trauma, injured, violence, NeuroAffective Relational Model

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The NeuroAffective Relational Model (NARM)

The NeuroAffective Relational Model (NARM) is a cutting-edge method of psychotherapy that addresses the impact of attachment, relational and developmental trauma, also known as complex trauma. complex trauma can result from adverse childhood experiences (ACEs) that disrupt the normal development of the self and impair the capacity for connection and regulation. NARM integrates neuroscientific, somatic and relational perspectives to help clients heal from complex trauma and reclaim their authentic identity. In this article, we will introduce the main principles and clinical interventions of NARM, and how it differs from other trauma therapies.

Contents

Introduction: This section provides an overview of the concept of complex trauma and its impact on the development of the self. It also introduces the main principles and goals of NARM as a trauma-informed and relationally oriented therapy.

Theoretical Foundations: This section reviews the relevant literature on attachment theory, neurobiology, affect regulation, and dissociation that inform the NARM framework. It also explains how NARM conceptualizes the five core adaptive survival styles that emerge from early relational trauma.

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Clinical Applications: This section illustrates how NARM works with clients in different phases of therapy, from establishing safety and rapport to addressing the core survival styles and their associated beliefs, emotions, sensations, and behaviours. It also discusses how NARM fosters the development of self-awareness, self-regulation, self-compassion, and self-agency in clients.

Empirical Evidence: This section summarizes the current research on the effectiveness and outcomes of NARM in treating complex trauma. It also identifies some of the limitations and challenges of conducting research on NARM and suggests directions for future studies.

Conclusion: This section highlights the main contributions and implications of NARM for clinical practice and research. It also acknowledges some of the limitations and critiques of NARM and offers suggestions for further development and refinement of the model.

Introduction
An overview of the concept of complex trauma and its impact on the development of the self

complex trauma is a term that describes the effects of exposure to multiple and prolonged traumatic events, especially those that involve interpersonal threats, such as abuse, neglect, violence, or discrimination. complex trauma can have a profound impact on the development of the self, affecting one’s sense of identity, agency, autonomy, and belonging.

Some of the common consequences of complex trauma include:

  • Difficulty regulating emotions and impulses
  • Distorted perception of oneself and others
  • impaired attachment and trust in relationships
  • dissociation and altered states of consciousness
  • Chronic feelings of shame, guilt, emptiness, or hopelessness
  • Increased risk of physical and mental health problems
  • Suicidal ideation and behaviour

complex trauma can interfere with one’s ability to cope with stress, form healthy attachments, and achieve personal goals. It can also impair one’s cognitive functioning, such as memory, attention, learning, and problem-solving. complex trauma requires specialized treatment that addresses not only the symptoms of post-traumatic stress disorder (PTSD), but also the underlying issues of self-regulation, self-concept, and relational functioning.

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Introduction to the main principles and goals of NARM as a trauma-informed and relationally oriented therapy

The NeuroAffective Relational Model (NARM) is a therapeutic approach that aims to address the complex effects of developmental trauma on individuals and their relationships. Developmental trauma refers to the chronic disruption of the attachment bond between a child and their primary caregiver, which can result in impaired emotional regulation, identity formation, and interpersonal skills.

NARM is based on the premise that developmental trauma is not only a psychological issue, but also a physiological and relational one, and that healing requires working with both the body and the mind. It integrates elements from psychodynamic, humanistic, somatic, and mindfulness-based therapies, and focuses on four main principles: 1) supporting connection to the present moment and the authentic self; 2) tracking survival adaptations and their impact on functioning; 3) exploring identity distortions and their roots in early attachment patterns; and 4) enhancing relational competencies and social engagement. NARM is a trauma-informed and relationally oriented therapy that respects the client’s innate capacity for growth and healing, and fosters a collaborative and empathic therapeutic alliance.

The four main principles of the NARM framework

The NARM framework is based on four main principles that guide the therapeutic process and help clients heal from their past wounds. These principles are:

connection: The NARM framework emphasizes the importance of establishing a safe and trusting relationship between the therapist and the client, as well as helping the client reconnect with their own body, emotions, needs, and sense of self. connection is the foundation for healing and growth.

Mindfulness: The NARM framework uses mindfulness as a tool to increase awareness of the present moment, without judgment or avoidance. Mindfulness helps the client access their inner resources, regulate their nervous system, and identify and challenge their negative beliefs and patterns.

