Title of the book: The Body keeps the Score
Author: Bessel A. van der Kolk
Year of appearance: 2014
The body stores trauma even more reliably than the mind – as the title of the book suggests. Comprised of 20 chapters, broken into five thematic sections, van der Kolk’s 2014 book provides the reader with an excellent account of the effects of trauma and the ways trauma dis-integrates the connection between one’s body, mind and emotions.
Balancing clinical and lay language, we learn the history of the way trauma and PTSD have been viewed, understood, and diagnosed in the past, and we learn the differences in impact and prognosis between acute and chronic trauma and between trauma originating in childhood vs. adulthood. Along the way we get introduced to attachment theory, brain anatomy and chemistry, and mirror neurons – all in a precise, scientific, yet readable and comprehensible language. Van der Kolk argues that we cannot just use drugs to treat Post-Traumatic Stress Disorder (PTSD) and other mental illnesses. We must treat the whole person. Research in neuroscience provides a straightforward explanation of components of the brain and their role in detecting and mitigating threats. “PTSD is the body continuing to defend against a threat that belongs in the past.” (p. 60). Many of his clinical vignettes are very inspiring in their depth of healing and, to be more helpful, he uses metaphors to describe the functions of the brain. For example: the thalamus is the “cook,” the amygdala is the “smoke detector,” the “Mohawk of Self-Awareness” (orbital prefrontal cortex, medial prefrontal cortex, anterior cingulate, posterior cingulate and insula)(p.93), etc.
Children, especially infants and toddlers, but also older children, adolescents, teens, and adults of all ages experience trauma every day, around the world. Adverse childhood experiences, notably child abuse and neglect change the way the brain is wired and ‘neither drugs nor conventional therapy’ has shown the necessary ability to change the brain. Traumatic memories are ‘lonely, humiliating and alienating experiences’ that unlike ordinary memories have not been integrated into a story. The therapeutic techniques and adjunctive approaches needed to successfully do this are varied, but suggestive of anything that includes more than talking alone: theatre work, EMDR, yoga and biofeedback included.
This book is a great synthesis of contemporary thinking about the impact of trauma on the body and mind – drawing research and experience from van der Kolk’s own clinic, neuroscience, psychiatry, history, and thinking from the fields of psychotherapy and psychology. van der Kolk’s training in body psychotherapy is PBSP, an approach he uses with his clients. Core Energetics with its own psychophysiological tools and theory, is another excellent and clinically tested method to help a client towards self-regulation. Because the energetic charge and feelings connected to trauma are held in the nervous system, specifically in the limbic brain, the Core-Energetics practitioner can support the client to create as much space as possible inside for the feelings without shutting down. The healing a client needs is related to a controlled lessening of the constriction and fragmentation. In Core-Energetics we know how important it is that we keep the emotional charge and feelings within a WINDOW OF TOLERANCE. The process of discharging in case of a traumatized client has to be “titrated” – broken down into small repetitive steps, the physical body always included. The process needs to be conducted slow and mindful, but along the way we know there has to occur a reevaluation of the traumatizing situation complete with taking self responsibility, empathy and owning what in CE we call one’s own Lower Self (“victimizer”). An evaluation of appropriate & mature pragmatic responses in case it would happen again: How to take appropriate action/non-action. Make appropriate expression/non-expression. This involves a healthy ego in service of the core. The creating of a new “narrative” (Story of self-experience: = How one speaks about an event) has been documented as the single most predictor of a positive treatment outcome! PTSD in the end is a problem of relating with one’s self. In CE that might mean:
“A key to trauma treatment is helping clients to ‘reactivate’ a sense of self, ‘the core of which is our physical body.” (van der Kolk, p. 89) Recovering this requires a sense of agency, of being in charge of one’s life. Looking at physiological changes as a symptom and reflection of trauma, van der Kolk describes how body posture, breathing, movement, and position during therapy should be viewed as a rich source of information for patients and clinicians. From it’s own ground, this is exactly also what Core-Energetics works with.
In any therapy, the client needs unbiased acknowledgement and validation of his/her subjective experiences. Dr. van der Kolk, with great humility and insight, details his admiration for each of his clients – because they have overcome such devastating hardship, and they have had the courage to share their stories with him, and in some cases, others as well. His vulnerability with his own story models a message for all of us to live by: only by confronting and accepting the past can we learn to live in the present. He writes about the importance of de-stigmatizing PTSD and mental illness, and he relates the issue of trauma to several societal factors. This perfectly resonates with the understanding I have of Core-Energetics, in our work also stressing the importance of the Spiritual significance of the shocking traumatic experiences.
Much of the book is devoted to discussing treatment options.
The treatments section focuses on examples of clients van der Kolk has personally treated. His stories exemplify the positive regard and respect he routinely demonstrates during sessions and may help people discover what they are looking for in a trauma therapist.
Here’s also why in a few quotes taken from the book:
“Most human suffering relates to love and loss so the therapist’s job is to help people acknowledge, experience, and bear the reality of life, with all its pleasures and heartbreak.” (p. 26) He goes on to say that we can’t get better until we ‘know what we know and feel what we feel,” recognizing the tremendous courage and strength it takes to remember.
In therapy, we need to a) draw out blocked sensory information b) help clients befriend, not suppress, body energies needing to be released and c) complete the self preserving physical actions that were thwarted when the survivor was restrained or immobilized by terror. (p. 96). Trauma survivors cannot recover ‘until they become familiar with and befriend the sensations in their bodies.” (p. 100)
“The fundamental issue in resolving traumatic stress is to restore the proper balance between the rational and emotional part of the brain.” (p. 205) => Breathing for hyperarousal, mindfulness to strengthen core of self awareness, relationships through good support networks and other ways of recovery through social connection are all useful strategies in Core Energetics too.
While the virtue of talking therapies for trauma are discussed in the book, Van Der Kolk presents a watertight case for every therapist working with trauma to work with the body too.
Here’s what he says we have lost (p. 38, paraphrased):
Van der Kolk’s directive to an effective trauma therapy involves the following steps (not in order and overlapping) for clients to achieve (p. 203-204):
I strongly urge Core Energetic Therapists to read the book. The Body Keeps Score provides an introduction to the complex issues surrounding trauma including a historical overview, offers an easily understood explanation of brain science, provides a taste of the different trauma focused interventions being used and in addition to all this- provides a wealth of resources/websites in the index.
Dirk Marivoet, MSc. PT (in Mental Health), Psychomotor therapist, Psychotherapist and deep bodyworker in private practice for over 30 years. He works with individuals, couples and groups. As a teacher at NICE (Netherlands institute of Core-Energetics) he regularly covers the material on trauma and psychosomatics. He also teaches the Bodymind Integration methods of ‘Postural Integration’, ‘Energetic Integration’ and ‘Pelvic-Heart Integration’ in several countries. Earlier he served as adjunct faculty psychiatry for over 10 years until 1994.
Date of this review: December the 27th of 2017