). These changes in communication patterns and styles usually lead to secondary problems resulting in a significant impairment in the quality of life. Focusing on the patient’s communication patterns in therapy it is possible to reverse them by facilitating awareness, insight and a safe space for experimentation and adjustment with the help of communication patterns that can be used by the therapist or emerge with the patient in the therapeutic setting (Haverkampf, 2017c, 2019).

Trauma is the result of an overwhelming amount of stress that exceeds one’s ability to cope, or integrate the emotions involved with that experience, which also depends on the type and range of the internal and external communication patterns a person has at their disposal (Haverkampf, 2016a). Trauma may result from a single distressing experience or recurring events of being overwhelmed that can be precipitated in weeks, years, or even decades as the person struggles to cope with the immediate circumstances, eventually leading to serious, long-term negative consequences. Because trauma differs among individuals, according to their subjective experiences, people will react to similar traumatic events differently. The different communication patterns and styles can explain some of these differences. Working with them in the therapeutic setting can help to reverse the symptoms of the mental health condition caused by the trauma and lift the impairments in everyday life, whether in terms of reduced self-confidence and fears and anxiety and in terms of the ability to interact with other people.

As physical trauma causes damage to the fabric of the body, psychological trauma causes damage to information pathways. Internal and external communication patterns change as a result, and rather than fixing the defect they may make it worse. The result is a negative effect of the trauma on the interactions with oneself and with the world, which can be self-sustaining in a vicious cycle. This can make it difficult to extricate oneself from the effect of the trauma. The main function of the communication patterns an individual uses is targeted at the individual from the information contained in the trauma. However, this leads to even more rigid and fragile communication patterns, which are then often held together by fear.

A Disconnect

A trauma is a rupture in the communication fabric one has with oneself and the world. A trauma goes beyond the unexpected, it has the potential to affect our understanding of the world in fundamental ways, and it does so in a way that creates greater uncertainty and instability about oneself and the world. Trauma gives rise to new communication patterns that force a disconnect, which is largely an attempt by the organism to protect itself from being overwhelmed by information from within and outside oneself. These information flows may continue anything from emotions to thoughts, sensations, perceptions, and anything that is transmitted from one place to another, whether within the body or between the body and the world. Numbing sensations, a lack of feelings, sudden onset cognitive and memory impairments can all be a result of the disconnect in information slow. It is important to keep in mind that the objective of these new trauma-related communication patterns is to lower the rate at which meaningful communication takes place. Everything is potentially hurtful, and the organism is trying to protect itself in the only way it knows, by withdrawing from what it perceives as the source of the hurt, new potentially meaningful information. While this explains why interpersonal trauma can cause more secondary damage, it also fits well with natural disaster, or any other trauma. Horrific experiences that threaten the integrity of the self, physically and mentally, produce information that is meaningful and thus forces change. However, the difference between a trauma and a psychotherapeutic session, for example, which both lead to change, is that the former causes destruction to existing helpful communication patterns, while the later is trying to repair and build new ones. In this sense, psychotherapy could be considered a positive trauma.

The communication disconnect causes some of the most negative consequences of trauma. Individuals withdraw from sources of meaningful information, whether from people directly or indirectly, which could potentially align with the own needs, values, and aspirations. Someone who suffers from trauma is thus distanced from situations, thoughts, interactions feelings, and events that can potentially make happy. This means positive feelings and the quality of live overall decreases. The traumatic disconnect from sources of meaningful information as a potential danger that could cause more harm makes it more difficult to engage in individually rewarding and fulfilling activities, which often leads to a decrease in mood and emotional and physical well-being.

Flashbacks, night fears and anxious thoughts can flourish better in the state of disconnect. Normally, the constant flows of information and a panoply of communication patterns have an autoregulatory function, so that the whole system does not veer off from the usual cognitive and emotional path too far. However, with the information disconnect the trauma has caused, the inner information world begins to revolve around the gravitational pull of the trauma, which is in the beginning not unlike a black hole. Nothing can escape from it. However, once the structures that maintain the information dynamics of the trauma are affected and changed with the help of beneficial communication patterns, the trauma loses its grasp on one’s thoughts and emotions. Once that happens, new positive experiences, thoughts and feelings can take over the space, which was occupied mostly by the trauma. An increase in connectedness with oneself and others takes place.