Inquiry: The NARM framework employs a curious and respectful attitude towards the client’s experience, without imposing interpretations or solutions. Inquiry helps the client explore their history, understand their coping strategies, and discover new possibilities for change.

Action: The NARM framework supports the client in taking concrete steps to implement the changes they want to make in their life. Action helps the client move from insight to transformation, from survival to thriving.

Theoretical Foundations
Review of the relevant literature on attachment theory, neurobiology, affect regulation, and dissociation that inform the NARM framework

The NARM framework is a clinical approach that aims to address the effects of complex trauma on the development of self and identity. It draws on various theoretical perspectives, including attachment theory, neurobiology, affect regulation, and dissociation. In this review, we will provide a brief overview of the relevant literature on these topics that inform the NARM framework.

Attachment theory is one of the most influential frameworks in the social and behavioural sciences. It explains how the emotional bond between a caregiver and an infant shapes the development of self and relational patterns. Attachment security is associated with the expression and recognition of emotions, as well as interpersonal functioning. Attachment insecurity, on the other hand, can result from adverse childhood experiences, such as abuse, neglect, or loss, and can lead to difficulties in affect regulation and interpersonal relationships. Attachment-based interventions aim to enhance the quality of the caregiver-infant relationship and promote attachment security.

neurobiology is the study of how the brain and nervous system function and develop. It provides insights into the biological mechanisms underlying attachment, affect regulation, and dissociation. For example, neurobiological research has shown that attachment security is associated with optimal functioning of neurotransmitters and brain pathways involved in stress response, emotion regulation, social cognition, and memory. Neurobiological research has also shown that early attachment experiences can influence the epigenetic expression of genes related to stress and inflammation. Psychotherapy can modulate neurobiological structures and processes by providing a new attachment relationship that can model and re-map neural networks involved in emotional self-regulation.

Affect regulation is the ability to modulate one’s emotional states in response to internal and external stimuli. It is essential for mental health and wellbeing. It is influenced by attachment security, neurobiological factors, and environmental factors. Affect regulation difficulties are common in substance use disorders and other forms of addiction, which have been considered attachment disorders. These difficulties can also lead to dissociation, which is a disruption of the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, or behaviour. dissociation can be a coping mechanism to deal with overwhelming emotions or traumatic experiences.

The NARM framework integrates these perspectives to understand and treat complex trauma. It focuses on how trauma affects the development of self and identity across the lifespan. It also emphasizes the importance of working with both top-down (cognitive) and bottom-up (somatic) processes in therapy. The NARM framework aims to help clients heal from complex trauma by restoring their connection to themselves, others, and the world.

How NARM conceptualizes the five core adaptive survival styles that emerge from early relational trauma

The NeuroAffective Relational Model (NARM) is a clinical approach to working with complex trauma that affects both the body and the mind. NARM is based on the premise that early relational trauma, such as abuse, neglect, or abandonment, can disrupt the development of a coherent sense of self and impair the capacity for self-regulation and connection. NARM aims to address these developmental disruptions by working with five core adaptive survival styles that emerge from different stages of childhood development. These survival styles are:

connection Survival Style

This style develops when there is a lack of attunement or connection with the primary caregiver in the first year of life. It leads to a sense of emptiness, isolation, and shame, and a difficulty trusting oneself and others.

connection refers to the quality of our relationships with ourselves and others. It is influenced by our early attachment experiences, which shape our sense of trust, security and belonging. connection also involves our ability to attune to our own and others’ emotions, needs and desires. When we feel connected, we experience a sense of wellbeing, vitality and meaning.

Survival Style is the term used by NARM to describe the adaptive strategies that we develop in response to relational trauma or chronic stress. It helps us cope with the challenges and threats that we face in our environment, but it also comes at a cost. Survival Style can limit our capacity for connection, as we may become defensive, avoidant, compliant or dissociated. Survival Style can also affect our sense of identity and competency, as we may lose touch with our authentic self and our potential.

The NARM framework suggests that by exploring the connection between our Survival Style and our early attachment experiences, we can gain insight into the root causes of our patterns of behaviour and emotion. We can also learn to recognize the signals that indicate when we are operating from Survival Style, and how to shift to a more connected and integrated state. By doing so, we can enhance our wellbeing, resilience and growth.

