Client Populations Clinical Interventions

Trauma-Informed Care for High-Conflict Couples

This article explores the intersection of trauma and couple conflict, presenting trauma-informed frameworks and practical interventions to support clinical work.

By Mental Health Academy

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This article explores the intersection of trauma and couple conflict, presenting trauma-informed frameworks and practical interventions to support clinical work.

Related articles: Trauma-Informed Practice: Fundamentals for Therapists, Trauma-Informed Supervision: Supporting Therapists Who Treat Trauma.

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Introduction

Couples therapy is inherently complex, often involving deep emotional undercurrents, divergent perspectives, and entrenched relational patterns. When trauma histories are present, especially in high-conflict relationships, these complexities multiply. Trauma – whether experienced in childhood or adulthood – can profoundly affect how individuals attach, regulate emotion, and engage in intimate communication. For mental health professionals, understanding and applying a trauma-informed lens is essential when working with high-conflict couples.

This article explores the intersection of trauma and couple conflict, presenting trauma-informed frameworks and practical interventions to support clinicians in facilitating healing and relational repair.

Trauma and its impact on couple dynamics

Trauma is broadly defined as the experience of actual or perceived threat to life or safety, often accompanied by feelings of helplessness, terror, and a loss of control (van der Kolk, 2014). Trauma can be acute (e.g., a car accident), chronic (e.g., ongoing childhood neglect), or complex (e.g., prolonged exposure to abuse). Each type has distinct implications for an individual’s relational capacities.

Trauma impacts the brain’s threat detection systems, emotional regulation, and sense of safety (Siegel, 2012). Survivors may operate from a heightened state of arousal, perceive benign interactions as threatening, and adopt protective behaviours such as withdrawal, attack, or dissociation. In intimate partnerships, these adaptations can be misinterpreted by partners, leading to cycles of misunderstanding, emotional escalation, and disconnection.

Research indicates that unresolved trauma correlates with increased relational distress, lower satisfaction, and higher rates of intimate partner violence (Lambert & Dollahite, 2008). Trauma may impair the ability to form secure attachments, negotiate needs, or respond empathically—all essential components of healthy partnerships.

High-conflict couples, defined by frequent and intense disagreements that often remain unresolved, may unwittingly be re-enacting trauma-driven patterns. Without a trauma-informed approach, therapy may risk re-traumatising clients or reinforcing maladaptive dynamics.

Principles of trauma-informed care in couple therapy

Trauma-informed care is a framework that recognises the pervasiveness of trauma and seeks to promote safety, empowerment, and healing (SAMHSA, 2014). In the context of couple therapy, these principles are adapted to the dyadic system:

Safety (physical and emotional)

Creating a safe therapeutic space is paramount. High-conflict couples may be accustomed to relational volatility. Establishing clear ground rules, maintaining a calm tone, and managing sessions tightly can mitigate escalation. Safety also means attending to power imbalances and helping each partner feel heard and respected.

Trustworthiness and transparency

Trauma often results from experiences of betrayal or unpredictability. Therapists should be consistent, predictable, and clear about their role and the structure of sessions. Explaining interventions and avoiding surprises helps build trust.

Peer support and mutual respect

While therapy is not a peer environment, fostering a climate of mutual respect between partners is essential. Validating each person’s perspective and helping them understand the other’s trauma-related responses can facilitate empathy.

Empowerment, voice, and choice

Empowering clients means affirming their autonomy and avoiding coercion. This includes allowing clients to set goals, opt out of triggering activities, and make informed choices about disclosures and interventions.

Cultural, historical, and gender sensitivity

Trauma is experienced and expressed through the lens of identity and context. Intersectional factors – such as race, gender, class, sexuality, and cultural background – must be integrated into conceptualisation and intervention.

Trauma and attachment in couples

Attachment theory offers a useful lens to understand trauma in couple dynamics. Early experiences with caregivers shape internal working models that inform how individuals seek and respond to intimacy and distress (Bowlby, 1988).

Trauma, particularly developmental trauma, often disrupts secure attachment. Survivors may adopt insecure strategies:

  • Anxious attachment: Seeking constant reassurance, hypervigilance to partner cues, difficulty tolerating ambiguity.
  • Avoidant attachment: Suppressing needs, withdrawing in conflict, minimising emotion.
  • Disorganised attachment: Simultaneously craving and fearing closeness; unpredictable or chaotic responses.

These patterns can clash in dyadic relationships. For instance, a partner with anxious attachment may pursue connection through protest, while an avoidantly attached partner withdraws, escalating conflict. Trauma-informed care helps couples understand these patterns not as character flaws, but as protective adaptations.

