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fartasticdurge · 1 month ago

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I have nothing clever to say about this, but I have seen several people give a CPTSD diagnosis, and I like how you called out that trauma shows up in all companions, not just Astarion.

A therapist perspective: Astarion and Trauma therapy

So I made a post on reddit... So Enby_Geek posted an interesting thread a couple of days ago but sadly, reddit isn't letting me comment on it on either the main BG sub or this one. I thought this could be an interesting perspective from someone who works in therapy and how they would approach Astarion's trauma.

For full disclosure, in general, I thought Astarion’s portrayal is one of the best depictions of trauma I’ve seen in media, let alone a videogame, and weirdly enough, as a trainee counsellor or therapist, depending on your region, I’ve put some thought into this.

Before we get into this, let's clarify something. Therapy is only for people who are ready and willing to do the work needed for treatment to have a beneficial impact on them. Therapy only works for people who want to be there and who want to work to grow or recover. This might be something they are implicitly or explicitly aware of, but the long and short of it is you need to want to go on that journey; no one can make you do it or do the work for you.

Therapy isn’t advice giving, or talking at a client, it's also not about telling Astarion specific things to make him feel better, it's about working with him and supporting him to be able to do that himself. Therapy is about forming a working alliance to help your client, in this case Astarion, explore their thoughts and feelings in a psychologically safe space so they feel better, cope better, and are capable of growth.

There are times when you have to challenge a client’s perceptions, of course, but I feel sometimes people misunderstand what therapy is intended to do; we aren’t giving advice or telling a client what to do. We respect their autonomy to make bad decisions, but help them understand the feelings, thoughts and behaviours that cause those decisions, but that’s a debate for a different subreddit, and I am not doing this on my main account 😛

General Observations

So, spawn Astarion (depending on player choices) sounds like he is ready to do that work when he says he’s ready to start living again, and he drops a fair few pieces of evidence that show he is trying to work through and process what has happened to him and what comes next in his life. He’s getting used to having autonomy again, feeling safe and secure and starting to form attachments to the wider group and Tav or the player character, depending on how you play. Ascended Astarion not so much. Ascended Astarion is the embodiment of the cyclical nature of abuse and how destructive it can be both to others around you and yourself. He has regressed on any growth made during the game. A!Astarion probably isn’t going to ever recover or grow back from that because he has power, control and the autonomy he craved to make some terrible decisions, and those decisions probably don’t include self-reflection and keeping a journal...

Case formulation: Astarion and Complex Post Traumatic Stress Disorder (CPTSD)

Astarion, particularly his spawn incarnation, is the video game poster boy for complex post-traumatic stress disorder. He pretty much fulfils all the diagnostic criteria according to the ICD-11. Bear in mind, this list is not exhaustive, but Astarion arguably exhibits the following diagnostic criteria:

Experienced or witnessed threatened death or sexual violence- becoming a spawn, two centuries of torture and sexual slavery, being compelled to bring back victims and the loss of all autonomy and identity. Being kidnapped, tadpoled and then waking up in the middle of nowhere, it's a long list.

Intrusive thoughts - flashbacks to Cazador, torture that seem to be re-experienced throughout the game, depending on decisions taken by the player.

Issues with cognitive development- This one may be a stretch, but given Astarion’s youthfulness for an elf, he also demonstrates some cognitive issues that can be attributed to his prolonged trauma, such as issues with organisation and planning, which are usually seen in adolescence.

Dissociative episodes during high stress- an obvious one appears to be that sex is a trigger that causes Astarion to disassociate.

Self-worth issues- there are multiple points where Astarion voices or demonstrates the belief that his only value is sex or seduction.

Issues with regulation - we see this with him using alcohol as a crutch, frequent anger, distrust and scepticism either at gods or his companions, to name a few.

Difficulties in feeling close to others or maintaining relationships*-* Act 1 Astarion is arguably avoidant of any meaningful connection and struggles greatly for some time in becoming comfortable with the concept of a relationship.

