Thursday, 8 May 2014

Exploring Mental Health and Trauma: Books To Get Us Thinking ....

Guest Blog by Jane Cooke.

There has been a focus on trauma-oriented work and ‘treatment’ in recent Powys conferences.  You can watch Jacqui Dillon at the Powys Stronger in Partnership conference last year here and you can watch Sami Timimi at the Finding Meaning in Psychosis conference in March 2014 here.

One of my roles in life (when I’m not working within PAVO’s mental health team) is as a counsellor/psychotherapist. I have a trauma-oriented approach which has been reinforced by listening to these speakers and by reading around the subject.

A trauma-oriented approach, as advocated by Sami Timimi, is a gentle way of beginning work that enables a person to feel safe and able to gradually build up a personal sense of control over their own boundaries and in time over responses to events or reminders that can lead to upsetting and overwhelming reactions. Even if a person doesn’t identify trauma as being relevant to them and why they come for therapy, this approach is empowering and helpful anyway. (It is not about forcefully inducing ‘catharsis’, re-living the situation, ‘facing up to it’ or any other similar techniques which can be re-traumatising or even abusive in themselves.)

Sami Timimi is a psychiatrist and a founding member of recently established Council for Evidence-Based Psychiatry.  He believes that working in a trauma-oriented way makes sense for most people who come into contact with mental health services. Much more sense than identifying ‘pathology’, symptoms and ascribing a diagnosis; all of which generally ignore the story, the experience of the person, how it is that they are who they are.

There are two writers who I have found very helpful and their work complements each other. Both Judith Herman and Peter Levine are concerned that people (clients, patients, service users, survivors) gain/regain their own sense of personal power and agency as they recover from their trauma/s.

Peter Levine has written a number of books about trauma. One of his books “Healing Trauma” is a slim self-help book with a CD covering a programme of exercises that anyone can follow to help overcome the neurological ‘holding’ of trauma. It is, he says “for restoring the wisdom of your body”.  He does caution that professional help may still be required. An empowering way of working could be therapist and client working together with the book and exercises, keeping the client in control of the work.

‘Trauma’ is a word we use in everyday speech,  but paradoxically in relation to emotional well-being there is a limited perception that trauma has to relate to major events that are, for example, combat situations, witnessing  extreme violence, being in danger of one’s life or experiencing sexual violence or abuse in childhood or adulthood. However, as Peter Levine says “People, especially children, can be overwhelmed by what we usually think of as common everyday events …The fact is that, over time, a series of seemingly minor mishaps can have a damaging effect on a person. Trauma does not have to stem from a major catastrophe” (his italics).

There is increasing evidence for this. So, for example, bullying, repeatedly not getting your needs for love and positive attention met, feeling fear regularly such as maybe a frightening  walk to school, regular contact with a frightening , threatening teacher or relative; being regularly shamed by powerful people when you are young.  Many things can build up to create a response in the nervous system which then needs to be ‘taught’ to respond to the here and now and to recognise/feel  current sources of support and comfort, including your own capacity  to support and nurture yourself.

Jacqui Dillon (a survivor of childhood sexual abuse) told us how much she had been influenced and empowered by Judith Herman’s book “Trauma and Recovery”. Herman looks at the way in which women’s (and children’s) experiences of violence, fear, captivity (and you can be captive in all senses without the doors being locked) and powerlessness in the domestic and community realm have been seen as variously: natural, bought on by the victim themselves, exaggerated  and overcome-able by normal acts of will. She looks at the way in which their experiences are minimised and belittled.  “Social judgement of chronically traumatized people tends to be extremely harsh” .She also looks at ways of working with people who have experienced trauma. Judith Herman has a framework for recovery from trauma. There has to be in her experience, in sequence (and returned to as often as necessary) Safety, Remembrance and Mourning and Reconnection. This works very well with Peter Levine’s work which in the early stages emphasises ways of achieving an inner sense of safety, and of course actual safety in daily life is essential.

Judith Herman is very clear that therapists need good training and good support, this is work that can be complex and challenging.

There are many books about trauma; I would recommend these two. They are compassionate and well-grounded in research and experience. They are as much for the person recovering from trauma as they are for therapists and other workers.  

Judith Herman’s “Trauma and Recovery provides a radical, community oriented approach to recognising trauma in the lives of women in particular as well as a way of working that can lead to recovery.

Peter Levine’s book is a gentle, practical self-help book (although he does not minimise the need for professional support as well).

Between them they are a very good ‘starter kit’ to this subject whether you are a health professional, or someone who has experienced, is experiencing, trauma – and you could very well, of course, be both.

Trauma and Recovery. Judith Herman.  Pandora  ISBN 978-086358-430-5
Healing Trauma. Peter Levine. Sounds True ISBN 978-1-59179-658-9

Written by Jane Cooke

Member of PAVO Mental Health Team:

And when not working for PAVO....
Gestalt therapist, ecotherapist  and interpersonal skills trainer.


  1. Very interesting, the bit about the effect of events, even if not catastrophic ones, being lodged in the nervous system is enlightening.