Autonomy Survival Style

This style develops when there is a lack of support for the child’s emerging autonomy and exploration in the second year of life. It leads to a sense of fear, anger, and resentment, and a difficulty setting boundaries and asserting one’s needs.

Autonomy Survival Style is one of the five survival styles that NARM identifies as adaptive responses to developmental trauma. It refers to the tendency of some trauma survivors to cope by becoming overly independent, self-reliant and detached from others. They may have difficulty trusting others, asking for help, or expressing their needs and emotions. They may also struggle with intimacy, vulnerability and interdependence.

The NARM framework suggests that exploring the Autonomy Survival Style can help trauma survivors heal by reconnecting with their authentic self and developing healthy relationships with others. By working with a NARM therapist, they can learn to identify and challenge the core beliefs and patterns that keep them isolated and disconnected. They can also develop skills to regulate their nervous system, communicate effectively and create boundaries. Exploring the Autonomy Survival Style can help trauma survivors reclaim their sense of agency, choice and freedom in their lives.

Trust Survival Style

This style develops when there is a lack of consistency and reliability from the caregiver in the third year of life. It leads to a sense of anxiety, insecurity, and doubt, and a difficulty trusting oneself and others.

Trust is the foundation of any healthy relationship, whether it is with ourselves, others or the world. It is the ability to feel safe, secure and confident in our own perceptions and needs. It is also the ability to respect and honour the perceptions and needs of others. When trust is violated or damaged by trauma, we may experience fear, anxiety, shame, guilt, anger or resentment. We may also develop coping strategies that interfere with our ability to trust ourselves and others.

The NARM framework helps us understand how Trust and Survival Style interact and influence each other. By exploring these themes in therapy, we can identify and heal the wounds of trauma and restore our sense of trust and connection. We can also learn to recognize and transform our survival strategies into more adaptive and authentic ways of living.

Love-Sexuality Survival Style

This style develops when there is a lack of affection and intimacy from the caregiver in the fourth year of life. It leads to a sense of shame, guilt, and confusion, and a difficulty integrating love and sexuality.

The Love-Sexuality Survival Style emerges when a child experiences a lack of healthy attachment and attunement with their primary caregivers, leading to a disruption in their sense of self and their capacity to connect with others. The Love-Sexuality Survival Style is characterized by a split between love and sexuality, resulting in difficulties with intimacy, trust, boundaries, and self-worth. People with this survival style may struggle to express their authentic feelings and needs, and may resort to manipulation, seduction, or withdrawal to cope with their emotional pain. They may also experience shame, guilt, or confusion about their sexual identity and preferences.

The NARM framework suggests that the way to heal this survival style is to explore the underlying beliefs and patterns that keep the person stuck in a cycle of disconnection and dissatisfaction. By becoming more aware of their body sensations, emotions, thoughts, and impulses, they can start to recognize and challenge the negative messages they received about themselves and their relationships. They can also learn to cultivate self-compassion, self-acceptance, and self-respect, as well as to communicate more honestly and respectfully with their partners. Through this process, they can gradually reconnect with their true self and their innate capacity for love and sexuality.

Self-Expression Survival Style

This style develops when there is a lack of validation and acceptance of the child’s self-expression in the fifth year of life. It leads to a sense of inhibition, depression, and alienation, and a difficulty expressing oneself authentically.

The Self-Expression Survival Style is characterized by a difficulty in expressing one’s authentic self, feelings, needs, and desires. People with this survival style may have learned to suppress their self-expression to avoid rejection, abandonment, or punishment from their caregivers. They may also struggle with self-esteem, identity, and boundaries.

The NARM framework suggests that the way to heal from this survival style is to explore the core dilemma of self-expression versus self-protection. This involves becoming aware of the implicit beliefs and emotions that inhibit one’s self-expression, and gradually challenging them with curiosity and compassion. It also involves developing a sense of agency, autonomy, and empowerment in relation to oneself and others. By exploring the Self-Expression Survival Style, one can reconnect with their true self and experience more joy, creativity, and intimacy in life.

