12/4/2018 Putting the Pieces Together

Putting the Pieces Together

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Putting the Pieces Together
25 Years of Learning Trauma Treatment
By Janina Fisher (/author/bio/2293/janina- sher)

May/June 2014 (/magazine/toc/10/treating-trauma)

I now realize that back in 1989, when I began my clinical internship in a big city hospital, most of our
patients—everyone from university professors to working-class families to the homeless and
chronically mentally ill—were su ering the e ects of some unrecognized traumatic experience. I say
unrecognized because, back then, we connected the word trauma only to combat veterans and victims of sexual violence. It was 15 years since the
opening of the rst rape crisis center, and just nine since post-traumatic stress disorder (PTSD) had become an o cially recognized DSM diagnosis.
Trauma, in fact, was still de ned as “an event outside the range of normal human experience.” We didn’t yet know to ask all clients about early
abuse or trauma, and we unconditionally accepted the idea that uncovering buried memories was the key to setting trauma su erers free. As
descendants of Freud, we believed that the therapist’s role was to remain neutral and say as little as possible while the patient free-associated
until the time came for the right interpretation or the always handy question, “How do you feel about that?”

By the early 1990s, however, The Courage to Heal, a feminist-in uenced self-help book by Ellen Bass and Laura Davis, had become a bestseller.
Bringing public attention to the previously taboo subject of childhood sexual abuse, it proposed a dramatic approach to trauma treatment, one
that was a far cry from the strict neutrality prescribed by psychoanalysis. In essence, Bass and Davis saw the main task of trauma work as
retrieving the missing pieces of the abuse narrative, however dimly it might be recalled, and encouraging victims to confront their perpetrators
with “their truth.” As a edgling therapist who’d never felt comfortable just nodding sympathetically in response to someone’s horrible tale of a
trauma experience, I was relieved by the permission this approach gave me to engage my clients more actively.

At the same time, I was troubled by what the The Courage to Heal model required of my clients: focusing on accessing their anger at the
perpetrators or neglectful bystanders and holding them accountable through confrontation. Most therapists applauded the way this model
encouraged survivors to become more vocal and empowered, but at the hospital where I worked, we were seeing some dangerous e ects of this
approach. Many clients became overwhelmed by the ood of memories that came once Pandora’s box was opened, and others began to doubt

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themselves when they couldn’t access memories. Worse yet, family confrontations frequently ended in retraumatization for the victim. Many
family members refused to believe the disclosures, and even turned the tables on survivors by accusing them of destroying the family. Rather than
nding support, our clients often found themselves becoming family outcasts.

During this paradigm shift in the trauma-treatment world, Judith Herman, who’d published Father-Daughter Incest in 1980, was working as a sta
psychiatrist at Cambridge Hospital in Massachusetts and establishing a special clinic called the Victims of Violence Program. In the broader mental
health world, few people knew of her book, her clinic, or the research she’d begun on the relationship between borderline personality and
childhood abuse. Even after the release of her groundbreaking Trauma and Recovery in 1992, it would take several years for her ideas to catch on.

Still, she was convinced that there was something deeply amiss and destabilizing about the confrontational tactics recommended by Bass and
Davis. She believed that good trauma treatment required a much more patient approach—delaying the focus on traumatic memories until
survivors felt safe in their daily lives and had su cient a ect regulation to tolerate the stress of remembering dark episodes in their histories. A
political feminist, she argued that victims needed to feel empowered in their relationships not only with their peers and partners, but also with
their own memories. To her, the idea of feeling overwhelmed and overpowered by the remembering process was antithetical to the resolution of
trauma. Although today the word retraumatization is used routinely by mental health professionals and stabilization rst has become the gold
standard of trauma treatment, these were new ideas at the time.

Also new was Herman’s insistence that the power imbalance of the therapeutic relationship was exacerbated by therapists’ keeping to themselves
the growing literature about PTSD, its treatment, and the course of recovery. She believed that therapists must become educators, providing
information that made sense of the client’s symptoms and helping them understand their intense reactions as survival adaptations to a dangerous
and coercive childhood environment. Her idea that knowledge is power resonated deeply with me, as did her view, which was contrary to Bass and
Davis’s model, that premature memory retrieval and disclosure could be harmful to many clients. Telling their stories of abuse was emboldening
only when they could tolerate the overwhelming feelings that this process was likely to trigger; and confronting families, if it ever took place, could
wait until they no longer needed anything from them.

