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Nicolas Pablo De la Tierra, October 21 2022

THE NARM MODEL OF DEVELOPMENTAL TRAUMA

The Neuro Affective Relational Model, or NARM model for short, is the brainchild of world renowned Dr. Laurence Heller and it builds on current research on resilience and self-regulation, a big topic in psychology today.

What does NARM stand for

NARM is principally focused with developmental trauma, and suggests that trauma occurring at different stages of our critical age period between 0 and adolescence, will manifest also consistent symptoms in later stages of life. In other words, the NARM model proposes that certain problematic adult behaviours are predictably correlated to overwhelming events occurring at particular stages of our early development.

So I will now summarise in some details these different Trauma Stages, what they stand for, and how they normally manifest themselves in later life.

The Connection Structure - In Uterus to 6 months

A trauma occurring from in-uterus to about six months of age stops the fulfillment or completion of one fundamental developmental need, that of connection, else known as bonding. I am referring here to events such as being on the receiving side of pregnancy issues due to mental or physical illness, domestic violence, substance abuse, attempted abortion, early surgery at birth, death of mother at birth, not being wanted or even detested, postpartum depression, or being born into famine, war, discrimination, natural disaster conditions, poverty, or being abandoned and then adopted to mention a few. 

If anyone is the subject of any of these circumstances then the answer to "Am I traumatized?" is a pretty straight forward yes. Because of the incomplete fulfillment of this basic existential need, the individual will struggle with his or her sense of existing, of being real, expressed in difficulties to be in touch with one's body and emotions or the capacity to be connected to others. For instance, withdrawing into depression or isolation, becoming hyper-active mentally but not emotionally, as well as spiritualizing, are all behaviours characteristic of this trauma survival response.

Children who experience pre-verbal trauma begin life profoundly overwhelmed and thus psychologically and physiologically unregulated. Never feeling welcomed in the world; feeling unlovable; being scared of relationships; being numb or absent to the body (If I am in my head and not in my body I won't feel pain and will be able to handle my fear); chronic anxiety and never feeling like one belongs are all feelings associated to the disruption of this stage of development (I have no right to exist, I do not have a place in this world).

The Attunement Structure - Birth to 1.5 years old

The core need being expressed at this level of development is the need to be attended to and cared for, and when the environment responds positively we develop the capacity to be attuned to our needs and emotions; the capacity to recognise, reach out for, and take in physical and emotional nourishment; as well as the capacity of nurturing others. Thus, the attunement structure.

But parents engaged in substance abuse or other family crisis can interrupt the fulfillment of this basic need, leading the child to develop a certain ambiguity about his or her natural need for being nurtured, attached, and emotionally and relationally engaged. As adults, we do not know what we need or even that we have needs, and thus we are not able to ask for what might be fulfilling to us. If we do come to identify the need and reach out asking for fulfillment, we are likely to experience guilt or shame. We have difficulties receiving, taking in and being nourished. When attachment needs are not attended to, for instance, a first attempt to protest may arise, but when this protest is not attended to a core belief develops: 'I don't deserve' becomes the default posture leading later in life to a sense of despair, helplessness, hopelessness, and resignation. Overall the child will begin to content itself with what is available in the impoverished environment, and will build strategies for having his or her needs met that revolve first and foremost on serving other's needs. People with unfulfilled attunement structures often follow a career in the health or educational field, fields strongly focused on other's needs.

The core dilemma is therefore around the fact that needing is not safe, causing a decrease or even a shutting down of reaching out behaviour. The core fear is that of abandonment and rejection if one expresses one's core needs.

The Trust Structure - 1.5 to 4 years old

With disruptions occurring in the third structure, that of trust, between the age of 2 and 5, the survival mechanism that ensues is different from the two previous ones in that it is rooted in a sympathetic nervous response, the system responsible for the Fight and Flight response, rather than parasympathetic nervous system, the system responsible for the Freeze shut down responses often triggered at the level of the Connection and Attunement structures. What this means is that these types of individuals face severe challenges in adjusting their level of control of anger and aggression, and are often sympotmatised with acting out behaviours. It is often the case that this disruption is caused by an environment where the child is asked to sell itself out, for example by becoming the parent of the parent, or the go between parents, or any other role that robs them of their individuality and places them into playing a specific emotional role. Children in this context get rewarded and empowered for responding to the specific role demands made on them. The most difficult part for them is to trust and be dependent on someone because their whole life they try to escape the feelings of helplessness they felt as a child in relationships that suffocated their true spontaneous emotivity.

