The Practical Guide for Healing Developmental Trauma: Using the NeuroAffective Relational Model to Address Adverse Childhood Experiences and Resolve Complex Trauma

by Laurence Heller, Brad J. Kammer

"A clinician's guidebook for treating developmental trauma with NeuroAffective Relational Model (NARM) to help clients overcome complex post-traumatic stress disorder (CPTSD), recover from adverse childhood experiences (ACEs), and map post-traumatic growth"--

Genres: Psychology, Nonfiction, Self Help, Mental Health, Counselling, Relationships, Audiobook

384 pages, Kindle Edition

Published July 26, 2022

Reviews

[Morgan Blackledge · Rating 5 out of 5]

DEVELOPMENTAL TRAUMA (DT) refers to abuse and neglect, occurring during critical periods of development, typically within caregiving relationships, which effect the individual at the level of self, personality and later in adult relationships.

DT can come to bear via a range of exposures, including: violence (domestic/community), racism, classism, ableism, sexism, homophobia, heteronormative gender role conflict, physical, emotional, or sexual abuse, neglect, emotional miss-atunment with caregivers/peers, bullying etc.

The brain and nervous system are still developing in early childhood and adolescence (and really throughout the lifespan). Simply put, we adapt to our psychosocial and physical environment. Exposure to DT signals the nervous system (and as such, our psychology) to become optimized to survive in dangerous, rejecting or otherwise “less than nurturing” environments and milieu.

Individuals subjected to DT nearly invariably feel like they are to blame for their mistreatment. As such, DT becomes internalized as a deeply felt sense of THREAT/SHAME whereby we NEVER feel completely safe, and we ALWAYS feel inferior, broken, incomplete, or too much, or not enough.

This pervasive sense of THREAT/SHAME can profoundly impact our psychosocial/psychosexual functioning.

DT frequently presents symptomatically as:
* Anxiety
* Depression
* Dissociation
* Hypervigilance
* Avoidance
* Self-harm
* Substance abuse
* Difficulty trusting others
* Problems with relationships
* Low self-esteem
* Learning and memory problems
* Attention problems

POST-TRAUMATIC STRESS DISORDER (PTSD) may develop after experiencing or witnessing overwhelming THREAT: e.g. a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.

PTSD symptoms include:

1. INTRUSIVE: flashbacks, nightmares, or unwanted memories.

2. AVOIDANCE: of trauma-linked thoughts, feelings, people, places, things and activities.

3. NEGATIVE ALTERATIONS: in mood or thinking, e.g. feeling numb or detached, having negative thoughts about yourself or the world, or blaming yourself for the trauma.

4. HYPER-VIGELENCE: involving changes in physical or emotional reactions, such as being easily startled, having trouble sleeping, or feeling constantly on guard.

COMPLEX PTSD (CPTSD) may develop after experiencing overwhelming THREAT/SHAME via DT and/or other types of long-term or repeated trauma in adulthood.

CPTSD symptoms include (all of the above PTSD symptoms, plus an additional cluster of symptoms referred to as disturbances in self organization (DSO), which include:

A. EMOTIONAl DYSREGULATION: difficulty regulating emotions.

B. NEGATIVE SELF CONCEPT: pervasive negative thoughts about self, e.g. worthlessness, helplessness, hopelessness and feeling like a fraud, or feeling defective etc.,

C. RELATIONAL DYSREGULATION: difficulty forming and maintaining healthy safety, trust, differentiation, connection, boundaries and stability relationships.

ATTACHMENT THEORY asserts that humans (all humans) have a natural need to form attachments with others (beginning with caregivers and later extending to peers, intimate partners etc.,). These attachments are initially formed in early childhood, and play a significant role in our emotional and social development throughout the lifespan.The individual develops a particular ATTACHMENT STYLE (relational connection/re-connection and emotional need meeting strategy).

