An Interview with Trauma Therapist Brad Kammer – Part Two of Two

In Part One of my interview with trauma expert Brad Kammer, LMFT, currently on the faculty of the NARM Training Institute, we discussed how Brad and his colleagues distinguish between PTSD and complex PTSD. In Part Two, we explore how NARM’s NeuroAffective Relational Model addresses the impact of adverse childhood experiences and complex trauma. Brad and Dr. Laurence Heller outline the therapeutic framework of NARM in their new book, The Practical Guide for Healing Developmental Trauma: Using the NeuroAffective Relational Model to Address Adverse Childhood Experiences and Resolve Complex Trauma.

(Note: This is the second of a two-part  interview)

You are currently on the faculty of the NARM Training Institute. What does NARM stand for? What is your working definition of trauma?

NARM stands for the NeuroAffective Relational Model, which is a model designed by my long-time mentor Dr. Laurence Heller, to address the impact of adverse childhood experiences and complex trauma.  In NARM, we recognize that in most cases we cannot change the traumas we experience.  But, we can change the ways we have adapted in order to survive these traumas.

We use a developmental framework that describes five Adaptive Survival Styles which are ways we learned to adapt to attachment and environmental failures early in life. These styles form the blueprint for our adult personalities.  We focus on five specific developmental stages early in childhood when the Self is just being shaped, and the ways that attachment and other environmental failures impact healthy development in each of these stages (which we are learning so much about through the Adverse Childhood Experiences research).  The way that our brain and bodies adapt to these early traumas – specifically through shame – leads to various levels of often profound Self-disorganization and creates various symptoms, disorders, and syndromes.

In Part One of our interview, you identified the important differences between Post-traumatic Stress Disorder (PTSD) and Complex-PTSD. How might the treatment for each differ?

I am biased as to how I’m going to answer this question since I have been a somatic psychotherapist and trainer now for over two decades. I believe that any form of trauma healing must involve the body. Many of my colleagues have been pushing back against the more prominent “evidence-based approaches” that are usually derivatives of Cognitive Behavioral Therapy, and which demonstrate questionable long-term efficacy. Dr. Bessel van der Kolk’s book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, continues to be a best-seller ten years after it was first published. Many people intuitively, and experientially, know that talking and thinking about our issues only take us so far. To make true and lasting change, they have to shift deeper internal patterns.  This is where somatic approaches come in.

I have practiced Somatic Experiencing for over twenty years now and I find it to be the most effective model out there for PTSD.  As I continued to seek models that worked more specifically with attachment, emotional, and relational trauma, I found NARM, which I believe is the most effective model out there for treating C-PTSD.

Please tell us what you mean by a person having “agency.” Why is it a game-changer?

The simplest way to define how we use the concept of Self-Agency is to highlight the various ways that individuals organize and relate to life experiences.  Agency is a by-product of secure child development where a child progressively experiences themselves more as actors in their life than simply passive conduits for life experience.  Other models may refer to related concepts such as Self-Activation, Self-Actualization, or Self-Realization.

When a child has experienced developmental trauma, they experience everything as just happening to them. They feel helpless to change not only their external conditions but also how they feel internally. Children may grow up feeling out-of-control (i.e., lack of impulse control), reactive (i.e., affect dysregulation), fragmented (i.e., dissociative self-states), and fragile (i.e., decreased sense of resiliency).  Their lives are significantly impaired by their inner sense that they cannot self-activate, let alone change the way they feel or how they relate to the world.

NARM is grounded in an inquiry process that explores Self-Organization – how clients are organizing their internal worlds, and then relating to both their inner and outer experiences, in ways that either support connection and health or lead to disconnection and disease.

For example, your client shares a story about their experience at work last week where they were walking in the hallway and said “hello” to a colleague they were passing, and the colleague didn’t say hello back. Immediately, your client started feeling worthless, unliked, and lonely, and then started telling themselves that “I’m stupid and no one will ever like me.” They use this experience to justify why they withdraw from social interactions and experience social anxiety and depression.  However, they later found out that their colleague had just received a text from a family member of a sudden loss in their family, had been in a state of shock, and not even heard your client say hello. Your client describes shaming themselves for having such a strong reaction, saying that “I’m stupid for telling myself that I’m stupid based on this situation.”  This cycle of shaming oneself for shaming oneself can go on and on.

