File Size: 9679 KB
Print Length: 465 pages
Publisher: Penguin Books; 1 edition (September 25, 2014)
Publication Date: September 25, 2014
I suffered PTSD and severe anxiety for many years, and tried all the usual therapies (CBT, medication , analysis, diet, exercise, acupuncture, vitamins, group remedy etc . ). Frankly, absolutely nothing really worked until I actually discovered - and applied - the somatic (body) techniques espoused by van der Kolk, and other luminaries such as Philip Levine, Pat Ogden, and Eugene Gendlin. It required me a long time to understand – and accept – their message that trauma impacts the more ancient (reptilian) part of the brain where talk-therapies just can't reach, aside from affect.
The only way to ‘communicate’ with this pre-verbal strategy is through the body, which can signal to the brain come that it is OKAY to commence the process of unfreezing the psychological paralysis that has affected us for decades. So much will depend on our willingness and capacity to feel and experience what is going on inside us - not simply think it over.
Of course, it is also important to understand what is going on at a cognitive level in order to make sense of things. So there is certainly a role for traditional speak therapy, but it is not the primary game. By simply combining a bottom-up (somatic) and a top-down (cognitive) approach, as van der Kolk suggests, you are able to move towards genuine healing - not just a suppression of symptoms. This is not theoretical for me. I actually have experienced it.
The particular other truly great publication on this subject is Peter Levine’s ‘In an Unspoken Voice’, which describes his ‘somatic experiencing’ (SE) therapy. Levine’s book is arguably narrower in opportunity than van der Kolk’s, but his writing has such a poetic quality that it communicates more than the words on their own. The 1st time I read Levine’s book I felt my body respond to his facts at a visceral level. It is a significantly healing and magical work., Psychiatrist, professor, world-class investigator, and traumatologist Bessel van der Kolk MD requires no introduction to injury psychotherapists. My enduring impressions of him over many years is 1 of meaning, cogency, frankness, and convenience - served up with a subtle dash of impishness. He is commonly a little disruptive - something of a provocateur - and everything of his I possess ever read has educated me something, confirmed something important, or pushed my thinking in a new direction. When he has something to express, I want to hear it.
Nevertheless, I almost didn't buy this book: I was put off by it. Common with major reviews of PTSD psychotherapy outcomes research, I know that research support for body-oriented approaches to treating psychological injury psychopathology is thin at best, and such treatment models simply do not have the study validation of either EMDR (Eye Motion Desensitization and Reprocessing) and PE (Prolonged Exposure), neither of which are especially body-focused.
J. Interlandi's excellent article anticipating publication of this publication - " A Revolutionary Method to Treating PTSD" (New York Times Magazine, 2014. 05. 22 - available online) - initially backed my fears that for some inexplicable reason van der Kolk was now promoting some treatment model which is why we have little confirming research. " Psychomotor remedy is neither widely utilized nor supported by medical studies, " Interlandi notifies us. Provocateur he may be, but I'm firmly biased in favor of making time for therapies for which we have solid empirical validation. Companies do not deserve to be fresh subjects - maybe not even if they accept this, as I'm uncertain they can ever know enough to make a truly informed consent. Information that PTSD and related disorders are usually highly curable, when using the right treatment protocols, regrettably remains the possession of a minority of people, even in the professional psychotherapy world.
Yet the accounts of van der Kolk's remedy work in Interlandi's article is gripping. Getting completely absorbed in the account, I had been convinced. (I've been here before, reading van der Kolk's own accounts of his work. ) And so the disruption commences! Deeper into the article, he has me. Van der Kolk's critique of CBT (cognitive behavioral remedy - a general class of therapies) and PE (E. Foa's exposure remedy model) is withering and correct: neither really work. " Trauma has nothing in any way to do with cognition... It has to do with your system being reset to interpret the world as a dangerous place.... It's not something you can talk yourself out there of. " Interlandi reports that " That view places him on the fringes of the psychiatric mainstream. "
But he's right, and I aren't stress this enough. Why? Because as a injury treatment professional I'm well aware of what the trauma treatment outcomes research actually says. The best current summary of this research well may be chapter 2 of Ecker, et al. 's (2012) " Unlocking the psychological brain". (Buy this book, too! ) Ecker et al. brilliantly presents a synthetic summary that encompasses 11 existing remedy models which actually DO cure trauma psychopathology, if done right. Within this context, what van der Kolk is doing makes perfect sense. Finally, it appears, the trauma psychotherapy field is moving in the direction of a consensus which has strong reliability.
Van der Kolk's new book has its own virtues. Parts One and Two (102 pp) provide a substantial review of the neuropsychology of trauma's impact on a person. It's fun, interesting, informative reading, for professional and layperson alike. Part Three (64 pp) studies childhood development, attachment experience, and " the hidden epidemic of developmental trauma". Van der Kolk has for years been a leading champion of the idea that there is a form of PTSD which substantially differs from all the rest. It evolves in reaction to long-term child abuse and/or disregard. I completely share his belief that the analysis of Developmental Trauma Condition (sometimes called C-PTSD, with " C" meaning " Complex" ) is overdue for elegant recognition. I actually find his review of the struggle to legitimize DTD as gripping and distressing as anything otherwise in the book. It is anguishing to know that a major problem exists, And the psychiatric business simply refuses to acknowledge it. DTD/C-PTSD is no fantasy. We all see and treat these people, as children and adults. They exist, and they are nothing like " ordinary" PTSD treatment clients.