ATTACHMENT THEORY recognises four main ATTACHMENT STYLES:

SECURE ATTACHMENT: Occurs when we feel comfortable and secure in relationship, and we trust our partners and feel confident that they will be there for us when we need them.

ANXIOUS ATTACHMENT: Occurs when we feel anxious and worried in our relationships, and feel or act clingy or demanding, and we have difficulty trusting our partners.

AVOIDANT ATTACHMENT: Occurs when we feel in relationship, and we push our partners away, and/or become emotionally unavailable or reluctant to get too close.

DISORGANIZED ATTACHMENT: Occurs when we feel like we took “crazy pills” e.g. emotional whereby we have difficulty regulating our emotions, and split between anxious and avoidant from one moment to the next.

NOTE: it is important to understand that no-one is just ONE attachment style, but rather utilizes all based on the situation at hand. The identification of a particular attachment style simply refers to the one the individual is most likely to utilize at any given time. Additionally, people change and grow throughout the lifespan (particularly via therapy and other types of self inquiry practice), and as such, commonly become less disorganized, and more flexible in their attachment behavior, a phenomena referred to as EARNED SECURE ATTACHMENT.

The NEURO-AFFECTIVE RELATIONAL MODEL (NARM) is a integrative psychotherapeutic model developed by Dr. Laurence Heller, designed to address the effects of DT/CPTSD.

NARM focuses on helping the client develop a sense of AGENCY via helping clients to:
* Identify their strengths and resources
* Set goals and develop a plan to achieve those goals
* Overcome obstacles and setbacks
* Build supportive relationships
* Advocate for themselves

NARM assumes that when people have AGENCY, they feel more AUTHENTIC in relationships, and more in CONTROL (in the good way) of their lives. As such, they are WAY more likely to ACHIEVE their goals and live in accord to their VALUES, and as such, leave more fulfilling lives.

NOTE: NARM assumes that AGENCY is a journey, not a destination, necessitating time, effort, and support to develop.

NARM is routed in interpersonal neurobiology (IPNB) and integrates elements from various therapeutic modalities, including psychodynamic therapy, somatic therapy, and attachment theory.

Key principles of NARM include:

1. SOMATIC AWARENESS: NARM emphasizes the importance of addressing both the psychological and somatic aspects of trauma, recognizing that the body stores and processes traumatic experiences.

2. ATTACHMENT FOCUSE: NARM works to identify and resolve early attachment patterns that may be contributing to an individual's current struggles in relationships, self-esteem, and emotional regulation.

3. IDENTIFY SURVIVAL STYLE: NARM helps clients identify and understand the survival strategies they developed in response to early trauma, and supports them in developing new, healthier strategies for coping with stress and emotional pain.

4. SUPPORT REGULATION: NARM encourages clients to develop greater awareness and regulation of their emotional states, helping them become more resilient and adaptive in the face of life's challenges.

5. RELATIONAL/EMBODIED MINDFULNESS: NARM focuses on the client's current experience and how it relates to their past, rather than delving deeply into the details of the traumatic event itself. This approach helps clients build a greater sense of safety and trust in the therapeutic relationship.

NARM practitioners adopt a CURIOUS, OPEN, ACCEPTING and LOVING (COAL) stance.

NARM practitioners use a variety of techniques to help clients heal from the effects of trauma and develop healthy relationships. These techniques are essentialized in what are referred to as THE FOUR PILLARS OF NARM.

FOUR PILLARS OF NARM are:

1. THE RELATIONAL MATRIX refers to the network of relationships that we form with others throughout our lives. These relationships shape our sense of self, our ability to regulate our emotions, and our capacity for intimacy. NARM practitioners help clients to understand how their early relationships have shaped them, and to develop new, healthier relationships.

2. THE PSYCHOBIOLOGICAL MIND refers to the psychobiological mind is the way that our brains and nervous systems process information and respond to the world around us. NARM practitioners understand that trauma can have a profound impact on the psychobiological mind, and they use a variety of techniques to help clients heal from the effects of trauma and develop a more resilient nervous system.

