A neuroscience-informed, relational approach to trauma therapy

James Tobin, Ph.D.

Introduction

Many people who have experienced trauma find themselves asking: “Why does this still affect me—even when I understand what happened?”

You may notice patterns such as:

• feeling triggered in relationships
• difficulty trusting others
• persistent shame or self-criticism
• a sense that the past is still present

These are common effects of trauma, PTSD, and childhood trauma, and they often do not respond to insight alone.

Trauma, especially chronic interpersonal trauma such as childhood abuse, affects not only memory, but the organization of the mind and body. Individuals often experience disruptions not just in recollection, but in identity, emotional regulation, relational trust, and bodily experience (Courtois & Ford, 2013; Herman, 1992; van der Kolk, 2014).

Many approaches to trauma therapy emphasize “rewiring the brain.” While this is true, it raises a deeper question: What kinds of experiences actually produce lasting psychological and neural change?

Psychodynamic psychotherapy approaches trauma therapy and PTSD treatment as a process of interpersonal, experiential neuroplasticity, where new emotional, relational, and bodily experiences reshape the brain over time (Cozolino, 2010; Fonagy et al., 2002; Schore, 2012; Siegel, 2012).

Who This Approach Is For

This approach may be especially helpful if:

• you understand your trauma intellectually but still feel stuck
• your relationships repeat familiar painful patterns
• you feel fragmented, disconnected, or inconsistent in yourself
• previous therapy helped, but did not reach deeper patterns

Trauma as a Disorder of Integration

Psychodynamic theory has long understood trauma as a failure of integration.

Freud (1920/1955) described trauma as overwhelming experience that cannot be processed. Later theorists emphasized breakdowns in symbolization and reflective functioning (Bion, 1962; Fonagy et al., 2002).

Bromberg (2011) expanded this further, describing trauma as a disruption in the continuity of self across states of mind. Rather than a unified self, the mind becomes organized into dissociated self-states, each holding different aspects of experience that cannot be fully experienced together.

Trauma is not simply remembered, it is relived.

It shows up in:

• emotional shifts
• relational expectations
• bodily reactions
• changes in sense of self

From a neurobiological perspective, trauma is encoded largely in implicit, right-brain and subcortical systems, including emotional, somatic, and autonomic processes (Schore, 2003; Siegel, 2012; van der Kolk, 2014).

Damasio (1999) emphasizes that these experiences are fundamentally embodied, involving the integration of emotion, physiology, and consciousness. Trauma disrupts this integration, leaving experience fragmented across mind and body.

Experiential Neuroplasticity: How Change Actually Happens

The brain changes through experience, especially interpersonal and emotional experience, not information alone (Kandel, 1999; Siegel, 2012).

Psychodynamic therapy works through interpersonal neuroplasticity, where repeated relational experiences reshape neural systems (Cozolino, 2010).

These experiences include:

• emotional activation in the presence of another
• co-regulation of affect
• repair following relational rupture
• awareness of bodily states
• integration of previously dissociated experience

Over time, this leads to changes in:

• affect regulation networks
• implicit relational memory
• autonomic nervous system functioning
• sense of self

This is not a technique—it is a process of lived transformation.

The Body, the Nervous System, and Trauma

Trauma is not only psychological, but also physiological.

Porges’ Polyvagal Theory (2011) describes how trauma affects the autonomic nervous system, leading to patterns of:

• hyperarousal (fight/flight)
• shutdown or dissociation (freeze)

These states are often triggered automatically and experienced as uncontrollable.

Ogden and colleagues (2006) emphasize that trauma is stored in sensorimotor patterns, e.g., posture, movement, tension, and bodily impulses.

In therapy, attention to bodily experience allows for:

• increased awareness of internal states
• regulation of autonomic responses
• integration of somatic and emotional experience

This is essential for trauma therapy, as many aspects of trauma are not accessible through words alone.

