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Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation (2017) by Janina Fisher. New York, NY: Routledge. ISBN: 978-0-415-70823-4 (pbk).

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Reviewed by:
Alexandra Bloch-Atefi, PhD, The University of Adelaide.

 

With her new book, Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation, Janina Fisher, a renowned international clinical psychotherapist with over 40 years’ experience specialising in trauma, makes a revolutionary contribution to the field of trauma work. Her contribution lies in weaving together the latest advances of trauma-informed work into a new coherent model accounting for the complexities of trauma treatment.

Fisher integrates the latest findings in neurobiological research on trauma and dissociation by Bessel van der Kolk, Alan Schore, and Dan Siegel, with evidence-based interventions from sensorimotor psychotherapy, internal family systems, attachment theory, mindfulness, and ego state therapy. Through incorporating body-oriented techniques, she addresses the underlying basis of emotional dysregulation due to trauma in the nervous system.

The book provides hands-on techniques and strategies for therapy, along with vignettes of therapy sessions that paint an engaging picture of the ideas in action. It is structured into 11 chapters plus an introduction and appendix.

Fisher introduces the reader to the breadth of this text by describing an effective and respectful way of working with clients struggling with the ongoing effects of trauma. Familiar and complex impacts are explored, such as self-destructive impulses that drive people to suicidal, self-harming, addicted, or eating disordered behaviours. The treatment paradigm presented is not limited to any one particular diagnosis, but can be used to support therapy across various trauma related presentations, whether the client carries a diagnosis of post-traumatic stress disorder, attention deficit hyperactivity disorder (ADHD), bipolar disorder, borderline personality, dissociative disorder, or has never even seen a mental health professional.

Chapters 1 (“Alienation from Self: How We Survive Overwhelming Experience”) and 2 (“Understanding Parts, Understanding Traumatic Responses”), provide readers with a theoretical foundation for understanding the contributions made by a neurobiological perspective on trauma, along with a “parts” approach to treatment. Fisher illustrates how a parts approach can support therapists to work more effectively with complex trauma as parts or ego-states may represent unprocessed trauma memories. She challenges any notion that clients are “acting out,” “manipulative,” “resistant,” or “unmotivated.” Instead, she presents a rationale for treating structural dissociation as a survival-oriented adaptive response to the specific demands of traumatic environments.

Chapters 3 to 5 stress the importance of incorporating mindfulness into the treatment of trauma due to its beneficial effects on the brain and body. Fisher presents evidence that mindfulness is key to trauma work. Mindfulness has a regulating effect on the nervous system while at the same time facilitating “dual awareness” or “parallel processing,” allowing clients to explore the past while minimising the risk of retraumatisation (Ogden, Minton, & Pain 2006). As part of their healing process, it is important to support clients in accessing dual awareness so they can stay mindfully aware to both the present moment experience and an implicit or explicit memory connected to the past.

Chapter 6 (“Complications of Treatment”) addresses the internal conflicts and struggles created by a history of traumatic attachment. Fisher warns therapists of the risk that clients with disorganised attachment patterns face when being misdiagnosed with borderline personality disorder. She presents practical skills relevant from the first session onwards, including listening for trauma-related themes through encouraging curiosity, psychoeducation about trauma and trauma treatment, and ways to stay mindful of patterns, themes, and triggers when gathering information from a new client. She describes how the trauma-informed therapist stays alert for signs of dysregulation and ensures that the client can stay present to intense feelings without dissociating or becoming dysregulated.

In chapters 7 and 8, unsafe and high-risk behaviours are recontextualised as manifestations of parts-related survival responses. Self-harming and suicidal behaviours can be better understood as attempts to cope with shame, rage, and fear. Similarly, clients with dissociative disorders benefit from understanding their fragmentation and learning to distinguish between different parts or ego-states responsible for a problem behaviour. Because the approach described in this book is mindfulness-based, it tends to be stabilising for clients and to facilitate deconstructing problems encountered in normal life, as well as trauma-related issues.

Chapters 9 and 10 encourage the reader to regard the resolution of traumatic experience as being dependent upon overcoming survival-related disowning of parts or ego-states. By cultivating attunement and compassion for young child parts in need of safe attachment, the implicit memories of early attachment rupture are repaired and healed. Rather than the therapeutic focus being centred on attachment to the therapist, the emphasis is on building empathy and attunement to different parts through mindfulness-based techniques. The therapist consistently asks the client, on behalf of young parts, to communicate, collaborate, and extend compassion to them, slowly building up a felt sense of an internal attachment figure, one who shares the same brain and body, one who might have once been the age of the parts but now is a strong, caring adult committed to creating a life different from the past: safe, nourishing, and relational.

In chapter 11 (“Safety and Welcome: The Experience of Earned Secure Attachment”), Fisher stresses the view that emotional healing of traumatic wounds is intrinsically linked to attachment. Integration of traumatised parts is not presented as a stand-alone goal of treatment, but as a process that occurs organically when mindfulness-based techniques are employed to bring awareness and compassion to the memories of inadequate bonding. The therapist facilitates moments of felt attunement, leading to the development and encoding of new implicit memories characteristic of earned secure attachment.

The appendices that follow Chapter 11 contain tools and worksheets to help with the tasks presented throughout the book and can be used by therapists to take up specific ideas in clinical settings.

The book is intended for use by a wide range of therapists and for an even wider range of clients, competently addressing the challenges faced by chronically traumatised individuals.

Fisher’s approach is unique as most psychotherapies lack the interventions to address posttraumatic physiological alterations directly. By synthesising bottom-up and top-down interventions, Fisher presents an effective roadmap for directly addressing the underlying causes of dysregulation in the body and nervous system that emphasises client safety and stabilisation. Importantly, this book uses easy-to-read language, inviting clients and practitioners alike. The author’s genuine regard for those who face the impacts of trauma shines throughout this text, bringing the ideas to life with compassion and sincerity.

References

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York, NY: Norton.

 

 — Alexandra Bloch-Atefi
alexandra.bloch-atefi@adelaide.edu.au

Alexandra Bloch-Atefi is a lecturer in the Graduate Program in Counselling and Psychotherapy at the University of Adelaide, specialising in trauma-informed and body-based modalities.

 


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