One of the most surprising things that I experience in my clinical practice is how often trauma is overlooked by psychologists and psychiatrists. This is an unfortunate event as trauma victims often suffer needlessly when they don’t receive appropriate treatment and more often are placed on a regime of psychotropic medications that have severe side-effects. Why does this continue to be the case with such highly trained Doctoral level clinicians? This is a complex issue but I believe one level of this problem is related to the lack of understanding of personality systematics or how the personality system operates at various levels of the total ecological system. Practitioners are often so focused on symptom complexes that they want to treat with medications and standard psychotherapy that they fail to listen with a third ear as Reich spoke of the need to listen beyond the words and symptoms. Another problem is that many clinicians have a very narrow view of trauma and don’t realize that little “t” trauma as Francine Shapiro terms it is severely derailing of personality development and can create a trajectory to adult psychopathology that becomes so obscure that those without the necessary framework don’t suspect that the story is one of developmental trauma. The issue of unrecognized trauma becomes even more apparent with patients who are professionals and have achieved a lot in their lives. There is a tendency by many to offer biological explanations and then prescribe medications which although can be helpful if not understood as only one level of the personality system can divert treatment and things can get worse. There are wonderful frameworks that assist me in my work at identifying these developmental traumata. Jeffrey Young’s Schema-Focused work is very elaborate and helpful in ascertaining early maladaptive schema that were learned in attachment experiences. I also think Francine Shapiro’s TICES using aspect of the memory network that are active is also a brilliant development in that it allows clinicians to identify the early trauma that has not been processed. Another good way to identify trauma is in re-enactment patterns. I have had quite a few patients who have shown patterns whereby they have acted out toward others when they were children in ways that are difficult to understand. Sometimes these individuals are labeled as predators when in fact they are re-enacting traumatic experiences that have happened to them and which are unintegrated psychic phenomena. I will discuss how our understanding of personality systematics can help with complex cases. Check out Wikipedia for a review of personality systematics.