*THE BODY REMEMBERS - THE PSYCHOPHYSIOLOGY OF TRAUMA AND TRAUMA TREATMENT

Babette Rothschild

Norton, 2000, 190 pp., £22 p/b ISBN 0393703274

*THE BODY REMEMBERS CASEBOOK

Babettte Rothschild

Norton, 2003, 240 pp., £19 p/b ISBN 0393704009

Reviewed by Ann Roden

Transforming Trauma

The first book is invaluable for clinicians working with clients, researchers, students and the general public who want to understand the psychophysiology of trauma and knowing what to do about its manifestations. Babette Rothschild is a practicing psychotherapist very involved in the International and European scene, working with stress and in particular posttraumatic stress disorder. Babette 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.

It is important to distinguish between the various types of stress, which affect the neurophysiology in different ways. The following terms are often used interchangeably but in fact they are distinct entities - stress, trauma, traumatic stress, post-traumatic stress (PTS), post-traumatic stress disorder (PSTD). Not all stress is bad and all stress does not necessarily need treatment. The current DSM-IV classification does not define these terms accurately enough.

This book is an important contribution to the management of the various types of stress. Only 20-25% of traumatic events lead to PTSD.

It is essential to have an understanding of the workings of the Autonomic Nervous System and the relationship to the amygdala and the hypothalamus. 'Understanding how the brain and body process, remember and perpetuate traumatic events holds many keys to the treatment of the traumatised body and mind.' Otherwise many 'talking therapies' just result in further trauma for the client and no resolution of the underlying cause. The felt sense in the body needs to be incorporated into the therapy. This helps to increase body-mind integration.

It is important to build sound foundations for safe trauma therapy. This may take a period of time before the client is ready to deal with their trauma. Safety for the client within and outside the therapy, client and therapist must be confident in applying the 'brake' before they use the 'accelerator' to prevent overwhelm, it is important to build on the clients internal and external resources, defenses are resources and should not be got rid of, trauma is like a pressure cooker - work should be to reduce and never increase the pressure, the therapy must be adapted to the client, not the client adapting to the therapist, no two clients are the same, the therapists ideas can get in the way of a successful outcome.

Within this safe environment healing can occur. The skill of the practitioner, whether psychotherapist, craniosacral therapist or body worker, is in slowing the whole process down, so that the client's neurophysiology has a chance to choose a healthier way of functioning and allow the necessary readjustments in the mind and body to occur, so that resolution of the difficulty can happen. Much of this work is based on the research of Dr. Peter Levine. Much more research is needed in particular between the lack of cortisol production and PTSD. From a craniosacral perspective, the suppression of fibroblast production by cortisol is crucial to the post-traumatic expression of potency.

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 incidence. Every therapist who reads this book is likely to find their work benefits from it.
If you are interested in details of case studies, then go on to The Body Remembers Casebook, where you will find a wealth of wisdom, integration and common sense. It brings together a way of combining an assortment of trauma treatment models, to bring about optimal healing to trauma survivors. Each case shows step by step healing by a sensitive therapist. For therapists, it gives some answers to how the mind and body can together ease the after-effects of trauma. Here you will find a wealth of wisdom, integration and common sense.

The book begins with a review of The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. There needs to be a differentiation between stress, traumatic stress, posttraumatic stress and posttraumatic stress disorder. Stress is remembered by the body. The hippocampus and the amygdala are central to memory storage. The amygdala is very active when there is a traumatic threat. The memories are not stored in the amygdala but must be processed by it in order for them to be recorded as implicit memories in the brain's cortex. The hippocampus is necessary to the essential storage of information that helps us make cognitive sense of our memories. It helps to put our memories into their proper perspective and slot in our life's timeline. Again memory is not stored in the hippocampus but information must be processed through it before being recorded as explicit memory in the cortex. In the recording of a traumatic event, the hippocampus activity may be suppressed by the stress hormones, so that the traumatic event is prevented from becoming a memory. A piece of information about oneself that lies in the past is unable to anchor in time, is floating freely and often invades the present. Without hippocampal activity, memories of unresolved traumatic incidents may remain in the implicit memory system. There the images, sensations and emotions can all be provoked but they cannot be narrated or understood. It is this mechanism that is behind the PTSD symptom of flashback - episodes of reliving the trauma as if it is happening now.

There are ten foundations for safe trauma therapy which form the basis for the casebook:-
  1. First and foremost establish safety for the client within and outside the therapy
  2. Develop good contact between therapist and client as a prerequisite to addressing traumatic memories or applying any techniques - even if that takes months or years
  3. Client and therapist must be confident in applying the 'brake' before they use the 'accelerator'
  4. Identify and build on the client's internal and external resources
  5. Regard defences as resources. Never 'get rid of coping strategies/defences; instead, create more choices
  6. View the trauma system as a 'pressure cooker'. Always work to reduce, never to increase, the pressure
  7. Adapt the therapy to the client, rather than expecting the client to adapt to the therapy. This requires that the therapist be familiar with several theory and treatment models
  8. Have a broad knowledge of theory - both psychology and physiology of trauma and PTSD. This reduces errors and allows the therapist to create techniques tailored to a particular client's needs
  9. Regard the client with.his/her individual differences, and do not judge for noncompliance or for the failure of an intervention. Never expect one intervention to have the same result with two clients
  10. The therapist must be prepared at times to put aside any or all techniques and just talk with the client.
There then follows a brief overview of the methods and theories applied in the casebook using somatic trauma therapy, body psychotherapy, psychodynamic psychotherapy, transactional analysis, Gestalt therapy, cognitive behavioural therapy, eye movement desensitisation and reprocessing, Levine's SIBAM model/ biodynamic running technique, neurolinguistic programming, attachment theory and psychopharmacology as an adjunct to trauma therapy.

The cases that follow use one, two or three of these methods to help improve the perception of the client and their ability to function more effectively. These need to used in a flexible, common-sense way. There is a useful chapter on learning from one's mistakes and failures. Babette's honesty is appreciated and the importance of supervision for the practitioners is emphasised. There is a list of references but it does not to include many of the European practitioners who were at the forefront of the development of psychological methods.

Dr. Ann Roden is a paediatrician who now practises craniosacral therapy and teaches Ayurveda