NARM conceptualizes these survival styles as adaptive responses to developmental trauma that help the child cope with an unsafe or unpredictable environment. However, these survival styles also limit the adult’s ability to experience life fully and authentically. NARM works with these survival styles by helping clients identify their core beliefs, emotions, sensations, and behaviours that are associated with each style, and by supporting them to access their inner resources and innate capacities for healing. NARM uses a mindful inquiry process that respects the client’s pace and choice, and that fosters curiosity, compassion, and connection.

Clinical Applications
How NARM works with clients in different phases of therapy

NARM stands for NeuroAffective Relational Model, which means that it integrates the latest findings from neuroscience, attachment theory, and somatic psychology to help clients heal from early relational wounds. NARM works with clients in different phases of therapy, from establishing safety and rapport to addressing the core survival styles and their associated beliefs, emotions, sensations, and behaviours.

In the first phase of therapy, NARM helps clients to develop a sense of safety and trust in the therapeutic relationship. This is essential for creating a secure base from which clients can explore their inner experience and access their resources. NARM therapists use attunement, empathy, curiosity, and validation to create a supportive and respectful environment for clients. They also help clients to regulate their nervous system and cope with distressing symptoms through mindfulness, grounding, and self-care techniques.

In the second phase of therapy, NARM helps clients to identify and work with their core survival styles. These are adaptive strategies that clients developed in response to developmental trauma, such as neglect, abuse, or abandonment. Survival styles are ways of coping with the threat of losing connection or losing oneself in a relationship. They include patterns of attachment, emotion regulation, self-esteem, boundary setting, and interpersonal communication. NARM therapists help clients to recognize how their survival styles have served them in the past, but also how they may limit them in the present. They also help clients to explore the underlying beliefs, emotions, sensations, and behaviours that are associated with each survival style.

In the third phase of therapy, NARM helps clients to integrate and transform their core survival styles. This involves helping clients to access and express their authentic self, which is the part of them that is not defined by trauma or survival strategies. NARM therapists support clients to develop a more coherent and flexible sense of identity that can adapt to different situations and relationships. They also help clients to cultivate a more compassionate and accepting relationship with themselves and others. NARM therapists use interventions such as reflection, inquiry, confrontation, feedback, and experiential exercises to facilitate this process.

NARM is a holistic and client-centred approach that respects the individuality and complexity of each client. It aims to help clients not only to heal from developmental trauma, but also to grow and thrive in their personal and professional lives.

How NARM fosters the development of self-awareness, self-regulation, self-compassion, and self-agency in clients
self-awareness

One of the core principles of NARM is to foster the development of self-awareness in clients by using mindful inquiry into the deeper identifications and counter-identifications that they take to be their identity. By helping clients become aware of their implicit beliefs, expectations, judgments and strategies that shape their sense of self and their interactions with others, NARM supports them to recognize and challenge these limiting patterns and to access more authentic and flexible ways of being. NARM also helps clients cultivate self-awareness by integrating both a nervous system based and a relational orientation, which means that it works clinically with the link between psychological issues and the body by helping access the body’s self-regulatory capacities and by supporting nervous system re-regulation. By working simultaneously with the physiology and the psychology of individuals who have experienced developmental trauma, NARM helps clients develop greater self-awareness of their bodily sensations, emotions, thoughts and impulses, and how these are influenced by their early relational experiences.

self-regulation

Another main goal of NARM is to help clients develop self-regulation, which is the ability to manage one’s emotions, thoughts and behaviours in a healthy and adaptive way. NARM fosters self-regulation by addressing the root causes of dysregulation, which are often related to unresolved developmental trauma. NARM uses a dual approach that integrates both top-down and bottom-up interventions. Top-down interventions involve working with the cognitive and relational aspects of the client, such as their beliefs, narratives, identity and attachment patterns. Bottom-up interventions involve working with the somatic and affective aspects of the client, such as their sensations, impulses, feelings and needs. By working with both aspects simultaneously, NARM helps clients to become more aware of their inner experience, to identify and express their authentic self, and to establish more secure and satisfying relationships with others.

Self-compassion

One possible way to explore how NARM fosters the development of self-compassion in clients is to examine how NARM addresses the core survival styles that result from complex trauma. According to NARM, complex trauma is any adverse occurrence that happens during childhood that leads to disconnects within the mind-body system and affects the development of a healthy sense of self and secure attachment with others. These disconnects manifest as five core survival styles: connection, attunement, trust, autonomy, and love-sexuality. Each survival style represents a way of coping with fear and shame that interferes with self-regulation and relational functioning in adulthood.

