This two-day training forms the third part of DBR training and offers participants an opportunity to understand more about how the deeper layers of the self can be affected by trauma. In DBR the focus is not on the upper-level parts of the self, such as self-states, ego-states or alters – but on the underlying emotional pain and the rage, fear, grief, and shame that deep wounding generates.

Most therapists working with complex trauma disorders will have experience of working with trauma memory processing techniques and of attending to parts of the self that have become detached, to a greater or lesser extent, from everyday awareness.

As separated parts of the self probably involve circuitry through surface level loops – that can become detached from their traumatic origins in the brainstem affective and defensive loops – the focus in DBR is to work from the putative midbrain level. This means starting always from the Where Self when processing any of the traumatic experiences or working with young parts of self. This goes beyond basic grounding as it brings in a different perspective from the deeper level towards what is held in the surface-level circuitry.

Another difference with DBR is the focus on core attachment shock and pain and their associated affects. The hypothesis is that the clearing of the distress at its origin withdraws all distressing activation from episodic memories and stops them from having power to intrude through re-experiencing. DBR often starts with present-day activations as the aim is to provide treatment that is immediately relevant to the person’s quality of life.

Some therapy approaches work primarily with traumatised parts of the self, getting to know them and increasing their communication and co-operation, as well as orienting them to the present. These methods are effective but don’t always get to the underlying pain of aloneness and abandonment. In DBR the focus is, instead, not on the upper-level parts of the self – but on the underlying emotional pain and the rage, fear, grief, and shame that this deep wounding generates.

Working at this lower level of the brain is difficult because the brain has found it necessary in the past to turn away from the pain. However, the person is now in a different situation, at a different age, and may have the capacity to confront that pain in a way which allows healing at the core of the trauma and abuse history. The brain has gone on developing around that core pain in such a way that it might now be helpful to approach it from a different angle.

There are no clinical studies of DBR for core aloneness pain in complex trauma and dissociative disorders – and none that compare it with approaches that focus on the parts of the self that have become compartmentalised. Sometimes people move between the approaches – working with the parts when necessary, working with the pain when possible. This training is, however, focused on the core emotional pain and its associated affective and defensive responses rather than the separated parts of the self.