As we help clients begin to gain greater awareness of the unconscious and often automatic ways they are organizing their inner reality and relating to themselves and the world through self-shame, self-rejection, and self-hatred, they begin to experience more possibilities for organizing and relating to themselves differently. This is not just a cognitive process. It entails working psychobiologically to shift long-standing personality patterns that keep shame-based identifications intact.

Collective and intergenerational trauma are vast and necessary subjects worthy of discussion. Individuals can’t change their ancestry, and in many cases, individuals cannot change their marginalized status or persecution within a society. Can the NARM program help people traumatized by an unchanging trauma-inducing culture?

I know from my own personal experience, as well as years of clinical experience, that NARM does impact unresolved cultural and intergenerational trauma. We focus on how clients are relating to the “unchanging trauma-inducing culture” that they are born into and are still part of.  For many people, the concept of “post” in post-traumatic stress disorder doesn’t truly exist.  Many people are still living within and adapting to environmental failures, including sustained oppression, violence, and dislocation.  And yet despite these traumatic realities, we see individuals and communities cultivating health and well-being within.  It is inspiring to watch as people stop defining themselves by how others define them and embody their own authentic humanity.

I see our modern times, at least in the U.S., as defined by a widespread failure of empathy.  We care less and less about our impact on others.  This leads to relationships based on objectification and systems reinforcing dehumanization. The social fabric is rapidly dissolving, leaving an epidemic of loneliness and disconnection in its wake.  To counter this reaction, NARM supports the development of authentic empathy.  As we help people develop an increasing capacity to relate to themselves and others through acceptance and compassion, they begin to shift their own internal objectification and experience themselves as more fully human. This increased sense of humanity allows people to begin to shift the way they are relating to their family, community, and cultural systems.  So while it will likely take time, I do believe NARM can impact larger changes within society.

(Read Part One: Diagnosing and Treating PTSD and Complex PTSD: It’s Not About “What’s Wrong With You?”)

This post appeared in a slightly different form on Dale’s blog on Psychology Today. You can find all of Dale’s blog posts for Psychology Today at 

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An Interview with Trauma Therapist Brad Kammer – Part One of Two

I can’t remember the first time I heard the word trauma. Vietnam, the wars in Afghanistan and Iraq? When did “trauma” enter popular parlance? Was it after 9/11? I recently learned that there are now 6,000 podcasts with “trauma” in the title. Are we somehow in the midst of a trauma epidemic? Or does this reflect our growing understanding?

Trauma refers to a wound to the psyche or the body or both. We now know that not only experiencing trauma oneself but witnessing trauma or being told about a traumatic event can be traumatizing.

To help us understand one of the emerging approaches to diagnosing and treating trauma, I’m delighted to introduce my guest, trauma expert Brad Kammer, LMFT, currently on the faculty of the NARM Training Institute.  NARM stands for the NeuroAffective Relational Model, a treatment model developed by Dr. Laurence Heller, Brad’s long-time mentor, to address the impact of adverse childhood experiences and complex trauma.  “In NARM, we recognize that in most cases we cannot change the traumas we experience. But, we can change the ways we have adapted in order to survive these traumas,” he explains.

Brad brings to his work a holistic approach that includes body-oriented therapies as well as a deep knowledge of attachment theory and survival styles. He and Dr. Heller recently co-authored The Practical Guide for Healing Developmental Trauma: Using the NeuroAffective Relational Model to Address Adverse Childhood Experiences and Resolve Complex Trauma. In a world reeling from destabilization, violence, hatred, and suffering, Brad Kammer and his colleagues at NARM present an opportunity for healing and hope.

This will be a two-part interview.

When many of us hear the word trauma, we think of soldiers, people caught in war zones or natural disasters, but you make a clear and valuable distinction between what you call shock trauma and relational or developmental trauma. Can you explain the difference?

It is difficult to differentiate because as humans we experience both shock and relational traumas, often at the same time.  For example, a parent who physically hurts a child will create a shock trauma reaction in response to the physical violence in the context of the relational failure of the parent not protecting or keeping their child safe from harm.

