#38 Book Review - Babette Rothschild Revolutionizing Trauma Treatment

In this 24 min Review I talk about the Book ''Revolutionizing Trauma Treatment' by Babette Rothschild.

Trauma treatment is now possible and it is much simpler and less painful than you might imagine. Babette was one of the first people to really understand that it is stored in the body not just the mind and that treatment therefore has to use the body to interact with and resolve the past experience.

This book taught me several important ideas that I was already using but it formalised them a little for me:
1/ the importance of knowing where on the autonomic arousal spectrum (ie. your nervous system balance) your client is by noticing certain signs and symptoms of each state.
2/avoiding going too fast into the past and keeping the client stabilised in the here an now with 'exteroception' - noticing things in the external environment
3/building resources of the client i.e. things that work or feel good to help the client stay calm
4/planning treatment like a recipe - what do we want to 'make' today
5/pacing appropriately by taking clients in and out of unsafety gently (pendulation)
6/ keeping the language accurate - ie., not going back into the past as if it's still happening (although of course that's how it feels with trauma) but reminding the client they are remembering the past and it's over.
7/adapting tools like yoga and mindfulness so they don't trigger the client

If you are interested in the book find it here. https://amzn.to/3eVpxHD

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Transcript

0:16

hi everybody it's patricia warwick here alchemy therapies rebel health radio and my emotional audit and today i wanted to review a book which i've recently completed and it's revolutionizing trauma treatment by babette roth's child um babette wrote a book called the body remembers way back i think it was 20 10 something like that um but certainly a few years ago now and this is an update of her second book the body remembers two so it's been it's been re-titled revolutionizing trauma treatment and the subtitle here is stabilization safety and nervous system balance and i think i think that's very well summarized really what this book is about because it's sort of extending the idea that trauma treatment is all about taking people back to the trauma and possibly re-traumatizing them so in in the past trauma treatment was simply about talking talking therapy talking about what happened to you in my new detail in in the mistaken belief that talking about it would resolve it for you in fact that's not the case and talking about it doesn't really solve the problem at all and can as i've said actually have negative effects in that it can re you can actually go into the past in the sense of reliving the trauma in your body and that can actually create more symptoms than it relieves and so i think babette wrote this book in order to wipe the slate clean really of that idea that we need to do that and actually you can help people by coming to the here and now by stabilizing them in the here and now and actually taking more recent events as the indicator to the past rather than necessarily going back over everything that's really traumatized them so for all of you out there who might be thinking um you'd like to engage in trauma therapy to try and resolve some of your past issues but you're too scared this is a really good message isn't it to know that you don't have to do that you don't have to go into the thing that happened and and completely frighten yourself and and i really liked this book um it wasn't as dense as i'd expected i've been putting off reading it for a long time thinking well i have i got time because it's a professional book um it's published by norton who are you know the publisher for psychology generally and but actually it's not as dense as as i thought and in fact i read it within a couple of days and i made some notes which i just want to go over with you now so the main thing about her approach is is noticing the autonomic state of the person you're working with now what do we mean by that everybody has an autonomic or kind of autonomous nervous system something that goes on behind the scenes without you being consciously aware of it you don't think about breathing for instance or your heart beating and your bladder fills and your stomach moves food along and digests all without you knowing or having any conscious input and that's the job of your autonomic nervous system or one branch of it in particular the thematic nervous system so it it's it's really interesting to be able to plot where your nervous system is on a scale because we all go from being calm to being agitated or anxious and we can do that very very quickly because our autonomic nervous system responds to our internal and external environment in a way that picks up a stimulus and responds to it and it's very very quick it's much quicker than you thinking about uh i don't know lifting your left leg for instance um which you have to consciously think about so it takes a little bit longer so she's come up with a sort of scale which she's got i think there are uh five states that she's and and helpfully she's actually produced a pull-out in the book which map these five states and what to look out for as a therapist because this book is primarily for therapists but i think it's also helpful for um individuals who are looking to go for trauma therapy because they could they could map their own system here you know is what are your pupils like are they large or small how is your breathing um what's your skin tone like you know when you're flushed we know that you're you're aroused