Part Four (29 pp) focuses on storage. I've long thought that much writing on treating psychological trauma generally seems to overlook the point: trauma storage is what causes the problem. Deal with that and the symptoms vanish. Exactly why is this so hard to understand? Yet, it is not a common understanding in any way. Explaining how injury memory works is invariably enlightening to my clients. And experiencing what are the results when we change the nature of trauma memory is revelatory to someone who's resided with it for years, if not decades. As he does throughout the book, van der Kolk offers fine stories about clients who have experienced exactly what I've seen happen within my clients, making excellent use of what cognitive research tells us: people understand things best through narratives. Give you a good story and you convince.
Emotional trauma remedy is intricate, but we are now well prepared to launch into the book's key content - Part Five (154 pp), " Routes to Recovery". He becomes right to it: we cannot undo the injury, but we CAN undo-options its effect on all of us, therefore get our " self" back. Ch. 13 reviews existing therapies. Their approach is to repair " Descartes' Error" (see Damá sio's 1994 publication of that title) by viewing mind and body as a single logical functional unit. His topical ointment coverage is complete and his critique of current therapies acute - not to be missed.
Then he writes of the significance of language (Ch. 14). We all construct our narrative mainly in words, and what we choose are critical. But language is not enough (this anticipates his next two chapters). Our own senses encompass a bigger world, and it's centre is our body, where all of our sensory receptors are located. He then introduces the treatment model he's long advocated: EMDR (Eye Motion Desensitization and Reprocessing). I'm trained in EMDR, and in fact van der Kolk and I had the same instructor for our advanced training: Gerald Puk PhD. Van der Kolk tells an amusing and self-deprecating story about his advanced training experience, in which Puk could provide a strong corrective to his approach to clients. This really is typical van der Kolk - he's a truth-teller, even when it may put him in a poor light! And, after all, at this point he has nothing to prove to anyone.
Getting an EMDR therapist is not hard (see his " Resources" section). Nor is it hard to find a yoga teacher, and yoga is exactly what he advises for helping a trauma victim get again into their body. Yoga is a wise choice, because it is available, already well known, and adaptable to a wide range of individuals and capabilities.
There is certainly much more in Part Five, and the focus is on self-empowerment. " Victim no more! " as they say. Most trauma therapists have a keen interest in seeing their clients leave remedy charged up and ready to fully adopt their life - that certainly is my own emphasis. Van der Kolk's thoughts on self-empowerment for those in recovery from emotional trauma will be invaluable to the trauma psychotherapy consumer.
For psychotherapy professionals, this book will be both delightful and confirming. Regarding everyone else, it will be a readable, gripping, highly educational tour of subject areas all of which are critical to a successful transition back from the impact of psychological trauma. That will he gives prominent though not dominating emphasis to developmental trauma disorders is totally appropriate. Our community has yet to understand that child abuse and neglect is a more often chronic than not, and that its impact is largely ignored and poorly treated, if at all. This does not have to be. Get educated (this book will do that), then invest in being an advocate for children and with older people impacted by injury. Each of them deserve the opportunity to be healed, and we can now accomplish that. Truck der Kolk shows all of us how.
The physical publication: Jacket design is nice and interesting. Binding is less so: color of spine wrapping is semi-florescent, along with paper, not fabric. The book feels considerable and nice to keep and look at.
* 6 pp: prefatory reward by peers and related luminaries (interesting comments from some important people in the field);
* 2 pp: Stand of Contents;
* 356 pp: genuine text;
* 4 pp: Appendix: General opinion proposed requirements for developmental trauma disorder
* 3 pp: Resources
* 4 pp: Further reading
* 51 pp: Notes
* 21 pp: Index, I will join the chorus of voices saying such a outstanding book this is: superbly written with an astonishing prosperity of information, penetrating, insightful, myth-breaking, revolutionary. I did not want to put it down, but it was so full and so emotional that I had to give myself breaks. The particular portrayals of patients are alive and realistic, unlike the composites in many books that ending upward feeling wooden. The author often lets his patients talk for themselves and sometimes they are downright brilliant.
But I'd like to go above praising this publication to pointing out that the information in it is immensely important, and recommending everyone who has any interest in understanding people to buy it, read it, and pass it on to friends. An individual will learn more from reading this than from reading dozens of other books. To me, it is the most important book I've ever encountered.
When older people are traumatized, or when children are abused, or traumatized by witnessing violence, or even simply ignored/neglected, their brains are permanently changed and often they are no more capable of coping with life in ways that are healthy for themselves and the people around them. Some are now living in regular or intermittent pain. Other people figure out how to anesthetize themselves and feel not much at all. Some give their trauma to others, especially to their children.
Truck der Kolk offers hope to those of us who have been damaged by talking about new (or ancient) therapies that can go deeper than ordinary talk remedy or medication. These are based on our increasing understanding of the brain, and the old but neglected wisdom of the oneness of mind and body.
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