Therapeutic frameworks and models

Effectively supporting high-conflict couples with trauma histories requires a flexible and integrative therapeutic approach. No single model fits all relationships, particularly when trauma has shaped each partner’s capacity for intimacy, safety, and emotional regulation. The following frameworks and interventions offer clinicians practical pathways for fostering relational healing, rebuilding trust, and addressing trauma-driven dynamics within the couple system. Each framework can be adapted to suit the severity and nature of the trauma, the couple’s attachment styles, and the level of conflict present.

Integrative behavioural couple therapy (IBCT) with a trauma lens

IBCT focuses on acceptance and change. In trauma-informed adaptation, therapists help partners accept trauma-based limitations while building skills for new interactions (Christensen et al., 2020). The framework supports:

  • De-escalation through emotional awareness
  • Reframing behaviour as trauma responses
  • Shifting blame to joint understanding

Case illustration: Maria (35) and Leon (37) frequently argue about Leon’s emotional unavailability. Leon, a survivor of childhood neglect, shuts down when Maria demands intimacy, which she interprets as rejection. In therapy, Leon’s withdrawal is reframed as a protective strategy rooted in early trauma. Maria learns to express needs without attack, and Leon practices staying emotionally present in small doses.

Emotionally focused therapy (EFT)

EFT is grounded in attachment theory and aims to restructure emotional responses to foster secure bonds (Johnson, 2004). In trauma-informed EFT:

  • The therapist helps clients identify attachment injuries and related emotional needs.
  • Emotion cycles are unpacked and reprocessed through present-moment exploration.
  • Partners learn to co-regulate rather than trigger one another.

Clinical consideration: For trauma survivors, emotional vulnerability may feel dangerous. Therapists must titrate affective exposure carefully, using grounding techniques and tracking dysregulation.

Resource tip: In the MHA course series on Emotionally Focused Therapy, Dr. Shea Dunham demonstrates the application of EFT with Jay and Danielle, an Afro-American couple who have come to session to work on trust in their marriage.

The neurosequential model of therapeutics (NMT)

While originally developed for individual trauma treatment (Perry & Dobson, 2010), the principles of NMT can inform couple work. This model emphasises that interventions should match the developmental level of brain function impacted by trauma (e.g., regulation before cognition).

Applied to couples:

  • Start with physiological regulation (e.g., breathing, posture).
  • Move to emotional attunement (e.g., validating feelings).
  • Then address cognitive processes (e.g., narrative reconstruction).

Example: In a heated exchange, a therapist may guide both partners to pause and engage in breathwork before resuming dialogue, bypassing the limbic hijack that often derails productive conversation.

The relational life therapy (RLT) approach

Terry Real’s RLT combines trauma theory with direct relational interventions (Real, 2008). RLT teaches partners to identify inherited family-of-origin messages, own their wounds, and cultivate relational accountability.

RLT’s trauma-informed aspects include:

  • Uncovering adaptive roles from trauma (e.g., “the caretaker,” “the controller”)
  • Challenging relational entitlement or passivity
  • Building relational skill sets (boundaries, repair, connection)

RLT’s structured confrontation is best used when sufficient safety is established and clients are resourced.

Clinical interventions and techniques

While theoretical frameworks provide a structural foundation for trauma-informed couple therapy, effective practice also relies on concrete, moment-to-moment interventions. High-conflict couples often need support in building emotional regulation, communication, and relational safety—skills that may not have been modelled or developed due to trauma.

 Here we outline practical techniques and tools that therapists can apply within sessions to help partners recognise patterns, de-escalate conflict, and foster connection in real time.

Psychoeducation and normalisation

Many clients are unaware of how trauma shapes their relational dynamics. Providing accessible neuroscience (e.g., “fight/flight/freeze”) and attachment education helps clients de-pathologise their responses and shift to a collaborative stance.

Window of tolerance

Helping clients recognise their window of tolerance (Siegel, 1999) supports emotional regulation. Couples learn to identify when they are within, below (hypoarousal), or above (hyperarousal) their optimal zone and use strategies to return.

Some recommended tools:

  • Colour-coded emotion thermometers
  • Somatic check-ins (e.g., “Where do you feel this in your body?”)
  • Break protocols (“Let’s pause here and come back in 10 minutes”)

Narrative reprocessing

Trauma narratives often shape relational expectations (e.g., “I will always be abandoned,” “Anger means danger”). Guiding couples to explore and reframe their personal and shared narratives helps challenge these assumptions.

Therapists can use:

  • Letter writing from the perspective of a younger self
  • Re-authoring exercises to imagine future relationship patterns

Grounding and somatic practices

High-conflict couples often experience dysregulation during sessions. Grounding strategies reduce the likelihood of retraumatisation and improve emotional presence (for a more in-depth exploration, read Beyond Talk Therapy: Somatic Interventions for Trauma Treatment).