in in not always a good way or conversely going up the scale are you completely collapsed because that's that's the final state of the nervous system is to collapse in preparation for death i've talked a lot about that as a precursor to chronic illness you know that we can get into these hypo freeze states where nothing works the energy systems of the body are just completely shut down and that's the basis of chronic fatigue syndrome and fibromyalgia and long covered but they're never they're never just the thing it's not the trigger that creates the disease it's the it's the experiences of that person up to that point that the trigger occurs so often they've had childhood trauma of some kind and it's not always the big traumas it's not always the obvious things um i think pabet's talking primarily about childhood abuse she's talking about um uh having major accidents being in a tsunami or something with the bombing those kinds of traumas they're obvious traumas i tend to deal with relational trauma which is the slow drip feed of trauma that happens throughout most people's childhoods being misunderstood being unsupported being made to feel different or the outcast those kinds of things but the the same principles apply and noticing where someone is on that spectrum of of autonomic arousal enables you to tailor your treatment to that person rather than having a one-size-fits-all and i think so it's a very useful uh thing to incorporate and it of course it brings in the ideas of polyvagal theory now i don't know if i totally agree with her scaling and she's got one um state which she calls hyper freeze uh sort of rabbit in the headlights state you know you're you're agitated but you're frozen at the same time i've never come across that state within polyvagal theory now either that's she's just ahead of the curve here and i'm out of step uh or i'm not sure but i i love the idea of of noticing where people are and being able to tailor something to them which is so so important that we don't approach everybody all the same and that's what modern medicine does of course it says if you've got a symptom here's here's the intervention here's the drug usually it's usually a drug treatment we'll give you we don't look at the history in modern medicine we don't look at who they are the kind of personality they are what responsibilities they have what experiences have come to bring them to this point but in natural medicine and in therapy we we do we take a very strong history of that person and the history is absolutely vital bet certainly agrees with me on that and and takes a very strong history of that person and then she talks about um often we go too fast we we try and solve the problem for people because we want to heal that's that's why we're in the business of healing is because we have a very strong desire to get the person to a state of healing and calm and sometimes we want to proceed quicker than their system can handle and i think that's very very true and something to be aware of and she talks about stabilizing people and how you can often choose something in the external environment to help anchor them in the here and now and i do that a lot so i'll ask people you know what's the chair like that you're sitting on you know is it comfortable is it hard how does it feel right now because if you go straight into internal sensations which people often do with trauma treatment they say right i want you to focus on your breathing that can be a source of terror for some people because maybe the breath is a trigger for them you know if if they were ever in a situation where they couldn't breathe like a birth trauma or an asphyxiation event um the breath can be highly triggering so just to be aware that you need to what we call pendulate between one and the other is really important and it can really ground you in where you are and help you to feel safe which is the basis of all treatment is to enable you to feel safe in this moment safe in this environment and safe working with the person you're working with which you may never have felt in your life honestly there's so many people i work with who've never felt safe in their bodies never felt safe in their life they've compensated by becoming very you know overworking or over responsible for other people high achievers but that doesn't mean they feel good about themselves it doesn't mean they have this great foundation for who they are and trust themselves interiorly so we've got to be very careful about that too and bringing resources to people which enable them to feel maybe for the first time that they are worthy of love they are worthy of being here they have a power that they've never accessed which is about their truth uh their authenticity why they're here what they're here to do sounds like big big things that i'm introducing here but it's really vital to give people hope and to give them a sense of motivation and purpose so she talks about being very careful about pendulating between the exterior and the interior sensations which are another thing with the autonomic nervous system does it as i've said it takes in information in order to produce a very very immediate response and so if you're if your exterior environment is not safe it will constantly trigger you and equally if you are ill and the interior signals are disrupted or they're saying you know something doesn't feel right here my gut doesn't feel right my heart's beating so fast all the time or um i can't maintain my heart my heart beat properly or even my blood pressure those internal signals will also trigger an anxiety because the brain is responding to something that doesn't feel good so we have to find ways in order