Prophylactic Communication Patterns

From a CFT perspective, improved communication patterns can help prophylactically since how the information about the trauma is decoded and processed, how meaning and connections are distilled from it, has a significant influence on the symptoms of the trauma in the future. Building healthy and effective communication patterns begins mostly with the realization that a flexibility in communication patterns makes internal and external communication generally more adaptive and stable. It is the fragility and rigidity in communication pattens, which in the face of traumatic stress causes instability and lack of adaptability (Haverkampf, 2017c, 2018b). Within a therapeutic setting, the patient’s experimentation, which raises the familiarity and comfort with flexible communication patterns, can be fostered through the therapeutic communication dynamic with specific therapeutic interventions in the form of yet other communication patterns (Haverkampf, 2018b).

In Communication-Focused Therapy (CFT) greater awareness is created for the internal and external communication patterns, which can then be reflected upon and adjusted or newly formed. Within the session observation of the communication patterns the patient uses and greater awareness for the communication dynamics, such as how one communication element leads to another, can give the patient a greater sense of stability, security, comfort and control, which helps against the fears and anxieties that often come with posttraumatic stress disorder (PTSD) and other trauma related conditions. Since communication is whereby an individual connects with oneself and with the world, experiencing that communication follows rules and can be used as a tool to fulfil one’s needs and aspirations in alignment with one’s values can help make the world feel safer and more predictable.

Many of the long-term effects of trauma are self-sustaining as maladaptive communication patterns are maintained. As trauma leads to greater rigidity and fear, there is greater resistance and rigidity to their change. It often also requires the experimentation stage in which the patient experiments with adjustments to existing communication patterns or forms new ones which can then be tried out in the interactions with the therapist. The communication style of the therapist should include all along throughout the therapy empathic listening and a non-judgmental focus on helping the patient.

Change Through Communication Patterns

While the memories of the trauma are not erased, their impact and meaning can change significantly as internal and external communication patterns change (Haverkampf, 2010b, 2016b, 2017a). The aim is to use the information about the trauma and the patient’s reaction to the trauma to build communication patterns that work better for the patient than before the trauma.

Helpful communication patterns are often those that support a better connection with internal and external information. Being able to read better the own emotions, and to identify them, can help counter the symptoms and secondary effects of trauma. While there is often a fear of what one may discover, it is important to realize that all the information is already present within the neuronal network and within the larger system of the body. So, when we look for information, it is already present. In clinical experience, even if self-reflection can cause some instability in the beginning, it is different from the persistent instability one often observes in disconnected free-floating trauma.

The power of questions as a family of communication patterns has been discussed by the author elsewhere (Haverkampf, 2017b). The important element is not primarily the retrieval of content, but how a question affects the flow of information. As mentioned in the paper by the author, there are several different forms of questions, and using the right type, whether in an interaction in a psychotherapy session or by the patient internally, can have different effects of communication flows and the generation of meaning, which has the potential to bring about change.

I, You, We

Trauma affects the personal narrative of one’s life. ‘I’, ‘you’, and ‘we’ and the distinctions among them get lost to some extent. Important is therefore to rebuild communication patterns that communicate an ‘I’ distinct from a ‘you’, while making it possible that there can be a ‘we’ again. Narratives in trauma victims become person- and boundary-less. This may also be a defensive reaction, a protection against the emotions that could be triggered if I fully feel like a person distinguishable from others with an own inner life. Trauma leads to defense mechanisms that try to quell the inner world, so that the hurt is reduced. From a communication perspective, it seems that trauma causes a flipping of internal and external communication. The hurt has been caused in the outside world, but I need to keep a lid on my internal world, my life. The resources on the inside could be helpful, but a severely traumatized person no longer expects help from anywhere, least of all from the inside. In order to change that, a reconnection is needed, but one that does not cause a retraumatisation.