NARM helps clients identify and work with their core survival styles by using a mindful inquiry approach that integrates both a nervous system based and a relational orientation. NARM therapists help clients access their bodily sensations, emotions, thoughts, and beliefs that are associated with their survival styles and bring them into awareness and organization. NARM also helps clients recognize the resources and strengths that they have developed despite their trauma and use them to support their healing process.

By working with the core survival styles in this way, NARM fosters the development of self-compassion in clients. Self-compassion is the process of turning compassion inward and being kind and understanding rather than harshly self-critical when facing challenges or difficulties. NARM helps clients cultivate self-compassion by helping them acknowledge and validate their trauma experiences and their coping mechanisms without judgment or blame. NARM also helps clients develop a more coherent and authentic sense of identity that is not based on their survival styles or their trauma history. NARM thus empowers clients to embrace themselves as they are and to relate to themselves and others with more kindness, understanding, and connection.

self-agency

A further core principle of NARM is to help clients establish connection to the parts of self that are organized, coherent and functional, and to bring into awareness and organization the parts of self that are disorganized and dysfunctional. By doing so, NARM fosters the development of self-agency in clients, which is the ability to act intentionally and effectively in one’s life.

self-agency is often compromised in people who have experienced developmental trauma, as they tend to identify with their survival strategies and lose contact with their authentic self. NARM helps clients reconnect with their true identity and consciousness of self, by using body-mind mindfulness and an orientation to resources to anchor self-regulation in the nervous system. NARM also uses mindful inquiry into the deeper identifications and counter-identifications that clients take to be their identity, and helps them explore how these patterns affect their capacity for connection and regulation. Through this process, clients can develop greater self-awareness, self-acceptance, and self-compassion, which are essential for self-agency.

NARM is a resource-oriented, non-regressive model that does not focus on the regressed, dysfunctional elements as the primary theme of the therapy. Instead, it supports clients to access their innate strengths and potentials, and to use them as a basis for growth and transformation. NARM also recognizes that healing complex trauma is not only a personal but also a collective endeavour, as it involves addressing the social and cultural factors that contribute to trauma and disconnection. By helping clients develop self-agency, NARM empowers them to become more active agents of change in their own lives and in the world.

Empirical Evidence
The current research on the effectiveness and outcomes of NARM in treating complex trauma

The current research on the effectiveness and outcomes of NARM in treating complex trauma is limited but promising. A recent pilot study by Heller et al. (2021) found that NARM was associated with significant reductions in symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, and dissociation, as well as improvements in self-compassion, mindfulness, and quality of life among adults with complex trauma. The study also reported high levels of client satisfaction and retention with NARM. However, more rigorous and larger-scale studies are needed to establish the efficacy and mechanisms of NARM for complex trauma populations.

Some of the limitations and challenges of conducting research on NARM

One of the possible fields of study that NARM could be applied to is research on complex trauma and its effects on human development and wellbeing. However, conducting research on NARM also poses some limitations and challenges that need to be addressed and overcome. Some of these are:

  • The lack of a standardized definition and measurement of complex trauma and its outcomes. Different studies may use different criteria and instruments to assess the presence and severity of complex trauma, as well as its impact on various domains of functioning, such as mental health, physical health, interpersonal relationships, and social integration. This makes it difficult to compare and synthesize the results of different studies and to establish the validity and reliability of NARM as a treatment approach.
  • The difficulty of isolating the specific effects of NARM from other factors that may influence the recovery process. complex trauma is often associated with multiple risk factors, such as poverty, violence, abuse, neglect, discrimination, and marginalization. These factors may interact with each other and with the individual’s biological and psychological characteristics, creating a unique and dynamic context for each person. Therefore, it may be hard to determine how much of the change observed in a person after receiving NARM is due to NARM itself or to other variables that may have changed over time.
  • The ethical and practical challenges of conducting randomized controlled trials (RCTs) with complex trauma populations. RCTs are considered the gold standard for evaluating the efficacy and effectiveness of interventions, but they also pose some ethical and practical dilemmas when working with complex trauma populations. For example, how to ensure informed consent and voluntary participation when dealing with people who may have impaired trust and agency? How to balance the need for random assignment and control groups with the respect for individual preferences and needs? How to deal with attrition and dropout rates that may be higher than usual due to the instability and unpredictability of complex trauma survivors’ lives?

