In the packed hospital auditorium, 260 therapists raptly watch as Bessel van der Kolk, MD, energetic pioneer in the nonverbal treatment of trauma, speaks of his work. Van der Kolk hails originally from the Netherlands, and trauma is part of his family history (his father was in a concentration camp). An internationally renowned psychiatrist and head of the Trauma Center in Boston, Van der Kolk has taught at Harvard University and has sat at the feet of such psychotherapeutic notables as Fritz Perls and Harry Stack Sullivan.
Van der Kolk has a slightly clipped accent, the thinly masked impatience of the brilliant thinker, and the capacity to mesmerize his listeners for six hours or more without relying on notes or an outline. He tells it like it is, wryly commenting, for instance, on the absence of psychiatrists in his audience, "We psychiatrists know it all anyway." The audience, 98 percent social workers, roars appreciatively.
His message? Well, there are many. Perhaps first, trauma is all about the oldest, reptilian part of our brains. Trauma lives in the body and cannot be reached through the thinking parts of the brain involved with language. When a disaster happens, we take flight. We run from the World Trade Center. We try to go home, where we can feel safe and be comforted by loved ones. If we can get there, we are likely to recover, but if catastrophe strikes at home and there is no escape, we feel helpless and trapped, and we are more likely to suffer long-term damage.
In the face of distress, we regulate our bodies, sensations, and emotions in many ways. When we change our posture, for instance, we recalibrate ourselves. Our emotions prompt us to move, to shift our relationship to the external environment. In the face of disaster, powerful stress hormones urge us to take action.
People soothe each other through a process Van der Kolk calls attunement. Imagine a mother comforting an infant. She touches, strokes, hugs, coos, rocks, and sings to the child, and her facial expressions are part of the message. Adults engaged in conversation do something comparable. They set up rhythms in their communication. Getting on the same wave length is more important than the substance of what is said. As people become attuned, they mirror each other. Trauma disrupts this healing connection, leaving the sufferer cut off, marooned in the past.
Talk therapy doesn't work for trauma, Van der Kolk says. "If words are the currency of the therapeutic relationship, we are at a serious disadvantage, because when we ask people to talk about what happened, they will relive it and become retraumatized." As therapists we should concern ourselves not with the story of what happened, which remains in the past, but with the trauma's imprint on the present. Indeed, the therapist need not know what happened at all. He or she can simply ask the sufferer to recall a feeling.
Once a painful sensation has been reawakened, relief may come from moving the body: "How does it feel when you breathe deeply? When you stand up? When you stretch?" Tai chi and qi guong, like yoga, offer people physical means of regulating themselves. (Van der Kolk notes that Westerners don't have much of a tradition of self-regulation; instead we resort to Lunesta, Zoloft, and alcohol.) Vigorous activity (playing squash, for example, or practicing one of the martial arts) can improve a person's ability to attend and to focus on the here and now. Imagining a different outcome can also help--as when the child Noah, after witnessing the destruction of the World Trade Center, pictured huge trampolines waiting to catch the people who jumped out of windows.
Staying focused on the sufferer's body, the therapist tries to bring the thinking part of the brain back on line. The story of the trauma cannot emerge while the victim feels numb. Rather it must wait until the sufferer feels a sense of strength. The cure, then, is not a cerebral understanding of events. Understanding does not make the pain go away. Rather the therapeutic goal is to enlarge the brain's centers of self-awareness, to remove trauma's interference with present functioning, and to increase the person's sense of feeling alive.
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