In order to square the circle of processing a trauma without retraumatisation, the therapist needs to give the patient significant control over the communication patterns they use. This may at first be unfamiliar and new to the patient, but by having some control over the information highways to the outside world, there will also be a greater sense of being able to manage the information flows on the inside. Again, it is important to point out that the aim is not control per se, but a greater feeling for the own communication systems, which have at least in part been blocked or even shut down. The three basic tools of awareness of, reflection on, and experimentation with communication patterns are here again essential. Rebuilding a strong and stable sense of ‘I’, ‘we’, and ‘you’ can happen when the focus is more on the communication itself rather than the content. Using metacommunication is not a withdrawal into overthinking but an awareness for information flows that involve the whole body.

Feedback

When something happens to us in the world, the first questions we ask are usually if we did anything to cause it. There are several reasons for seeing ourselves as the possible cause of the trauma, particularly as children. Firstly, by seeing ourselves as a possible cause of it, we imagine that we could have some control over it, which makes us feel less helpless and more powerful in the face of the devastating effect of the trauma. Secondly, we want the world to be a predictable and safe place. By imagining we cause the trauma, at least in part, there is some comfort that the world is not an entirely random and unpredictable place, that could hurt us any minute. In other words, after a trauma happened, there is a gut reaction, if one can call it that, to hold on to as much stability as possible, when faced with the effects of a trauma which seem to destroy and wash away structures we depend on, structures that make us feel safe and comfortable.

Using feedback as a communication in therapy sessions is important to let the patient experience positive and healthy feedback. Often victims of trauma withdraw from their social networks, their relationships, and the communication web around them in general. So, they have less opportunity to experience positive and helpful feedback after the devastating ‘feedback’ they received from the world in the trauma. Therapeutic feedback can be aimed at directing a spotlight on the small voice inside the patient that is a reflection of the former self, the carefree, spontaneous and optimistic attributes, which are in PTSD often pushed aside by anxiety, fear, and quite frequently a rigid clinging on to a harsh part of oneself that tries to put a lid on any form of self-expression. The latter is a consequence of what we discussed above, the suspicion that the trauma was a feedback reaction from the world to something I did wrong, the illusion that trauma has to make sense fully within the confines of my own actions and my little world. However, most traumatic events can only be grasped within a much wider statistical context. They usually do not happen, but there is a remaining probability that they can, over which I have little control.

But I can control my interactions with other people, and I can influence these interactions. Experiencing this in a psychotherapeutic setting can go a long way towards rebuilding a sense of safety, comfort, and agency in the world around, which are all crucial in recovering from the secondary effects of trauma.

Caring Questions

The power of caring, interested and empathetic questions is often underestimated. Many therapists may be overly hesitant to ask questions when working a severely traumatized patient. But it is possible to facilitate creation of a safe and comforting space with the right questions. Particularly in the beginning, these questions may be directed at the part in the patient that will help to just create a space, particularly after boundaries have been violated. It may not even address particular strengths or resources, which could trigger defensive reactions, but just make room so that the patient can feel safe, comforted, and understood in the immediate needs.

Particularly with questions it is important to distinguish clearly between the communication pattern and the content. Though both are linked, with empathetic questions, the pattern itself is of key importance, which the therapist has large control over. The content may be part of feedback of an emotion, feeling, or thought the therapist perceives coming from the patient. The question can thus become part of feedback. But it is the pattern used which distinguishes it. Important is also to show genuine caring, interest and empathy within the question. Usually, interest in finding out and helping the patient is a good starting point. Particularly with questions, one may not know where the journey is going, but for the patient in the early stages of therapeutic work, it is already comforting to feel that one is on a journey with another who is used to and experiences in being on a journey.

Associating: Connecting the Dots

As discussed, trauma frequently leads to a disconnect with internal and external worlds. This does not necessarily mean the information from a receptor of bodily sensations, for example, is not transmitted anymore but that the information fails to be integrated at the level of conscious awareness or immediately below it. A sensory flatness or numbness results, which can then also cocreate a lack of feelings in general. Various information inputs are not linked up anymore sufficiently. In this situation it can help to use communication that is directed at making associations between different pieces of information, where the patient fails to make the link, for example, by saying “I noticed every time you mentioned your brother your face tenses up, can you describe how you feel when we talk about him?” Again, it is important to keep in mind to not rush things and to get a real understanding for where the patient is. Therapy should not be boring, but on the other hand it should also not overwhelm a patient, particularly one who has experienced severe trauma.