The Autonomy Structure - 1.5 to 4 years old

The fourth structure is the Autonomous structure, where the compromised structure is the child's autonomy and need for independence. This survival strategy too is rooted in the sympathetic nervous system response. Children in this category felt invaded, controlled, on the receiving end of anxiety when they tried to individuate, or they were threatened when they tried to stand up for themselves (threat of abandonment, of being crushed, punished, isolated), and as a result they have given up their autonomy in a direct way, becoming very pleasing.

Underneath they live with a very deep resentment and anger, a superficial yes and a very deep-seated no.They do not like confrontation, so they will play along, be appeasing, but with a partner they will assert themselves either by making them so miserable they end up leaving, or leave suddenly themselves. In this relational context, aggression and assertion means loss of love, so these individuals will typically be very removed from their own anger and use others to express their anger, which is the primary cause of misery. It is the position exemplified in Dr. Walker's model with the Fawn. The child-adult reproduces the internal dysfunctional experience of autonomy at the cost of attachment, paralysed by their internal contradiction, this push-pull dynamic derived from a need to assert themselves, but the inability to do so because of the menaces that this entails. Even in therapy this may play out in a tendency to seek “the program, the expectation”, on the one hand promising total commitment to it, and on the other unconsciously planning to sabotage it. As clients, individuals carrying this traumatic profile, are so used to identify what is the right thing to do outside of themselves that thee will often appear as trying very hard to follow the book, by efforting harder than anyone, but that is exactly what derails them, because by doing so, they are unable to build a healthy level of autonomy and inner authority.

The Love Structure - 3 to 6 years old and puberty

Finally, the fifth survival style is to do with love and sexuality, and here a healthy structure is able to integrate love and sexuality well while the survivalist in this category of trauma takes identification with either one at the cost of the other. The healthy development of this structure will allow for a capacity to live with an open-heart; to integrate a loving relationship with a vital sexuality; the capacity to experience and share pleasure; and the capacity to be playful, graceful and sensual. But the rejection, disapproval, or anxious meeting of the child's open-heartedness, tenderness and affection will leave the child with the feeling that something is wrong with them, that they are somehow profoundly flawed. In many family systems, the rejection of the child's heart comes when their parent misunderstands their loving feelings as some sort of sexual expression. Parents with repressed sexual feelings and or sexual wounding may be incongruent in their own behaviours leading to sexual violations and abuse, including "emotional incest", often the result of premature encouragements towards the child's expression of his sexuality. Children faced with unsafe or non nurturing environments at this stage of development may learn early on to split off any sensual and sexual feelings from their expressions of love.

Here it is important not to confuse the love-sexuality survival style with issues surrounding love and sexuality such as those arising from sexual abuse. Sexual abuse will manifest different survival styles depending on the stage of development at which it occurred and will be more or less strongly associated with sexual issues.

A typical outcome of the disruption of this stage of development, on the other hand, is rigidity of mind and behaviour around one or other component of the love-sexuality cluster. Rigidity can, initially, balance out the sense of constant flawness and provide a sense of perfection at either the body or the intellect level, the core belief being that if one is perfect one will deserve love. By shifting attention away from internal experience to external rules of morality and away from pleasure and satisfaction to performance and achievement, individuals affected at this level may become masters of form, order, and performance, be extremely competent and attractive, perform skillfully and energetically, and even present gifts in areas like design, music, performance and languages. However, the price of flawlessness is an eventual exhaustion of the body, and a deep profound feeling of rejection of one's nature and humanity in favour of an idealised version of oneself, one in which perfection is the only choice in all aspects and dimensions of life. For a more comprehensive overview of the different survival styles please consult this slides published by the NARM Training Institute.

Visit my interactive visual summary of the NARM model here

Wishing you Well,

Your Shrink in Bansko

Written by

Nicolas Pablo De la Tierra

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