I began writing this month’s post at Harrison Hot Springs, on a week off from my practicum. During my only other week’s break in the practicum so far, over Christmas and New Year, I found myself refreshed when I returned, and I also found some of the people I’d been in conversation with changed: they’d had a chance to stand back a little from the counselling process, and to reflect, even if this was at a difficult time of year when normalized notions of family were everywhere. Something shifted, for both them and for me.

Inspired by this, we planned the second break for the end of February, with only six weeks of my practicum remaining after I returned. Harrison Hot Springs was an obvious choice. It’s two hours drive up the Fraser Valley from Vancouver. Before you reach Hope, you turn north, take a bridge across the Fraser, and drive across rich farmland to the lake. There’s a rambling, old-fashioned hotel there, which has expanded over the years. We treated ourselves to the newest section, the East tower, with a view up the length of the lake, hemmed in by mountains capped in snow that were white in the morning light, and then turned pink in the sunset. The weather was unseasonably cold, but dry: you had to rush out from the warmth of the hotel, peel off robes, towels, and slippers as quickly as you could, and submerge yourself in the soft warmth of the outdoor pools. It seemed that everyone in Vancouver had made the same holiday plans as us, and the pools were teeming with humanity: nothing orderly or ritualistic here, like a Japanese onsen, but somehow this Canadian gift of making do, accommodating each other, and muddling through. In the morning we’d walk around the artificial lagoon the town built out onto Harrison Lake, with its weeping willows permanently bent back by the wind and now swelling with buds.  One night we ate at the German schnitzel house on the waterfront, which has hardly changed since we first started coming to the resort decades ago. We returned, refreshed, to the Vancouver rain.

 In January and February, I realise I also cut myself off from much of the outside world. In one way of thinking this was quite sensible. Omicron was a real danger to my group of older adults with whom I who met in person in my family of origin group, and it made sense to minimize other contacts. UBC moved classes online for a month. Yet I also realise this is something in my nature, or at least a long habit that comes from childhood: if the going is difficult, I don’t reach out, but withdraw. In March, even before practicum ends, I’ve resolved to reach out more, to begin a process of opening to possibilities that will take me through the remainder of the year. This blog, and the narrative of self that has sustained me over the last few years, has centred on my training in counselling. As this part of my story comes to an end, I want to pause a little before I rush off into a new narrative, to be open to possibilities that come my way. I’m now much more distant from an academic world than I was three years ago, and yet critical questions still fascinate me. At the same time, I’m also conscious of the need to practice care, even when the larger politics of what I’m doing aren’t fully clear: the tension between critical and therapeutic knowledge and practices, present throughout my studies and training, continues.

One area in which this tension has been most acute for me over the last month has been in thinking through the current focus on trauma-informed care in counselling. Trauma is everywhere nowadays. An expertise in trauma-informed care is often listed in job advertisements for therapists. Our UBC graduate elective course on Stress, Coping and Adaptations Related to Trauma and Addictions fills up very quickly when registration opens, in contrast to, for example, electives such as the Cross-Cultural Counselling course, or Gender and Sex Role Issues in Counselling. In December, I found myself becoming anxious when preparing for sessions, and began working with a new counsellor. My family’s history of moving around when I was young, the counsellor explained to me, had resulted in a series of traumas that had influenced the way in which my sympathetic and parasympathetic nervous systems operated: anxiety was, in this sense, now hard-wired into my body.

The focus on trauma does, I think, have many positive possibilities in counselling and psychotherapeutic practice. I took an initial training in trauma-informed practice a year ago, and I’ve found elements of it useful in working in session, especially in its movement beyond the cognitive to embrace the emotional and somatic. Anyone who works in counselling practice will hear heart-rending stories of abuse, involving both victimhood and perpetration which can be readily viewed through the lens of trauma.  And I’ve also heard testimony from others about transformative work with individuals that used a trauma-informed lens. Above all, an awareness of trauma asks you not to make assumptions about the person with whom you are in conversation: it opens up new possibilities of empathy and understanding.