Just how revolutionary the idea of stabilization was in the early 1990s is illustrated by my meeting with a young client named Ariana. Despite a long
history of childhood sexual abuse and many attempts to get help, she hadn’t been able to tolerate therapy for more than a few months. Since she
seemed to be the ideal therapy client—bright, insightful, and articulate—I was curious about why this was so.

“What told you in each of your experiences with therapy that it was time to leave?” I asked.

“Well, that’s easy,” she laughed. “Either the therapists wanted to make me cry—or they wanted to move in for the kill!”

“The kill?” I asked, confused.

“The kill is when they say, ‘Next week, we can begin to address the trauma.’”

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She’s right, I thought. In those days, most trauma therapists would’ve wanted a client like Ariana to cry as evidence that she was “in touch” with her
emotions, and most assuredly they’d have wanted to help her tell her trauma story. Even among the converted at Herman’s Victims of Violence
Program, the pervasive view was still that stabilization was just a prerequisite for the real trauma work.

It seemed to me, however, that stabilization wasn’t just a dress rehearsal for the “important stu .” Instead, it gave clients their lives back, o ered
them a meaningful present as an alternative to reliving the past, and was invaluable in their learning to tolerate their often volatile emotions. After
all, shouldn’t traumatized clients have the power over the remembering process and the right to remember more or to remember less? And why
was the ability to function and build a new life a less honorable task than memory work? Although the mid-’80s to mid-’90s o ered a promising
start in a eld that was still relatively new, it would take the next phase, the neuroscience revolution, to explain why remembering the past was not
the centerpiece of the trauma recovery process.

Busting the Monopoly of Talk Therapy

Neuroscience was brought into the eld of trauma by the outspoken and sometimes controversial psychiatrist Bessel van der Kolk. Ever since his
work with the Veterans Administration (VA) in the 1970s put him on the path to studying trauma, he’d begun to challenge the conventional
psychiatric framework of trauma treatment. Even though the VA showed a marked lack of interest in studying the e ects of shell shock on
veterans, his curiosity and crusading spirit led him to explore trauma in ways that more cognitively focused researchers tended to ignore.

When I started working on van der Kolk’s clinical team as a new supervisor in 1996, he’d been arguing for years that traumatic memory included
not just images and narratives, but also intrusive emotions, sensory phenomena, autonomic arousal, and physical actions and reactions. Working
with his team, I had a weekly front-row seat to his determination to change the way the eld approached trauma treatment. In 1994, when his
paper “The Body Keeps the Score” was published in the American Journal of Psychiatry, the message that trauma often lives nonverbally in the body
and brain was a source of tremendous discomfort in a eld that didn’t yet recognize body-based treatments as reputable. However, the advent of
brain-scan technology allowed him to conduct the research needed to support his arguments. His ndings laid the groundwork for an alliance
between traumatologists and neurobiologists, one that challenged the reign of talk therapy, even for therapists outside the eld of trauma
treatment.

In van der Kolk’s groundbreaking 1994 study, 10 subjects volunteered to remember a traumatic event while undergoing a PET scan of their brain.
As they began to recall these events, the scan revealed a surprising phenomenon: the cortical areas associated with narrative memory and verbal
expression became inactive or inhibited, and instead there was increased activation of the right hemisphere amygdala, a tiny structure in the
limbic system thought to be associated with storage of emotional memories without words. These volunteers had begun the scan with a memory
they could put into words, but they quickly lost their ability to put language to their intense emotions, body sensations, and movements.

No wonder our clients were having such di culty putting their experiences, even present-day ones, into words! No wonder they had di culty
remembering the past without becoming overwhelmed! Psychotherapy from the time of Freud had been premised on the assumption that putting
words to emotions and painful past experiences would set us free, but this research (and the many replications since) told a di erent story. If the
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experiences are traumatic, if the emotions exceed the client’s a ect tolerance, then the parts of the brain needed for di erentiating past from
present go o ine and become inaccessible. Retraumatization now made sense: if we purposefully or inadvertently trigger old traumatic
responses, brain areas responsible for witnessing and verbalizing experience decrease activity or shut down, and the events are reexperienced in
body sensations, impulses, images, and intense emotions without words.

