Over the last 20 or 30 years, probably no other diagnosis has been more alluring to the therapy profession, more interesting to the general public, and more prone to evoking fervid discussion than trauma. Trauma itself seems to be an astonishing shape-shifter of a diagnosis, encompassing in its range of mental and physical symptoms just about everything a therapist is likely to see in any client—anxiety and fear, mood swings, guilt and shame, sadness and depression, dissociation, irritability and anger, insomnia and nightmares, difficulty concentrating, chronic fatigue, various bodily aches, substance abuse, eating disorders, relationship difficulties, not to mention spiritual anomie and the loss of any sense of life’s meaning. No other single condition tests the therapeutic relationship quite so stringently, demands so much from the clinician, or combines so many disparate treatment challenges in one messy package as the traumatized client.
At the same time, no diagnosis has done more than trauma to spark therapeutic creativity, generate new and innovative treatments, and even transform the way we think about and practice therapy in almost any setting with almost any client. For one thing, we no longer think only in terms of psychotherapy as a largely mind-to-mind exercise between therapist and client. Trauma studies have led the way to incorporating not just brain science into our work with trauma clients, but knowledge about interactions among the body, mind, and—what we now call without too much embarrassment—spirit. In what’s really a revolution in the field, trauma has largely ushered in a truly holistic, integrated way of thinking about all so-called mental disorders. If anything can kill off the last remnants of Cartesian dualism in psychotherapy, it should be this profoundly integrative convergence of what were once thought incompatible streams of knowledge. Now that is something to talk about.
And yet, as is always the case in this wonderful, maddening profession, the more we know, the more we’re aware of what we don’t know. One door opens, and we barely have time to say, “Now we get it!” when we spy another closed door just ahead of us. In this issue, three long-time practitioners of trauma therapy give us their individual and very different takes on treating a condition that, if a little less mysterious than it once was, is still far from an open, easily readable book.
Freud said that the two basic measures of mental health were the ability to love and work with reasonable success. Why is it then that in spite of an enormous increase in our understanding of trauma and a vastly increased fund of sophisticated treatment methods, so many trauma clients still, after months or years of therapy, have so much trouble with their relationships and work lives? The authors in this issue offer their own compelling take on this question. But their contributions, as revelatory as they may be, certainly don’t end the conversation. Luckily for our clients and our field, the deep curiosity and creative energy that have already led to so many advances in our understanding of how to treat trauma show no signs of flagging any time soon.