Rebuilding the Timeline

Unprocessed trauma often is free floating in time. It can influence how one feels when seeing or experiencing something in the present, impact how one sees the future, and distort the past by leaving memory blanks, such as reducing the emotions attached to negative as well as positive events. Putting the trauma firmly into the past and making it feel like a footnote in a history textbook are goals of every trauma therapy.

Our mind creates a timeline, which is entirely subjective. The reason that people have similar concepts of time has to do with the similar hardware humans share, but also with the information that we exchange with others. It would be difficult to speak of a history of a deserted island if there is no one I can share it with and no one to talk to. What and how we communicate about ourselves and our perceptions of the world thus has an impact on our own and other people’s timelines.

Creating Space for Oneself

Trauma violates boundaries, whether psychological, physical or both. This does not only apply to violent crimes, but also to natural disasters and losing someone important. We all have a garden around our sense of self which harbors many of the wonderful things that reflect a world it is worth living in. Now, if someone bulldozes across this garden or just rips out something and leaves, we may feel sad, angry, devastated, and most importantly hurt. As the word ‘hurt’ implies our integrity, psychological, emotional, and physical has been damaged and compromised. A natural reaction is to withdraw rather than have to look at a wonderful painting that has been slashed with a knife right across it with pieces of canvass hanging listlessly from the wound lips. However, this means we cannot be in the garden anymore, which is so important to us.

After a trauma happened, the first important step is to reclaim space, space that is ours and ours alone, where we do not have to live in constant fears of trespassers, may that be a sociopath, a work colleague or the powerful forces of nature itself. Therapists can help their patients build this space by literally giving them the room to talk about whatever seems important to them. Non-intrusive, empathic and open questions can support this process. The next step is then to fill the garden again with whatever is close to heart of the patient.

Communicating Emotions

Emotions are also packed information, which can be communicated in the form of meaningful messages like other information. However, it is usually easier for someone who has suffered a trauma to give a report on what happened, the facts, than to talk about how one felt. There can be several reasons for this, from the biological to the entire psychological. One reason is that the information about the facts of the traumatic event is already out there in the world, while this is not the case for how one feels about the trauma. Here it can be helpful for the therapist to convey to the patient that more is already being communicated through non-verbal language about the own feeling states than it seems. It is incorrect to assume that facts are already out there in the world, while feelings are not. It will also help to support the patient in rediscovering words and the own language for the feelings, emotions and thought fragments that were and are experienced.

Making emotions communicable by putting them into language has the advantage that it is easier to engage in metacommunication about them. Language helps to create a distance mentally from an experience. It is difficult to feel about emotions, while we can talk about them. As pointed out by the author elsewhere (Haverkampf, 2018c), verbal metacommunication allows processing of non-verbal information, such as feelings and emotions, in parts of the brain that are accessible to consciousness and rational thinking. The aim is not to give rational thinking control over the emotions, but to use the unique features of this mode of thinking to resolve any internal communication patterns that are not helpful.

Building the Now

As already discussed about the timeline, many individuals suffering from trauma always live with their feelings, emotions and thoughts partly in the past. Helping a patient describe the now, what is experienced, felt, seen, heard, and so forth, can lead to a firmer rootedness in the present. Even describing how the arms feel supported on the armrest or the slightest sensations of touch one may feel, strengthen the link with the physical world on the outside and the world of feeling and emotions on the inside. All this strengthens of owning the present moment, the living in the now.

Several of the therapies that exist for trauma, including EMDR, aim to lessen the emotional intensity when a memory of the past is activated. However, from a communication perspective it is important to observe that emotions contain information, just like information that is retrieved from memory about a traumatic event. Ultimately, the question is how best to work with and communicate information. We are constantly bombarded by an enormous amount of information flowing in from the outside and flowing on the inside. The focus of Communication-Focused Therapy® is to better select, process and communicate information back. The steps involved have been discussed in more detail elsewhere (Haverkampf, 2017a).