These are some of the limitations and challenges that researchers may face when conducting research on NARM. However, these challenges are not insurmountable and can be addressed with careful planning, collaboration, innovation, and reflexivity. Research on NARM is important and necessary to advance the knowledge and practice of working with complex trauma populations and to contribute to their healing and empowerment.

Conclusion
The main contributions and implications of NARM for clinical practice and research

The main contributions and implications of NARM for clinical practice and research are:

  • NARM offers a developmentally informed, neuroscientifically informed, and resource-oriented model that addresses the root causes of complex trauma, rather than focusing on the symptoms or the regressed aspects of the self.
  • NARM provides a framework for understanding how complex trauma affects the five core capacities of human development: connection, attunement, trust, autonomy, and love-sexuality. These capacities are essential for healthy functioning and wellbeing in adulthood.
  • NARM introduces a set of clinical skills and interventions that help clients establish connection to the parts of self that are organized, coherent, and functional, and bring into awareness and organization the parts of self that are disorganized and dysfunctional.
  • NARM emphasizes the importance of working simultaneously with the physiology and the psychology of complex trauma, and recognizes the interplay between issues of identity and the capacity for connection and regulation.
  • NARM is a mindfulness-based clinical treatment that fosters a phenomenological approach to addressing identity and consciousness of self, and supports clients in discovering who they truly are beneath their patterned ways of relating to themselves and the world.
  • NARM is compatible with other modalities and can be integrated into existing trauma-informed practices. NARM also offers opportunities for further research on the effectiveness and mechanisms of its interventions, as well as on the nature and impact of complex trauma on human development.
Limitations and critiques of NARM

NARM integrates neuroscience, mindfulness and relational practice to help clients heal from the effects of adverse childhood experiences (ACEs). NARM works with both the physiological and psychological aspects of trauma, and focuses on the connection between the self and others.

However, NARM also has some limitations and critiques. Some of these are:

  • NARM is a relatively new model that has not been extensively researched or validated by empirical studies. The evidence for its effectiveness is mostly based on clinical observations and case studies, which may not be generalizable or replicable.
  • NARM may not be suitable for all clients or contexts, especially those who have severe dissociation, psychosis, substance abuse or other co-morbid conditions that require more intensive or specialized treatment. NARM may also not address some of the cultural, social or systemic factors that contribute to trauma and its aftermath.
  • NARM may be challenging to implement for some therapists who are not familiar with its concepts, principles and techniques.
  • NARM requires a high level of skill, sensitivity and flexibility from the therapist, who needs to balance between supporting the client’s self-regulation and challenging their identity patterns. NARM also requires a strong therapeutic alliance and collaboration between the therapist and the client, which may not be easy to establish or maintain in some cases.
Suggestions for further development and refinement of the NARM model

One possible direction for future research is to explore how the NARM model can be extended to incorporate other types of information, such as user profiles, item attributes, or contextual factors. These additional features may help to capture the user’s preferences and intentions more accurately and improve the recommendation performance.

Another possible direction is to explore how the NARM model can be applied to other domains or tasks, such as social media, news, or e-commerce. The NARM model may be able to generate personalized and diverse suggestions for different scenarios and users.

A third possible direction is to explore how the NARM model can be optimized or enhanced with more advanced techniques, such as attention mechanisms, graph neural networks, or reinforcement learning. These techniques may help to overcome some of the limitations or challenges of the NARM model, such as handling long-term dependencies, dealing with sparse or noisy data, or adapting to dynamic environments.

Further reading

If you would like to learn more about the NeuroAffective Relational Model, you can check out these weblinks for further reading:

https://www.narmtraining.com/what-is-narm/

https://www.psychologytoday.com/us/therapy-types/neuroaffective-relational-model

https://www.goodtherapy.org/learn-about-therapy/types/neuroaffective-relational-model

https://www.amazon.com/Healing-Developmental-trauma-self-regulation-Relationship/dp/1583944893

These weblinks provide an overview of NARM, its principles and applications, and a book by the founder of NARM, Dr. Laurence Heller.

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