Creating a Therapeutic Narrative

January 12th, 2017

Jane awakened experiencing  a  state of “wilderness dissociation”, with prominent symptoms of isolation, recurrence of bonding-failure, and early object-loss. This  early developmental history of caretaker failure is referred to as “prolonged interpersonal” or “Type-II” Trauma. My immediate intervention was to provide her with a “brief-holding environment” using emotional empathy and validation. Such victims of early loss or rejection, can present with feelings of abandonment, and poorly-developed “self-soothing” skills.  At such moments, overwhelmed by feelings of emptiness, and absent self-esteem, such victims are most vulnerable to “acting-out” behavior such as binging, substance-abuse, and (in cases of Borderline Personality), self-mutilation or overdoses. Psychological rescue, using techniques of “being there” and verbal validation, can provide them with the “self-soothing” mechanisms that they are lacking.

Jane describes her trauma symptoms


I really don’t know why I’m emailing you, It is 7: 15 am and I haven’t slept yet,

I’ve been lying in bed for the last 6 hours and I still can’t sleep, This has been happening a lot lately and I guess I want to know why.

I don`t know why I still try to reach out, but   I just want someone to give me any suggestions on

what to do. But this should sum everything up:

I’m 18 years old, 19 next month, I’m currently living on my own, I’ve been on
my own since I was 17. At the age of 17 I was in high school and working 2
jobs, I went to school from 9-12 and worked 1-9.

I never got along with my mom and never seen much if my dad, I was raised by
my grandparents from the time I was 6 months old. I lived with my
grandparents till I was 14, a few months before I turned 15 my grandfather
passed away from cancer, this was a very hard time for me, he was more than a
grandfather, our worlds revolved around each other. I use to figure skate.

And he always got more nervous than I did when I was going out on the ice to
compete. There wasn’t anything we couldn’t do.

After my grandfather passed away our house was sold and my nan and I moved in

with my mom because we couldn’t afford the house. Long story short I tried
moving out when I was 15, the cops made me go back home because I wasn’t 16,

I was tired of always fighting with my mom every single day. It was worse
that walking on egg shells, emotional and borderline physical abuse.
When I finally turned 16 I moved out of my mom`s house one day when she went
to work so she couldn’t force me to stay, I moved into my uncles.

Things didn’t work out I ended up back at my moms, main reason being it was
the only way she would let me see my brother and my grandmother.

When I was 17 I moved out into my own place, I had made arrangements with my
school that I would take my classes from 9-12 so I could work 1-9 so I could
support myself and pay rent.
Friday the 13th came along and my nanny went into the hospital, she was there
for 8 months, April, 13 2011, was her last day with us, she never made it
On April 13th I was buying my prom dress and had full intentions on wearing
to the hospital to go see her, just in case she wasn’t allowed out of the
hospital on June 26th to see me graduate.
That’s all I really ever wanted was for her to see me graduate. I would visit
her in the hospital every chance I got,
I miss both of my grandparents more than ever.

I feel hopeless, working dead-end jobs trying to save up some money to go back to school so I don’t have to struggle like this for the rest of my life. And I just feel like I’m going now here.

Honestly I don’t even know if you`re going to reply to this, and if you do, I
don’t know if you’ll know what to say or if your even the right person to
talk to.

There’s a lot more bumps in the story that I didn’t mention like how

there were several times I was called to the hospital to say good bye to my
nanny because she wouldn’t make it through the night.

I guess all I’m looking for is someone I can have in my life that I can
depend on.

So if I don’t have money for food I don’t have to worry.

When I was 12 laughing and having fun with my grandparents I never would have imagined myself in the position I’m in 6 years later…


Dr. Trappler responds

Hello Jane,

It’s 4 a.m. here, and I haven`t slept yet. I had many important “duties” to perform. I was forced to put-off several as I felt compelled to spend time with other people in need. But I had promised myself that I would not end the day until making some form of contact with you.

Since the early days in my career of helping others, I had an entirely different approach towards addressing hardship and suffering than the conventional one: As a senior medical student and young intern, when my friends would “holiday” for the summer, I worked as a volunteer at the main hospital in a very small undeveloped country called Swaziland.

The scarcity of trained clinicians there necessitated duties far beyond my skill-level. I recall the first night after I arrived being assigned to “Pediatric I.C.U.” There was a critically ill African child who was conscious, but gradually slipping into septic shock because of a “gram-negative” infection. I was titrating the maximum tolerated level of Gentamycin as his vital signs continued to deteriorate.

And as we spoke through the lonely hours of the early morning, his life slipped away.

I was 21 at the time, and my immediate emotions were those of grief and guilt.

As a young physician in South Africa, that experience was repeated time and again.

When I came to the United States I was confronted with the reverse scenario: Teenagers who had been given “everything”, and were turning to drugs to blunt the pain of meaningless and spiritual emptiness.

That was when I thanked the Creator, for giving me the opportunity to diminish the suffering of others and participate in helping others. In fact, my pity went out to those whose “good-fortune” imprisoned them to the shallows of their limited personal existence, blinded to the suffering of the universe around them.

Your Grandfather was your “Good Caretaker”. He validated and soothed you. He was also a safe-haven against a toxic mother and “absent” father. His life was snatched before the “soothing” that you needed had been fulfilled.

That’s why your nights are so fretful – you remain “un-soothed”.

Now there are some, who in your position would become bitter, even angry at G-d, for having everything you treasured taken away at such a young age.

Yet, while you may feel tortured, you didn`t allow yourself to be hijacked by your tragic losses.

In fact, you persisted in your attempts to become independent, even beyond your years.

And that is a testament to how much you received emotionally from your grandfather and subsequently your nanny.

What I have found, (and this is supported by the literature) is that one “Good Caretaker” is crucial during the early “formative” years.

There are many challenges ahead, such as dealing with a lingering “bereavement”   process while escaping your mother`s toxic projections in order to “self-preserve”; the latter can be daunting, but is do-able.

Later, as you heal, you will find that as a result of this suffering you have acquired a unique skill: empathy and compassion.

And if you can harness that by recognizing and comforting others, you will feel true gratification.

Most people live shallow lives trapped within their own superficial narratives, failing to notice or care about “victims” like yourself.

This deeper level of “service” will also keep you connected to your grandfather and nanny.

A truly meaningful life will soothe you. And when you are soothed, their souls become soothed because they always remain connected to you.

Separation only exists in the physical plain.

Hoping this resonates with you.


Brian Trappler M.D.

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