While it is true that the past influences today’s communication patterns and structures, with awareness, reflection, and experimentation, these can change. The therapist can help with various communication patterns, such as questions, feedback, and more. What we feel in the moment is essential to make the changes that are necessary for the adjustment of existing communication patterns. Trauma has influenced the communication patterns we currently use, but we can build new ones, which affect our everyday experiences.

Building the Future

Along the treatment process, the future will gain more relevance and more meaning. Rather than being a focus of worries, it needs to become a place for opportunities. Important is that the patient can develop openness towards the future rather than being stuck with a plan. Openness will make it easier to fill the future with things that really matter to oneself, that align with genuine needs, values and aspirations. In some cases, it can even be easier to build an image of the future according to one’s basic parameters after a trauma, because moving ahead means there is little choice in whether to keep something or not. The personal garden has been ransacked and needs cleaning up. This is not to say that a trauma has a positive effect. Reassessing one’s vision of the future can happen at any time, and the trauma can lead to distortions in the perception of one’s needs, values and aspirations, in how one sees one’s own resources and the world overall, which can also lead to distortions about the future. However, a trauma very often leads to a reassessment of one’s role in the world and one’s vision of the future.

An attractive future can be a motivator and provide direction for decisions. It is important for the therapist not to push it, however, as the patient may feel overwhelmed and under even more pressure. Understanding, empathy, and getting the information one needs, can help a therapist to softly guide the process where needed.

Making Connections

The communication patterns the therapist uses in the session should help the patient develop communication patterns, which promote making connections with others. Trauma leads to a protective wall, which lets through little meaningful information, rather than healthy boundaries, that support the exchange of meaningful information. The therapist can help the patient experience communication, which is helpful to the patient, communication, in which the patient can have a sense of control rather than feeling helpless and not having control because of a rigid control wall that makes human interactions difficult. At the same time, it is important to acknowledge that there have been reasons to build a wall to protect oneself from hurt and other painful feelings.

Healthy boundaries, which support communication with others, are best built in interactions where one can relax the feeling of having to be vigilant all the time. This is best accomplished in a communication setting where information can flow freely without the sense of being judged harshly or punished for what one says. Regaining one’s voice is an important step in working with trauma. Feeling how communication can work for oneself instead of against oneself unlocks the possibilities for growth through communication.

Communication Structures

Communication structures contain communication patterns sequentially and in parallel. The act of buying something in a shop or a psychotherapeutic session, for example, have a communication structure. In a shop it usually contains of informing about a wish, questions, and so forth. While they can be predictable, and are more so in common everyday tasks, their essence is to provide a backdrop for the communication dynamics that actually take place and which are never entirely predictable, except maybe for the simplest and most repetitive interactions.

When someone has experienced trauma, particularly an interpersonal one, trust in the predictability and benefit of human communication is the one thing that is often most severely damaged. The same applies to the communication one has with oneself, the internal flow of information. The result is a disconnect from others and from oneself. Communication structures play here an important role. Normally we are not even aware of them in everyday life. They provide a statistical average, and are not a guarantee that a date, a job interview or an oral exam will play out the same every time. But if asked how one buys a coat in a shop, most people would agree on a sequence of communication patterns. And one may be as unlikely to leave the shop without a coat as leaving a job interview without a job or a date without the expectation of another one. All these communication events have structure, but in some the stakes seem much higher (e.g. a date) than in others (e.g. buying a coat). In a patient who has been traumatized the stakes of any interaction with another human being or oneself become very high, while faith in the predictability of communication patterns become very low. Aside from the damage of being exposed to destructive communication patterns, an amplifying factor is that most traumas are rare occurrences. If something rare happens, it is much more likely that one will ask oneself, why it happened. Unless one delves into the psychology of perpetrator psychology, this question can be a slippery slope to looking for the answer within oneself and blaming and being upset about oneself.

