Trauma Education Essentials
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Book Reviews

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

'Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-alienation' by Janina Fisher, PhD

“I have long believed that trauma treatment must address the effects of the traumatic past, not its events.” – Fisher (2017)
In an era eroded by an “us versus them" mentality, it’s refreshing to read a book that talks about the importance of integrating different psychotherapeutic modalities rather than clinging doggedly to one approach above all others. Though the book is firmly rooted in the Structural Dissociation model, it is richly informed by Internal Family Systems, Sensorimotor Psychotherapy, Mindfulness, and other modalities.
The book starts by explaining that children have a need to attach to a caretaker for survival and comfort. If this is done within the confines of a reasonably safe relationship, the children learn how to regulate themselves through emotional and physical attunement with their caretaker(s).
If children are in an abusive or chaotic environment growing up, they miss out on the opportunity to feel a sense of stability and safety, and their neurophysiological survival systems (fight, flight, freeze, submit/dissociate) are left in overdrive. This can leave them in a state of hyperarousal and hypervigilance, and/or a state of numbness and disconnection.
While these survival states of fight, flight, freeze, submit/dissociate are important mechanisms which allow an abused child to survive, they also can carry on as over-activated states or responses in adulthood. This can cause all sorts of problems including overwhelming exhaustion, difficulty connecting with others, emotional turmoil, and many other struggles. As well, that universal drive to attach to a protective, loving caretaker continues into adulthood as a painful, and often confusing, unmet need.
In this book, Fisher uses various models to explain that everyone has an adult functioning self, a here and now self that enables a person to do things in their adult life such as parent, work, socialize, pay bills, engage in interests, and other activities. Everyone also has other parts or facets of themselves inside that are influenced by earlier life experiences. For example, you may have a part that feels really afraid of being judged by others, based on your experience of being teased and bullied as a child. Or you may feel a pull from a part of you to confront your colleague who said something hurtful the other day, but an equal pull in the opposite direction from another part to avoid conflict. The idea here, is that multiplicity is the healthy, typical internal state of human beings. This is not say that we are formed of discrete different personalities, but rather, we are composed of various aspects of ourselves which may have different pushes and pulls, and sometimes conflicting needs or wants.
So, what happens if someone has experienced repetitive, childhood trauma?  When traumatic experiences occur in childhood, or a child lives in a continuously unsafe environment, their neurophysiological survival response (fight, flight, freeze, submit/dissociate) can become aligned with parts of self that hold different experiences of trauma. When triggered, the activated trauma-related emotions and body memories cause the parts to hijack the functioning adult self which causes a person to feel completely overwhelmed or shut down. The person can feel transported back into emotions, body sensations, and thought patterns that are rooted in the past. For example, perhaps as a child, a person coped with their parent yelling by shutting down and becoming numb and disconnected from everything around them. They may then have a part that copes with conflict as an adult by shutting down and disconnecting.
The work in therapy is to begin to identify the traumatized parts needs and fears in order to understand the role that it plays within the internal system. The goal is to be able to “unblend” and create a “mindful distance” between the here and now adult self and the younger traumatized parts. This distance then allows the adult self to get to know the younger traumatized selves in order to understand their needs and eventually, to respond to their needs in a healthy, consistent and present manner. Noticing body sensations, feelings, and other symptoms allows for a growing observing self and, over time, that observing adult self doesn’t get as hijacked or blended with the traumatized parts. 
In summary, an internal attachment system is fostered that allows a person to experience themselves as the protective, understanding, loving caretaker to their own internal traumatized parts. The fight, flight, freeze, submit/dissociate responses become less intensely and less frequently activated in response to here and now stressors. And, the unmet attachment needs from childhood are soothed by the adult self who gives to the traumatized parts, the love and nurturing and sense of safety that was so painfully missing from their own early life.
Fisher covers a lot of ground in this book and also writes about how she sees this integrated approach as a shift in the role of the therapist from one of witness to that of educator. She also highlights that regulating the nervous system by understanding how the survival responses are tied to earlier trauma experiences, and how they hijack people as adults, is a key point in this work.
The idea of transformation comes up in the book a number of times; transforming the way in which clients understand their symptoms and struggles and transforming one’s relationship with their parts to build secure internal attachment systems.

This book highlights what I feel is a fundamentally important perspective; trauma therapy is enhanced when therapists use multiple modalities that can be customized to the unique and diverse needs of the people we work with. Fisher does an excellent job of weaving together complex theories and ideas, transforming various models into a coherent, yet flexible, approach to trauma therapy. Her book is essential reading for anyone working with people who have experienced complex trauma.

Thanks everyone!   - Dana

Dana RossComment