to train the nervous system to not perhaps take so much attention to what's not working because unfortunately we have what's called a negative bias the brain will focus on things that aren't right that don't work that are you know a potential threat to us so we have to build the resources through focusing on things that are working that do make sense that feel good to you and we may have to search for those because with a lot of the people i work with they don't have much they've been ill for a long time they feel hopeless and helpless and and part of trauma treatment is is really introducing hope and taking people through this process gently gently one step at a time we get to where we want to go if i give you everything straight away and um i take you into a state of super calmness the brain is so unused to that it really doesn't know what to do with it and it will reject it so we have to build that capacity so she talks about pacing and pendulation she also talks about planning so it's sort of three ps isn't it planning planning a treatment outcome now of course this is really important as a therapist that you don't um perhaps just go into something and rely totally on instinct although often i do i must admit um my intuition tells me where to go usually with people but but having some idea of what you want to work on and i do that through what i call the initial consultation which is where we go through your history and we find out what events of your life were really key for you um that maybe haven't been resolved in you bodily and then i design a a series of segments but often i have to depart from that you know because something else comes in from the current life which points us in a new direction so she talks about um a recipe it's a bit like a recipe and what you need to make today in asking the client what do you want to make today what where do you want to get to what's your goal and i think that's a wise um idea and i i often i must admit uh after the first consultation sometimes i'm guided by where they are and i always start with you know what's happened in the last two weeks or so since i last saw you because that's my guide to what needs to be worked on the brain is very intelligent consciousness which we now know doesn't reside in the brain but is a sort of external thing that we kind of transmit through the brain is is very wise and intelligent and it always will present you with what you need and it will reward you when you are on the right track people don't believe that but it it happens uh synchronicities start to happen um things start to be presented either in dreams or flashbacks or feelings about memories about people that need to be resolved and so although i agree with the idea of having a plan i also like to be a bit flexible on that so but i do agree with her starting from the present starting from what happened in the last few weeks or something that's quite immediate for that person and it's mainly because they can access it much more readily and also it's a more gentle introduction to memory reprocessing memories are not as you might think uh always stored in the brain there are obviously ordinary memories narrative memories like you know what you had for breakfast or um what you did last christmas but there are different types of memory and one of them is a sort of body memory or somatic memory which is not at all narrative and it isn't accessible in the same way and that's why we have to use the body to access some of these experiences that you've had and so um we start from the present because that's accessible to you but it will instantly remind the body of other times in your life where you've experienced similar emotions or similar um similar experiences that you've internalized and meanings let's say and so we we follow your experience that's what make that what is what makes this type of therapy so different is that we're following you and not a protocol that we've designed in an office or from theory so i agree with her on that and pacing it very gently so we build people's capacity for safety for stabilization before we get to the most traumatic memories if we need to go there at all sometimes we don't sometimes that spontaneously happens anyway and gets resolved through the current life but more more likely we do eventually get to some of the more painful times in your life but once you've built a sense of rapport and you've connected with the person it's so much easier to trust that you can get through something without being overwhelmed by it because that's the main reason why people hold on to these experiences for years and years without doing anything because they feel that therapy is so frightening and it's going to overwhelm them and stop them being able to cope the opposite is actually true once you can get through the memory is over and know that you're safe in the present everything becomes easier life becomes easier goals are easier to set you start to have more joy in your life because you can actually engage with the present without being pulled into the past all the time she also talks about language using language very carefully and and avoiding that sense of being pulled back into the past by saying i'm there it's happening in the present tense and she points out that you need to remind your client that they're remembering it's the past it's over now i do that in a slightly different way because um the tools i use are slightly different and i use something called tapping i also use eye movement desensitization or emdr um and so i always start with the present tense i'm here it's okay i'm safe i'm looking at this problem whatever the problem is um but she was saying actually