Posted by: faithful | April 16, 2015

healing trauma: attachment, mind, body and brain

Healing Trauma: Attachment, Mind, Body, And Brain

Reviewed by Hilary Le Page, MBBS

Healing Trauma: Attachment, Mind, Body, And Brain.
Marion F Solomon, Daniel J Siegel, editors. .  New York, NY:  W.W. Norton and Company;  2003.   357.  CA $60.00.

The eight chapters of this multi authored book provided a synthesis of the work of leading researchers, clinicians and theoreticians in the fields of attachment, trauma and psychotherapy with the aim of enhancing the understanding of both the etiology and the healing of trauma. The initial chapters aimed to translate brain phenomena into readily understandable models of how biology and environment shape perception and behavior. The later chapters illustrated how this knowledge could be utilized therapeutically.

In the first chapter Daniel Siegal described an interpersonal neurobiology of psychotherapy: the developing mind and resolution of trauma. This read as a primer to the neurobiological basis of self-regulation, the healthy brain being one that can deal with complexity while trauma produced incoherent narratives because of impairments in integration of traumatic memory. Along with many other gems he mentioned the role of the 12 ‘C’s of psychotherapy (connection, compassion, contingency, cohesion, continuity, coherence, clarity, co-construction, complexity, consciousness, creativity, and community) and their neurobiological correlates in producing healing.

Chapter two, by Hesse, Main, Kelly and Rifkin, provided a review of the second-generation effects of trauma, how impairments in self-regulation could be transmitted from one generation to the next. The main argument was that lapses in the monitoring of reasoning during discussions of loss or trauma (when using the Adult Attachment Interview) might be subtle indicators of sporadic mental representational disturbances. These may cause subtle anomalous parental behaviours, which can have adverse effects. It was not trauma itself, but trauma without resolution, producing parental behaviours that were confusing to the child, that led to specific attachment patterns i.e. ”fright without a solution, when the infant, frightened by his attachment figure, has nowhere else to turn.” I was glad to read that, since initial descriptions of disorganized attachment behaviour of infants stressed their neurological normality. Later, the authors described other conditions in which disorganized attachment behaviours occurred.

Chapter three, by Allan Schore, described the building of the neural circuitry necessary for self-regulation, as the flow of information and energy created the mind, the regulation of the flow was essential to how the self developed. He described early relational trauma, how early traumatic dysregulating attachments impacted negatively on the maturation of the brain during its growth spurt from the last trimester to the middle of the second year (the period of accelerated growth in the right hemisphere). He also described a possible neurobiological genesis of antisocial personality disorder.

In Chapter 4, Bessel van der Kolk gave an over view of Post Traumatic Stress Disorder and reported on his explorations into the brain activity of subjects during the reading of a script recounting their personal trauma. This showed that the left Broca’s area was shut down during a flashback whilst the non-verbal right visual cortex was activated. These findings paralleled van der Kolk’s impression from his clinical work, disconnection occurred and impaired the ability to produce a verbal narrative.

Francine Shapiro and Louise Maxfield presented an overview of Eye Movement Desensitization and Reprocessing (EMDR) which, Shapiro suggested for the purpose of the chapter, should stand for Emotional and Mental Development and Reorganization. The goal of this would be to forge new connections between unprocessed memory and more adaptive information that was stored in other memory networks. In the wake of the tsunami, the descriptions of the use of EMDR to treat trauma (in the school children victims of the Mexican Earthquake) using a group program developed by the members of the EMDR Humanitarian Assistance program, might be especially relevant.

In Chapter 6, Diana Fosha described, Accelerated, Experiential-Dynamic Psychotherapy (AEDP). In a case example, she demonstrated how to work with the affective experience of the client in the “stuck” state that originated in a mother-child traumatic experience. The process, which involved experiencing and expressing emotion, empathic reflection by the therapist, and somatic focusing and reflection, allowed the client to be freed from the constraints and somatic rules imposed earlier in life and to make fresh choices in the present.

In Chapter 7, Robert Neborsky described his method of short-term dynamic psychotherapy as related to the insecure attachment framework. He theorized that layers of feelings and defenses were formed because sub-optimal attachment experiences gave rise to a “primitive aggressive self-organization (PASO).” His therapeutic focus was the experience of the core emotions related to the PASO in the therapy. He illustrated this by a case example covering six hours of therapy.

In the final chapter Connection, Disruption, Repair Treating the Effects of Attachment Trauma on Intimate Relationships, Marian Solomon described a model for couples therapy. In this model, marital disagreements were seen as the outward sign of unresolved attachment yearning with resultant emotional disengagement leading to anger and despair. Her method involved focusing couples on the defensive processes that blocked emotional responsiveness during effective repair, since effective repair was seen as essential for secure attachment.

A colleague confided to me when I said I was reviewing this book that she had borrowed it from the library 8 months previously and hadn’t been able to return it yet.

It is a book which constantly made me want to hunt out the source references, raised many questions, updated my knowledge in the area of attachment and trauma theory and renewed my enthusiasm for short term dynamically oriented psychotherapy. All in all, this book was a great, even if at times not easy, read and a worthy addition to my personal library and yours.

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