In the experience of being present the therapist can listen more fully and deeply not just to the words but to the meanings behind breathing, movement, inflection, pauses, facial expressions. The therapist can listen to the surface and the possibilities which may be coming from a deeper structure with the patient.

The point at which memories and feelings from past trauma threaten to overwhelm a person's everyday consciousness is a critical and sometimes extended period in recovery from PTSD. It is a challenging time as patients go through strong and fast changing expressions of terror, sorrow, rage and often dip or sink into irrationality and age regression.

Imagery can be helpful in metaphorically seeing moving and interacting forms in a patient's inner experience. When I look at computer drawing of fractals and solitons, I see various schematics of one human mind. A soliton moving as a complete entity within a larger framework is like an archetype, a complex, or an identity fragment existing as a whole in a vast inner life space. Tiny fractal formations, like gossamer dust, are like bits and pieces of diffused identity in protective retreat. There is beauty and organization in these structures which often were created so the system, the psyche, the person could cope with stressful stimuli and survive. Because survival issues were the forces behind the creation of these structures, they are strongly entrenched.

Immersing oneself in the concepts and images of chaos and complexity can open a realm of possibilities to a clinician. Our patients are human and thus, familiar. Our patients are unique individuals and thus, unknown. Concepts of chaos and complexity can help us hold the tension between the familiar and the unknown. This can help us be present for what is, what is in the process of becoming, and to hold back our own desires to shape a definition into something we expect, anticipate or worse, prefer.

My discussion concerns working with people who have lived under chronic stress and traumatic conditions. These people grew up often accepting as normal rather drastic life situations, i.e. minimizing their traumatic experiences - "He never broke any bones." (despite the fact that he regularly beat the boy). "I always had food to eat" (despite the fact they she was sexually violated from age 3 to 11). "We stayed together and slept on a feather bed." (minimizing adversities during the flight from Poland to Russia as the family fled the Nazis). They developed dissociative methods for coping with this world. Or more usually, they used a combination both strategies.

Their dissociation protects them from unbearable emotional pain. Their psyches divide. Some various parts carry awareness of emotional trauma. Some parts are oblivious to that experience. Sometimes they live primarily through parts of themselves which are oblivious to most feelings. They may have occasional outbursts of feeling which seem (to others) to be unconnected to current life situations. These outbursts can be bewildering to friends, co-workers and family and cause intolerable disruptions which neither the patients nor their associates understand.

At varying points in therapy some of these strong feelings will emerge in temper tantrums, rages, bewildered terror episodes and grief. Early outbursts can be wild, dramatic and short-lived. Patient are often convinced that their feelings are about something that has occurred in their here and now life. Expressions can be intense and particularly remarkable in that they seemingly resolve rather quickly. In fact, when a strong outburst dissolves quickly with no resolution that I can see I wonder if we are getting a glimpse into what has been a dissociative style.

My personal relief that the stress is over and the patient's relief that the stress is over may actually run the risk of colluding with a dissociative style. Yet it seems natural to feel relief after a storm passes. In the aftermath of such turbulence, depending on timing and the stage we are in within the therapy as a whole, I may ask the patient, "What was that like for you? Being so angry with me, or being so noisy, or letting me see you cry so hard and long?"

A variety of memories and associations can come with their answer. But the most prevalent answer among patients and the most recurring answer in each patient is: "I can't believe you're still here." or "I thought you'd throw me out after that." Or, "No one ever heard me go through that. I didn't think I could ever let anyone see that."

We will often marvel together about how the room, the furniture, our bodies and our relationship are still intact. Then the patient discovers that we can continue to work with this episode supposedly behind us. It usually will be my job to bring it up as an association to something in the future so it becomes an integrated and remembered piece of our shared history. I know we are making headway when sometime in the future they can with ease and thoughtfulness, relate it to something on their own initiative. And so, we chip away gradually at the powerful defense of dissociation.

The patients' challenge is to learn that they can tolerate their feelings, that they can feel and stay alive and maintain a relationship all at the same time. It's a challenge because in the traumatic environment they lived through in the past they believed with their very cells that self awareness and basic survival were incompatible. Therefore knowing themselves, honoring themselves, living a life based on self-respect and self-awareness is unimaginable. When it is imaginable we may be looking at the new attractor that will lead the psyche to a new organization.

The therapist's task - one of many - is to develop and strengthen a stance in which the patient and the therapist, separately and together can learn to creatively adapt to the changing inner and external environment. The therapist and then the therapist and patient together, create this co-evolutionary stance by increased toleration of feeling, developing understanding, boundary testing and self-awareness.

Using concepts and images of flowing fractals helps me to follow a patient's seemingly disjointed reasoning. Holding the concept of possibility space and phase space is a way of listening and quietly reflecting genuine wholeness back to a person who feels and is fragmented.

Knowing with certainty that there are various patterns and structures within chaotic behavior and that chaotic behavior is sometimes necessary for needed transformation helps me stay present and able to listen better through a patient's uproar and demands.