Restoring Communication Structures

Trauma affects the communication structures one has. When less or even negative things are expected of other people, this changes not only the patterns one uses in interacting with others, and, by extension with oneself, but also the larger communication structures that define the sequences of events in an interaction. If I am triggered by sensations or thoughts that the mind associates with the trauma, a current structure may abruptly be reconfigured to allow for seemingly more protective communication patterns. For example, if someone buys something in a shop, seeing something that can be associated with the trauma can change the normal ‘buying in a shop’ communication structure so that one uses less interactive communication patterns with the shop assistance, such as omitting the usual smalltalk questions. Or if there is a heightened level of anxiety and apprehension before going into the shop the ‘relaxed buying in a shop’ communication structure may be replaced with the ‘I have to keep my guard up while buying in a shop’ communication structure. The consequence of all these modifications is that one experiences the ‘buying something in a shop’ sequence differently, that information gets decoded and meaning extracted differently, and the information flows are impaired. In summary, the trauma wields its secondary effects through changes in communication patterns and structures. Since external and internal communication reflect each other, this will also affect the internal sense of stability, certainty, comfort, and predictability in the world. The thematic content of the trauma is apparent in external and internal interactions, but the real damage is through changes in the communication dynamics.

Work on reflecting and gaining insight into communication structures with the patient can thus be very helpful in restoring a faith into the rules of human interactions. Seeing that a trauma is a rare event can push one even further to look for explanations, but it can also help to regain the sense that the world usually operated in predictable patterns. There are standard ‘going into a shop and buying something’ routines, which day in and day out work reasonably well. It is also important to note that the greatest harm is done to communication structures, which can be linked more closely to the trauma. If a trauma happened in a shop, the ‘shopping’ communication structures may be the most affected ones. Looking at communication structures in therapy can thus also provide more insight into the fabric and determining characteristics of the trauma. Avoidance may appear primarily be to a thing, people, or a situation, but it is usually directed at a possible interaction, or communication, that could take place.

Meta-Communication

The worst a psychological trauma can do is to change a patient’s view of communication in general and in specific situations. Communication is the defining process of life, when the exchange of information stops, the organism dies. Communication with oneself and others is also needed to fulfill one’s needs, values and aspirations. Making internal and external communication better raises one’s quality of life, and all mental health conditions cause their symptoms primarily through the effect they have on internal and external communication. This is no different if someone has experienced a trauma. Talking, thinking, reflecting and experimenting with communication are key components of any therapeutic process. Communication-Focused Therapy® puts a special emphasis on them.

Particularly when the communication patterns an individual uses have been affected by trauma, such as a more avoidant or anxious-averse communication style, there is a significant risk that it can make helpful interactions even rarer. Thinking and talking about communication constructively is a skill we are not born with. Communication is supposed to be automatic and outside of conscious awareness to keep it away from any thought processes that could interfere with it, which could have serious consequences for the organism.

Communicating about communication is best practiced with the patient in a therapeutic session. It is a practice thing, but fortunately relatively easy to pick up. When the therapist does it, there is usually a pull for the patient to do it as well. The fundamental steps mentioned below are awareness, reflection. and experimentation. They are needed to translate the exercise in meta-communication into a change of existing communication patterns, which can be helpful to the patient in lowering the symptoms.

Awareness

Becoming aware of the communication patterns and elements one uses is maybe the most important first step one can take in the process towards healing. This comprises both the internal and external communication patterns. How I talk to myself on the inside and how I communicate with the world is tightly linked. The one is in some sense a reflection of the other (Haverkampf, 2010a). Awareness can be gained in any setting; it does not have to be a psychotherapeutic one. However, psychotherapy can offer the space in which the freedom to observe and reflect is more easily given. Whether this is possible and to what extent depends to a large degree on the therapist. An open, empathic, interested, nonjudgmental, non-ideological, skilled and experience professional, who genuinely cares about the patient and is not averse to following new routes and experiment within certain limits would be in a good position to help, even though this level of perfection may not be fully achievable in real life. Setting the bar an inch lower, the therapist should be able to use communication patterns and interaction styles that benefit the patient in becoming more aware of the own communication patterns. As mentioned above, questions can be a powerful tool, but so can repetition, confirmation, encouragement reflection, non-directive feedback, statement about own feelings and thoughts that are triggered in the interaction, and so forth.

