JOURNAL OF SANDPLAY THERAPY 2015 REFLECTIONS: BOOKS, EVENTS & DVDs THE BODY KEEPS THE SCORE: BRAIN, MIND AND BODY IN THE HEALING OF TRAUMA by Bessel A. van der Kolk, M.D. A Reflection by Linda Cunningham San Francisco, California, USA Auden s Rule Truth, like love and sleep, resents Approaches that are too intense. --W.H. AUDEN 2015 SandplayTherapists of America / Journal of Sandplay Therapy Linda Cunningham, PHD, LMFT, CST-T is a teaching member of Sandplay Therapists of America and of the International Society for Sandplay Therapy and the author of Sandplay and The Clinical Relationship (2013). PAINTINGS (pp. 3-7) Donna Johnson donnajohnsonart.com In The Body Keeps The Score, Bessel van der Kolk, M.D., a clinician and trauma researcher for over thirty years, brings together in one book what we know about trauma as of 2014. He takes us through the history of trauma from Charcot, Janet and Freud through WWI s shell shock, Vietnam veterans flashbacks, the repressed memory controversy, to the current dominance of psychopharmacology, and recent DSM debates. The history of trauma is one of mysterious symptoms, misdiagnosis, denial of its very existence and disregard of the profound suffering it causes. Throughout this masterful work, he emphasizes that the body cannot forget that which the psyche cannot bear. He highlights the prevalence of trauma in our lives. He describes how trauma changes the brain itself in the area that communicates the physical, embodied feeling of being alive (p.3, 2014). Throughout, Van der Kolk demonstrates his deep compassion and understanding of trauma s symptoms, and gives the trauma survivor hope:
what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on body, mind and soul: the crushing sensations in your chest that you may label as anxiety or depression; the fear of losing control; always being on alert for danger or rejection; the self-loathing; the nightmares and flashbacks; the fog that keeps you from staying on task and from engaging fully in what you are doing; being unable to fully open your heart to another human being. (p.203) Speaking to both trauma survivor and clinician, he then shows us the many ways in which trauma can be healed. Of particular interest to sandplay therapists is the chapter on developmental trauma. Developmental trauma, which results in insecure attachment, is also called complex trauma, early trauma, early relational trauma, early maternal deprivation, little t trauma (as opposed to big T, single event trauma, such as a car crash). Developmental trauma results from cumulative misattunement, neglect or abuse, and arises clinically in the form of Field One: Oneness/Merger and Field Two: Twoness/Rupture of the four archetypal relational fields (Cunningham, 2013). Kalff (1980), of course, referred to this kind of trauma as a rupture in the mother child unity. Van de Kolk gives the reader the inside story on the political and financial forces that drive mainstream, insurance-approved trauma treatment which does not address trauma at its source, but rather seeks to manage behavior. He describes his work with the National Child Traumatic Stress Network (NCTSN), which, after reviewing 130 relevant studies, arrived at the proposed diagnosis of Developmental Trauma Disorder (DTD), and by providing abundant research, attempted to convince the DSM committee to include this diagnosis in DSM-V. He points out that children with developmental trauma are often given several diagnoses based solely on behavioral symptoms (ADHD, bipolar, disruptive mood dysregulation disorder, conduct disorder, or oppositional defiant disorder, to name a few). These clients are often medicated to eradicate or dull their symptoms, the problem with this being that dulling the symptoms also dulls their capacity for pleasure, curiosity and aliveness and stunts their development. Van der Kolk criticizes the current treatments that encourage symptom management through medication, behavioral modification or exposure therapy which rarely work and often cause more damage (p.157). But even given the evidence provided by NCTSN, the DSM-V committee declined to include the DTD diagnosis, stating: The notion that early childhood adverse experiences lead to substantial developmental disruptions is more clinical intuition than a research-based fact. There is no known evidence of developmental disruptions that were preceded in time in a causal fashion by any type of trauma syndrome. --From the American Psychiatric Association s rejection of a Developmental Trauma Disorder diagnosis, May 2011 (van der Kolk, p.149)
Pause 1 Donna Johnson encaustic monotype Van der Kolk notes the high cost of abuse and neglect of children, and calls developmental trauma our nation s largest public health problem because it underlies, to a very large extent, suicidality, substance abuse, depression, domestic violence, and incarceration (p.148), according to research. Van der Kolk is surprisingly open to alternative treatments for trauma, and has used and researched many of them. He surveys techniques for building safety and trust, a crucial first step in trauma therapy, such as breathing techniques, mindfulness practices, resourcing and tapping in, imagery, neurofeedback, yoga, and apps that can help improve heart rate variability (HRV). He explores therapies that he has researched and found helpful: Eye Movement Desensitization and Reprocessing (EMDR), somatic approaches, Internal Family Systems (IFS), equine-assisted therapy, art therapy, and theater (which uses the healing power of the voice and communal rhythms). He emphasizes the need for supportive relationships and community in healing trauma. Stunningly absent from this list is sandplay therapy. Yet so much of what he says about trauma would confirm that sandplay should be researched as one of the treatments of choice. Trauma cannot be put into words; it is stored in the body as images and body sensations. Sandplay accesses these realms of not-knowing, and reorganizes the internal chaos in a safe, noninvasive way.
