The Needs Paradox: Clinical Implications for Working with Relational Trauma in Children

Theoretical and Conceptual Paper · Open Access

Karen O’Neill¹ and Tara McDonald²

¹ Independent Psychotherapist, Colchester, Essex, UK² Independent Psychotherapist, Cheltenham, Gloucestershire, UK

Corresponding author: Karen O’Neill, enquiries@pipsolutions.co.uk

Perspectives on Complex Trauma, Volume 7, Issue 1 (2026)

Published: August 2026

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Abstract

Over the past fifty years, there has been a significant body of evidence that details the impact of relational trauma on the infant’s developing brain and the child’s capacity to form healthy interpersonal relationships, particularly to the primary caregiver. This article presents The Needs Paradox, a concept developed by Dr Karen O’Neill and Tara McDonald that describes the psychobiological conflict children who have experienced relational trauma encounter when they are offered adult care, attunement and co-regulation. Deeply rooted in attachment wounding, this type of trauma results in embedded defensive relational strategies once essential for survival which have become maladaptive in the context of safer caregiving experiences in the here and now. As adult psychotherapists, play therapists, and dyadic attachment therapists, we draw upon developmental neuroscience, attachment theory and trauma informed practice. We argue that The Needs Paradox may reflect neurobiological adaptations that shape affect regulation and interpersonal functioning. We introduce three key concepts: Conditions for the Development of Self, Developmental Dehiscence and Representing Positions. We highlight the importance of the therapist’s role in intentionally attending to the repair of the child’s original relational wounds, while emphasising parental involvement and active engagement throughout the course of individual child therapy.

Keywords: Attachment; Relational Trauma; Developmental Trauma; Transference; Child Psychotherapy; The Needs Paradox

Cite this article

O’Neill, K., & McDonald, T. (2026). The Needs Paradox: Clinical implications for working with relational trauma in children. Perspectives on Complex Trauma, 7(1), 14–28.

Permanent article URL: https://www.complextraumainstitute.org/post/the-needs-paradox-clinical-implications-for-working-with-relational-trauma-in-children

Copyright and licence

© 2026 The Author(s).

This article is licensed under the Creative Commons Attribution–NonCommercial–NoDerivatives 4.0 International Licence (CC BY-NC-ND 4.0).

Published by the Complex Trauma Institute.

ISSN 2635-0807