I’ve just finished reading this fascinating book, and really wish that I’d read it before doing any real-world therapy… or better still, that we would have been taught the main thrust of it during our training.
I understand why my training didn’t cover trauma basics. Primarily it was because whilst we were volunteering we were not supposed to be working with clients that were ‘above our competence’; and therefore clients that presented with more complex issues (in the form of active self harm or dissociation for example), should be screened out by the organisation we were volunteering with and taken on by properly trained practitioners.
The problem with this approach is that clients with those kinds of symptoms don’t always share that type of intimate detail in a hurry, especially to someone new during a counselling intake interview; and it has been my experience that even during weekly therapy, some clients only gather the confidence to reveal symptom like that after some months of work together, and by then they may well have already begun to share and explore some of the traumatic experiences that fuel their current and potentially harmful destabilising symptoms. This is a significant problem.
Before I get onto the actual book, I need to add something else. Because being aware of the degree of a clients traumatic past and harmful ongoing symptoms isn’t possible to know during early therapy in all cases, I think it’s good practice to tread carefully and approach any work with a client who attends due to issues that could relate to a trauma history (eg addiction, self harm, or
‘a difficult past’ as some clients say in shorthand) with the wisdom that is outlined in the book.
‘a difficult past’ as some clients say in shorthand) with the wisdom that is outlined in the book.
The fantastic thing about Revolutionising Trauma Treatment, is that it lays out a treatment journey for trauma clients that’s miles away from the premise that just being there in the room and empathically hearing them retell their trauma experiences is enough - and rightly so as this can do real harm to clients that aren’t ready for such work the author (Babette Rothschild) points out. Rather, it’s aim is to help the client build up the psychological stability and resilience that’s required in order to even begin to approach such work.
The early stage of trauma therapy then is the ‘Stabilisation phase’ which includes building up protective resources like helping the client rediscover good memories of past times - even if rare and fleeting there will likely be some - when they felt genuinely positive and in control in some
aspect of their life, or if that’s not possible, to remember people or events that capture a potent and meaningful positive experience. These memories not only help address the huge imbalance of negative to positive internal experience that the client exists within but also serves as a tool to be drawn upon if the client experiences loss of contact with themself and needs to be brought back in the room.
aspect of their life, or if that’s not possible, to remember people or events that capture a potent and meaningful positive experience. These memories not only help address the huge imbalance of negative to positive internal experience that the client exists within but also serves as a tool to be drawn upon if the client experiences loss of contact with themself and needs to be brought back in the room.
Stabilisation also involves the therapist keenly observing the client for signs of psychological destabilisation, and when it seems that they are struggling (like with increased breathing rate, colour draining from the face or mental blankness), the therapist will proceed to re-route the
client to focus on protective experiences such as the powerful positive memories identified earlier. The author also includes fascinating case examples of how she successfully worked to reground clients who experience dramatic and terrifying PTSD flashbacks during sessions.
client to focus on protective experiences such as the powerful positive memories identified earlier. The author also includes fascinating case examples of how she successfully worked to reground clients who experience dramatic and terrifying PTSD flashbacks during sessions.
It’s only after Stabilisation, where a client has built up a buffer of resilience and confidence -through experiencing how destabilisation can be worked with and reduced, and in realising that the positive memories from their past can indeed overcome the pull towards deeper loss of control - that the client is offered the opportunity to actually begin the process of sharing their traumatic past, and even then this is managed in a way that shows the extreme care with which the author treats the process.
And this starts a new phase, where the client is asked not to detail any specific events, but is asked to imagine that if their trauma history was a book, divided into half a dozen chapters, what would the chapter names be? This I think is a wonderful strategic approach which of course encourages the client not to sink into any weeds but rather to bundle the big areas of content together internally and then to come up with a chapter name that fits, and as a result are able to share with the therapist a very brief but meaningful overview of their history with the least risk of harm to themself. This act is a so powerful in helping clients give their past a distinct form andstructure that help position it psychologically into a shape that’s manageable, rather than it being an amorphous ever pervading horror. The process too helps the client unburden some of the shame and pain associated with keeping their past tightly guarded, whilst also allowing them to experience how careful pacing can help expand the envelope of their ability to cope. All of these treatment approaches together make for significant client progress.
So much so that in some cases the author states, a detailed unpacking of traumatic experiences is never even undertaken with some clients, who feel that the benefits of the work to this point enables them to experience a genuinely good quality of life, free from - or with an ability to self manage - the most distressing and life limiting symptoms they once had.
Overall this is a fabulous book that answered all of the questions I had, and much more, and has been an invaluable resource that will influence how I work for many years to come and help me confidently and safely provide therapeutic care for my clients.
* PTSD is characterised by a loss of control, where clients suffer intrusive symptoms (for more than a month) related to a traumatic event, including one or more of the following… involuntary memories, recurring nightmares, dissociation (including flashbacks), distressing psychological and/or physiological responses to trauma triggers.
