2001-03-12 A clear development of new theory and practice for trauma

This book gives a fascinating account of some of the ways trauma work has evolved in recent years. It is framed around a particular episode of traumatisation which is developed in parallel with the theoretical model. Various other case histories are cited which give a real "hands-on" feel to the writing. The physiology and theory sides are clearly developed with references to other people working in the field - there is a strong influence of Dr. Peter Levine. Some of the physiology is not yet fully verified by research eg the apparent link between lack of cortisol production (one of the glucocorticoids produced in the adrenal glands) and post-traumatic stress disorder (PTSD). This line of research has huge possibilities. Rothschild states clearly in the introduction to her book that the theory is speculative and that controversy abounds amongst researchers in the field. She realistically refers to her book as minimalist and short-winded and it is all the better for that. People's ego-attachments to their beliefs in theory, as I know so well for myself, can only hinder their capacity to really listen. Rothschild quotes neurologist Antonio Damasio on the subject of scientific theory .... "I am sceptical of science's presumption of objectivity and definitiveness. I have a difficult time seeing scientific results, especially in neurobiology, as anything but provisional approximations, to be enjoyed for a while and discarded as soon as better accounts become available".

Although the theory is speculative, the practice is thoroughly grounded in years of successful clinical experience. About half way through the book Rothschild really gets on a roll - this is when she introduces the practical aspects of her work - much is related to tracking signs or autonomic nervous system (ANS) arousal and ways of using this as an indicator of when to start slowing the process down and helping to resource the client. I have been having a long internal debate about to what extent this work is directive and analytical. As a client I have always felt at least a vague sense of discomfort when in the hands of a therapist coming from a directive and analytical viewpoint, due to a sense of being subtly (or not so subtly) manipulated by the therapist to do whatever they think is necessary, rather than respect for my own process and inner wisdom. Working with trauma is not the same as normal process work however, as Rothschild makes abundantly clear. My sense of this type of work, having been on the receiving end of it, is more that it creates a necessarily extensive framework of safety within which healing can occur. It is a method of work where the therapist takes a lot of initiative in terms of establishing clear boundaries, slowing the process down or finding resource. The concepts of attunement, misattunement and reattunement (not Rothschild's), despite being horribly ponderous terms, do lead to a very useful understanding of the development of therapeutic trust and progress. Briefly the phenomenon described is the shifting from an empathic state of well-being (attunement) to a polarised stand-off or conflict (misattunement) which then gives the possibility for finding the health in the situation which allows a greater level of empathy to develop (reattunement). This is seen as not only an inevitable but also a useful part of the healing process. In some ways similar to the way the immune system develops its strength as a result of coming in contact with say measles and then dealing with it (my analogy).

Babette Rothschild counsels against the use of therapeutic touch with the most vulnerable and de-stabilised of PTSD clients (classed as type II B -where "clients have suffered such massive and/or multiple trauma that they lack the resources and resilience necessary for any direct confrontation of traumatic memories to be constructive. A betrayal of trust appears to figure in the overall picture of these clients." Whether it is possible for body therapists to have a clearly enough developed sense of safety and boundaries to be able to work with people experiencing this type of distress is open to debate. The author points out that it certainly is something where extreme caution is essential because of the likelihood of transference issues where the client will start to see the therapist as the perpetrator of the trauma.

Rothschild investigates the phenomenon of different levels of trauma and PTSD in a number of ways - all of them useful and interestingly presented. Her explanation of the history of development of understanding of the phenomenon of shock and traumatisation is grounded in years of successful practice and teaching. She has enormous clarity and a transparent appreciation of the dynamics of trauma, which enable the reader to make a deep exploration of her work in a way which is readily understandable. There are two chapters on the ways of developing the somatic resources of the body - presented as simple exercises. This book breaks new ground in the understanding of trauma-related work, particularly with respect to the development of resource in relation to what happened after the traumatic incident. Every therapist who reads this book is likely to find their work benefits from it and all other readers will some hitherto unknown solace from it.

Reviewed by Mij Ferrett RCST (Editor The Fulcrum)