W.W. Norton and Company, 2017
Reviewer Errol B. Dinnall
Without question, Babette Rothchild is a master of the dark art of accessibility. One does not have to read volume 1 to reap the benefits of this volume. This is a book for the seasoned clinician and beginners alike, its prose gently supportive, openly inviting, as well as instructive and edifying. Ultimately, it’s a book in pursuit of the apparently mutually exclusive positions of ‘restrictions’ and ‘freedoms’ in therapy, of being securely tethered and through that having free reign to support. The reader is guided through eight chapters divided into two parts of 4 chapters each, the first section exploring theory and principles, and the second the application of the former. To my mind it encapsulates these conditions with ease and aplomb.
Throughout, Rothchild invites both the seasoned and newly arrived trauma therapist into her confidence. Based upon an innate and thorough understanding of the variable impact of her subject matter, she sensitively reveals the importance of rigour when working with trauma and the traumatised. Rothschild does this in part by airing her frustrations as she reminds/introduces us all to the central importance of a phased approach to treatment. An approach, she makes clear, that is often at risk of being minimalised and rushed, or at times ignored altogether, sacrificed upon the alter of instant/immediate returns; a modern (Western?) decease, I wonder. The fundamental, pivotal importance of having clinically relevant trauma knowledge is not only supported by her incisive and rigorous research, but also revelations from her own clinical faux pas when Rothschild herself was not as informed.
Such an approach, which enables clinicians to facilitate clients’ accessing themselves and their innate resources whilst on a journey towards being stabilised, is but one of the gems of this book. As therapists we are – I am – reminded that being able to encompass a client informed resourcing protocol is all that is needed for some clients. Rothschild provides examples of clients’ positive memories being activated to assist the curative journey, the importance of therapists being culturally aware and allowing clients to utilise what they know, and for clinicians to be ever mindful of not imposing preconceived notions upon them. Whilst such approaches may be sufficient for some, for others the engagement of these oft dismissed resources will form a secure base for additional therapeutic work. Rothschild not only reviews the importance of accessing and developing clients’ resources but constantly reminds us of the equal importance, the absolute necessity, of self reflection and self care on the part of the clinician.
Her ability to acknowledge, capture and then make use of nuances in client behaviour, as demonstrated in her many clinical vignettes, provides us all with a road map of why being ever present with our client’s journey is essential. Rothschild’s ability to succinctly capture the at times delicate wispiness of bodily expressions made by clients reassures that the listening and observation of our clients are of equal importance. This takes me to a central feature of this book, one that enables the development of the intensification of clinical endeavour when working with the traumatised. For me it amounts to a template, a scaffolding, a guide or indeed a gift offered by Rothschild to all clinicians, no matter our therapeutic orientation, that when applied aids, and in all probability will increase, our tendency to be ever present within our roles as therapists.
Querying and building upon her previous knowledge, Rothschild presents an innovative theory on how trauma manifests in the nervous system. She provides a comprehensive reviewing of the classical appreciation of the autonomic nervous system (ANS) from a binary division between the parasympathetic and sympathetic, to one wherein the process of the ANS is expressed through six categories of possible “degrees of ANS arousal”. She argues that the traditional model of the ANS is restrictive, and not expansive enough to encapsulate the multiple nuances of traumatic expressions.
Rothschild maintains, correctly in my opinion, that therapists who regularly work with the traumatised need to be able to precisely track the at times subtle movements not only within clients, but also within themselves. Having an approach that enables a therapist to recognise and take note of delicate alterations in breathing, of facial colouring and other likely changes that can impact clients as they progress through the categories/degrees of ANS arousal is essential, as without this ineffective treatment plans or inappropriate interventions may be attempted, resulting in clients’ conditions stagnating or deteriorating.
Overall Rothschild in this, her second volume of The Body Remembers, takes us on a beautifully crafted journey, one infused with three unrelenting qualities:
- her unrivalled capacity to access herself, using her life encounters to enhance her clinical awareness through which she encouragingly invites us all to accept our insecurities, and at times less than perfect interventions, and use them as opportunities to learn and develop,
- her profound breadth of knowledge of and humane passion for working with trauma and the traumatised, and the varied ways in which trauma presents,
- her insatiable desire to improve the noble art of trauma treatment by relentlessly fine tuning processes with innovative thought and research, which is the ever present guest at this holistic banquet of traumatic enquiry.
Anecdotally, as a practicing clinician working with a significant case load of traumatised clients I have, having read this book, began viewing myself and my clients through Rothschild’s prism of degrees of ANS arousal. The beauty of her theory in postulating a gradation of ANS arousal, with each level clearly colour coded to indicate the direction of arousal from ‘too low’ (parasympathetic) to ‘excessive overwhelm’ (again parasympathetic), with sympathetic arousal levels in between, is borne from a fundamental understanding of the transitory process though which a traumatised person’s nervous system journeys. Moreover, Rothschild provides us with her thoughts on how such clients might present within each category/degree of arousal, whether emotionally, physically, behaviourally or cognitively. What astounds is the specificity, the detail, the care in her work. All clinicians should take a moment to reflect on how best they might be able to incorporate this work.
Errol B. Dinnall is a Psychotherapist and EMDR Practitioner at Transport for London’s Counselling and Trauma Service. He has a small private practice in SE London. He also works with the aftermath of gang-related violence and is passionate about restorative mental health-led interventions.