Some recommended practices:

  • Feet-on-the-floor visualisations
  • Squeeze balls or fidget objects
  • Body scan meditations

Related discussion: Do you use somatic approaches and techniques?

Communication scaffolding

Traumatised partners may struggle with direct, safe communication. Therapists may introduce structured dialogue formats, such as:

  • Speaker-listener technique
  • “I feel… when you… because… I need…” statements
  • Role plays and rehearsal

Individual sessions within couple work

In some cases, brief individual sessions are essential to stabilise trauma symptoms or assess safety risks. However, these should be transparent and reintegrated into the couple dynamic.

Resource tip: In the course Emotionally Focused Individual Therapy (EFIT) for Trauma: Dancing Tango and Reshaping Self, Dr. Leanne Campbell takes you through example sessions with two trauma survivors undergoing EFIT therapy, and explains the process of the EFIT Tango through example. The first in the series, What is Emotionally Focused Individual Therapy (EFIT) , provides you with an introduction to the EFIT approach.

Ethical considerations

Working with high-conflict couples who have trauma histories presents a unique set of ethical challenges. Clinicians must navigate complex dynamics while maintaining neutrality, ensuring safety, and preventing harm. Ethical practice in this context goes beyond informed consent and confidentiality – it involves careful assessment of relational risk, sensitivity to power imbalances, and continual reflection on the therapist’s role in potentially volatile interactions.

The following considerations highlight key areas where ethical vigilance is essential to support both partners safely and effectively.

Avoiding retraumatisation

Therapists must monitor for signs of dissociation, overwhelm, or shutdown. Pacing is critical—going “too deep too soon” may reinforce helplessness. Always obtain consent for trauma processing.

Balancing the system

When trauma leads to one partner being seen as the “problem,” therapists must carefully avoid collusion or triangulation. Maintain neutrality while holding both accountable to change.

Safety and IPV screening

Conflict does not always equal abuse, but where intimate partner violence (IPV) exists, couple therapy may be contraindicated. Screen routinely, and if IPV is present, prioritise individual safety and support referrals (Warshaw et al., 2013).

Conclusion

High-conflict couples often bring complex trauma histories into the therapeutic space, which can both challenge and enrich the work. Applying a trauma-informed lens helps therapists hold both partners with compassion and accountability, recognising that behind conflict lies pain, fear, and a longing for connection. By integrating trauma frameworks, attachment theory, and relational skill-building, clinicians can support couples not just in reducing conflict, but in transforming their relational narratives into sources of healing and growth.

Key takeaways

  • Trauma significantly affects attachment, communication, and emotional regulation in couples.
  • High-conflict dynamics may be trauma re-enactments rather than evidence of incompatibility or pathology.
  • Trauma-informed care in couple therapy emphasises safety, empowerment, and trust-building.
  • Frameworks such as EFT, IBCT, and RLT can be adapted to address trauma-rooted relational patterns.
  • Somatic and psychoeducational tools, scaffolding for communication, and careful pacing are essential.
  • Ethical vigilance around safety, consent, and neutrality must be maintained throughout the therapeutic process.

References

  • Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books.
  • Christensen, A., Doss, B. D., & Jacobson, N. S. (2020). Integrative behavioral couple therapy: A therapist’s guide to creating acceptance and change (2nd ed.). Norton.
  • Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection (2nd ed.). New York: Brunner-Routledge.
  • Lambert, N. M., & Dollahite, D. C. (2008). The threefold cord: Marital commitment in religious couples. Journal of Family Issues, 29(5), 592–614. https://doi.org/10.1177/0192513X07308395
  • Perry, B. D., & Dobson, C. L. (2010). The role of healthy relational interactions in buffering the impact of childhood trauma. In E. Gil (Ed.), Working with children to heal interpersonal trauma: The power of play. New York: Guilford Press.
  • Real, T. (2008). The new rules of marriage: What you need to know to make love work. Ballantine Books.
  • SAMHSA. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Prepared by SAMHSA’s Trauma and Justice Strategic Initiative. U.S. Department of Health and Human Services. https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
  • Siegel, D. J. (1999). The developing mind: How relationships and the brain interact to shape who we are. Guilford Press.
  • Siegel, D. J. (2012). The pocket guide to interpersonal neurobiology: An integrative handbook of the mind. W.W. Norton and Company
  • van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
  • Warshaw, C., Sullivan, C. M., & Rivera, E. A. (2013). A systematic review of trauma-focused interventions for domestic violence survivors. National Center on Domestic Violence, Trauma & Mental Health. https://www.nationalcenterdvtraumamh.org