And that’s just a small start into the many, many issues of Astarion. So, with that in mind, let's look at possible ways forward for treatment and healing that could be for Spawn Astarion if Faerun had/has therapists. If I were Astarion’s therapist, I would be looking to utilise the Tri-Phasic model for trauma therapy or three-phase trauma therapy, as it seems best fitting for trying to work with the experiences of Astarion and his captivity. Across the three acts of the game, I’d argue that Astarion, in some ways, is following the model in his actions, albeit unwittingly and on a how-to process trauma speedrun..

I’m not going to delve too far into EMDR or trauma CBT, but you can use these modalities with this trauma model; it all depends on the client’s needs and what they are comfortable with.

Tri-phasic Trauma model Stage 1’s Safety and stabilisation (dealing with immediate threats)

This stage is about ensuring that Astarion is physically safe and helping him emotionally stabilise himself before starting to attempt to process what has been done to him. Trying to skip to telling the story of trauma generally only retraumatises.

In Act 1, Astarion, who has spent centuries being in peril, vulnerable and powerless with his identity stripped away from him and is understandably terrified. As well as coping with the trauma of his slavery, he now has the fresh trauma of what has been done to him by mindflayers, his potential recapture by Cazador at any moment and being marooned in the middle of nowhere with a bunch of strangers that he now has to assess for potential threats with no clear insight into their motivations.

We see an Astarion who now has autonomy, and is now in an environment where, for the first time in centuries, he is not being exploited either by strangers wanting to use him sexually or tortured by Cazador. Now, while this is better than his previous situation, for someone who has experienced severe trauma, this shift can feel very emotionally destabilising and a trauma on top of trauma. While Astarion is physically safer. Emotionally and behaviourally, he is likely to be much more unstable, and we see that at points throughout the game with his dialogue and actions..

A key part of this stage is regaining control- both external and internal- and ensuring the client feels stable and safe at first with help from the therapist, then gradually demonstrating stability on their own using appropriate tools. You are helping someone cope with moving from unpredictable danger to more reliable safety by collaborating with them to create an environment around them of stability, clear and open communication, comfort and, when needed, containment.

It's interesting to note that the Astarion we meet in Act 1 is convinced that only power and strength can secure safety, and the player character, if they choose to treat him with respect, can model the behaviours that allow him to show more vulnerability later on in Act 2 and eventually turn down the chance to ascend later in act 3. By the player character's actions, they are disproving Astarion’s internal narrative that kindness is weakness, dominance is strength and asking for help is weak.

When it comes to building a therapeutic alliance with Astarion, to start, I would be working to build a strong, functional bond, based on trust, understanding and as well as the core conditions. I am there to help teach my client about healthy attachments, how this is fundamental to building relationships, while modelling this behaviour in my interactions with my client by setting out what they can expect of me and our work together and the boundaries of that work. I would also start to feel out what safety looks and feels like for the client as well as their goals for therapy, because that can be highly subjective, particularly when working with trauma.

What is considered safe by one client would not be considered safe by another, and when working through it, we clearly define the goals for therapy. It's not unheard of to have a client say something like Astarion does with “it's time to start living again”. The issue with that is that it's a fairly wide-ranging goal, so we would start examining what “living” looks like, address what is realistic and unrealistic and how it can be broken down into smaller, more accessible goals. It's not uncommon for trauma victims to sabotage themselves, either intentionally or otherwise, because their goal feels too much once they start getting into it.

A key part of this stage is helping to teach your client to self-soothe, and this is all a case-by-case approach. What works well for one trauma survivor doesn’t work for others. Dissociation is an attempt to self-soothe, and we see that happen on a few occasions to Astarion, so that is something for a therapist to be mindful of when working with him. While it is protective, it's also shutting down any sense of self, which is not good news.

Some of the tools we can use for that are flashback journals, listing and detailing triggers and glimmers, anchors, guardrails (when talking about certain situations or topics that threaten to overwhelm, etc) and soothing lists. As a therapist, you are attempting to teach the client to “rescue” themselves when traumatic memories or triggers arise, without or with less and less intervention from the therapist when remembering traumatic thoughts, until they can cope with them.

