Abstract
It has struck me recently that my personal and idiosyncratic version of the impact factor involves the presence or absence of underlining. If a passage in any text is underlined it has registered as important, something I want to take in and remember. If a passage has been underlined several times, it has been read as many times as I have underlined it and been struck afresh by its importance.
Healing trauma: attachment, mind, body and brain has been extensively underlined. It is an excellent work, bringing current findings from neurobiology and attachment theory together with clinical theory and practice in the field of early trauma and the development of the human brain and mind.
Siegel's opening chapter ‘An interpersonal neurobiology of psychotherapy: the developing mind and the resolution of trauma’, is a tour de force, taking up and expanding the themes of his book The developing mind: how relationships and the brain interact to shape who we are, published in 1999. In Healing trauma he explores the impact of early trauma (importantly including emotional trauma in the form of emotional deprivation and neglect) on the development of the brain and how memory, emotion and the regulation of behaviour are affected.
The importance of this knowledge for the practice of psychotherapy cannot be underestimated. It underlines the importance of the provision of a secure base in psychotherapeutic treatment for the patient who has experienced trauma, particularly early trauma, and the relevance of neural integration to the development of reflective function or ‘mindsight’ as Siegel calls it.
Solomon and Siegel have collected articles from many eminent authorities in the fields of attachment and trauma for this book. Each has come up trumps with a quality contribution. The field of attachment is represented by Erik Hesse and Mary Main, who discuss how unresolved loss or abuse can have second generation effects. Allan Schore's gift for synthesizing large bodies of data from different fields is displayed in his examination of the connection between early relational trauma and the development of a predisposition to violence. Van der Kolk discusses posttraumatic stress disorder and the nature of trauma. The later chapters are more clinically focused, the best of them to my mind being Marion Solomon's account of treating the effects of attachment trauma on intimate relationships, which should be read by all psychotherapists dealing with relational problems in couples.
I recommend the book to all psychiatrists and psychotherapists. It integrates the latest findings from neurobiology, the developmental sciences and psychotherapy, in ways likely to enhance the work and understanding of all psychiatrists and psychotherapists. We are fortunate to be practising at a time when the art and science of psychotherapy are moving toward integration, when findings from the brain sciences are increasingly informing those of us who work with people whose early life has been marked by emotional, physical and sexual abuse and trauma. But our good fortune also means that we have a responsibility to try and influence social policy in relation to the early life environment of infants and children. As Allan Schore says in this book (p. 148): ‘The answer to the fundamental question of why certain humans can, in certain contexts, commit the most inhuman of acts, must include practical solutions to how we provide optimal early social-emotional experiences for larger numbers of our infants, the most recent embodiments of our expression of hope for the future of humanity.’