The Therapeutic Relationship as the Engine of Change

The therapeutic relationship is the primary mechanism of change.

The brain develops, and reorganizes (“rewires”), through relationship (Bowlby, 1988; Schore, 2012; Siegel, 2012).

Psychodynamic therapy reshapes the brain through:

• co-regulated emotional experience
• integration of somatic, emotional, and cognitive systems
• revision of implicit relational patterns
• strengthening of regulatory neural circuits

Kandel (1999) demonstrated that experience alters gene expression. Cozolino (2010) and Siegel (2012) emphasize that psychotherapy is fundamentally a biological process occurring through social interaction.

The following components of therapy promote change.

Right-Brain-to-Right-Brain Communication

Schore (2012) emphasizes that therapy operates through right-brain-to-right-brain communication:

• tone
• timing
• facial expression
• emotional presence

These interactions regulate affect directly and reshape neural pathways involved in attachment and emotional regulation.

Co-Regulation and Polyvagal Safety

Within the therapeutic relationship, the nervous system begins to experience safety in connection.

According to Porges (2011), this activates the ventral vagal system, supporting:

• calm engagement
• emotional regulation
• social connection

Repeated experiences of co-regulation gradually shift the baseline functioning of the nervous system.

Rupture and Repair

Change occurs not through perfect attunement, but through cycles of:

• misattunement
• recognition
• repair

These processes build resilience and flexibility (Safran & Muran, 2000; Tronick, 2007).

Revision of Implicit Relational Memory

Trauma shapes implicit expectations about:

• self
• others
• relationships

Through consistent relational experience, these expectations are revised at a procedural level (Lyons-Ruth, 1998; Stern et al., 1998).

Bromberg and Integration of Self-States

Bromberg (2011) describes therapy as creating the capacity to “stand in the spaces” between self-states.

Rather than eliminating parts of the self, therapy allows:

• multiple states to be experienced simultaneously
• internal conflict to be tolerated
• dissociation to decrease

This reflects increasing integration across both psychological and neural systems.

Symbolization and Mentalization

Trauma disrupts the ability to symbolize experience.

Through therapy, implicit experience becomes:

• thinkable
• nameable
• shareable

This enhances mentalization (Bateman & Fonagy, 2008; Fonagy et al., 2002;) and reflects increased integration between emotional and reflective brain systems.

Research on Psychodynamic Therapy for Trauma

Research supports psychodynamic therapy as an effective trauma therapy:

• Comparable outcomes to other treatments (Abbass et al., 2014; Shedler, 2010)
• Long-term gains that increase over time (Leichsenring & Rabung, 2008)
• Improvements in attachment and emotional regulation (Bateman & Fonagy, 2008; Levy et al., 2006)

Psychodynamic Therapy vs. EMDR

EMDR is effective for processing specific memories (Chen et al., 2014; Shapiro, 2018).

Psychodynamic therapy focuses on:

• identity and self-experience
• relational patterns
• interpersonal neuroplasticity

For complex trauma, these broader processes are often essential (Courtois & Ford, 2013).

What Therapy Feels Like

In therapy, patterns are not only discussed but they are also experienced.

You may notice:

• emotional shifts in real time
• bodily responses becoming clearer
• different parts of yourself emerging

Over time:

• emotional regulation improves
• dissociation decreases
• self-continuity strengthens
• relationships feel more authentic

This is change through lived experience.

Working Together

In my psychotherapy practice in Orange County, CA, I work with adults navigating trauma, anxiety, and relationship difficulties using a psychodynamic, neuroscience-informed approach.

If trauma continues to shape your relationships, identity, or emotional life, therapy can help you work through these patterns at their roots.

Conclusion

Psychodynamic psychotherapy offers a comprehensive, empirically supported, and neurobiologically grounded approach to trauma therapy and PTSD treatment.

At its core, it is a process of interpersonal, experiential neuroplasticity—where new emotional, relational, and bodily experiences reshape the brain and transform the self.

