Review from Ronald C. Naso, PhD, originally published at Division39.org:
In Theaters of Trauma: Dialogues for Healing, Richard Raubolt provides an unusual and compelling account of trauma and its treatment; unusual in how much it conveys about the inner workings of the therapist’s mind, compelling in its deep engagement with patients’ suffering. It is a haunting rendering of trauma’s legacy, accompanied by drawings that speak in a way that words cannot about experiences of loss, invalidation, and fragmentation. But more than this, Raubolt offers a glimpse of the toll the healing process takes on the therapist, no longer a detached observer, but a co-participant who must share the
immense burden of the patient’s pain. Raubolt’s account inspires hope about
the possibilities for healing through a process that leaves neither the therapist
nor patient quite the same as he or she was before.
Nowhere has it become
more fashionable to note how far
psychoanalysis has moved beyond
Freud than in the field of traumatology.
One effect of this sentiment has
been to restore to its rightful place
the importance of real events and of
traumatic impingements on the patient’s
life. But it must be remembered that
Freud (1930/1975) did not overlook
these matters entirely. Not only did he
notice that our bodies are subject to
deterioration and decay, but that we
remain ever vulnerable to forces beyond
our control as well as to the strain of
our relationships with others “The suffering that comes
from this last source is perhaps more painful to us than any
other . . . [and is not] . . . any less fatefully inevitable than
the suffering that comes from elsewhere” (p. 77). By taking
all three sources into account without privileging any one
of them, Raubolt offers a unifying perspective that is like a
breath of fresh air.
Raubolt begins this study with brief description of
his dissociative model of the mind that will be familiar to
the psychodynamically informed clinician. In both illness
and health, he proposes that we think and behave in ways
that are not easily reconciled. Following MacDougall
(1985), he describes these disparate perspectives as theatersor areas of private folly. Why folly? Because each reflects
but one aspect of our inherent multiplicity, the fact that the
perspectives and roles we occupy often are antinomious.
Populated by a veritable cast of characters, each of us
remains strangely unknown to ourselves. These characters
express themselves variously in our thoughts and deeds
as well as silently through bodily symptoms. Sometimes,
however, the patient cannot communicate his or her pain
by any of these means because without activating fears of
retraumatization. In such circumstances, the only way to
convey it is by evoking experiences in the therapist’s mind
and body where it can be formulated
safely. It is this third possibility that
Raubolt develops with particular
effectiveness in the fifteen clinical
vignettes contained in this book. Each
vignette describes the creative use of
countertransference reactions to decode
the patient’s inner world. His approach
is thoroughly intersubjective, centrally
concerned with how to fashion a unique
and viable intersubjective space within
each individual treatment.
Raubolt sets himself the
formidable task of speaking from “inside the wounds of trauma” (p.
7). He wants to convey the patient’s
experience from a first–person
perspective, which he endeavors to
accomplish by speaking in his own
voice and from his own perspective.
He describes his work with Missy, a
young, attractive woman whom, we learn, killed her father.
“As pretty as she was to others, Missy appeared monstrous
to herself . . . The act was simple enough; he died shoveling
the snow she had refused to shovel” (p. 17). Traumatized
by an act of omission, Missy could not forgive herself.
She was haunted by her refusal and, as a result, remained
completely cut off from others, unable to reach out to
them or allow anyone to connect with her emotionally. She
greeted the world with a seductive, if somewhat coarse and
jeering veneer, drawing them close only to abruptly push
them away. Beneath this facade was the terrible burden of
guilt she could bring herself neither to own nor relinquish.
She became increasingly involved in a series of petty thefts that cried out for a response. Raubolt movingly describes
his struggle to engage her pain, to re-frame her selfunderstanding
in a way that accurately captured her feelings
while drawing very different conclusions about them.
In reading this book, one is reminded of the
image of a mirror and the very important role of empathy
in the therapeutic relationship. What Raubolt mirrors to
his patients, however, is not so much their experience as
such, but those aspects of it that cannot be experienced or
entertained. Ever alert to the threat of retraumatization,
he eschews an experience–distant, interpretive approach
in favor of one that seeks a unique relatedness with each
individual patient.
Boulanger (2007) argues that the effective treatment
of trauma requires that the therapist be emotionally available
to the patient in the role of witness. As a witness, the
therapist models how traumatic experience can be tolerated
and later reflected on without emotional dysregulation.
Raubolt’s work extends this approach by a focused
examination of the therapist’s holding and containment
functions. At another level, Raubolt invites us to bear
witness to his struggle to contain unmentalized experiences
and to put them to good therapeutic use. He allows us,
at least in part, to occupy his mind, to see his patients
through his eyes. He writes as he works: with great courage,
imagination, sensitivity, and flexibility. He describes the
challenges of working with individuals who have been
victimized by loved ones and devastated by misfortune. It is
a humbling experience in which there can be no guarantee
of success. Raubolt meets this challenge with commitment
and with the conviction that examining the inevitable
disruptions and conflicts in the patient–therapist relationship
is the primary vehicle for healing.
References
Boulanger, G. (2007). Wounded by reality. Understanding and
treating adult onset trauma. Mahwah, NJ: Analytic Press.
Freud, S. (1975) Civilization and its Discontents. In J. Strachey
(Ed. & Transl.): The standard edition of the complete
psychological works of Sigmund Freud, 21, 59-148. London:
Hogarth (Original work published, 1930).
MacDougall, J. (1985). Theaters of the mind. New York: Brunner/
Mazel.
Ronald C. Naso
Stamford, CT
rcnphd@gmail.com
