One of the books my clients refer to most when they come to work on trauma and PTSD with me is The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, M.D.
I remember reading his article entitled “The Body Keeps the Score” in social work school. I was stunned by how much it addressed my own experience of feeling history living in my body, including the difficult places, and the experiences of my clients. It also gave me hope, because if the body keeps the score we can pay attention to how to work with the body and help people find their own healing in moving into what is next for them.
Since this book has been such a touchstone, I have decided to read it through over the next while and to write reflections as I go, probably once a month. I expect to go chapter by chapter for a while, pulling out what seems most important to me now and using it as a meditation on what happens in therapy and how that happens in my office. You can also read more about me, about therapy for trauma and individual psychotherapy elsewhere on my site.
Trauma and Resiliency
Van der Kolk acknowledges that even in the face of trauma we have resiliency, that to a large extent we manage to rebound from disasters. However, often we live with the aftermath, culturally and in our private lives.
“…traumatic experiences do leave traces, whether on a large scale (on our histories and cultures) or close to home, on our families, with dark secrets being imperceptibly passed down through generations. They also leave traces on our minds and emotions, on our capacity for joy and intimacy, and even on our biology and immune systems.”
Trauma affects not only those directly exposed to it, but those around them. This is called secondary trauma. It happens not only to the families of soldiers who come home with PTSD, but also to families with all kinds of trauma, migration and immigration, abuse survivors and even therapist working with trauma.
Sometimes family members discount their own symptoms because they feel it shouldn’t affect them, if it was was their mother’s or their grandparents’ story. But trauma is passed down through the family generation after generation. The trauma wound is present in the relationship, even as the family member did not experience it directly.
What is Trauma?
The word trauma comes from the greek word for wound. Defined as a deeply distressing or disturbing experience or the emotional shock following a stressful event or physical injury, a more function definition of trauma for the therapy process is an event that is too difficult to process fully in the moment.
In the prologue to The Body Keeps the Score, van der Kolk states “Trauma is by definition unbearable and intolerable.” This is a useful viewpoint because not all distressing experiences are held as traumas. Two different people witnessing the same traumatic event may not both experience a trauma reaction.
What is PTSD?
Post-Traumatic Stress Disorder or PTSD is a diagnosis with symptoms, a duration of symptoms, a minimum span of time to pass after the trauma, and several other criteria.
In The Body Keeps the Score, van der Kolk discusses how PTSD is linked to our survival mechanism. We see this in how the person with PTSD responds to events, triggers, that remind them of the trauma. Part of our brain wants to ensure survival. The brain becomes activated because it wants us to know about possible danger, even when that danger is long gone. These reactivations can seem insurmountable.
But PTSD is treatable, and the brain can and does change. We now know the brain has neuroplasticity, and that through attending to experience and noticing and developing novelty, including through the body, the brain can develop and change.
Working with Trauma in Therapy
van der Kolk outlines three ways of proceeding to work with trauma in the prologue.
- Top down, talking, re-connecting with others, telling our stories, processing memories
- Taking medicines that help with PTSD symptoms to help the brain change how it manages information
- Bottom up: “allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma”.
It isn’t about finding out the one best way, since we are all individual. van der Kolk says that many of us need more than one way to approach this.
How I work with Trauma and the Body
When I work with people suffering from trauma, I combine a top down and bottom up approach, as outlined in The Body Keeps the Score. Talking about what happened and spending some time figuring it out and relating the trauma to your life story is where we begin, but always with attention to your body experience, sensations, kinesthetic feeling (the feeling of movement) as you remember.
Then we move more fully into the body to address the feelings connected with the trauma that might not have words. I work a lot with clients who were adopted as infants or young children, and the early loss of the original family (and sometimes other caregivers or foster families) happened before they had language, so these traumas are in some ways only accessible through feelings in the body that emerge when events re-trigger some of the same feelings. Many of my adopted clients feel intense sensations that they associate with abandonment, rage, numbing, or rejection around relationships in their adult lives. We process here-and-now abandonment issues through attention to how they live in our bodies now.
I also work with people who were abused, physically or sexually, as children, by adults or other children. And I work with family members such as parents or siblings. Although those traumas often occurred when my clients had words, the combination of it being secret and shameful makes it difficult to speak and to put words to feelings.
Ultimately the goal is to process the memory, stored in the body (somatically), in the here and now. This could be through pure experiential awareness or with the aid of language and expression, so that the unaware habits of behavior and feeling associated with it can now come into awareness and be subject to conscious choice. Because my guiding theory, Gestalt theory, is deeply relational, it is important to feel and move through this in relationship. That could be with a therapist or with another person in your life, and to experience the growth and possibility of reconnecting parts of yourself and with the world outside yourself.
I’ll have more to say about this in upcoming blogs. Interested? Get a copy of the book and read along with me. I will continue with chapter one in November. Meanwhile if you are suffering from the after effects of trauma or a diagnosis of PTSD know that there is help, and you don’t have to suffer alone. If you are in NYC and interested in speaking with me about treatment, please get in touch or you can schedule an initial call or appointment directly. Wherever you I hope that you will be able to find a therapist who has somatic training and works with trauma.