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Critique of 20th Anniversary Edition
on January 11, 2010
I have just read the 20th anniversary edition of Courage to Heal. As a therapist working the field of mental health for 40 years with a specialty in working with abuse survivors and their PARTNERS, I was stunned to see that the book, while purporting to be an update of the 1988 edition is essentially the same as what was written in 1988 despite the fact that over the past 25 years we have made enormous gains in understanding and treating abuse/trauma from a research and clinical treatment perspective. The general message of the book is that the healing process will be most likely a long process, and focuses on "healing" processes such as writing in a journal, meditation, accepting the abuse as a reality and a brief mention of the value of medication to assist in managing painful and often, at least temporarily, seemingly uncontrollable painful thoughts and emotions. While posing as new, updated knowledge about the healing process about healing from trauma, I was absolutely stunned to discover that there was not one word about the extraordinary new understandings about the effects of abuse/trauma seen later in adult life and methodologies for treating abuse related symptoms. Each of these new therapeutic methods has been extensively researched and shown to lead to extraordinarily more effective methods for treating the after effects of trauma/abuse, shortening the recovery period and producing enduring positive effects. Everything from PTSD symptoms, negative cognitive processes (negative self-thoughts), the effects of distorted memory, the dissociative states as well as many other issues that profoundly impact upon the survivors themselves and their PARTNERS and are the real targets of the healing process received only the barest of recognition and explanation. Earlier complaints by readers that the book was very much overly simplistic and often ultimately left clients feeling discouraged because their situations were invariably more complex will undoubtedly be revisited by contemporary readers. When I have presented this new research and clinical material to participants of my workshops, ongoing groups for PARTNERS and couples in conjoint therapy, to a person, there was a collective sigh of relieve and recognition of the complexity and power of often unconscious processes that make the problems survivors face to seemingly intractable and grueling. The new research and clinical practices address this sense of overwhelm and confusion and have proven to be invaluable. Instead of just saying that their symptoms are not their "fault" this new information makes their sense of helplessness and powerlessness understandable and at the same time offers new hope.
Also, the book does not address the massive amount of research that links abuse/trauma to a whole host of other disorders (besides PTSD) with which survivors must contend including, depression, pervasive anxiety, somatic correlates, and a other psychiatric, emotional and physiological symptoms to name a few, that truly address the utter complexity of the aftermath of abuse in adult life. While paying the obligatory homage to the new brain science that has revolutionized our understandings the section on "Trauma and the Brain" is particularly discouraging in its simplistic explanations.
Finally, perhaps most disconcerting is that the book makes NO mention of the new methods for treating trauma ranging from EMDR (Eye Movement and Desensitization and Reprocessing) procedures, cognitive behavioral approaches (CBT), DBT (Dialectical Behavioral Therapy), especially for those suffering from character disorders such as borderline personality disorder, helpful couples approaches to healing and so on that have been developed and proven to be invaluable to the recovery process. Essentially this version of Courage to Heal throws us, survivors and therapists alike, back more than 30 years into the extremely limited and marginally useful approaches to healing which we now know can potentially lead to even further revictimization survivors related to their internal states. Earlier complaints by therapists and others that the authors are not clinicians and are dealing with issues they don't truly understand is yet again validated.