This changes everything, I remember thinking when van der Kolk rst described his ndings—and it did. Accustomed to using words as the primary
treatment tool, talk therapists had to nd other approaches, ones that weren’t so dependent on language and narrative and could therefore
address the brain and body shutdown demonstrated in van der Kolk’s study.

Van der Kolk has been instrumental in bringing greater visibility and credibility to a new cadre of nontalk treatments, including eye movement
desensitization and reprocessing (EMDR), sensorimotor psychotherapy, Somatic Experiencing, Internal Family Systems, yoga therapy, and
neurofeedback. Though each was known before his interest in them, his air for polemic and drama brought heightened attention to them,
emphasizing their distinctive neurobiological impact. EMDR, in particular, expanded our notions of what constitutes e ective psychotherapy in
those early years.

Developed and extensively researched by psychologist Francine Shapiro in the late 1980s, it uses bilateral eye movements, tapping, and other
forms of bilateral stimulation to help clients process traumatic experiences. Like van der Kolk, Shapiro was convinced that PTSD was the result of
the brain’s failure to digest traumatic experiences. However, because of EMDR’s unconventional, nger-waving method and a lack of support from
other researchers at the time, it seemed more snake oil than legitimate therapy to many skeptics in the eld. In fact, it’s embarrassing now to recall
the advice I gave a member of my Mothers of Incest Survivors group in 1993 when she asked whether I’d recommend EMDR for her daughter. “Oh
no,” I said. “EMDR is too woo-woo. I wouldn’t recommend something like that.”

Two years later, I found myself at my rst EMDR-training weekend. Caught up by the fervor of a eld in search of new discoveries, I was willing to
try this approach, which was being strongly championed by van der Kolk, a former skeptic himself. Given that up to this point, straightforward
therapeutic approaches had demonstrated such limited ability to alter the e ects of trauma, why not try something di erent? To my amazement,
in a 20-minute session during that rst training weekend, my rst practice client overcame a phobia of riding escalators dating back to childhood.
When she hugged me, thanked me e usively, and went o to take a victory ride on the escalator at a nearby mall, I knew I’d been wrong about
EMDR.

By the early 2000s, news of EMDR’s success was commonly being noted in popular newspapers and magazines in print and online. Soon, I was
returning phone calls to potential clients who’d learned about EMDR on their own and were seeking it as their treatment. Judith Herman’s wish
that survivors empower themselves with information that can help set them free was coming to fruition. But EMDR spurred another revolution as
well—one in the therapist. Once EMDR-trained therapists had become accustomed to methods outside their habitual treatment frame, it suddenly
seemed like a logical next step to learn other approaches that involved something more than sitting in a chair, listening, and talking. Millions of
therapists around the world have subsequently become open to using treatments that di er from the talking cure. Each of these new approaches
validated my thinking that the answer to trauma recovery wasn’t to be found in reliving the past, but in having a di erent experience of the

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present. They con rmed my belief that trauma treatment shouldn’t have to hurt too much. Despite the long-held assumption in the eld that
e ective trauma work must involve staring down one’s personal Godzillas, it never felt fair to me for the treatment to be as painful as the e ects it
was treating, or for my traumatized clients to have to su er all over again, to become well.

How Neuroscience Changed Psychotherapy

The idea that neuroscience research could be germane, even necessary, to psychotherapy began as a seed planted by van der Kolk to help
survivors of trauma understand how their bodies tended to perpetuate post-traumatic reactions. With the publication of works such as Allan
Schore’s A ect Regulation and the Origin of the Self in 1994, Joseph LeDoux’s The Emotional Brain in 1996, and Daniel Siegel’s The Developing Mind in
1999, the world of science began to inspire new growth in psychotherapy. Each of these experts challenged the primacy of the mind as the basis of
human emotional life, bringing attention to how the brain a ects our capacity to use our minds. Each argued that not just social-emotional
development, but the slowly maturing brain and nervous system, could be dramatically and perhaps permanently a ected by early attachment
relationships, neglect, and trauma. Still, the question remained as to how to translate into clinical practice this new understanding about how the
brain and nervous system worked.

