International Society for Traumatic Stress Studies

Book Review: Bridging Body and Mind in Trauma Treatment

Posted 1 April 2002 in StressPoints by David Read Johnson

The recent trend by body-oriented psychotherapists to justify their methods with neurobiological research on the amygdala, HPA axis, or hippocampus raises interesting questions. Certainly the truism that trauma is recorded and processed in the body should not be used to merge distinctly different meanings of the body. Neuroscientists generally examine chemical and electrical processes within the brain or bloodstream. Body psychotherapists, on the other hand, generally attend to the body at the level of kinesthetic sensation and muscular tension.

Our clients may view their bodies as the target of attack from their perpetrators, past and potential. Clearly these and other meanings of the embodiment of trauma will have distinct ramifications for treatment. Fortunately, Babette Rothschild's book, The Body Remembers, avoids this confusion and makes a solid contribution to the examination of this complex topic. The book is a modest, even conservative, approach to body psychotherapy that provides the reader with a basic review of the psychophysiology of trauma, followed by a thoughtful presentation of clinical interventions using a body-oriented approach.

For Rothschild, body psychotherapy is not defined by a set of techniques, but rather by an understanding that traumatic memories are stored and represented in states of muscular tension, and that attention to bodily sensation can be an important component of treatment. Her interest clearly is in providing an integrative framework for all clinicians involved in trauma work.

The first part of the book reviews research on the effects of traumatic stress on the nervous system, memory, emotional expression, dissociation and kinesthetic experience. The material is largely derived from research conducted by members of ISTSS such as Bremner, Charney, Pitman, Southwick, van der Kolk and Yehuda and is summarized in a manner easily accessible to the nonspecialist.

The second part of the book focuses on practice, where Rothschild continually emphasizes the need for establishing and maintaining a safe, structured and explicit working relationship with the client. She describes techniques designed to control the affective load on the client, such as braking, accelerating, developing resources, oases, anchors and safe places. She describes in detail methods of using body awareness to help clients establish a sense of trust in their emotions, so as not to fear the arousal of traumatic affect. The author emphasizes the need for clear physical boundaries between client and therapist, and generally avoids any form of touch in her work. She describes methods of bringing sessions to proper closure.

The clinical examples demonstrate the similarities of a body-oriented approach with many other forms of psychotherapeutic intervention, and, in fact, most of her ideas can be incorporated into a general clinician's practice. Throughout, Rothschild illustrates her work through principles of awareness, rather than elaborated body techniques, revealing her long experience with trauma survivors. Absent are lofty claims of cure or exclamations of the significance of ideas presented.

In this book, however, Rothschild complies with the current zeitgeist of concern about the interpersonal dimensions of the body. Due to both increased awareness of the harmful effects of therapists' acting out through physical touch, and the fact that many clients' bodies were invaded and harmed directly by perpetrators, discourse has tended to avoid or minimize the "encountered body," preferring views of the body as a dysregulated but contained system (whether neurological, hormonal or muscular). Unfortunately, such views leave many aspects of the interpersonal environment of psychotherapy unaddressed, as is the case in The Body Remembers.

Nevertheless, this book helps us see that the connections between neuroscience and psychotherapy truly are possible. Rothschild adds to the work of Peter Levine, Pat Ogden and Bessel van der Kolk in deepening our understanding of the complexities involved in linking body and mind. I consider it the best and most well-rounded presentation yet published of body psychotherapy for trauma.

David Read Johnson is chair of the Special Interest Group on Creative, Body and Energy Therapies, StressPoints contributing editor in Creative Arts Therapies and co-director of the Post Traumatic Stress Center in New Haven, Conn.