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When Talk Isn’t Enough: Easing Trauma’s Lingering Shock

By Ryan Howes

As therapists, we inhabit a professional culture that stresses the importance of being accommodating, tactful, nonconfrontational. It’s part of our job description to get along with people, play well with others, and not rock the boat. Nevertheless, there are times when a therapist with a sufficient sense of mission who genuinely cares about underserved clients needs to stop worrying about rubbing some people—particularly the powers that be—the wrong way.

On one level, Bessel van der Kolk looks and sounds like one of the powers that be. Not only is he a classically trained psychodynamic psychiatrist who underwent his own analysis, he even looks and sounds a bit as if he could have been in Freud’s inner circle. Medical director of The Trauma Center in Boston, professor of psychiatry at Boston University Medical School, and director of the National Center for Child Traumatic Stress Complex Trauma Network, he perfectly embodies the role of Big Cheese in psychotherapy circles. And yet, fundamentally, he’s a rebel—or perhaps a knight-errant would be a better term—who fights on behalf of traumatized people, fervently committed to bringing them the best treatment possible and not afraid to offend the therapeutic establishment in the process.

For the past 30 years, he’s been instrumental in bringing the insights of neuroscience into our understanding of trauma, and was the first “establishment” psychiatrist to publicly champion a range of unconventional mind–body approaches—including yoga, mindfulness, eye movement desensitization and reprocessing (EMDR), neurofeedback, sensorimotor therapy, martial arts, and theater—in treating trauma. He’s used his privileged position within academic circles to get the funding for research projects to establish the scientific legitimacy of approaches once considered on the fringe of mainstream acceptance. By any measure, he’s a pioneer in the field. In this conversation, he shared his thoughts on the differences between public and private trauma, the vital importance of community healing, and the often unacknowledged role of gentleness in our approaches to healing work.

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RH: How are the public traumas we read about in the news—events like school shootings or the Boston Marathon bombings—different from the far more private traumas psychotherapists typically treat?

Van der Kolk: With public traumas, everybody gathers around you, and there’s a lot of comfort and the acknowledgement of the reality of what happened. That’s very different from a private trauma that involves assault, incest, rape, or domestic violence. Those are hidden traumas, in which victims rarely get to publicly acknowledge what took place and rarely get the support they need to move on in their lives. When they have a community that rallies around them, the victims of public traumas tend to do much better. Too often, victims of private trauma end up with a deep sense of shame and invisibility, along with silent rage about not being seen or protected.

RH: Is the brain’s processing of the traumatic incident different as well?

Van der Kolk: Well, the mind certainly processes it differently, and I suspect the brain does as well. But we’re not yet at the point of getting funding to study how this sense of secrecy, isolation, and shame shows up in the brain and its neural networks. The basic orientation in trauma research is still car accidents and soldiers, not incest, child abuse, or domestic violence, which are more difficult to study.

RH: I know you’ve been researching the relationship between early childhood trauma and borderline personality. What have you found?

Van der Kolk: In our data, we looked at 125 people with borderline personality disorder, and 87 percent of them had severe childhood abuse. In fact, we found that the earlier the trauma occurs, the more impact it has on the developing mind and brain. Further, if the trauma is meted out by caregivers, it has an even more pervasive impact on the children’s relationships with the people around them. Borderline personality is usually related to that survival strategy, but not always. That’s the important thing.

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1 Comment

  • Comment Link Wednesday, 16 July 2014 23:36 posted by jeffrey von glahn

    The key to trauma resolution is what I refer to as the unforced activation of emotional experiencing; i.e., it spontaneously emerges coincident with the support the person receives for what he/she has been experiencing. Debriefing immediately afterwards on cue violates this principle, and it causes the forced activation of emotional experiencing, which overloads the ANS and isn't therapeutic. This also, unfortunately, gives the impression that crying only makes the person feel worse. With unforced activation, crying is the best medicine. See my brief article in the May/June 2012 issue. EMDR creates exemplary conditions for unforced activation and many clients are reported as crying. In Shapiro's very first article (1989), a person recovered from a childhood trauma with 11/2 minutes of deep crying. Crying is psychotherapy's Best Kept Secret.