As increasing numbers of therapists read LeDoux, Schore, and Siegel, the vocabulary and perspective in the therapy eld began to enlarge and
shift. Whereas we’d once believed that the symptoms and behavior exhibited by our clients primarily re ected their psychological defenses—a
view that attributed a degree of intentionality, no matter how unconscious—now, we better understood the symptoms as manifestations of
instinctive brain and bodily survival responses. We understood that sympathetic activation fuels anxiety and rage, parasympathetic dominance
causes shutdown and passive-aggressive behavior, ight responses spur eeing the therapist’s o ce, and ght responses lead to verbal or
physical aggression or violence turned against the self. When clients self-harm, for example, these days, we understand their actions to be
instinctive, rather than thought out—an e ort to regulate or relieve, rather than punish.

The case of Jessie illustrates my own education into how neuroscience came to guide more and more of my clinical work. Jessie’s long history of
suicide attempts, hospitalizations, and dramatic deteriorations in functioning challenged everything I thought I knew about treating trauma up to
this point. One week, she’d disclose childhood memories of a mentally ill, terrifying mother, who’d tormented her; the next week, she’d look
confused or annoyed, snapping, “I never said I was abused!” Between sessions, she’d email me with desperate pleas to help her, but often came to
therapy professing boredom and a lack of anything to talk about. She’d vigorously deny suicidal impulses and then call me hours later to say that
she’d just taken a whole bottle of pills.

As I pieced these contradictory bits of evidence together, I realized that although she may not consistently have remembered being traumatized,
her body and nervous system were constantly being activated by the simple challenge of maintaining a consistent sense of selfhood from day to
day. Ordinary interaction with coworkers, clients, neighbors, friends, family, and even her therapist propelled her into extreme, alternating states
of longing and fear, a desperate wish to trust, and a erce determination to avoid trusting. She declared her opposition to most of my therapeutic
tools and refused to talk about trauma or dissociation, try EMDR, or “do that stupid body stu .” I didn’t know whether to rush in or hold back,
empathize or hold my tongue. At a loss, I turned to Schore and LeDoux for help in understanding Jessie in a di erent way. 
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According to LeDoux, Jessie’s amygdala—the part of the brain that scans for danger and initiates the stress-response system—had undoubtedly
become irritable in the context of growing up with a frightening mother, a nonprotective father, and equally helpless siblings. Schore’s work helped
me think about Jessie’s suicidality as a problem in a ect regulation, rather than a wish to die. With a dysregulated nervous system and a coping
toolbox limited by her childhood, her ability to soothe and regulate emotions was minimal. She often ran from the stresses of her job, hid under
the covers, and fought for control over her feelings by planning her death. The a ect associated with even acknowledging her traumatic
experiences dysregulated her nervous system and set o false alarms in her amygdala, shutting down or hyperactivating autonomic arousal, and
interfering with her ability to self-observe and think clearly.

My reading of Schore encouraged me to become more of a right-brain-to-right-brain interactive neurobiological regulator. Instead of using words,
logic, or interpretation of the connections between emotions and triggers, I’d base my response on her response. This meant noticing my own
words, tone, and body language, then observing her nonverbal and verbal reactions, then slightly modifying my next communication to heighten
what seemed to be creating more connection or interest in her or to change a way of speaking that shut her down more or evoked irritability.

I began to work more creatively with Jessie. Instead of linking past events to her present distress or trying to help her learn skills for regulating
overwhelming feelings, I concentrated on just two goals: not activating her amygdala in session and using my voice and body language to soothe
and regulate her nervous system. For instance, when she’d fold her arms and announce, “I have nothing to talk about today,” I’d chuckle.

“Why are you laughing?” she’d ask irritably.

“Because there’s always so much to talk about,” I’d respond, chuckling some more. “That’s just too funny.”

A little smile would curl on her lips as long as I was amused, rather than dysregulated, by her attempts to shut me down.

