Rethinking Trauma Treatment: Attachment, Memory Reconsolidation, and Resilience

“Clinicians who already use the book’s cutting-edge memory reconsolidation approach will deepen their knowledge of its principles and find myriad practices and applications to make certain that trauma survivors are well served.”

“The aim of trauma treatment is to update memories that have been encoded to produce fear, shame and other painful emotions in response to an event with new interpretations or meanings so that the memories become non-threatening.”

Not only does Courtney Armstrong have a deep understanding of the nature of trauma and treating its debilitating effects, she has the ability to explain complex theory in language that readers can understand. This winning combo makes much of the information in Rethinking Trauma Treatment, a book written for clinicians, worthwhile for trauma survivors as well as for the people in their lives who are trying to support and care for them.

The book is divided into three sections: developing the therapeutic alliance, transforming traumatic memories, and post-traumatic growth. Armstrong’s liberal use of case histories and client anecdotes illustrates what happens intrapsychically and interpersonally to people who have experienced trauma and are trying to move beyond its lingering, painful memories. Describing how therapists need to create safe havens in their sessions with trauma survivors, she underscores how attachment disorders leave them anxious, insecure, reactive, and mistrustful of others—all of which make developing rapport and sustaining connection a challenge.

She goes on to present exercises that ground and soothe clients and are necessary not only for them to tolerate the therapist’s exploration of their traumatic memories, but for them to become less reactive in their lives.

The range of Armstrong’s interventions is impressive, and her clinical examples show the reader what approaches work and how attunement is key to providing exactly what each client needs for healing.

This process, similar to observing master therapists interview clients, will teach novice clinicians a great deal about how to approach and relate to all, not just traumatized, clients by paying attention to Armstrong’s nuanced and enlightened therapeutic responses.

Section two explains what happens to the brain and body when someone experiences trauma. Armstrong defines trauma as “a disorder of memory,” a definition which is key to understanding how she works with it. Early on in the book, she describes how the brain reacts to “emotionally stressful encounters” through the amygdala encoding “all the sensory information associated with the event into what is called an implicit memory . . .  a network of neurons that contains the felt, experiential part of memory.” She stresses that implicit memory is far different from explicit or didactic memory, which records the factual details of events.

The aim of trauma treatment is to update memories that have been encoded to produce fear, shame and other painful emotions in response to an event with new interpretations or meanings so that the memories become non-threatening. Armstrong uses the example of a “virus or software program with a bug that gets downloaded to a computer.” Just as the computer needs to be recoded when there are errors, so do our brains. Once memory updates are completed through a five-step protocol contained in Armstrong’s acronym RECON, the painful emotions experienced in an event lose their toxicity.

Section two also addresses specific types of trauma: sexual and combat, abuse from childhood, and traumatic grief and loss. Again, Armstrong uses an abundance of examples to illustrate the theory behind memory reconsolidation, so that what she is doing therapeutically, which may feel like magic to the transformed client, is grounded in intentional interventions that are tailored to resolving each type of trauma.

The final section of the book is devoted to clients’ improved mental health and to what therapists must do to hold onto their own. Most readers will be familiar with the term PTSD or Post-Traumatic Stress Disorder, but many may not know what Post-Traumatic Growth is: the healthy, positive changes that occur in trauma survivors’ lives down the road.

This transformation has been studied and validated by scientific research—many people who had horrific experiences that they thought would scar them for life instead have gone on to achieve five specific positive changes: “greater sense of personal strength, openness to new possibilities, greater appreciation for life, spiritual development, and enhanced relationships.”

Additionally, Armstrong cautions therapists who work frequently and intensively with trauma survivors to watch out for common hazards that might arise and impact their own mental health. She describes therapists’ risk for compassion fatigue or numbing out, loss of empathy for trauma clients, and emotional burnout from the stress of their work. Citing examples of each, she encourages therapists to take care of themselves by finding emotional balance in their lives.

Therapists who are new to the complexities of trauma resolution will be grateful for Armstrong’s inclusion of learning tools such as diagrams, client worksheets, and verbatim therapist-client dialogues. Clinicians who already use the book’s cutting-edge memory reconsolidation approach will deepen their knowledge of its principles and find myriad practices and applications to make certain that trauma survivors are well served.