3. THE DEVELOPMENTAL PROCESSES refers to the developmental process is the way that we grow and change throughout our lives. NARM practitioners understand that trauma can disrupt the normal developmental process, and they use a variety of techniques to help clients heal from the effects of trauma and resume their normal developmental trajectory.

4. THE THERAPEUTIC RELATIONSHIP refers to the relationship between the client and the therapist. NARM practitioners understand that the therapeutic relationship is a powerful healing force, and they use a variety of techniques to create a safe and supportive environment where clients can heal from the effects of trauma.

NARM is based on the understanding that DT/CPTSD can lead to the development of attachment based SURVIVAL STYLES that, while initially adaptive, can become maladaptive over time.

NARM identifies FIVE SURVIVAL STYLES:

1. CONNECTION SURVIVAL STYLE: Develops when a child's early relational environment lacks consistent emotional attunement or connection. As a result, the individual may struggle with self-regulation, boundaries, and interpersonal relationships. They might also have difficulties feeling safe and trusting others.

2. ATTUNEMENT SURVIVAL STYLE: Develops when a child's primary caregiver fails to adequately respond to their emotional needs. In response, the child develops an excessive focus on the needs of others, often at the expense of their own. This can lead to chronic self-sacrifice, emotional enmeshment, and difficulty asserting personal needs.

3. TRUST SURVIVAL STYLE: Develops when a child experiences betrayal, deceit, or a pattern of broken promises from caregivers. The individual learns to rely on themselves and may become overly independent, dismissive of others, and skeptical of trust and vulnerability.

4. AUTONOMY SURVIVAL STYLE: Develops when a child's attempts at independence and self-expression are met with punishment or disapproval. To protect themselves, the child suppresses their own desires and needs, leading to difficulties in decision-making, low self-esteem, and a fear of asserting oneself.

5. LOVE-SEX SURVIVAL STYLE: Develops when a child's early experiences of love and sexuality are confusing, shaming, or exploitative. The individual may struggle with intimate relationships, experiencing difficulties in separating love and sexuality or developing an unhealthy focus on either.

The NARM PERSONALITY SPECTRUM (NPS) can help clients understand their personality traits, and how they were shaped by early experiences. The NPS can also help clinicians understand the client/(individual of human personage) personality type, in order to best them achieve their therapeutic intentions.

THE NPS PERSONALITY TYPES INCLUDE:

DISORGANIZED personalities are those who have experienced and adapted to severe trauma or neglect in early childhood. They often have difficulty regulating their emotions and behavior, and they may have difficulty forming relationships.

DETACHED personalities are those who have learned to avoid emotional pain by disconnecting from their feelings and relationships. They may appear cold and aloof, and they may have difficulty expressing themselves emotionally.

AVOIDANT personalities are those who are afraid of being rejected or abandoned. They may be shy and withdrawn, and they may have difficulty trusting others.

DEPENDENT personalities are those who rely on others for support and guidance. They may have difficulty making decisions on their own, and they may feel lost or helpless when they are not around others.

OPPOSITIONAL personalities are those who are constantly in conflict with others. They may be argumentative and defiant, and they may have difficulty following rules.

AGGRESSIVE personalities are those who use anger and violence to get what they want. They may be impulsive and reckless, and they may have difficulty controlling their behavior.

HEALTHY personalities are those who have developed a strong sense of self-esteem and self-efficacy. They are able to regulate their emotions and behavior, and they have healthy relationships with others.

NOTE: it is important to understand that the NPS taxonomy is not intended to ptahologize, but rather empower clients in their agency and healing.

OK.

DUDE.

That was a LOT!


MUCH more to NATM.

But…

That’s just about ALL I GOT (for now).

AND.

And…

That’s (partially) what NARM is (almost) all about.

Jeez!

I need to catch my breath.

Anyway.

This book portends to be a “practical” guide.

But no TEA/SHADE.

