Healing Trauma: Attachment, Mind, Body and Brain

American Journal of Clinical Hypnosis,  Apr 2005  by Chefetz, Richard

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Solomon, Marion & Siegel, Daniel J., Eds. (2003). Healing Trauma: Attachment, Mind, Body and Brain. New York: W.W. Norton. Reviewed by: Richard Chefetz, MD, ABMH, Washington, DC.

Was there ever a time of practicing psychotherapy, with or without hypnosis, where the idea of trauma, big "T" or little "t," was not at least a thoughtful consideration? For all those moments of thoughtfulness, Healing Trauma occupies a "sweet spot" of especially tuned in and pertinent contributions from some of the leading thinkers of our time: Daniel Siegel, Erik Hesse, Mary Main, Allan Schore, Bessel van der KoIk, Francine Shapiro, Diana Fosha, Robert Neborsky, Marion Solomon, and additional colleagues. The authors focus on topics related to interpersonal neurobiology, disorganized attachment, and early relational trauma as a predisposition to violence; PTSD, EMDR, dyadic therapeutic relationships and comprehensive treatment that focuses on intense affects; and the lasting effects of infant attachment styles on adult intimate relationships. Each chapter is carefully written. Some chapters, especially those by Siegel, Schore, and Fosha represent cogent summaries or advancements in thinking from previous and more comprehensive previous publications. If you want to spend some quality time with a book on trauma, you are in for a treat. (We all owe Jack and Helen Watkins a debt of gratitude for their work on Ego-State Therapy, long before work on dissociative disorders became popular. Much of their clinical wisdom is visible in these chapters, but it is rarely acknowledged.)

I have taught psychoanalytic psychotherapy students from Daniel Siegel's book, "The Developing Mind," for several years, as a supplement to a corresponding course on Freud's introductory papers; a course I had previously taught. Siegel never makes the claim, and I think he is too wise to do so, that adopting his view of the mind as organized around states of mind is a radical replacement for a psychoanalytic psychology that is moribund and in chains when it tries to hold on to archaic models in the face of mountains of new information about how minds and brains work. Every psychotherapist needs a starting point for training, and Freud is a good one. But if we are to treat Trauma, then working with states of mind is a necessity. Siegel's chapter elegantly summarizes hundreds of contributions to the field of neuroscience, and neatly parses the information into a well organized parade that builds on ideas about memory, emotion, states of mind and self regulation, the development of a core sense of self, attachment, and integration, in an iterative and common sense fashion. He builds a solid case for thinking about the flow of information between states of mind and integration of this flow to produce a higher and integrated "autonoetic" consciousness. It is not that lower modes of consciousness don't exist in healthy people. I think that Siegel would say that the issue is one of an individual's capacity for flexibility and resilience in the face of life's challenges so that they would not be restricted in the range of responses they might use to face a trauma, or a creative moment. It is in the rigid constellations of wounded states of mind with obligatory response patterns that we fail to cope with life and rely upon childhood-sized solutions for adult-sized problems. In some ways, Siegel's work stands as a summary for the entire book, but don't stop reading after the first chapter!

Hesse, Main, and colleagues provide the interested reader with a summary of attachment theory and then detailed exploration of the basis for their understanding how Type D infant attachment seems capable of provoking second generation effects on adults and their children. In other words, infant attachment and the associated internal working models that Bowlby long ago proposed are, in fact, inter-generationally transmissible on the basis of patterns of relatedness. Any thoughtful interviewer is aware that some patients seem nearly incoherent in trying to describe their childhoods, and may actually have experiences of amnesia, acute distractibility, or confusion in trying to talk about an abusive parent. Systematizing the patient's discourse in a standardized interview led Hesse and Main to be able to reliably predict internal states of mental disorganization based upon the extent of incoherence in patient's use of language. From this work on the Adult Attachment Interview, and extending work on Type D infants, it would appear that parents transmit to their infants their own internal fear-evoking responses. In other words, to simplify, Type D parents frighten their children, and teach them to be frightened, just like they are/were. The intergenerational transmission of psychology is visible in this work. Freud showed us how infantile neurosis produced adult neurosis. Hesse and Main show us how parents teach their children the "parental disturbance" and that these children grow up to teach their children the same disturbance.