What I Learn About Complex Trauma When I Ask About Family Dysfunction
- Whit Davison
- Oct 18
- 3 min read
When I ask a new client, “Would you call your family of origin dysfunctional?” I’m not looking for gossip or blame. I’m gathering essential data about complex trauma, because the way someone describes their family or relationship environment when answering this question often reveals more about their history than they realize.
Where I Started: The Adverse Childhood Experiences Scale
Many people know about the Adverse Childhood Experiences Scale (also known as ACES, learn more here), and using the ACES scale with clients is an excellent and evidence-based way to assess for situations likely to contribute to severe anxiety, complex trauma, and dissociation.
However, I have learned that when asking directly, “Was or is anyone in your household addicted to alcohol or drugs,” the answer will be “no.” After a couple of sessions, the client shares that mom drank a bottle of wine each night and they regularly got themselves and their siblings dinner and ready for bed because mom was incapacitated, and I have to revise my understanding of their situation at a fundamental level.
The ACE questions about emotional abuse and neglect are even more likely to create a “no,” no matter what the actual situation was like. No one wants to think they were emotionally abused or neglected.
“Would You Say Your Family Is or Was Dysfunctional?”
I realized I had to figure out a way to get the information I needed without the client having to reveal something to me (and to themselves!) that they weren’t ready to face.
Enter an easy, basic question: “Would you say your family (or relationship) was (or is) dysfunctional?” Somehow, everyone recognizes the dysfunction around them even if they don’t recognize its impact on them as an individual.
At the very least, most of my clients can identify their own contributions to the dysfunction and will readily share this, giving me insight I need to help move their treatment in the right direction.
But What Is “Dysfunction,” Really?
The APA Dictionary of Psychology defines a dysfunctional family as “a family in which relationships or communication are impaired and members are unable to attain closeness and self-expression. Members of a dysfunctional family often develop symptomatic behaviors, and often one individual in the family presents as the identified patient.”
There is so much packed into that short definition:
Impaired relationships leave people isolated and alone, even when family or a partner is present
Impaired communication can include triangulation, people pleasing, or an avoidance/blowout cycle
Lack of closeness means no feelings of true safety and connection
Limited self-expression leads to feeling unknown as an individual or feeling “forced to fake it”
Symptomatic behaviors range from addictions to perfectionism
Key to my understanding of how this question informs my assessment is the idea of “the identified patient.” Usually the client sitting across from me plays this role in their family, as they have been labeled “crazy,” “the problem,” or “difficult,” and they are seeking help from me to make themselves better fit into the mold that has been created for them.
Family Dysfunction as a Core Cause of Complex Trauma
Yes. This is the core of complex trauma: a mind is divided against itself. Most of my clients come to me with their severe anxiety or dissociative disorder, and what they want most is to have a loving family or a healthy relationship, with their existing family or partner.
For this to work, the client has to be a different person. Often, these clients feel there is something fundamentally wrong with them because they can’t make this work. Black is white, up is down, and the person trying to get healthy is also the problem. It’s confusing, complex, and difficult to untangle.
This is another reason the “dysfunctional” question is so important in my assessment. If the person sitting across from me is easily able to identify traumatic experiences, recognizes their own and other’s roles in dysfunction, and has a solid sense of what has happened to them, they need a totally different treatment approach from someone who has bought into the idea that they are the problem. And of course, there are a million variations in between.
A Complex Situation Needs Subtle Assessment
It has taken me time to refine my assessment process. I want to get as much useful information as I can without forcing clients into areas they are not ready to or unable to access. Those delicate and pointed questions come later in treatment, but whether it is three weeks or three months later, the questions I ask are almost always based on what I learned in response to “Would you say your family was or is dysfunctional?”
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