NARM is not a practical model.

Its VAST.

This book does about as good a job of making NARM “practical” as could reasonably be expected.

But expect to have TONS of HIGH quality QUESTIONS/CURIOSITY after reading it.

And DON’T expect to feel completely clear about how to implement NARM just by reading this book.

Never the less.

It’s GREAT.

So GET IT and READ IT.

5/5 STARS

[Whitney Sutherland · Rating 5 out of 5]

As a parent and therapist committed to addressing the intense degree of suffering and oppression in the world, the daunting question of “where to begin?” can feel like an uphill battle. Some would even consider it an unrealistic ideal to attempt to bring a more humanizing approach to the current clinical framework and culture that has become increasingly pathologizing and objectifying, (unfortunately often reinforcing the deep states of shame and disconnection inherent to trauma adaptations). For these reasons, I find this practical guide to be such an invaluable resource in showing us how to actualize this possibility into reality.

The Practical Guide For Healing Developmental Trauma elucidates straight-forward methods of refining our own relationship to ourselves to facilitate deep healing and growth in relationship to others on an identity level, rather than a temporary behavioral or symptom-reducing level. True to the experiential nature of NARM therapy, this guide includes several opportunities for the reader to pause and reflect on their internal experience as a means of deepening capacities for presence, exploration, and connection. I find these exercises not only interesting, but so essential in the practice of learning to be with myself as a subjective human-being so that I can increasingly show up in true curiosity and connection with others without pressure or an agenda.

For a model as nuanced and rich as NARM, I am impressed by the clear and accessible language in this practical guide. In fact, though primarily written for clinicians, I have shared passages of the book with clients and friends who reported deeper understanding of their own life patterns and experiences from a new, illuminating perspective. Though I have completed one of the NARM therapist trainings and participate in NARM-specific continuing education, I found that the simple breakdown of the core NARM principles and concepts outlined in this text has allowed for greater ease, less effort, and significant self-trust in how to balance being directive and intentional while holding an open space for discovery with a wide variety of clients presenting across differing levels of capacity for self-organization/regulation.

I particularly appreciate chapter eight, which emphasizes the relationship or the “R” in NARM, heart connection, and awareness of countertransference, all such crucial aspects of this model. This chapter reminds me how to shift from pressuring myself into the inner knowing of how powerful and reparative attuned presence itself truly is. I especially value being able to apply these principles and concepts as they unfold in real sessions by studying the provided annotated transcripts. So much is emerging each moment in a session and I find it highly useful that the authors provided this detailed breakdown of what was occurring “behind the scenes”, including key choice-points of direction, languaging, and attention to countertransference. As a NARM student, these annotations are inspiring, as they demonstrate how one can learn the techniques and interventions of NARM until the expression and artistry of the craft become spoken in their own authentic voice and style.

What a breath of fresh air and encouragement this model and guide are to the field of mental health, to our communities, and to the present-day world at large. I feel hopeful thinking of the many healers, educators, parents, and human beings who may read this guide and integrate such heartfelt understandings into their moment to moment interactions with clients, students, children, and loved ones.

[Nate Bate · Rating 5 out of 5]

It has been 3 1/2 years since I read the forerunner to this book - Healing Developmental Trauma, and so I am not in a great position to compare the two. However, I will do it a little. This book is supposed to be a practical guide, and it does seem to give more focus to practical methods. It does include a lot of foundational information from the first book, but with a new focus on complex trauma (an emerging focus within psychology as opposed to classic shock trauma or PTSD).

I remember loving the first book, and was no disappointment. It is very thought provoking, and it is helpful for a therapist or a amateur counselor to understand how they can better help people.

[Vampfiction · Rating 4 out of 5]

Enjoyed this one. Like how it was for both therapist and patient. May reread at some point.