Frequently Asked Questions About Trauma Therapy

What is psychodynamic psychotherapy for trauma?

Psychodynamic psychotherapy is a depth-oriented form of therapy for trauma that focuses on how traumatic experiences shape emotions, relationships, and patterns of self-experience over time. Rather than addressing symptoms alone, it works to integrate trauma at the level of identity, attachment, and emotional regulation.

Does therapy actually change the brain?

Yes. Psychodynamic therapy works through experiential neuroplasticity, meaning the brain changes through repeated emotional and relational experiences. Research shows that co-regulation, attachment, and meaningful interpersonal experiences can reshape neural pathways involved in emotion and stress regulation (Kandel, 1999; Schore, 2012; Siegel, 2012).

How does therapy “rewire” the brain?

Therapy “rewires” the brain through repeated experiences of:

• emotional regulation within a safe relationship
• integration of thoughts, feelings, and bodily states
• revision of implicit expectations about self and others

These changes occur gradually through lived experience, not just insight.

What type of therapy is best for childhood trauma and complex trauma?

Childhood trauma often affects identity, attachment, and the nervous system, not just memory. Psychodynamic psychotherapy is particularly well suited because it addresses these deeper patterns, including dissociation, relational difficulties, and emotional dysregulation. Other approaches such as EMDR or somatic therapies may also be helpful depending on individual needs.

Is EMDR better than psychodynamic therapy for trauma?

EMDR can be very effective for processing specific traumatic memories, particularly single-event trauma. Psychodynamic therapy focuses more broadly on identity, relationships, and long-standing emotional patterns. For complex trauma, many individuals benefit from psychodynamic therapy, sometimes alongside other modalities.

Can psychodynamic therapy help with dissociation?

Yes. Psychodynamic therapy is particularly effective for dissociation because it works with dissociated self-states (Bromberg, 2011). Through the therapeutic relationship, different parts of the self can be experienced, understood, and gradually integrated into a more cohesive sense of identity.

How long does psychodynamic therapy for trauma take?

The length of therapy varies depending on the individual and the complexity of the trauma. Some people benefit from shorter-term work, while others engage in longer-term therapy to address deeper patterns. Because psychodynamic therapy focuses on lasting change, it often unfolds gradually over time.

Does psychodynamic therapy work for PTSD and trauma?

Yes. Research shows that psychodynamic therapy can reduce PTSD symptoms while also improving emotional regulation, relationships, and overall functioning. It is particularly effective for complex PTSD and trauma rooted in early life experiences.

Why doesn’t understanding my trauma make it go away?

Trauma is often stored in implicit emotional, relational, and bodily systems, not just in conscious memory. This means that insight alone is usually not enough. Healing requires new emotional and relational experiences that allow the brain and nervous system to reorganize.

About the Author

James Tobin, Ph.D., is a clinical psychologist and psychodynamic psychotherapist in Orange County, CA, specializing in trauma, PTSD, and relational difficulties. His work integrates contemporary psychoanalytic theory with neuroscience, including attachment theory, interpersonal neurobiology, and experiential approaches to trauma treatment.

Dr. Tobin’s clinical focus centers on how early attachment experiences, social environments, and cultural conditions shape emotional development, identity, and relationships. He works with adults seeking deeper, long-term change in how they experience themselves and others.

In addition to his clinical practice, Dr. Tobin writes about contemporary psychological life, exploring how shifts in modern culture influence mental health, emotional intelligence, and the ways people relate to one another.

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Disclaimer

This article is provided for informational and educational purposes only and is not a substitute for professional psychological or medical advice, diagnosis, or treatment. Reading this content does not establish a therapist–client relationship.

If you are experiencing emotional distress, mental health concerns, or relationship difficulties, you are encouraged to seek guidance from a licensed psychologist, mental health professional, or qualified therapist.

If you are in crisis or require immediate support, please contact emergency services or a crisis hotline in your area.