Years ago, a friend of mine told me about a case that still haunted him. It involved a little girl who had been sexually abused whose parents felt she should tell all on the witness stand so that she could recover. When her testimony began, she started screaming and could not stop.
Often people come to therapy thinking they must relive the trauma in order to come to grips with it, and want to begin telling the story in detail almost as soon as they sit down. As Babette Rothschild points out in The Body Remembers, Volume Two, when clients do that, they can become overwhelmed and re-traumatized and unlikely to return to therapy.
In fact, telling all may not be a requirement to get better for a person. At one of her workshops, Rothschild asked therapists to raise a hand if they had experienced trauma. Many raised their hands. She then asked how many were functioning well without having gone into detail in therapy about the trauma. Most hands, usually about half to four fifths, stayed up.
“Trauma treatment does not need to be traumatizing,” writes Rothschild.
The work of Pierre Janet is central to Rothschild’s work. At the end of the 19th century, Janet proposed a three phase treatment for trauma. The first phase is establishing safety and stabilization. This process, which Rothschild identifies as essential, can take anywhere from hours to years. Only after the first phase is established can phases two and three be addressed, but Rothschild says that phase one alone can also be enough for some clients.
Phase two is the processing and resolution of trauma memories, while phase three focuses on integrating the gains from phases one and two into everyday life. The ultimate goal is to help the person function better, so if the client chooses to address their traumatic memories, that is their choice, not the therapist’s.
The process of resolving trauma includes taking a good history, finding out what specific factors led the person to come in for therapy, and coming up with a good treatment plan. Importantly, the treatment plan is based on what the client wants to accomplish – not what someone else wants them to accomplish.
“It is never a good idea to follow a third party’s agenda,” write Rothschild.
But this can be difficult. When I worked in public mental health, there was often pressure to have referring agents’ goals take precedence over clients’ goals. At other times, it may be a family member or someone else in the client’s life who has an agenda separate from the client and is pushing them. I appreciated Rothschild’s emphasis on the client being the expert on his or her life.
“The therapy should be about their life quality and emotional health,” she writes.
Rothschild addresses evidence-based practice in a way that I wish more would do. She points out that all research is biased, and that outcomes-based research may be the most biased of all. She gives an example from her own experience with irritable bowel syndrome (IBS) and the very different advice she got from three different doctors – her primary care physician, her cardiologist, and her gastroenterologist.
She also cites the 2005 work of Ioannidis, which comprehensively deconstructs the accuracy of research. She points out that no one treatment in trauma stands out as superior to any other, and that it is important to have several tools in your tool box. I was reminded of the ongoing work of Scott Miller in looking at what works in therapy. He has been advocating similar ideas for years, and talks about “practice-based evidence” versus the standard “evidence-based practice.”
The Body Remembers, Volume 2 includes an updated overview of the autonomic nervous system and includes information on the polyvagal system and theory. There is a chart insert on physical signs to look for to help you monitor your client’s arousal state as well as your own. I found this to be very useful, both conceptually and pragmatically.
There are also case studies and transcripts of therapy sessions to help guide readers in doing the work. Rothschild also shares what has worked and what has not worked for her in counseling clients, and I appreciate her candor very much.
She also emphasizes culture, and cites the work of Ethan Watters’ 2010 book Crazy Like Us, which is one of my favorites. We can actually do damage when we try to put our evidence-based practice theories into one-size-fits-all therapy. Watters gives good examples.
We do carry memories in our bodies, and it is important for both the client and therapist to be aware of that and understand it in the context of the way we work with the body in recovery from trauma.
For more about Babette Rothschild, visit her online at Somatic Trauma Therapy.
The Body Remembers, Volume 2: Revolutionizing Trauma Treatment
W. Norton and Company
Hardcover, 224 Pages