This is not a short process and can take months or years to get through even this first stage. For someone like Astarion and what he has experienced, I’d say you would likely be looking at years irl before he would be safe and stable enough to move onto phase 2.

Tri-phasic Trauma model's Stage 2: Remembrance and mourning (processing trauma)

At this stage, Astarion hopefully has the tools and techniques to rescue or soothe himself if need be when examining trauma, and it's time to start processing what has happened to him while being more in control rather than reactive to memories. This is where the intense emotions kick in, but the skills taught to the client in the first stage keep the emotions tolerable as the client’s window of tolerance has now grown to be able to cope with what they are about to work through their experiences.

The aim of this is to acknowledge the trauma, be able to tolerate it and take away its power.

If you thought stage 1 was complicated, when it comes to multiple trauma, there are a lot of layers to work with as you are working to address the trauma as well as the impact it has had on your life as the client. Here we are trying to help Astarion identify common themes that come up from his traumas, such as the loss of identity and autonomy, rather than give a blow-by-blow account of every terrible thing to has ever happened to him.

I think it's important to note here that trauma therapy does not require the client to remember and relive every traumatic memory. That is retraumatising, and while therapy is work, it is not meant to be an ordeal. The aim is to address the pivotal points that influence Astarion’s understanding of himself, his emotions, behaviours, thouts and feelings. You would start with the least traumatic experiences and work towards the more traumatic over time. Again, working on slowly expanding that window of tolerance.

You are only working with what the client can tolerate and you aren't pushing the client to reveal more than they are ready for, its always at their pace with the therapist intervening only if the client appears to be getting overwhelmed.

As well as trauma, you are also working with the client to address loss. People who have experienced trauma often feel a sense of loss, and therapy can’t undo what has been done; it can only help you live with it. It's ok for someone with traumatic experiences to mourn for the life they could have had, damage to relationships, and experiences they feel have been tainted by traumatic events. There will also be strong emotions; it's pretty common when working with trauma for clients to have big feelings, anger, shaking, crying, and you would be bringing in the skills in stage 1 to help them pace themselves or soothe as they explore their traumatic memories.

Tri-phasic Trauma model's Stage 3: Reconnection: reintegration and connection with others

Once Astarion can demonstrate he can keep himself safe, regulate his emotions with all these skills he’s learned, it's time to reconnect with the world, rebuild his sense of self and start building meaningful connections and relationships. You can see throughout the game that the more authentic and supportive you are with Astarion, the more genuine he becomes.

With the support of the player character (and presumably his therapist), he can demonstrate that he can build relationships and care for others. He is less reactive, focused only on survival and can start integrating the trauma into his life rather than be defined by it. We unfortunately can’t take away trauma fully, but that doesn’t mean it destroys someone or they can’t have a fulfilling life.

There is the person before the trauma, and then there is the person after the trauma who has learned to carry what has happened to them and reconcile that with their new sense of identity or self.

It's fairly common when working with victims of trauma at this stage to observe them to have newfound levels of compassion and maturity as they look ahead to moving forward past their suffering. They can take the work and skills from stages 1 and 2, and add that to what they have learned about themselves and their experiences and use it to live in the present and envision a future rather than being shackled by the past. Astarion is quite literally building a new identity. It's also common here for victims of trauma to grapple with relationships, some of which they might need to end for their wellbeing. For example, I don’t see Astarion keeping in touch with his vampiric siblings, at least not for very long, but that is a whole post on its own about family systems..

And that, is the abridged version of how we start to address trauma and dissociation. I feel you could write a dissertation on this and how trauma weaves in and out of pretty much all of NG3 and its characters. Hopefully its interesting to some nerds out there.

I've had a few DM's from people with their experiences with trauma. Ethically, I can't be your therapist, but I can at least give you some guidance on what you should be able to expect from your therapist if you are living with trauma and want to take the next step on trying to work past it with the help of a competent therapist.

This article is a good place to start on what you should expect: https://www.bps.org.uk/psychologist/principles-good-therapy

#baldurs gate 3 #astarion #therapy #trauma

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