    1. Hi Phil – glad you found it interesting – there is a lot of interest in the therapy world in the neuroscience – and an increasing recognition of the impact of many ‘smaller’ events –not only psychologically but on the nervous system –causing it to ‘think’ that life/survival threatening situations are always ‘live’. We know so much about trauma and the impacts and yet as a society we continue to describe the very impacts/reactions/thoughts/ etc that we know are a reaction to trauma, as symptoms of illness, evidence of illogical thought patterns, evidence of ‘badness’ in some way (let alone the way we let these ideas feed into assumptions and prejudices about gender, class, ethnicity, sexuality etc). Trauma -oriented ways of working enables the person themselves to let their nervous system ‘stand down’ rather than being on constant alert.

    2. Thanks Jane, my tuppence worth of emphasis on this is that it seems micro-sociology and the subject matter of neuroscience are interwoven to the extent that some things are now irresolvable without probing macro-sociological relations and the political.
      In any individual, separating out brains, nerves, muscles and so on might possibly work for some in terms of treatment, but separating one individual from their interactions with others over time, and then further from the currents of gender, class, ethnicity, nationality, sexuality etc that affect us all could be, and is, taken to absurd lengths by mainstream services.
      Keep up the good work-- maybe one day the message will get through and my/our local consultant will be in a position to agree that not being currently 'in severe crisis' means that a person is still worthy of having some resources deployed to overcome enduring issues in such ways as approaches like yours could and would do.
      I risk going off on one, but on the practical terrain and in my little life I just can't see how taking a few prescribed magic beans each and every day (powerful medication- the only treatment for many) can or will ever alter a good proportion of what led to the presentation of original and then recurrent 'symptoms'.
      Your approach and those it is aligned to sound great. Just to be awkward though, I appreciate that you say it's not about re-living trauma or facing up to things - but to what extent is there a practical caveat there for people like me who don't want to stay in a pharma-drug fuelled haze that wanting to 'live the dream' in the not-too distant future does in fact mean 'embracing the nightmares’?

    3. Hi Phil - great to read your thoughts - & sounds like the potential for hours of interesting discussions, seminars, etc - hope those can happen …
      Just to pick up on your last point though –(& I’ll use ‘you’ – but in the general sense –not meaning to mean you in particular!) the work of Peter Levine & others (eg Babette Rothschild) is that by following their approaches your nervous system gets to realise that the events are in the past -they are memories - they are not happening in the present - that might still leave work to be done about the event(s) – how come it happened, what are the lasting effects – e.g. not trusting, or entering damaging relationships, or avoiding some things etc etc – but by working first with the nervous system, gently and systematically to show it that it no longer needs to keep your traumatic experience/s held in the present it becomes possible, in time, to talk about the traumatic event(s) without re-experiencing the terror and sense of overwhelming danger and threat to life and survival, along with all the sensory overload of hearing, feeling, smelling whatever was originally present and associated with the event/s. So this is very different to forcing yourself to ‘face up to’ something that a large part of you ‘knows’ is imminently life-threatening. That will lead to being re-traumatised, keeping those nervous system responses still active (potentially things like nightmares, flashbacks, panic attacks, sweats and tremors, spacing out, hearing, smelling etc things that others say aren’t there etc etc or finding some everyday things and experiences unbearable) What I'm saying is that this means things can be felt as painful and sad, etc but not experienced as a 'nightmare' -it's not about an act of immense will - that can't work - it's about letting the nightmare take it's place in the past
      The medication issue, as many people reading this will know, is difficult. My view is that a good support system that includes those you live with, friends and others who know you (& I’d remind you that the ‘you’ here is ‘any-reader’) etc as well as the mental health system, from GP to psychiatrist, depending on who does the prescribing and who you see, should support someone to reduce medication whilst going through this kind of therapy and support them in daily life when it becomes very difficult to experience reactions to the medication not being in your system as well as any emotional responses that have been blunted by the ‘pharma-drug fuelled haze’ that you (you!) describe here. It may be that some form of medication becomes a positive, informed choice once therapy is over. In my view it’s not much of a choice though if it’s pretty much all that is on offer and is given because of a ‘diagnosis’ that takes the understandable responses to trauma and turns them into ‘symptoms’ of an ‘illness’ for which there is no scientific evidence.

    4. Nice one Jane, it's good to know about the work of people who can offer this kind of therapy. The picture is always a bit different with the right kind of therapy and additional support, you're right.
      The question or issue for discussion I am wondering about now is the whole NHS or private availability thing; in general terms as in how a national economy could be enhanced by more talking therapy, and in particular terms in my own personal goal to ditch the tablets one day.

  2. Hello Phil - great to hear from you. Glad you found this interesting. I am sure Jane will respond as well. Thanks for reading ... Laura

    1. Cheers Laura, always read this blog. Might try the books too! Best wishes, Phil

  3. There are some interesting videos featuring Peter Levine on the web... Jane tipped me off, I took a look... Plenty to choose from, but for starters try this one, just click the link and scroll down the page on our website for the video Trauma, Somatic Experiencing and Peter A. Levine PhD