Trauma Education Essentials
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Book Reviews

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Book reviews written by Dana Ross, MD, MSc, FRCPC. 

'Complex Psychological Trauma: The Centrality of Relationship' by Philip J. Kinsler, PhD

'Complex Psychological Trauma: The Centrality of Relationship''
by Philip J. Kinsler, PhD

If you had a chance to read my last book review, you already know that I’m probably going to like a book that has, “The Centrality of Relationship” in its title! In this book, Dr. Kinsler walks us through the therapy relationship from initial contact to termination, and provides interesting examples throughout from his own extensive career as a trauma therapist. He outlines the following 6 phases that often occur during the course of therapy with clients who have experienced complex trauma.

  1. The opening gambit

The beginning of therapy, what Kinsler refers to as the opening gambit, is of critical importance to setting up a solid enough relational foundation and therapeutic structure that can weather the work ahead. He writes that clients present to therapy in varied ways, often influenced by their attachment style, but despite these differences, “…the terror of exposure and abandonment and being found worthless undergirds virtually everyone.” Being aware of these common fears can help therapists understand what lies beneath some of the client’s defenses and relationship patterns.

The following sentence struck me in particular: “One of the major failings I have seen in years of training therapists is the application of empathy without direction.” Though empathy is an important part of therapy, he writes that it is not enough on its own. The often uncomfortable and painful work of therapy must be a journey the therapist is willing and able to go one with a client. I found it interesting to think of an overload of empathy as a form of avoidance or enmeshment on the part of the therapist.

2. The first crisis

Regardless of the particular details of the first crisis or emergency that arises for the client during therapy, Dr. Kinsler writes that at this stage there is also a relational process within the therapeutic relationship that must be attended to. Questions hang in the air amidst the chaos, “What kind of container are you going to be? Will you be able to handle my emotions, without running, or getting angry and rejecting me? Or worse, will the intensity of my rage/grief/pain destroy you?” He then goes on to describe different types of containers: the shipping container (resistant therapist), the broken vessel, the commode (you can use your imagination on this one), or ideally, the safe container. The answers to the above questions will be influenced by the type of container the therapist is. 

3. The empty depression

This phase is about the importance of ‘being with’ a client without moving too quickly away from their pain or drowning in the abyss along with them.

4. Omnivorous rage

In this phase, the client, and sometimes the therapist, fear that the anger that may emerge will be overwhelming, destructive, or evoke retribution as it did in the past.

5. Rebuilding the devastated life

Encouraging growth of a wider field of view and supporting movement towards a more open involvement in life. Kinsler outlines a number of ways in which the therapist can start to feel a pull towards loosening boundaries in this phase. As he points out, this is a good time for peer supervision!

6. Termination

Kinsler reviews a number of different termination patterns including a well-planned and processed goodbye, to a sudden and angry ending that can sometimes be an attempt by the client to individuate in the only way they know how, or the fade away. The ending in therapy is a time to honour the work that has been done, and to acknowledge and feel the loss of the therapeutic relationship.

As I read this book, I was reminded of a conversation that I had with a supervisor years ago who asked me if I had enjoyed a particular workshop at a conference we were both attending. I replied that I wasn’t quite sure if I had gained anything new from it. He then said something that has stuck with me since, “It is not always about learning something new, sometimes it’s about confirming that you’re on the right track, or adjusting what you’re already doing.” He was right of course. There can by layers of wisdom to excavate underneath the familiar.  
At first glance, Kinsler’s book could be summed up as an excellent and succinct overview of the therapeutic process when working with clients with complex trauma. And that would be accurate, in fact, it's very impressive how much he covers as this book is not overly long.  For those who regularly work with clients with complex trauma, there will likely be much that resonates and feels familiar. But there is something even more here, a compelling subtlety and richness to his insights, as well as a sense of kindness that comes through the page. I could imagine reading this again years from now and finding new depths in his words. It’s worth delving into this book; the wisdom runs deep.

Thanks everyone!   - Dana

Dana RossComment