Therapists working with traumatized patients suffer from their closeness to this horror. They come to feel personally the experience of victim, abuser, accomplice and bystander. Patients’ experiences resonate with therapists’ own trauma. But therapists also feel uplifted by witnessing the courage of survivors in facing their private horrors and in daring to reach for a more hopeful future. They feel themselves enriched as they participate in this progress with their patients, and they gain the satisfaction of helping people overcome trauma and move on with their lives.
Richard Gartner’s book is hard to read and to review because it is so full of painful experience. Many chapters have case material full of sadistic cruelty, selfish use of children and callous disregard for their needs. One can lean on its concepts of resilience and counterresilience for support, even though they are sometimes elusive in their meaning. Many of the contributors to this book describe their personal journey into the field of doing therapy for trauma survivors. A number of the contributors also coin their own terms to describe their work, in line with Gartner’s countertrauma and counterresilience.
Gartner is a leader in bringing attention to the suffering of men who were sexually abused as boys and in describing their treatment (Gartner, 1999, 2005). In this new book he has expanded his focus to the relations between men, women, and their therapists working with trauma of all sorts. The contributors to this volume include some of the most important people working in this field. Gartner introduces the papers in this book with a look at the language that has been used to describe work with adults traumatized as children. He uses the terms countertrauma and counterresilience to emphasize the normality and inevitability of this relational flow of internal reactions between two people, rather than to give priority to the idea of trauma residing first in the patient and then transferring to the therapist. Countertrauma, for example, refers to the cumulative effect of hearing from patient after patient about terrible things, leading therapists to experience not only their patients’ traumas, but also their own traumas in response to those of the patients with whom they work. He compares the idea of countertrauma with the terms countertransference and vicarious traumatization, terms that have already appeared in the literature on work with traumatized adults. Resilience refers to the heroic ways in which patients summon the ability to move through and beyond trauma. Counterresilience is various; I will review ways of finding counterresilience described throughout the book.
I find three categories of topics in this book—psychotherapy of trauma, societal influences on trauma, and counterresilience. To start with the first category, Sheldon Itzkowitz introduces the term dissociative identity disorder (DID) and gives case examples. Mikele Rauch describes the losses of innocence, the corruption of love, the pervasive shame, and the moral injury caused by sexual abuse. Richard Chefetz focuses on the need for the therapist to use his or her own sexual feelings about sexually abused patients as an important part of therapy rather than to try to banish such feelings, while also valuing and using boundaries. Karen Hopenwasser compares vicarious traumatization to her own term “dissociative attunement,” and advocates using common words with patients like fear, panic, safety, or suffering rather than clinical words like trauma and dissociation. Elizabeth Howell offers an example of dissociative attunement as the therapist joins with the patient for a while in avoiding evidence of trouble and therefore avoiding the need for worry. Steven Gold recommends a “contextual therapy” that promotes “countergrowth” by teaching survivors how to soothe themselves, realize their strengths, value strong bonds with other people, learn that is not too late to thrive, and establish a better life in the present. Only then does he recommend exploring with them whether it would be helpful to review their traumatic past. Alison Feit describes the expansion, among people who work with survivors of sexual abuse, of the belief in horrors that are actually possible, especially for workers whose lives had not included growing up with traumatic events as the norm. But she also describes the therapist’s loss of an intact self that existed before exposure to terror. Finally, Karen Saakvitne describes vicarious traumatization and distinguishes it from countertransference, compassion fatigue, and countertrauma. Vicarious traumatization is cumulative, and extends not only into the clinical relation with particular clients, but also outside the therapist’s professional role into all aspects of his or her personal life.
A number of the papers deal with the influences of professional, political, historical, medical, disaster and academic events on trauma. Sandra Bloom describes her creation of a successful trauma therapy program followed by a painful sense of betrayal as she realized that destructive changes in mental health delivery systems had compromised her ability to continue this program. Kathy Steele discusses the destructive impact of the false memory movement on therapists and patients struggling to deal with DID. Jane Gartner discusses the “systematic oppression” of teachers in the New York City schools that was experienced through the way No Child Left Behind policies were implemented without teacher training, with rewards for scripted rather than creative lessons and with emphases on teaching to the test. These policies led many experienced teachers to feel deceived, betrayed and angry. Philip Kinsler and David Lisak examine the influence of growing up among Holocaust survivors on work with trauma survivors. Lisak also describes his project of making narrative and photographic portraits of survivors of sexual abuse, portraits that let the survivor reject stigma and shame in public acts of defiance and strength. Jill Bellinson compares long-term work with trauma survivors to mental health work with survivors of recent disasters; in comparison, disaster work is brief, busy, with many people, and fosters less transference and countertransference. Nonetheless, emotional overload in disaster work comes from its disorganization, mess, exhaustion, worry, upset over missed opportunities, and not knowing how people fare in the end. Ruth Livingston describes her work with a woman dying of Amyotrophic Lateral Sclerosis, or ALS. Alpert offers the term “academic traumatization,” a process occurring through the study of trauma, as another way people can “catch” trauma (alongside being traumatized, intergenerational transmission of trauma, and vicarious traumatization). Christine Courtois notes that the most personal dangers and disappointments in her career have involved ethical transgressions perpetrated by colleagues, trainees, and employers rather than by clients. She calls these transgressions “colleague betrayal-trauma” and gives many examples. She also faults herself as sometimes too reticent and trusting, not assertive enough, and cowed by potential legal implications.
These authors have found sources of buoyancy and counterresilience in the uplifting effect of patients’ courageous strength, heroic determination, humility, dignity, humor, and focus; in their passion to persist, reconsider priorities, make adjustments, find spiritual solutions, and let go of anger; and in witnessing their struggle between shame and grace. Therapists value being of help, witnessing growth, getting pleasure in a patient’s thanks, and feeling real and engaged when working with people with a dissociative identity structure whose part-selves speak the truth of their experience in a refreshing way. Further, therapists feel rejuvenated by immersion in music, art, poetry, humor, spiritual practice, study, peer supervision, public presentation of one’s work, and self-care. They find strength in forgiving oneself for failures, struggling to retain and regain perspective, contemplating the energy and curiosity of children, enjoying hobbies and friends, working in teams, taking breaks, sleeping and eating well, self-soothing activities, and relying on the example of one’s own therapist. Bloom described her move into the field of public health to study systems which compromise effective trauma programs, with a focus on research, training and writing.
An edited volume like this one requires a reviewer to impose an arbitrary order. I have done so through organizing the authors’ ideas into the categories of psychotherapy of trauma, societal influences on trauma, and counterresilience. I have also tried to say something about each of the 18 contributions, every chapter rich with the authors’ emphases and experiences. One reads the book (and works with trauma survivors) at the cost of countertrauma, but I found the counterresilience to be worth it.
Gartner, R. (1999). Betrayed as boys: Psychodynamic treatment of sexually abused men. New York: Guilford.
Gartner, R. (2005). Beyond betrayal: Taking charge of your life after boyhood sexual abuse. Hoboken, NJ: Wiley.
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Gensler, D. Trauma and Countertrauma, Resilience and Counterresilience: Insights from Psychoanalysts and Trauma Experts, edited by Richard Gartner, Routledge, New York, 2017, 316pp.. Am J Psychoanal 78, 97–100 (2018). https://doi.org/10.1057/s11231-017-9123-4