1. The early days of trauma therapy, especially therapy for childhood trauma and abuse. 1980s to 2000s.
2. Trauma therapy in the age of neurobiology/brain science – updated essentials for healing. 2010 to 2015.
1. THE ORIGINAL ISSUES from the 1980s
THE COURAGE TO HEAL. Laura Bass & Ellen Davis, 1988
Back in the 1970s, there was almost NOTHING in print to help a survivor of either adult or childhood trauma. It wasn’t just that there was no guiding light – there was no pathway! Today there are dozens upon dozens of well-informed books and websites describing trauma, its consequences, methods of therapy and approaches to healing. But when Bass and Davis published their book The Courage to Heal, it was revolutionary. It was passed from person to person, it was devoured as if women had been starving for centuries. This book gave us our first language with which to start speaking and break the silence.
The book had chapter headings that defined and illuminated the path of healing. What is so amazing is that this first exploration of the subject got it so absolutely right. The defining phrases of the chapter headings are still at the core and foundation of trauma therapy. And although it took me many years to understand it, the book’s title exactly captures the essence of the healing journey – the courage of the people who do this healing work. To be honest, only those who have done it or those who have witnessed it can understand how much courage it takes to face that pain and find one’s way through it.
A glance at Wikipedia on the subject of this book will indicate how controversial it was. But in fact their categorization of a survivor’s healing journey has stood the test of time, even if aspects such as family confrontation and whether the memories have to be recovered have been modified with experience and practice.
The Chapter Titles updated
The list below represents an updated version of Bass & Davis’s “Essential Issues” in the Healing Journey. I present them in a general order of how the process usually evolves, being aware that of course, as with any process, there are overlaps and idiosyncrasies in people’s individual journeys. The titles/statements that originated as chapter headings in The Courage to Heal (though slightly reworded) are coloured red.
Safety: the essential ingredient
Breaking the silence
The effect of trauma: recognizing the damage
Honouring what you did to survive
Recognizing dysfunctional coping strategies
Understanding it wasn’t your fault
Dealing with internal conflict – splitting
Meeting the inner child/ wounded self : issues of dissociation
Letting yourself remember : emotions and body
Parenting the wounded self
Grieving and mourning
Anger: the backbone of healing
Taking back your power : self esteem
Further chapter titles that I have not included in my list, but which are still parts of the process, are:
Believing it happened
Disclosures and Confrontations
Resolution and moving on.
There is a further section in the book, “Changing Patterns”, which discusses issues of feelings, the body, intimacy, sex, children and parenting, and families of origin. These are all important elements within a transformative journey, but in one way or another tend to be covered within the essential issues listed above.
SAFETY : THE ESSENTIAL INGREDIENT
Whether the trauma was in adulthood or childhood, the event/s involved acute loss of the safety that forms a primal basis for survival. Survival is linked to safety, and therefore lack of safety is linked to death.
There is a belief in PTSD theory that incidents leading to PTSD must always include an element related to death. This is often misunderstood as meaning the traumatized person must have witnessed a death or death-related event. But in reality the death link can be far more subtle, and is often to be found in the profound loss of safety at a bodily or psychological level.
If you are working with a survivor of trauma and you ignore the issue of safety, you may be wasting yours and the client’s time. Without the re-establishment of some degree of safety, the client CANNOT heal. Their nervous system will simply continue to act on high alert, despite all your efforts. The original traumatic stimuli needs to be removed for the autonomic nervous system to be able to make its way back to baseline functioning. Even then, triggers of similarity and reminder will continue to set off false alarms (flashbacks), so these must be minimized in every possible way. In order to do this, the client needs to be taught how to keep themselves safe, both internally and externally. In cases where the traumatic stimuli cannot be removed, the therapy room can be constructed as a safe refuge in which the nervous system can have temporary relief.
External safety: triggers that exist in the external environment – places, sounds, smells, particular people, particular activities, etc. In the early stages of recovery, advise the client to make informed choices about exposing themselves to such triggers. Once you make them aware of what is happening, they’ll quickly connect cause and effect, and can then make an informed choice.
Internal safety: survivors of childhood abuse are particularly prone to recreating traumatic settings, seeking out abusive relationships and engaging in self-destructive behaviour. In these cases, the danger is coming from within. The lack of safety, or need for excessive safety, is an internal focus.
Therapist contribution to safety: the therapist needs to work patiently and sincerely to demonstrate their trustworthiness. This includes not only providing outward and practical consistency and reliability, but also emotional stability, demonstrating an absence of judgement and reactiveness to whatever the client presents. Survivors of childhood abuse are extremely sensitive to non-verbal signals, having learnt the need to be able to read faces and body language for any sign of danger. Allied health workers and clinicians working with such survivors should be aware of this underlying fear and lack of trust, and the need to build some platform of safety before going deeper into the therapy process.
Creative strategies and safety issues: survivors who are attempting to heal from adult-acquired PTSD or Complex PTSD can be helped to create safety through creative arts exercises, guided visualizations and cognitive behavioural exercises. They need to be able to connect at the physical level and in their imaginations with ‘safe places’ where they can feel in control again and not be in continual fear of annihilation by a chaotic world. Since the world IS chaotic and unsafe, they need to learn how to create order and safety internally, in their minds, and then in their immediate environment.
FURTHER PAGES OF DISCUSSION of ESSENTIAL ISSUES
As time allows, I will add discussion of each of the Essential Issues. Those below, highlighted red, link to a page of discussion.
Breaking the Silence
Recognizing the Damage
Honouring what you did to Survive
Recognizing dysfunctional coping strategies
Understanding it wasn’t your Fault
Dealing with Internal Conflict – Splitting
Meeting the Inner Child / Wounded Self
Letting yourself Remember: emotions and body
Parenting the wounded self
Grieving and Mourning
Anger: the Backbone of Healing
Taking back your Power: self esteem
2. ESSENTIAL ISSUES IN THE AGE OF NEUROBIOLOGY – approx 2010 – 2015
In addition to the essential elements listed above, the field of trauma therapy can propose a further number of treatment interventions that are now regarded as essential for satisfactory recovery from traumatic stress disorders and developmental trauma disorder.
Developing the Compassionate Observer Self
Addressing the traumatic freeze response – discharging the emotional memory
Doing body-based feeling work
Taking effective action: DOING things to change the brain
Traumatized people need to have physical and sensory experiences to :
unlock their bodies,
activate effective fight/flight,
tolerate their sensations,
befriend their inner experiences,
and cultivate new action patterns.”
Bessel van der Kolk, 2015
These neurobiologically derived interventions are discussed in the sections on Bessel van der Kolk and The Healing Journey/Somatic & Emotional Release Therapies.
More on The Healing Journey