[Bruin Mccon · Rating 4 out of 5]

When I say I’m not the target audience, I really mean it as I thought this was a book to help me when interacting with loved ones with deep childhood trauma. As a non-therapist interested in healing, this book was excellent. Once I realized this was meant for talk therapy providers, I was about to turn it off (audiobook) and return it to the library. Before I knew it, I’d been sucked in and now I’m reviewing it. There was a lot of good information about staying neutral that was helpful for a non-practitioner, including some specific language and case studies. I’m not going to use this with friends or anything but it will influence some future difficult conversations for sure.

[Rick Wilson · Rating 4 out of 5]

It’s good. At times a little “sunshine and gumdrops“ with just the constant reiteration that “nothing is wrong it’s just behavior “ and my bristling at that is probably more an indication of my own status than anything else.

This is sort of a continuation of Jenna Fisher and Bessel VDKs research on trauma, and attempts to put together a sort of holistic healing methodology for developmental trauma, which is yet a further niche past CPTSD.

[Mac Wilson · Rating 5 out of 5]

One of the best practical guides I’ve read of how to use somatic, neurobiological, and psychodynamic techniques for clients with trauma.

[Cristan✨🪐 · Rating 5 out of 5]

4.5⭐️

This was an enlightening read! More review to come…

[Lance · Rating 4 out of 5]

While I think I'd give NARM (the model of therapy for cPTSD discussed in this book) a 5/5, I've got to give the book overall a 4/5. The first big issue is that it's sold as a practical guide that anyone can use, but it is actually very much more geared towards therapists. A NARM book meant for the clients, still doesn't exist. The next big issue I had is with the instructional design of the book. For example, there's a LOT of vocabulary - much of it needlessly confusing. The NARM folks give cutesy names to some important moments, use clumsy phrases to differentiate things instead of assigning sensible names, and then seem to also refer to a single thing with various terms despite clearly defining it with a single term earlier.

That being said, I have a lot of hope for the NARM approach. I hope that cPTSD becomes recognized as a real, verified diagnosis and that therapeutic approaches such as NARM become the standard for care. Sadly, none of this is the case yet. It is hard to find a NARM therapist. It is even harder to find one that takes insurance. Even if they did, they'd have to actually submit things as symptoms (anxiety, depression, etc.) instead of the true issue of cPTSD.

The NARM approach has many facets, but the biggest differences it has from most other modalities is in being intensely client-focused and on recognizing/using the therapist-client relationship as a microcosm to learn about and then heal the connection-disconnection issues a client is struggling with. It's a deep approach that simultaneously digs deep into childhood while also staying anchored in the present moment. What that means is it examines long-held beliefs about yourself but doesn't get bogged down in the details of it, instead focusing on how you relate to those beliefs/experiences and how they're showing up now. NARM avoids reliving and rehashing those experiences, as they believe that is not therapeutically helpful.

Overall, I'm not sure if I can recommend this book. It's a tough read, academically jargony to some extent and just quite dense too. My recommendation is to listen to episodes of their Transforming Trauma podcast that interest you and read some free articles that explain the basics of the NARM framework instead. Or, better yet, find and get an appointment with a NARM therapist. That being said, I don't think NARM is for everyone. While it COULD be someday, that is not today. I'd say spend a year or more doing other therapy first. Many people just need psychoeducation and some skills, so CBT is great. Others with shock trauma or PTSD can get a lot from EMDR. Somatic therapies, ACT, IFS, and so on are great to explore first to see if you can get help from these more accepted and established modalities first.

[Courtney Hope · Rating 4 out of 5]

Trigger Warnings: Childhood trauma, abuse, neglect, CPTSD, mental health struggles.

There’s something comforting about a book that says:
“You’re not broken. You adapted.”
Reading this felt like a quiet but firm reminder that so many of the behaviors I’ve struggled with (the ones I’ve blamed myself for, shamed myself for) aren’t proof of failure. They’re survival tactics. They once served a purpose, even if now they just keep me stuck.
This book is rooted in compassion — not diagnosis. Not pathologizing. Just understanding. It gives words to the things many of us feel but don’t always know how to explain: why we shut down, why we push people away, why we over-function, why we can’t always sit with peace.
What I appreciated most was how this wasn’t just a book for therapists or professionals (though it’s certainly helpful for them). It’s for anyone trying to untangle themselves from patterns that no longer serve. Anyone trying to heal the self beneath the shame, the fear, the armor.

