Healing from Trauma – Titration

In Peter Levine’s excellent book about trauma, Waking the Tiger, he talks about the principle of titration. This means that when healing from trauma, one must make sure not to re-experience the trauma too strongly to the point where one becomes overwhelmed. There is something called the zone of tolerance, where one is experiencing some discomfort but not so much that they become overwhelmed and either dissociated or potential re-traumatized. This is important to remember if trying to work with trauma. Some discomfort is necessary, but it should not be overwhelming. Before I learned healthier practices, I was engaged in some spiritual practices that emphasized having intense cathartic experiences. This is not helpful for healing, instead a gentle gradual approach is best.

This also will help when attempting to get more into one’s body. This can easily bring up intense feelings and if the feelings are too intense it is okay to back out and go gradually. When one is dissociated, no healing can occur. This also will reinforce the idea that you are in control, and you get to decide when to go in and out of the trauma. This is an antidote to the feelings of being out of control and helpless that are commonly associated with trauma. It is also a way of being gentle and having compassion for oneself.


  1. I think the general approach you suggest is good. Trauma history needs much more attention for understanding the genesis of gender issues. Do you have one or two concrete examples involving gender dysphoria?

    1. Well for myself, the trauma came from a combination of constant bullying as a child and being raised by a narcissistic mother. I was the lowest in the male hierarchy when it came to physical activities and was often beat up. Then in puberty this trauma became eroticized.

      As many problems as I have with John Money, I think his ideas about “love maps” are quite good. He talks in particular about “vandalized love maps” where intense childhood experience or trauma effects the erotic imprint.

      It is important to note that once this happens the erotic imprint is independent of the trauma and won’t change even if the trauma is healed. I still have fantasies of being female, the difference is I accept and understand them as fantasies. I do not identify with them, or think of them as anything more than an automatic function in my brain. I don’t have any desire to present as a woman or be perceived as a woman, and these thoughts are contained to my fantasy life.

  2. My experience with the TG population suggest testosterone often activates the GD and the craving to modify one’s body and social presentation. The question then becomes to what extent can that be managed or contained short of transition or will transition prove to be a better option? Other forms of possible trauma may include, parental expressed dissatisfaction with the child’s sex, poor or abusive same sex role models, marked differences in warmth and nurturance by parents, repeated cross dressing a child with positive attention and redefinition of worth, etc. Depending on circumstances, frequency, and interpretation/meaning, such events may contribute to a person’s view of self and personal narrative.

    1. Yes, that is very true. The presence of testosterone activates the erotic imprinting and it can manifest as craving to modify the body and social presentation, or compulsive cross dressing or any number of things. Further, it can be progressive and increase over time. That component can only be managed like you say. Managing it is not really any different than any unwanted sexual imprint like a paraphilia. Ironically, one of the things used to manage these is anti-androgens. One of the benefits of not treating it as an essential identity is that it allows for the possibility of using anti-androgens or low dose estrogen therapy to manage this without transitioning. Also SSRIs are sometimes effective, at least with paraphilias. I think treating the decision to transition separately from the decision to alter hormones allows for more options, and can help someone find the best solution that works for them.

  3. I love Levine’s books. Healing Trauma and In An Unspoken Voice are my favorites. Much of the stuff from Waking the Tiger is in the latter, I think. The former is small but includes audio cds and a lot more focus on some practices for people to do by themselves when they can’t go to a therapist.

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