When she’d say, “You can’t help me,” I’d let my arm drop onto the arm of my chair in a reaching out gesture and just leave it there. Indeed, I noticed
that she seemed calmer when she saw my slightly outstretched arm, and sometimes I’d even call attention to it, saying, “Look at this—even my arm
is wanting to help.” Somehow it was regulating for her. I didn’t try too hard to help (because that would dysregulate her), but I made sure that she
could see the message held in the gesture of my arm.

Instead of trying to convince Jessie that trauma lay at the root of her di culties, I began simply to comment about how much her parents had
struggled—and that soothed her enough to articulate her dilemma. “I love them,” she said one day, “but even a short visit can unglue me for
weeks. I don’t know why.”

Not giving in to my impulse to tell her why, I tried to evoke interest without investment in the answer. Just to keep her medial prefrontal cortex
online, I said, “Well, we can simply be curious about that, huh?”

That year, although Jessie never wavered from her stance about what we could and couldn’t talk about, she made no suicide attempts and was
more stable in sessions. Although I didn’t realize it at the time, I was becoming a body-oriented therapist—using my body to communicate, not just
my brain.

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The Contribution of Somatic Psychotherapy

In 1999, I was still working in van der Kolk’s clinic when his motto became “Go to the body!” If trauma-related symptoms were driven
neurobiologically, he argued, and the problem wasn’t so much the traumatic events as it was the legacy of autonomic and bodily responses fueling
intense emotions, numbing, or con rming distorted beliefs about the self, then it was imperative that we nd ways of working with the body.
Personally, I resisted undergoing any body-centered psychotherapy training. I maintained that I’d never study a therapeutic approach that
required touch—an incorrect con ating on my part of body therapy and bodywork.

At the same time, I knew that there were clients and places inside them I couldn’t reach with my existing repertoire. So, in spite of myself, I signed
up for Pat Ogden’s training on sensorimotor psychotherapy after watching videotapes of her help clients resolve trauma without them becoming
overwhelmed and with not just with tears but laughter as well. Slowly, I came to understand that a body-centered psychotherapy was less about
touch and more about how to work e ectively and sensitively with emotions and cognitive schemas. Counter to the training I’d received when I’d
begun my career, I learned to interrupt clients to ensure that they didn’t become dysregulated and overwhelmed. Plus, I learned to use Rogerian
mirroring to deepen their ability to listen to themselves. Most intriguing to me, however, was that each element of sensorimotor psychotherapy
had a speci c brain-based goal. Interrupting and remaining in vocal contact, for example, was intended not only to help the client feel met, but to
regulate autonomic arousal and keep the prefrontal cortex online. In addition, mirroring and repetition were meant to activate trauma-related
neural networks so they could be reorganized through experimentation with alternative responses to create a di erent present-moment
experience.

The basic tenets of treatment involved evoking just enough of the narrative to activate implicit memory, asking the client to pause and be curious,
and then mindfully attend to how sensations, movements, thoughts, and emotions unfolded until we could sense what the body wanted to do
next. With what Somatic Experiencing developer Peter Levine called a bottom-up approach, the narrative could simply be the narrative of how
someone felt in that moment, not necessarily a trauma narrative.

This new understanding enhanced my work with Jessie. Now, although I continued to chuckle when she said she had nothing to talk about, I went
on to ask her, “When you say, ‘I have nothing to talk about’ what happens inside? Do you feel more open or closed? Do you pull back a little? Shut
down?”

“It’s more like a wall,” she said.

“Interesting. A wall in your chest, your abdomen, or both?” I asked.

“It’s all the way down my front.”

“Like armor?”

“Yes.” Jessie seemed deeply engrossed in this moment.

“And is it a familiar feeling?” I continued gently.

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“Oh, yes! I get it with anyone who gets close to me. When I’m wishing to get to know them or wanting them to like me, it’s not there. But when they
get closer, when they want something from me, the wall goes up.”

“How clever!” I said. “So your body created the wall to protect you from people who want things. That’s brilliant! Let’s just be curious about how it
works, how your body knows when people want things.” I noticed that as I reframed the wall as a helpful tool, she looked more relaxed—and
eager to keep talking. She was no longer that person who had “nothing to talk about.” Instead, she told me in detail how the wall helped her keep a
poker face in her professional career as a demographer, but how it confused her friends.