Following what van der Kolk calls Auden s Rule (p.125), above, sandplay offers a tolerable way of revisiting the actual experience of trauma. Sandplay therapists know that experiences in the sand touch the body, integrate negative, traumatic emotions on a very deep, implicit level, and ultimately may connect clients with a spiritual sense of wellbeing. In fact, sandplay strives to build enough trust in the beginning to allow infusion in the client s mind and body of that fundamental, vital trust found in a deep connection with the Self. This kind of trust provides secure attachment. It is the kind of trust that is lost or perhaps never built at all when one suffers developmental trauma. It becomes clear that there is no integrated treatment for trauma yet exists. Each clinician must become familiar with a variety of approaches and work with these in a client-centered way. After reading The Body Keeps the Score, I am even more convinced of the necessity for research on the efficacy of sandplay therapy, particularly in this nebulous area of developmental trauma. Sandplay s current body of knowledge consists of case histories. Sandplay therapy should be on the list of viable trauma treatments, but we need to provide evidence-based studies to make this happen. REFERENCES Cunningham, L. (2013). Sandplay and the clinical relationship. San Francisco: Sempervirens Press. Kalff, D. (1980). Sandplay: A psychotherapeutic approach to the psyche. Cloverdale, CA: Temenos Press. van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking Penguin: Pause 2 Donna Johnson About the author of this reflection LINDA CUNNINGHAM, PHD, LMFT, CST-T is a teaching member of Sandplay Therapists of America & International Society for Sandplay Therapy and the author of Sandplay and The Clinical Relationship (2013). Over the past twenty years, she has written many articles for the Journal of Sandplay Therapy on the topic of the therapeutic relationship in sandplay therapy, and has presented at both national and international conferences. Dr. Cunningham has taught sandplay therapy as well as contemporary relational theories for many years in both graduate and postgraduate settings, and currently gives trainings in Depth Psychotherapy and Sandplay in San Francisco. In her private practice in San Francisco and Marin County, California, Dr. Cunningham works with adults suffering from anxiety, depression, blocked creativity, and relationship issues, including early relational trauma. CORRESPONDENCE: Linda@drlindacunningham.com
Pause 3 Donna Johnson (encaustic monotypes) www.donnajohnsonart.com About the artist DONNA JOHNSON, LCSW, ATR-BC,CST-T is a Jungian psychotherapist and artist who was born and raised in the southeast United States. She currently resides in Atlanta, Georgia. For 30 years she has specialized in art therapy and sandplay therapy. She is a registered and board certified art therapist and a licensed clinical social worker. She is a certified sandplay therapist and a teaching member of the International Society for Sandplay Therapy and is a faculty and board member of the Sandplay Therapy Institute. Simultaneously, she has studied painting, first at Wake Forest University earning a BA in psychology and then at the University of Tennessee where she earned a BFA in 2003. She received an MA in painting at Savannah College of Art & Design specializing in encaustic painting in 2008. A number of her paintings have been published in the Journal of Sandplay Therapy due to their archetypal content. She was showcased to the Atlanta art scene as an emerging artist in 2009 in shows at both Alan Avery Art Company and Bill Lowe Gallery. Her encaustic work has received international acclaim in IEA EncaustiCon 2012 and Metamorphosis: Contemporary Statements in Encaustic. She is a fellow of Hambidge Art Center with residencies in 2011 and 2012. Her work is on view at Reinike Gallery, Atlanta, Georgia, USA. Donna Johnson s work explores psychological and spiritual transformation merging her background as artist, art therapist, and Jungian psychotherapist. She is fascinated with abstracting the forms of archetypal motifs from alchemy and Jungian symbolism. Her desire to paint comes from a need to express visually what cannot be concretized into words. CORRESPONDECE: www.donnajohnsonart.com
THE BODY KEEPS THE SCORE: BRAIN, MIND AND BODY IN THE HEALING OF TRAUMA by Bessel A. van der Kolk, MD A Reflection by Linda Cunningham San Francisco, California, USA KEY WORDS: Trauma, trauma treatments, trauma research, neuroscience, brain, developmental trauma, insecure attachment, complex trauma, little t trauma, neglect, abuse, misattunement, Field One, Field Two, the four archetypal relational fields, DSM-V controversy, EMDR, sandplay research, sandplay, National Child Traumatic Stress Network (NCTSN), misdiagnosis of trauma, Reflection. ABSTRACT: In The Body Keeps the Score, Bessel van der Kolk, MD, a clinician and trauma researcher for over thirty years, brings together in one book w hat we know about trauma as of 2014. Throughout this masterful work, he emphasizes that the body cannot forget that which the psyche cannot bear. Van der Kolk takes us through the history of trauma in psychiatry, through current neuroscience and clinical applications, always citing the research. Focusing on developmental trauma, which van der Kolk considers to be our nation s largest public health problem, the reviewer considers the need for sandplay research and the importance of providing evidence that sandplay is a treatment of choice for developmental trauma. OPPOSITE: Pause 1, Pause 2, Pause 3 Donna Johnson (encaustic monotypes) www.donnajohnsonart.com