Monday, June 26, 2023

The Body Keeps the Score

The Body Keeps the Score, Bessel van der Kolk (Penguin, 2014) 

I have been slowly working my way through this seminal work on trauma over the semester. After it sat on my shelf unread for years, taking a trauma-informed therapy course at uni suggested it was now time to read it. 

It’s excellent and I can see why it’s so well regarded by other trauma experts, as well as by numerous health professionals, and the general public. van der Kolk presents the details of trauma, how it impacts the brain and body, and numerous treatment paths in a very digestible, easy to read format. This is impressive, for the book is over 400 pages, and requires reasonable concentration and attention. His storytelling skills are evident as he weaves stories, case studies and examples throughout while also explaining research, outcomes, programmes, and the impacts of public policy. 

Broken into five sections, he begins with the rediscovery of trauma, described through his work with Vietnam veterans. 

“Trauma results in a fundamental reorganisation of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think…For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present.” (p.24) 

He explores the brain and how it is impacted by trauma, and then gives detailed attention to the developmental impact of trauma in children. He supports the view that child abuse is the gravest and most costly public health issue in the US. It’s a sobering observation that, 

“In today’s world your ZIP code [post code], even more than your genetic code, determines whether you will lead a safe and healthy life. People’s income, family structure, housing, employment, and educational opportunities affect not only their risk of developing traumatic stress but also their access to effective help to address it. Poverty, unemployment, inferior schools, social isolation, widespread availability of guns, and substandard housing all are breeding grounds for trauma. Trauma breeds other trauma; hurt people hurt other people,” (p. 418-9) 

If you are around my age (or older), you likely are aware of the prevalent view (of the 80s/90s) that people needed to relive or talk through trauma in all its details to process it. Reading this book (and my study) has clarified that talking therapies alone can be traumatic and triggering, and an integrated phased somatic trauma approach can be much more beneficial. An understanding of what your body & brain is doing, how it responds, and various treatment approaches are all important. It is these pathways to recovery that make up the final section (and almost half the book). He explores reestablishing ownership of your body and mind by finding ways to be present and calm, integrating traumatic memories, EDMR, body awareness through yoga, a parts awareness of our inner selves, psychomotor therapy, neurofeedback and community theatre. Some of these more technical terms may be familiar to those already in the field, but all are well explained and therefore understandable for any reader. 

One could read this book overwhelmed by the challenges that trauma presents to both individuals and our society at large. Yet, there is hope scattered throughout as well. It’s an area with growing understanding and increasingly research proven methods of treatment. People can process and integrate their trauma in ways that enable them to go on to live stable, safe and meaningful lives. 

“Trauma consistently confronts us with our fragility and with man’s inhumanity to man but also with our extraordinary resilience.” (p.427) 

For the Christian there are other areas worth exploring that overlay the current secular thinking. These include our view of God in the midst of suffering and pain, what forgiveness could look like, how our redemption in Christ changes us, and how ongoing sanctification could impact the person with trauma. To consider what it means to be a child of God, trust in him as the God of comfort who truly loves and cares for us, even in our brokenness. All areas still to explore. 

This book is an excellent introduction to the current thinking and research on trauma. It is highly recommended for health professionals who want to understand this field better. I would say it also has great benefit for those with trauma, although caution is needed as it is likely to contain triggers, and does require a fair amount of concentration to read.

Monday, June 5, 2023

The Christian Counselor’s Medical Desk Reference

The Christian Counselor’s Medical Desk Reference (2nd ed). Charles D. Hodges Jr. (Ed.) (New Growth Press, 2023)
This book is intended to be a reference guide for counselling individuals with medical problems, and as such it is a helpful and well researched resource. Its stated goal is to be a tool for those helping those who struggle and are looking for hope. The opening chapters consider general principles when counselling those with a medical or psychiatric (DSM-5) diagnosis. Then it moves to detailed chapters on a wide range of medical and psychological challenges. There is a stronger emphasis on psychological challenges, from anxiety & depression, ADHD & ASD, PTSD, schizophrenia, OCD, post-partum depression, and bipolar disorder. There is information about medications, psychotropic drugs & alternative medicines, and how they impact the body and brain. Chapters that address more medical diagnoses include PMS, dementia, sleep disorders and rheumatological conditions.

There were numerous authors of different chapters, each addressing their areas of expertise. However, it resulted in various tones. Some authors were gentler, more compassionate, and more client-focussed. Others seemed harsher, and quick to call certain challenges sin, and I was left wondering about their compassion with a client struggling with such challenges. It was this variety of language usage that highlighted the range of interpretation amongst biblical counsellors. While titled for “Christian counselors”, actually it’s intended for biblical counsellors, which depending on your definition can be a different thing.

I would have liked to see more consideration of the impact of trauma in people’s lives (this was only touched in with PTSD), and how it can impact both medically and psychologically. But I can see why it was structured around DSM labels, as that is how many medical professionals operate, and how funding is allocated.

I appreciated this comment from Jocelyn Wallace (in a very helpful chapter on postpartum depression):
“My job as a counselor is to love my counselees, to sacrifice to serve them at the most terrible times of their lives, and to suffer with them while they grow in their understanding of God, themselves, and this world we live in.”
Despite my concerns with some aspects, overall this is a helpful resource. A counsellor’s awareness of medical challenges that clients face can only further enable their understanding of their client, and their ability to helpfully work alongside them.

I was given an ecopy of this book in exchange for an honest review.

Note: as per usual, if quoting a resource I use their spelling (e.g., counselor), but for general usage I follow the Australian convention - counsellor.