“Yes,” I agreed, “the wall sometimes confuses me, too. Which is great—that means it’s doing its job.” At this point, we both laughed. Rather than
letting the wall dominate her therapy and other close relationships, Jessie was learning to be aware of it, to hang out with it, and to be interested in
its role in her life.

The Mindfulness Revolution

Over the past decade, thousands of therapists and clients have taken up meditation to bridge mindfulness practice with the relational and
practical challenges of psychotherapy. Mindfulness is inherently a practice of being here now; the past is only of interest as it arises and intrudes
on present-moment experience. In contrast, the hallmark of PTSD is being trapped in the past, experiencing fear, rapid pulse, butter ies, rage,
tightness, impulses to run or hurt, and humiliating or punitive thoughts—not as a reaction to what’s occurring in the present, but as a
consequence of overwhelming experiences in the past. Without a way to understand these responses as memory, our clients experience them as
data about who and where they are now.

While the neuroscienti c world gave us the beginning of a science-based explanation for understanding PTSD, mindfulness o ers a way for clients
to change their relationship to the darkness of their pasts. Mindfulness is inherently about relationships: how we relate to our bodies, beliefs, and
emotions. In other words, when Jessie became interested in her wall as expressed in the body sensation of armoring, her relationship to it
changed, and she became less attached to maintaining it and more to understanding how it served her in both good and bad ways. That change in
her relationship to the wall spontaneously changed our therapeutic relationship. From my end, instead of seeing her wall as an impediment to the
real work of therapy, I could appreciate how it had protected her from a frightening mother who’d alternately clung to her and attacked her. But
using a mindfulness framework, I didn’t have to name the connection to the past. I simply had to notice my associations to her past as my own and
then, along with her, to appreciate the here-and-now process of getting to know the wall. Jessie and I were doing trauma treatment not by
exploring the past, but by reorganizing her relationship to it. Gradually, the wall softened, and when it became rigid again, it was easier for both of
us to be curious, to nd it interesting rather than frustrating.

I now ask clients to take a more accepting Buddhist approach to their present and past experiences. I ask them to avoid their usual habits of
attachment or aversion and discover how to build new habits of nonjudgment, which, with su cient repetition, evolve into increasing self-
compassion, or at least neutrality. In this way, the mindfulness movement has been a practical extension of the neuroscience revolution, which has

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shown us that mindful concentration activates the medial prefrontal cortex and decreases activity in the amygdala—which, in turn, eases
regulation of the autonomic nervous system.

Helping clients heighten curiosity and interest while not automatically descending into shame and self-blame is a slower process than helping
them tell a story, describe a problem, or even devise solutions.

It may feel to both therapist and client that not much is going on, yet research on neuroplasticity tells us that focus, concentration, and repetition
of new responses to traumatic phenomena can help us encode new neural networks, ones that, side by side with the memory networks associated
with trauma, allow us moments of peacefulness, well-being, and even joy.

Mindfulness has also introduced the psychotherapy community to the idea that, instead of looking to painful, dark emotional states, we can look
to positive states of mind and body as the source and essence of healing. In mindfulness practice, positive states are cultivated, rather than
interpreted as a defense against grief, anger, resistance to trauma processing, or denial. If positive states don’t arise spontaneously, therapists can
help clients induce them by focusing on phrases that cultivate bodily sensations of well-being. These phrases include “May I be lled with loving-
kindness. May I be safe from inner and outer dangers. May I be well in body and mind. May I be at ease and happy. May I be free of su ering.”

Often di cult for trauma survivors simply to utter at rst, such meditations may increase clients’ ability to tolerate peacefulness and well-being. As
neuropsychologist and therapist Rick Hanson explains in his bestseller Hardwiring Happiness, we need to be aware of “the negativity bias”—the
human brain’s tendency to attend preferentially to negative stimuli, scan for danger rather than pleasure, and encode negative experiences more
rapidly and permanently than positive ones. Hanson warns that if we don’t attend to and install positive experiences in psychotherapy, “the brain’s
net will automatically keep catching negative experiences.”

