Book Review

by

Constance I. Dalenberg

2000, American Psychological Association

Reviewed by Fran Grossman, Ph.D.

I first saw Constance Dalenberg’s work when I was leafing through the ISSD newsletter some months ago. There was a column on dealing with therapists’ own reactions to very angry clients, and since I was then struggling with my own feelings towards such a client, I read it eagerly. A doctoral student of mine who is just beginning to treat trauma patients has it now, so I no longer have the column to refer to, but I remember it was tremendously helpful. I then ordered her book, Countertransference and the Treatment of Trauma, which has turned out to be as helpful and appealing as the column.

There are nine chapters, the first two discussing broad issues about countertransference and reviewing the research and professional literature on this topic. The next six chapters focus on specific aspects of treatment of traumatized people that often evoke strong countertransference reactions. In the final chapter, Dalenberg talks about the life history of the transference through trauma resolution.

Dalenberg, who is herself a clinician, with colleagues carried out research at the Trauma Research Institute in La Jolla, California. Her book is based on data from five major studies, as well as from her own clinical work and case histories written by others. The studies include the Trauma Countertransference Study, for which they interviewed 84 clients with trauma symptoms about their therapist; the Child Disclosure Study, for which they studied more than 3000 taped interviews of children being interviewed by expert forensic interviews; the Sexual Countertransference Study, for which experienced and inexperienced therapists listened to professional actors portray sexual transference themes and then responded to these on tape; the Holocaust Remembrance Study, for which 30 survivors were interviewed about their experiences telling their stories; and the Standards-of-Care Study, an experimental study in which the punitive behavior towards children by trauma survivors was assessed. This extensive and rich database is beyond any I know of as a basis for such a clinical book. Out of it, Dalenberg creates a fascinating and helpful book.

For example, Chapter 3 addresses "Speaking trauma: the inadequacy of language in trauma treatment." Dalenberg articulates those moments when it is not only the patient who is speechless, who says there are no words to describe what the traumatic experience was like, but when we therapists also feel that anything we say will be inadequate and trivial in the face of the horror and evil. Dalenberg makes clear from interviews with patients that they often interpret their therapist’s silence as blame or indifference. Dalenberg suggests that one solution is for us to directly "face the inadequacy of language" in our work. She cites a phrase from a book by Lawrence Langer, "controlled inaccuracy," as capturing a reasonable goal for both therapists and clients and quotes the following from a client:

"I guess the most helpful thing my doctor did…well, this is going to sound strange, but he tried to guess what it must have felt like to me as a kid. And when he was groping for the words he just hit on a couple that worked. And until that happened, I couldn’t grip them in my mind, you know? They kept slipping away. His descriptions weren’t exactly right, but they were like sandpaper. My own truth stuck to his words well enough for me to trap it and talk about it." (p. 62-63). Dalenberg gives other examples of ways to deal with our own felt inadequacy in putting words to horrific experiences, such as constructing individually designed metaphors.

She writes with a deep humanity about patients and therapists, and the complicated relationships we find ourselves in with each other. This is a book that trauma therapists should buy and read and re-read when the necessity arises.

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