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The word trauma is used liberally and uncritically throughout the book although in my professional work I take a far more critical stance in relation to its use, and this raises very important issues to do with how we survive the bad things that happen to us. Extreme events happen frequently but not everyone who endures such an event will suffer psychological trauma. The reasons for this are complex and can be under- stood in terms of hardiness and resilience. This can involve many factors from how we process emotional overload neurologically and physically, through to the nature of the communities in which we live, and most importantly the social meanings that are ascribed to extreme events. This doesn’t mean that trauma only appears when it is labeled as such. Trauma can live underground for years, consider the Me Too movement; or gener- ations, consider Black Lives Matter, or centuries, consider the pernicious effects of slavery. My preference is to use extreme events to label the event itself, and trauma as the psychological aftermath that may follow, but is not inevitable. In the territory that lies between there are a plethora of contending forces: how much light and voice that are brought to events to validate experience; how much support is forthcoming; the extent to which people are empowered to cope with events, and in the extreme moment how overwhelmed we are in ways that compel us to respond in ways that undo us. To this can be added our individual capacity for hardi- ness or our vulnerability to overwhelm, and these are not static qualities but are deeply influenced by social factors, the quality of our relation- ships and quite critically, our fluctuating capacity for reflection. However, in the book trauma is used liberally for those who self-identify as being traumatized, and for families, friends, and therapists who would offer this description. In brief, this means people who have survived extreme circumstances that would ordinarily overwhelm any of us, and who have

Contents 1 Introduction 1 References 5 2 Beginnings 7 Bodily Signs and Symptoms 9 Mental Signs and Symptoms 9 Environment Signs and Symptoms 9 Making a Story of Trauma 9 The Four Dimensions of the Trauma Story 11 Trust 12 Making Sense of Signs and Symptoms 13 Signs of Being More Easily Aroused 13 Avoiding Things to Do with the Trauma and Being Less Involved in Life 13 Having a Sense That the Extreme Event Is Ever Present 14 Often Trauma Comes Out Sideways 15 The Wish to Remember and the Need to Forget 15 A Systemic Scaffolding 16 Beginning at the Beginning 18 ix x Contents Capacity for Reflection 18 Supporting Someone Who Doesn’t Want Therapeutic Help 19 Felt Experience 20 Felt Shift 21 Finding the Middle Ground 23 What We Can Do as Family and Friends 25 References 26 3 Body, Brain and Trauma 27 Basic Trust 28 The Limbic System: Our Fight and Flight and Freeze Protector 30 The Biology of the Limbic System 32 What Our Body Can Teach Us 33 Amygdala 33 Hypothalamus 34 Hippocampus 35 Cingulate Gyrus 37 The Low Road and the High Road 39 Mirror Neurones 41 How Trauma Narrows Attention and Breathing Opens It Up 43 The Vagus Nerve 44 Body Work 45 What We Can Do as Family and Friends 45 References 46 4 Creating a Welcome 47 Containment and Validation 50 Bordered Experience and the Exiled Self 51 Gaze Aversion 52 What We Can Do as Family and Friends 54 References 55 Contents xi 5 Trauma, Attachment and Resilience 57 Attachment 58 Avoidant Attachment 59 Ambivalent Attachment 60 Attachment and Trauma 63 Developmental Trauma and Event-Driven Trauma 64 Resilience to Trauma 65 The Circle of Security 67 Resolving Childhood Abuse in Adulthood 68 What We Can Do as Family and Friends 71 References 72 6 When Secure Attachments Are Blown Apart 73 Coherence 74 Metacognition 74 Dual Coding 76 Developmental Trauma and Forgetting 77 What Happens in Trauma 78 When Trauma Detaches Us 80 Learning Point 82 What We Can Do as Family and Friends 83 References 84 7 Trauma, Pain, and Transformation 85 Pain Is Not Pathology 86 Being Safe 89 The Need for a Secure Base to Work Through Trauma 90 Meeting Physiological Needs 92 Meeting Safety and Security Needs 94 Meeting the Need to Belong: Unravelling Inner and Outer Experience 100 Needs for Esteem, and Self-Actualization 101 Transformation 101 Groupwork and Transformation 102 Learning to Sit with Trauma and When to Respond 103 Mindfulness 104 Summary 105 xii Contents What We Can Do as Family and Friends 106 References 107 8 Trauma and Death 109 The Singularity of Death 110 The Web of Life and Death 112 The Need to Remember and the Wish to Forget 114 How to Help with Deeply Traumatic Grief 117 Whether to Seal off Memories or Work with Them 118 Sleep 119 Alienation 121 The Pathway Toward Recovery 121 What We Can Do as Family and Friends 122 9 Social Systems That Promote Attachment Versus Systems That Create Trauma 123 Poverty and Trauma 123 What Could Be More Natural Than a Natural Disaster 126 Gender and Trauma 127 Social Systems That Promote Attachment vs. Systems That Create Trauma 128 Relational Learning 130 Social systems That Work Against Attachment Cause Trauma 130 Family Violence and Trauma 132 Attachment as Tenderness 134 Social Systems Geared Toward Attachment 135 Attachment, Violence, and Trauma 135 Resilience to Trauma 136 Frameworks for Social Protection Are Frameworks for Self Protection 137 What We Can Do as Family and Friends 137 References 138 10 When Disaster Strikes 141 Psychological First Aid 143 More Targeted Psychological Help 144 Contents xiii Visualization 147 Self-Help 148 Moving Beyond First Aid 149 What We Can Do as Family and Friends 150 References 151 11 Learning to Look After Ourselves 153 Secondary Traumatic Distress 154 What to Do? 155 Remedial Measures 155 Daily and Weekly Self-Care 158 Guidance 159 The Hidden Effects of Stress 160 Pain and Memory 161 How We Are Affected 162 Forms of Self-Protection 164 Compartmentalization 164 Questions to Subjectively Determine if Stress Is at Breaking Point 165 Compassion Fatigue and Secondary Traumatic Stress 166 Looking After Ourselves When It’s a Family Who Is Traumatized 167 What We Can Do as Family and Friends 169 References 169 12 Mainly Theory 171 The Presence and Absence of the Body in Psychotherapy 173 Shell Shock and Work in Groups 174 Fear of Intimacy and Projective Identification 176 The Body as Container 177 Containment and Validation 177 Shame 178 Attachment Theory 179 Vietnam War Veterans 180 Unclaimed Experience 181 EMDR 182 Body Psychotherapies 183 xiv Contents Mindfulness 185 Family Therapy 187 Integration in Theory and Practice 189 Finale 195 References 196 Index 199

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