This is an extremely simplistic way to differentiate it – but in my teaching, I often use this as short-hand to distinguish between PTSD and C-PTSD: PTSD (post-traumatic stress disorder) is about the psychobiological process of fear, and C-PTSD (complex post-traumatic stress disorder) is about the psychobiological process of shame.  While there is certainly much overlap, research suggests there are different neural circuits responsible for fear than for shame.

The example I often use is you’re walking in the woods and a bear jumps out at you.  In that very moment, you’re not worrying about your relationship with the bear, you just want to survive.  So your brain will bypass the emotional, relational and cognitive centers and go straight to activating the hyperarousal centers of the brain in order to optimize your chances for physiological survival.  Mortal threats activate the fight/flight response.  This is experienced through fear.

Now imagine that the threat isn’t a bear jumping out of the words; it’s your parents, and each day of your life you feel that your sense of security in the world, and within yourself, is not welcomed or supported, but may be dismissed, undermined or attacked.  This puts you into a bind – as young children, we cannot run or fight against the people we are 100% dependent on for our survival.  While these threats may not be immediately life-threatening like the bear, we still have to find ways to survive the ongoing, persistent failures of in our development.

Humans are designed to be connected to themselves and others.  When connection to self and others becomes fraught with pain and danger, we use various strategies to disconnect from ourselves and the pain that we experience internally.  One such process involves the way we relate to ourselves through shame and self-rejection.  We internalize the failures of our early environment and personalize them as our inherent failures.  These shame-based identifications form the foundation of our personality development.

For so many people, they don’t even consider this “trauma.” I have had so many people – not just clients, but mental health and other healthcare professionals – push back that we are broadening the term trauma too much.  “This is just life” they say, or “This is just how childhood is.”  But minimizing and dismissing the effects of these failures is itself a sign of unresolved trauma.

My mentor used to say, “In a world of bent-over people, the one standing upright looks strange.”  So I push back on the notion that we use trauma too broadly. I argue that we don’t have a broad enough understanding of the impact of unresolved complex trauma.

What are some other ways in which PTSD is different from Complex PTSD?

As the trauma field continues to evolve, we have begun to more clearly differentiate between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (C-PTSD).  PTSD, which is sometimes called “shock trauma,” is generally caused by one-time events like accidents, assaults and natural disasters, and leads to hyper- and hypo-arousal in the nervous system that creates symptoms like intrusive images, flashbacks, hypervigilance, avoidance and dissociation.

C-PTSD is generally caused by relational and social failures, and leads to disorganization and insecurity in one’s sense of Self, as defined by the three symptom categories that include affect dysregulation, negative self-concept, and interpersonal disturbances.  Developmental trauma, a subset of C-PTSD, is generally caused by adverse childhood experiences that impact a child’s development.  NARM was created specifically to address C-PTSD, focusing on attachment and developmental trauma, but also working with larger social failures such as cultural and intergenerational trauma.

The trauma-informed field has been rapidly growing over the past 40 years since the first introduction of PTSD into the DSM in 1980.  While this field has made tremendous strides, our understanding of complex trauma has lagged behind.  Trauma pioneer Dr. Judith Herman suggested that PTSD doesn’t go far enough, and presented “a new diagnosis” in her 1992 book Trauma and Recovery, which she called C-PTSD.  And yet here we are in 2022 and we still don’t have an official complex (C-PTSD) or developmental trauma disorder (DTD) diagnosis in the United States.  This means that so many people are being misdiagnosed, or at the very least, are being treated for secondary issues.  What if many of the symptoms and disorders we see in our clients are driven by unresolved early trauma?  This changes the way we look at diagnostic categories and even challenges how we currently view psychopathology.

As we describe in our work, maybe it’s not about “what’s wrong with you,” but about “how have you adapted to what happened to you?”  For many of us in the trauma field, we see many “symptoms” and “disorders” as understandable reactions and adaptations to abnormal conditions and environments.  This is particularly true for children and how they have learned to adapt to persistent failures in their early lives.  These are not one-time traumas that can easily be resolved.  This is the territory of complex trauma, and it truly is very complex to understand.  It is also challenging to treat.  This is why we need comprehensive therapeutic models that understand how to identify, navigate and address this complex territory.

Part Two of our interview will be posted next month.

This post appeared in a slightly different form on Dale’s blog on Psychology Today. You can find all of Dale’s blog posts for Psychology Today at 

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