Twenty- ve years ago, who would have thought that the experience of joy had a place in trauma treatment? We began with the belief that
excavating dark and unspeakable horrors would set trauma survivors free. This approach brought greater awareness to what happens to soldiers
in wartime, to women and children when they’re victims of violence, and to families whose lives are destroyed in natural disasters. But now, we’ve
changed our focus from the dark to the light. In fact, in this new age of trauma treatment, we aim to help our clients nd the light—or at least to
nd their bodies, their resources, and their resilience.

Of course, listening to and witnessing the clients’ experiences remain central to the treatment process, but we now focus on much more than the
traumatic events in their histories, knowing these events don’t de ne who they truly are. We’ve learned to give weight to our clients’ attachment
experiences, to how their brains and nervous systems work, their ability to notice rather than judge, their appreciation of what it took of them to
survive life’s setbacks, and increasing their capacity for noticing what’s happening in their bodies as the primary pathway for staying in tune with
the present moment.

In contrast with 25 years ago, the trauma treatment of today focuses survivors not primarily on pain, but on accessing new, more expansive
feelings, the kinds of feelings they would have experienced if they’d never been traumatized. As I often say to my clients, the goal of therapy is
simply helping them reclaim their birthright, the basics to which all children are entitled: a sense of safety, welcome, and well-being.

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Janina Fisher, PhD, is a licensed clinical psychologist in private practice, assistant director of the Sensorimotor Psychotherapy Institute, and instructor at the
Trauma Center. Her forthcoming book is Healing the Fragmented Selves of Trauma Survivors. Contact: [email protected].

Tell us what you think about this article by emailing [email protected]. Want to earn CE credits for reading it? Visit our website and
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Illustration © Warren Gebert

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7 Comments

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Tuesday, May 13, 2014 9:38:57 PM | posted by Zyg Kaminski

My compliments on a very clear and concise account of a very di cult area.

Tuesday, May 27, 2014 6:00:14 PM | posted by Sachelle Le Gall

This article provides such a context into the evolution of trauma treatment with case examples that helps to translate the discoveries of
neuroscience and how it can be applied to clinical practice. Thank you for this Janina.

Wednesday, May 28, 2014 5:58:48 PM | posted by Fred Stephens

Excellent article with a nice balance of history and treatment antidotes. I work with Appalachian traumatized kids in long term residential
treatment. I will make immediate use of what I have learned from Ms. Fisher. Fortunately I learned quickly when I started this work that
my academic training about healing PTSD was not applicable to my patients. I was introduced to the term \"complex trauma\" after
graduating in 2011. TF-CBT is useless if not damaging most of the time! Sad state of academic training?

I appreciate Ms. Fisher\'s suggestions of what to look for and what to say. Despite all said about \"busting\" talk therapy, we rely (not
solely) on a nely tuned talk dialogue. Only with her suggestions we are putting more attention to mindfulness and reducing noise.God
and the devil are in the details. Ms. Fisher gives us ne details reduced noise in her writing style.

However, I want to contribute a general critique. More references would be helpful. For example, when you (Ms. Fisher) mention van der
Kolk\'s 1994 study, it would be nice to have a reference.

This is a criticism of the magazine in general: too few references. In this case, I could probably nd the 1994 study/paper. However, some
Networker authors make important assertions without readers having any clue as to where the \"fact\" comes from. I am thinking about
recent gender related writings were emotional bias appears to overcome solid writing. For a professional magazine, the Networker slips
too often into this reference free zone.

Tuesday, July 21, 2015 2:18:21 AM | posted by Judy Theobald

Very clear and insightful

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Monday, September 26, 2016 1:01:39 AM | posted by Ilana Nayman

Excellent summary of very recent development and growth in a eld in which I trained prior to 1989 as well. It has been quite a journey
to learn this new Body based psychotherapy paradigm, a post Freudian world in which "somatising" was used perjoratively

Monday, October 10, 2016 10:11:00 AM | posted by Caroline Le Sueur

Thank you Janina for sharing your experiences and professional growth. It was insightful, informative and brought together in an
accessible way complex ideas for treating complex trauma.

Tuesday, October 25, 2016 4:20:41 PM | posted by Elizabeth Hector

Yeah, amazing stu . This could make all the di erence in the world for little kids who are afraid to work with the trauma history. thank
you.

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