At the same time, I wonder about some possible excesses of trauma-informed practice. There seems to be a temptation, for instance, as my own experience showed, to see all presenting problems as sources of trauma within “adverse childhood experiences” which are recovered and then worked through in a variety of therapeutic modalities. And there’s something about trauma as a narrative that gives a lot of power to the therapist or the therapeutic modality: it’s a matter of “peeling the onion” of selfhood to reveal a hidden, fractured, interior, which needs to be restoried, integrated into a stable narrative of the self.  Finally, while there is a great deal of work, largely outside of psychology, on collective trauma or intergenerational trauma, much trauma work seems to be individualising. I write “seems” here, because much of what I’ve written in this paragraph is a kind of hunch or a reaction: I haven’t read the research deeply. 

With these thoughts in mind, I read the bible of trauma-informed therapy, Bessel van der Kolk’s The Body Keeps the Score. Originally published in 2014, the book has continued to be a bestseller over much of a decade, and indeed there’s evidence its sales have increased during the COVID-190 pandemic. In a prologue to the text, addressing an American audience, van der Kolk notes that trauma is not a distant phenomenon associated with PTSD from returning soldiers, but a domestic one:

Research by the Centers for Disease Control and Prevention has shown that one in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; and one in three couples engages in physical violence. (1)

At the end of his book, van der Kolk notes that the US is “on the verge of becoming a trauma-conscious society (347)”: in the eight years since the book’s publication, trauma has arrived as a central element of social discourse.

There’s much to admire about van der Kolk’s book. It’s written by someone at the culmination of a long and incredibly rich career as a psychiatrist and as a researcher. Van der Kolk writes of his experiences of living through deinstitutionalization, and the advent of antipsychotic medication, and later, in the 1990s, of SSRIs such as Prozac. He acknowledges advances made by pharmacology but critiques a “brain-disease model”in which medication is used without thinking of an individual’s relationships, need to communicate, capacity for physical self-regulation, and their social context. He then examines neuroscience and the connections between the brain and the body, and introduces polyvagal theory, centred on the connections that the vagus nerve makes between mind and body. This is central to his thesis that “the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems” (86). Given this bodily connection, trauma cannot be fully addressed by either medication or by talk therapy, especially cognitive interventions that focus on rationalization.

At times Van der Kolk’s book reads like a summary of many of the areas of contemporary counselling psychology I’ve studied: there’s a section on attachment theory, and then a review of alternative possibilities in working with trauma, including eye movement desensitization and reprocessing, yoga and mindfulness, the use of family tableaus in what Van de Kolk calls psychomotor therapy, neurofeedback, and participation in drama. 

What’s not to like? I’m bookmarking here something for future thought, but I’m intrigued by the rhetoric of Van der Kolk’s book, and indeed of many other popular psychotherapeutic texts, whether books, podcasts, or other media. On the one hand, and appeal is made to science, and to scientific studies that support arguments being made. On the other, Van der Kolk, resorts to anecdotes of clients he has worked with, which are described in detail, and all of which end in unqualified success. Yet there seems to be a “missing middle” here: carefully gathered qualitative data that would engage nuanced research: stories of failure, or limited change and transformation, placed in dialogue with stories of “success.” Quantitative data produced by application of experimental or correlational methodology is useful, but it isn’t uncontested, as Van der Kolk at times suggests. Different studies, for instance, have produced different assessments of whether EMDR produces better results in working with post-traumatic stress disorder than Cognitive Behavioural Therapy or postmodern, psychodynamic, or person-centred approaches. Even meta-analyses differ in their conclusions, and of course there are many fewer studies of humanist, postmodern, or psychodynamic approaches because they are difficult to manualize for a controlled study using the experimental method. 

And of course, after this reading, I return to the people I am in conversation with, often following what seems to work, listening, empathising, reflecting, and reframing, so that restorying begins to take place. In a month my practicum will be finished, and yet I feel I still have so much to learn.