When There Are No Words: Repairing Early Trauma and Neglect From the Attachment Period with EMDR Therapy
Sandra L Paulsen, PhD. (Author, Illustrator)
Katie O’Shea M.S. (Contributor)
CreateSpace Independent Publishing Platform, 2017
Reviewer: Fe Robinson
In ‘When There Are No Words’, Sandra Paulsen sets out an approach she originally co-developed with Katie O’Shea for repairing early trauma and neglect from the attachment period, using Eye Movement Desensitization and Reprocessing (EMDR) Therapy. I practice EMDR integrated within psychotherapy, and I was drawn to the book having read reviews indicating the book was useful to therapists who wanted to understand early relational trauma and the attachment difficulties arising from it.
The book provides a summary of the neurobiology of affect, trauma and attachment and of ways of achieving brain integration, as well as a thorough introduction to the approach described. As well as setting out the four-step approach to Early Trauma EMDR, I valued greatly the emphasis in the book on preparatory work; much of this is useful to any therapeutic discipline.
The four-step Early Trauma approach described has two preparatory steps. First, enabling the client to contain their material so that it can be worked on bit by bit. Second, ventral vagal resourcing to enhance the client’s capacity to process trauma by widening their window of tolerance. Panksepp’s work on affective neuro-science is very clearly explained. Before the author describes how to ‘reset’ the affective circuits, Panksepp described how clients can smoothly flow between different affective states. The final step, which is EMDR specific, is the processing of traumatic material by time-period, rather than through use of explicit memories as is usual in the EMDR standard and modified protocols. The rationale for this alternative approach is that very early memories are remembered bodily and accessed through felt-sense, and explicit memories may not be available for processing. This chimes with my experience of the client group.
The layout of this book is unusual, with much use of evocative cartoons, and bulleted lists. The use of case studies is informative, as is the separately presented information for consideration with more severely dissociative clients. At times the book is eloquent and clear, yet, in other sections, I found it technical and academic in tone and repetitious. The book also provides a wealth of onwards references but, at times, a short summary of what they would reveal would be welcome. I found the appendices extremely useful with clear worksheets and step-by-step guides. The feel of the book is of a theory-informed practical manual. The content of the book was in part new to me, setting out a different way of using EMDR and adding much to my understanding of how dissociation comes about and of ways of working with it. The format grew on me, the cartoons were at times illuminating; they certainly engaged me in a different way to less visual therapy books.
I would recommend this book to EMDR professionals who want to broaden skills in working with clients’ attachment and relational difficulties. It will also be of benefit to those who specialize in trauma using approaches other than EMDR. Many of the principles and concepts are transferrable. It is not a light read, but it does have depth and, on balance, is worth considering.