Reflection

Reflection includes meta-communication, thinking, feeling and talking about communication, but it can mean more. It can ne anything from thoughts about the setting to the feelings and thoughts that are triggered in the interactions with others or oneself. One aim is to gain insight, another to think about the range of options that are available.

Experimentation

Often small changes in a communication pattern can lead to wildly different results. An extra pause here, a smile there, and another question somewhere in between can make a world of a difference. Often people are not aware of the differences such small changes can make. The therapeutic setting is essentially a playground to experiment, observe, reflect, and then experiment again. The more the patient becomes an expert at it, the more it will also be carried into the real world into everyday life. Making a habit of the three basic tasks awareness, reflection, and experimentation leads to changes that are ultimately aligned with the three basic parameters, the needs, values, and aspirations of oneself. Particularly for trauma, it is important to add that reflection comprises all input and processing modalities, thoughts, feelings emotions, and more.

From New Meaning to a New World

Being able to extract more meaning from information helps build a changed world. The more meaning one can see in the world the richer and the more supporting and holding it is. A trauma is information that is destructive. It breaks down a world one has built as a reflection of what one values and is important to oneself, one that encapsulates one’s aspirations. So, trauma harms the image of oneself by damaging the world of one meaning on has built. As the processes of how one perceives meaning in the world is deeply rooted in how one processes information and the basic parameters one has, the needs, values and aspirations, we always build a representation of the world that is distinctly ours; it is ‘our world’. This is where we can feel comfortable, secure, where we can relax, and be creative and caring. The meaning induced by trauma can change this experience of the world in several ways. It may make the existing world less stable and safe. It can affect how the different parts of the world can fit together, making it inherently less stable and predictable. It can change how one sees parts of the world by changing how existing information is interpreted within the context of other information, which also includes the trauma information. One may say that trauma contains information that cannot be fit into the overall experience of how the world works, and it also should never fit in.

As already mention, the aim of Communication-Focused Therapy® is to work towards communication patterns which help the individual repair and, even more importantly, extend the own experience of the world. A communication pattern may be something as simple as a defining element in exchanging a hug with another person. Although it may seem simple, there are complex flow of information and various individual communication patterns involved to give us the complex communication structure of the hug. Information exchange in a hug happens in many different ways with haptic, cognitive, interpersonal, and other information involved. As long as it is meaningful information, it leads to changes in oneself and the other, if the other can extract meaning, which may be partially compromised in trauma, for example.it has the power to bring about a change. So, the hug leads to changes in state and otherwise in both (or more) participants. It is the sum of all the individual effects, which in the end calls into being the living concept of the hug. Even beyond that, it needs to be understood that


Dr Christian Jonathan Haverkampf, M.D. (Vienna) MLA (Harvard) LL.M. (ULaw) trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. He is the author of over 200 articles and several books and the founder of Communication-Focused Therapy®. The author can be reached by email at jo****************@gm***.com or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.

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Haverkampf, C. J. (2017a). Communication-Focused Therapy (CFT) (2nd ed.). Psychiatry Psychotherapy Communication Publishing Ltd. https://jonathanhaverkampf.com/books/

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Haverkampf, C. J. (2017c). Treatment-Resistant Borderline Personality Disorder. J Psychiatry Psychotherapy Communication, 6(3), 68–89. http://borderline-treatment.com/wp-content/uploads/2019/01/Haverkampf-CJ-Treatment-Resistant-Borderline-Personality-Disorder-J-Psychiatry-Psychotherapy-Communication-2017-Sept-30-63-68-89.pdf

Haverkampf, C. J. (2018a). Communication-Focused Therapy (CFT) – Specific Diagnoses (Vol II) (2nd ed.). Psychiatry Psychotherapy Communication Publishing Ltd. https://jonathanhaverkampf.com/books/

Haverkampf, C. J. (2018b). Communication Patterns and Structures.

Haverkampf, C. J. (2018c). Metacommunciation.

Haverkampf, C. J. (2019). Communication Patterns to Change Communication Patterns.

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