Book Review: Emotionally Focused Therapy with Trauma Survivors: Strengthening Attachment Bonds

I had a direct professional interest in reading this book; I work in a psychology department of a major transport organisation assisting clients after a traumatic event.

It had often been a point of enquiry between me and my colleagues on the central importance of the phenomenon coupledom between a traumatised client and his/her partner. Our working environment dictates that we only work with the traumatised person, consequently a fundamental resource or supportive input is not being directly accessed and processed: due, in part, as we had not the theoretical template from which to address trauma in relationships. It was this fundamental fact, the acknowledgement of the central facticity that humans are relational, and moreover, that this intersubjectivity could be worked with differently in traumatised relationships, that whetted my appetite.

I found Emotionally Focused Therapy with Trauma Survivors to be a well balanced book. Its eleven chapters carefully crafted to illustrate and illuminate its central thesis and I quote 'EFT [emotionally focused therapy]/couple therapy has a vital role to play in addressing the interpersonal effects of trauma and helping partners to turn their relationship into a safe haven' (p5). Those who may not be overly versed in Bowlby's theory of attachment, will find a passionate and focused hands-on exposition of attachment and its links to trauma. This work does not provide therapists with revolutionary insight into something extraordinary. We are all, I'm sure, aware of the importance of the relationship, the centrality of the connection between two humans, particularly those in intimate union. What Johnson has done is to provide a frame from within which therapists can not only appreciate limitations of one-to-one support for traumatised persons in relationships, they can also conceptualise that the traumatised person's trauma can impact upon the un-traumatised partner – either entrenching behaviours (withdrawal, argumentative exchanges etc.) already manifest or arousing latent traumatic events in the partner. And, importantly, she provides a solution.

Emotionally Focused Couple Therapy with trauma survivors is divided into two distinct complementary categories. The initial section takes the reader through a very comprehensive overview of the theoretical philosophical underpinning of couple therapy, along with being embellished with social data – albeit American – on rates of abuse/events that result in traumatised individuals. We're also provided with a summary of the diagnostic categories of PTSD and how such diagnoses or other abusive life events can have a critical effect on an individual's ability to relate to another person.

To this end the reader is introduced to the concept of a multifaceted phenomenon, what Johnson described as the dragon, the significant occurrence that occasioned the emotional symptoms now being resolved in couple therapy. Symptoms that, she seems to imply, because of the nature of attachment, now threaten the fabric of not only the individual's capacity to cope with him/herself but also the capacity of the relationship to survive, as both partners struggle between them to make sense of what's happening. And in that in-between, that struggle, a new, possibly destructive relatedness is created that undermines, as it impacts upon the individuals' ability to cope, by destroying the safe haven within relationships. By setting the scene in this way the reader is oriented, successfully I feel, towards the raison d'être of the book. And the solution that Johnson has identified is to work carefully through three interrelated therapeutic/clinical stages of stabilisation, restructuring and integration.

This process forms what might be called the scaffolding within which the theoreic/clinical applications can be applied. Stabilisation, Johnson divides into two sections, commenting that this process is not only the creation of a safe context it is also serves to clarify the couple's interactional patterns (p87). Of the second aspect, restructuring, she says the the therapist collaborates with the partners in three tasks. First is the restructuring of the partners' emotional experience in the relationship, and second is the use of new emotional experiences to revise the partners' associated sense of self. Third, the therapist sets interactional tasks' to bring new and more positive interactions by partners (p100). Finally Johnson works to instil a process of integration. This part of the engagement between therapist and clients' is done on three levels: self determination, relationship definition, and an exploration of each partner's resilience to traumatic stress. Johnson points out that the The first task is for the therapist to help integrate newly processed emotional experiences and new self-schemas into both partners' sense of self; the second is to integrate new kinds of interaction and finally the ensuring that the new ways of coping with the ghost and scars of trauma are explicitly integrated into models of self and into the relational system (p107).

What becomes evident from the above is that the process of bringing to the open issues that require normalisation; the engagement with such issues in order that a new mindset/approach can be formulated and adoption/adaptation of changes in every day communications, may appear discreet, yet they are integrally interconnected and as such intricately delicate to achieve.

In the second part of the book, wherein Johnson provides clinical vignettes of varying presentations, Emotionally Focused Therapy with Trauma Survivors truly comes alive. Here she provides sales demonstrating how EFT provides a context for the traumatised client, a social context that is in and of itself an essential aspect of both partners' experiential world. Unlike other approaches that significantly focus upon the traumatised client EFT not only affirmed the traumatised client but also directly reinforced and developed the inter-subjectivity between couples whilst also highlighting and addressing long standing psychological blockages that made such attachments between couples difficult. It is here that Bowlby was truly enlivened.

Whilst accepting that Johnson does acknowledge that there are many modalities that can and do work with traumatised clients, there is non-the-less a strong assumption that therapy will not be as effective unless both partners are present. Johnson indicates, by default, that those therapists who work with clients on a one-to-one basis, whilst being aware of their clients' partners, are not able to reach beyond the didactic relationship of the therapeutic encounter, to impact upon the in-between of the traumatised client and his or her partner. This, in my experience is not always the case. The client, depending upon a number of factors, not least the degree of trust established between him/herself and the therapist, can be significantly assisted along the tentative path of new encounters with his/her partner. With the therapist, the client can begin to develop an intimate and personal appreciation of the somatic and psychological changes that they have undergone. From this burgeoning awareness the client, assisted by the therapist, may reach out gingerly and delicately to his/her partner.

It should also be borne in mind that contemporary loving relationships are recognised as being expressed in many ways. Successful unions are to be found in long term unmarried common-law arrangements as well as between same sex couples. Whilst no specific comments were expressed to suggest that Johnson did not approve of liaison other that of the married heterosexual type, her not infrequent comments/observation about husbands or wives, could seem to indicate a preference. A more open narrative may have felt more inclusive of other human loving encounters.

Emotionally Focused Couple Therapy is a very informative book. It held my attention from cover to cover. I felt Johnson ably demonstrated how the couple can be both worked with therapeutically to ameliorate psychological distress and cause the exasperation of distress. And, not withstanding the points of concerns highlighted.

Johnson's EFT has most definitely brought another level of awareness, when working with traumatised clients, to the therapeutic table.

Errol B. Dinnall