Bessel van der Kolk, M.D., one of the leading voices in the field of trauma and the author of The Body Keeps the Score, writes, ““Trauma, by definition, is unbearable and intolerable.” However, his research also shows that healing is possible. Specifically, van der Kolk describes three avenues for “help[ing] survivors feel fully alive in the present and move on with their lives.”

Before we jump into these three avenues, I want to speak a bit more about what it means to “heal” from trauma. Healing does not mean forgetting. Attempting to live life as if the trauma never happened is not only impossible, it’s unhelpful. Healing is found when we are able to integrate the experiences from our past into our current experience of life, or as van der Kolk describes, by “feel[ing] fully alive in the present and mov[ing] on with their lives.” Trauma keeps us trapped in the past, but healing from trauma enables us to live fully in the present moment. 

Van der Kolk describes three avenues for recovering from trauma: (1) top-down, (2) bottom-up, and (3) medicine. Every person who seeks treatment for trauma will find one or a combination of these three avenues helpful, and what works is unique to each individual.

Top-down

Top-down healing includes “talking, (re-)connecting with others, and allowing ourselves to know and understand what is going on with us” (van der Kolk, The Body Keeps the Score). While healing can and often does occur outside of a relationship with a therapist, it can also be helpful to work with a professional who specializes in the treatment of trauma, because they will support you in talking about trauma in a safe and helpful way. I often utilize narrative therapy to guide clients in talking about traumatic experiences. This approach allows clients to process their past experiences while also empowering them to take ownership of their own story. Support groups, in which you can connect with other survivors, can also be a helpful way of facilitating a top-down approach to healing.

Bottom-up

Hillary L. McBride, in The Wisdom of Your Body, writes, “Trauma does not happen to our thoughts but to our bodies - and it remains in our bodies until we know we are safe. Therefore, we cannot process trauma only by thinking; we have to use our whole selves, including our physicality.” Bessel van der Kolk describes this approach to healing as “allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma.” The importance of the body in the healing of trauma is precisely why I describe myself as a body-centered therapist. The body is central in the integration of trauma (another way of saying “healing” or “recovering”). To learn more about the brain-body’s role in the experience of trauma, please read Part 1 of this series on Understanding Trauma. 

As doctors, researchers, and therapists gain a better understanding of the impact of trauma on the physical body, many therapeutic modalities have been and continue to be developed that specifically focus on the body. The approach that I most often use within my practice is mindful movement, yoga, breathing, and developing a relationship with your body (just as you would with a friend or significant other). One specific evidence-based modality that is gaining in popularity is Trauma Center Trauma Sensitive Yoga, which Dr. van der Kolk discusses in The Body Keeps the Score and which I am currently training in. Other bottom-up approaches include Somatic Experiencing and Sensorimotor Psychotherapy. 

While working with a body-centered therapist can be helpful, it is not the only way to incorporate the body in the healing of trauma. Mindfulness meditation, including, for example, Mindfulness-Based Stress Reduction, can be an approachable at-home method for reconnecting with your breath and body. Dancing, mindful movement, walks in nature and anything else in which you are honoring and connecting with your body, can be helpful, especially in conjunction with professional trauma-focused mental health treatment. 

Medicine

The third avenue for healing from trauma as described by van der Kolk is medical intervention. Van der Kolk describes the effect of medicine as “shut[ing] down [of] inappropriate alarm reactions.” Just as talking and a bottom-up approach do not work equally for every body, medical intervention is sometimes appropriate and helpful, but can also be ineffective, depending on a person’s unique needs, environmental factors, and biological make-up. A skilled psychiatrist is the most effective person to speak with if you are interested in medication, and psychiatrists and psychotherapists often work together to implement an appropriate and effective treatment plan that includes psychopharmacology in conjunction with talk and/or body-based therapy. 

If you are interested in learning more about how I, or another trauma therapist, can help you on  your journey, please reach out to schedule a free consultation. 

If you are interested in learning more about trauma on your own, I highly recommend the following resources:

The Body Keeps the Score by Bessel van der Kolk, M.D.

The Wisdom of Your Body by Hillary L. McBride, Ph.D.

What Happened to You? By Dr. Bruce Perry and Oprah Winfrey

Your Number Story website

To read the previous posts in this series:

Part 1

Part 2

Part 3