that that be careful with the words and i would agree with that you have to watch the people don't go too deep too quickly into the past as if it's still the present um but i i also like to keep things very very simple and so i don't use long complicated phrases or words the body is feeling it's it it's connecting by your back brain your your limbic brain and your brain stem which are very primitive uh brains you actually have three brains in your head you have the cortex or thinking brain that's the most recent one in evolutionary terms but there's also a limbic brain which is in the middle and there's a back brain which is sort of brain stem that links to your spinal cord and they they're much more basic all about survival and these autonomic functions in your body and that's the brain we have to talk to and so keeping things really really simple in terms of language is so key so i am here i am learning i'm good enough i i always say keep it in the language of a seven-year-old because seven is the age at which we kind of start to individuate it's the time when our cortex or thinking brain comes fully on not fully online but begins to develop and so this is when children begin to realize they can take in context you know everything isn't just about them that there is a bigger picture out there but keeping it very simple so that a seven-year-old would understand because that's the language really of the body it's it's very basic it's am i safe am i loved am i enough and many people grow up not feeling any of those things and they are sitting ducks for chronic disease of some kind as i was um because we don't have a good foundation for being us for knowing who we are and for trusting ourselves and our own self being fully developed as a safe and uh valid individual and the final thing she ends on is adapting certain tools like yoga or mindfulness and she makes some really good points here which i've i've actually made in other videos i've done and audios i've done about what's wrong with some of these treatments which are not adapted they're not trauma-informed so i've already hinted at this so if you go into meditation and the meditation teaching says you know i want you to sit for 30 minutes and just focus on your breathing for some people that is so traumatic that they will go into a panic attack just being immobile for that length of time and also focusing on something that feels really unsafe in other words going interiorly so we have to adapt some of these things for people who've had trauma and invite them to do things that feel more safe for them so limiting the amount of time you're still for instance so for people with trauma and moving meditation is often a lot better something like qigong tai chi gardening even walking slow movements done mindfully are usually easier for people who've had trauma which has involved some form of immobilization being stuck in a in a panic situation where you could not move and one of the most common ones by the way is surgery surgery of any kind where you've been anesthetized is immobilizing and your body remembers that and so people can often have huge triggers and yoga too um stretching she points out can because it it sends messages from the muscles to the brain of certain movements of stretching in your proprioception what's called proprioception which is the position of your muscles in space can also be a trigger and so having a set routine for people where they do this and then they do that can often be not not taking account of their own particular situation and so certain postures will not be very comfortable and not because they're stiff but because they trigger you being prone for instance can be a huge trigger that's lying face down which you do do in yoga you often rest your hands uh your head on your hands and lie prone or or bending over forwards can be another huge trigger for obvious reasons it exposes the rear of the body so there are all sorts of ways in which we have to be trauma-informed and not use one size one-size-fits-all approaches so i liked that i i overall i like the book very much um it was published in 2017 as paid it as a hardback and now in 2021 as a paperback and therefore is much more accessible with the price of a paperback obviously being a lot less and it's not a difficult read actually what i loved another thing i loved about it is she uses actual transcripts from sessions so for practitioners like me who are interested to see how she works it's absolutely brilliant and i'm actually going to borrow that i'm going i have been long thinking about using some transcripts and i've got some clients who've agreed to that me using their session transcripts in some way and i would like to i think my next book will be um some practical applications of what i now know and how i work because i've not done that before i've written a lot of theoretical texts uh on on some of the theories i work within why it changes the way you feel and why it helps chronic illness and alleviates pain and all these sorts of things but i want to show people the how and so i'm going to take away lots of things from this book but mainly it's about being very very mindful of your clients situation and drawing them from the present to the past and not the other way and yeah i look forward to using some of the ideas she's given me in the future and actually making something of my own approach which is slightly different to hers but nevertheless in the same ballpark so i can highly recommend the book and if any of what i've said today interests you you know where i am you can get in touch with me from the links below and do subscribe thank you so much for listening take care everybody bye for now