One of the key figures in trauma recovery
My recent blog article looked at the work of Peter Levine and this article looks at another major player in the world of trauma recovery, Babette Rothschild. She is an author, lecturer and practising body-centred psychotherapist who is based in Los Angeles but who makes regular trips to Europe. I was lucky enough to attend a weekend workshop with her in Dublin last year.
This article is the first of two looking at her book entitled “8 Keys to Safe Trauma Recovery”, which is written for both therapists and those recovering from trauma and PTSD.
Babette makes quite clear that the only goal of trauma therapy is to improve a person’s quality of life and that sometimes processing trauma memories by talking about what happened serves that goal. However, sometimes it has the opposite effect and actually compromises quality of life. If this is the case, it is not helpful to work with the trauma memories. Some people are very clear that they don’t want to talk about their memories – and this must be respected. She highlights the fact that people who recovered on their own from trauma without ever going to see a therapist, don’t tend to go over and over memories. It is only over the past 20 or so years that we have found ways to work with trauma in therapy, yet for thousands years people worked away on their own, using all their internal resources, their spiritual beliefs and the support of their family and community in what could be called a “natural” process.
The 8 keys in the book’s title are mindfulness, starting at the end with the knowledge that you made it, knowing that remembering is not required, stopping flashbacks, reconciling forgiveness and shame, taking small steps, keeping physically active and finally what she calls “making lemonade” which is stepping back, seeing the bigger picture and seeing what good might have emerged from the whole process.
The key role of mindfulness in trauma recovery cannot be overestimated. In Babette’s words, it puts one in the driver’s seat of recovery. This is not necessarily practicing meditation – even very simply daily decisions such as “what do I want to wear today?” or “what in my diet agrees with my body and what does not?” can be difficult for someone who has been traumatised. They are vulnerable, their nervous system is off-kilter and they can have difficulty making decisions about what their needs are.
She talks about the fact that our minds and bodies have “somatic markers” as for example when the smell of stale cabbage immediately makes us think of hospitals or school dinners or when a favourite pop song from your teenage years takes you back to a night at the disco with friends! And suggests that we use a “mindful gauge” where we start to become aware of factors (both past and present) that continue to affect us, by triggering our memories. First of all, what was it that provoked the memory and then did it affect your thoughts or your emotions, did you feel tension in your body or butterflies in your stomach or did a particular image come into your mind? Be prepared to really investigate this closely – when does it happen, when does it not happen and use the information to work on what is really a problem for you. For some it may be the fear of being touched.
She suggests we check with our own unique gauges all the time and the following simple exercises can help to make us more aware of them: First of all, imagine you are drinking a hot drink – really imagine how it feels in your hands, in your mouth, as it goes down into your stomach. How does it affect your gauges of bodily sensations, moods, feelings, thoughts and images in your mind. Try the same exercise with a very cold drink and see if it has different effects. These are very benign safe examples and you could think up many similar ones such as “if I wear this outfit to a meeting I will feel like this” – or “if I choose that outfit, I will feel like that.” Then gradually, over time apply the same technique to more important choices and decisions – “If I spend time in this person’s company, I will feel like this” or “If I go for that job, I will feel like that.”
For more information on Mindfulness, go to my Mindful Self Help page
Begin with your epilogue – I made it!
Taking the phrase “What does not destroy me makes me stronger”, Babette says that typically when we talk about about trauma we start at start and go through everything in time sequence right to the end. But the true end is today – and we survived. So we should start our recovery HERE. This is particularly important because trauma involves the misperception that in one’s mind and body that the trauma is still happening. Physical sensations of trauma keep activating the mind’s fear response, an endless loop of fear as though it’s happening again and again. So although it sounds very simple and obvious, it is very powerful to realise that there is an end, the event was in past.
In purely biological terms, in our brains the hippocampus, or memory store, remembers facts, not emotions. It records the time frame of important events – the start, the middle, the end. It sends this information to the cortex, the thinking part of brain. In trauma the high levels of stress hormones necessary for survival responses of fight or flight or freeze stop the hippocampus from working properly. An accurate time frame is not processed properly and we might end up with a jumbled up order of events, or big chunks missing. Also it does not register that the trauma actually ended.
For this reason sometimes people find that writing their own “epilogue can help” ending with a positive message of survival and hope. You survived BECAUSE YOU ARE HERE! (NB this will only work if you do truly feel that you are now safe. If a person has gone back into a situation where there is domestic violence, for example, it will not be useful.) The advice is to start with where you are now and work backwards is best – or if you prefer, start just after trauma and work forward. Include all the events that will reinforce you survived such as graduation, going to college, getting job, finding a new relationship – anything to reinforce the time difference. THIS IS DEFINITELY NOT AN ACCOUNT OF THE TRAUMA. You don’t have to write complete sentences with perfect grammar – you might include drawings, pictures from magazines, odd words. And some people even celebrate their wo survival by doing a simple and personal ritual or ceremony or giving themselves some kind of special token or treat – not important in itself but standing for the fact that they have survived.
Remembering is NOT required
Research has shown that most people recover without any formal reviewing of their past. Indeed some get worse if they revisit their past. For some remembering is a viable option. Whichever works best for you, safe recovery is possible.
The 3 phases of recovery first suggested by Judith Herman come into play here: Phase 1, the stabilisation phase means that making sure you have the basics needed for survival is essential. This phase also means you learn to control your memories and symptoms, including stopping a flashback (see part 2 of this blog article for more information) And also that you are able to manage a normal day, a normal schedule and activities. Phase 2 the memory stage: Do you want to revisit memories? Does it make you feel worse? When you pay attention to past do you lose connection to here and now? If so, don’t process those memories. If memories do come unwanted, find ways to distract yourself by getting absorbed in art, reading, music, physical. The type of trauma is important here – if you experienced a single traumatic episode in an otherwise stable life where you had plenty of support then exploring your memories is not necessarily going to be harmful. If you experienced multiple traumas but now have a high degree of stability and support in our life then it’s possible that you may be able to address each issue at a time and remain resilient despite what happened. It may be OK to process memories. If you experienced multiple traumas and are not at the point of stability and able to access a high level of support then it is very important NOT to process your memories.
Some of the possible benefits from processing trauma memories are: it may change the way you think about yourself, may make it easier to challenge connected negative thoughts, may be able to rehearse defensive impulses eg kicking, be able to manage self-defence training etc.
In order to identify which type you are she suggests the following exercises: Evaluate your stability. How safe do you feel in your life and if you get upset is there someone you can talk to in order to settle yourself down? Then, find tools to increase your stability. This may take time but could include taking more exercise, building up your support network and circle of friends, impose a structure on your day, look out for ways to achieve meaning and purpose in tour life – take a course, find a job, do some volunteer work. And chart pros and cons for revisiting.
For more information on my trauma counselling services go to my Trauma Counselling Cork page.
Need some more advice and support?
If you have experienced trauma and would like to explore some of the issues raised in this article , call Alison Winfield, Mindfully Well Counselling Cork on 087 9934541.
Judith Herman Herman, Judith Lewis (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror ((Previous ed.: 1992) ed.). Basic Books.
Babette Rothschild http://www.somatictraumatherapy.com/
8 Keys to Safe Trauma Recovery: Take-Charge Strategies to Empower Your Healing (8 Keys to Mental Health) Paperback 2010