Why This Resonated:
It centers agency over pathology — healing isn’t about fixing; it’s about reclaiming.


Reminds us healing isn’t linear, and “progress” looks different for everyone.


Reframes our protective behaviors as survival strategies we can gently outgrow.


Encourages curiosity over judgment, both in ourselves and others.



A Few Personal Takeaways:
Attachment wounds run deep and shape so much more than I realized.


There’s immense power in learning how to regulate — not control — our emotions.


Safety, connection, and choice aren’t luxuries. They’re essentials.


Healing requires presence, patience, and the willingness to be with what is.



Final Thoughts:
This isn’t a quick-fix manual or a “just think positive” workbook. It’s a steady, reassuring hand that reminds you: the body remembers, but so does the heart. Healing developmental trauma isn’t about erasing the past — it’s about learning how to live in the present with more freedom, more choice, and less fear.
I’ll be keeping this one close.

[Shannon · Rating 4 out of 5]

I decided to listen to this audiobook on the recommendation of a social worker, despite the fact that it's a bit outside the scope of typical couples therapy which is what I'm currently in training for. I'm trying to get as ahead as I can on becoming trauma-informed and this was a great addition to my personal library in regards to that goal.

This was a slightly dry, but very clear and well-written manual for therapists to utilize for clients who have had AVEs and are dealing with the continuing issues stemming from complex trauma.

I appreciate how distinct and precise this guide was compared to the other skillsets I've learned in grad school so far. Compared to Cognitive Behavioral Therapy, which I know is useful but I find lacking for deeper issues like dealing with trauma, it's a lot more focused on reconnecting the client with their emotions and the physical, bodily experiences of them which is apparently the key to at least begin healing trauma. I intend to use a lot of the methods, lingo, and suggested dialogue when I get the chance to practice.

My one complaint is the same I have for every single textbook I've read in grad school so far - that the transcripts showing examples of the model in practice is always so stilted and unbelievable, and the client is always fawningly grateful to the therapist for the work being done. I wish the dialogues would be less cleaned-up and that there were more examples given - in addition to seeing how the method works, I'd also like to see how it could potentially fail and how to recover from a breach in the therapeutic relationship related to those failures.

[Carrie · Rating 5 out of 5]

This is an absolutely essential read for anyone working with other humans: therapists, coaches, educators, parents, etc will all benefit from understanding complex trauma and how to approach it with curiosity and presence. I took NARM's online basics training and this book mirrors the process they lay out beautifully. Definitely recommend their other book and trainings!

[Apzmarshl · Rating 5 out of 5]

Overview of CPTSD. Touches on developmental trauma as part of that. Talks about not taking on emotions of the client and mixing your own underlying needs with fixing them. Breaks down NARM and how to get deeper with the client, what they want from therapy and what might cause resistance.

[Faheem Lea · Rating 4 out of 5]

Although this book was primarily written for professionals who are already in the field, there was a lot of good information here for reflection and further study. A great read!

[EmberMantles]

The model used claims that clients are "not being burnt out, but are burning themselves out". This blames us for systemic issues. Not here for it.

[Abi Owen · Rating 5 out of 5]

this explains a lot

[Mackenzie Mccoy · Rating 5 out of 5]

Elevates my understanding of therapy

[Lisa Santa Barbara · Rating 5 out of 5]

Great Read- Informative

NARM is a profound process of healing developmental trauma. It not only is a guide for how to apply the process but also for how to educate the client on the understanding of how trauma has affected them. This model covers more than any other therapeutic model out there. And I believe this model is the one that can create sustainable change for the client.