bookReview: Complex Psychological Trauma: The Centrality of Relationship
Philip J. Kinsler
Reviewer: Beth Glanville
Contemporary research within the field of psychological trauma clearly demonstrates the value of secure attachment and positive relationships, as the greatest bulwarks against developing PTSD following an overwhelming incident (de Zulueta, 2003). Working as a trauma-specialist psychotherapist, whilst living in an increasingly atomised society – one that seems intent on wiping out social interaction through ever developing automaton, screen-based communication, increased remote and lone working, and the closure of communal and social spaces – continues to fuel my desire to stress and re-stress the value of relationship, even when it feels trying, both in healing from trauma as well as for better mental health – and well-being – overall. According to the National Institute for Health and Care Excellence (NICE), (2005): ‘the most important risk factor is the lack of social support at the time and after the traumatic experience’, thus in the case of unrecognised long-term traumatisation – as well as ‘simple traumatisation’ – we potentially risk embedding the trauma/PTSD response if we do not provide appropriate clinical assessment and face-to-face support and contact to individuals who have been impacted by trauma, or re-triggered – perhaps out of conscious awareness – into earlier/long-standing traumas.
I see the fight for the recognition of the value of relationship as especially important within our professional contemporary context, where many face-to-face psychotherapy services are being cut, and we see the advent of services offering counselling through telephone, apps, and other means of electronic communication. Where face-to-face services remain in place there can be a growing threat of the manualisation of therapy, with “treatment” being offered according to a set of instructions and “session plans”, with less and less value being placed on the relationship which has been proven, time and again, to be the key factor in enabling sustainable change in our clients, as Kinsler recurrently references in his work (p.3; p.12). Kinsler himself iterates, from an earlier text, that: ‘Stated simply, whether it occurs within or outside of psychotherapy, healing of complex and chronic trauma associated with abuse (especially when there is a foundation of attachment trauma) occurs in safe, dependable, kind, and bounded relationships’ (P.J. Kinsler et al., 2009, p.183). It is refreshing to return to basics and simplicity regarding effective trauma therapy, and validating to re-realise the value of the “bearing witness” role of the therapist, as they grow in relationship with the client and work towards moving them beyond trauma, and potentially even into the realm of post-traumatic growth.
In his introduction Kinsler tells us that “this book is written for three purposes. The first is to set the stage … the second is to discuss diagnostic thinking … [while] the third section … follows three complex trauma cases through the process of therapy relationship formation, and the actual therapy relationship management work” (p.3). Ultimately Kinsler aims to support therapists in helping their clients to develop “earned security”, “… through the provision of safe relational therapy” (p.11). In subsequent chapters, Kinsler follows through on his intentions with the production of a book written in a supremely accessible manner, through which his voice of experience – over 50 years of experience – can clearly be heard. Kinsler develops a sense of trust between himself and the reader, which perhaps could be viewed as a parallel of his stress on the value of developing relationship in his therapeutic work, and I welcomed being able to access the wealth of his experience through the text without feeling patronised, or as if I in turn required a few more decades of experience in order to grasp what he was saying.
Following the introduction in part I, which gives an overview of the concepts of complex trauma, attachment, and the relationship between the two, Kinsler goes on to explore, through the lens of trauma, both “the less trauma-aware theories” and “the more trauma-aware theories” (chapters 3 and 4 respectively), thus initially widening the net for clinical thought and formulation, before drawing theory and practice together through the integration of knowledge and experience. In this manner he cites “the three-stage consensus model of treatment” (p.61) which, “regardless of trajectory, the major societies and theorists writing about trauma treatment have adopted…” (p.62), of stabilisation, processing of trauma memories, and integration. Within this section Kinsler manages to simplify the concept of transference into what, for me, has been the clearest example I have come across: “It is as if we have a video projector in our foreheads and that projector sends out a movie composed of all our prior important interpersonal learning,” he writes, “and we then live as if that movie was ‘the truth’, ‘reality'” (p.25). Nowhere before has the idea of transference felt so beautifully clarified and concretised for me, whether or not in direct relation to the field of trauma.
Part III focuses on case studies following clients through the development, maintenance, and termination of the therapeutic relationship, highlighting along the way common relational ‘crises’ that frequently occur throughout the course of therapy. Kinsler draws on real case examples in demonstrating how he has worked with and through crises as they have arisen, drawing on three quite different case examples which inform his writing from their beginnings to their closures, both planned and unplanned. Kinsler brings in examples from working with dissociative clients – or patients – throughout, which can contribute to confidence building for the therapist working with a client group that can feel particularly tricky and complex.
This is a beautifully written book that brings the heart back into the study and practice of trauma therapy – and therapy in general – through reinstating the value of relationship, and being with an other. One pointer remains that it would be interesting to hear some more diverse case studies and differing cultural slants on the subject. Overall I highly recommend this text to both trauma specialist and non-specialist therapists to reconnect with the basic value and concepts of our work with healing, development, and moving towards a fuller future, though with a realistic element, whereby clients can move beyond their pasts and deal with “‘normal persons problems’” (p.141) in their everyday life, rather than remaining psychological prisoners to times gone by.