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Related Topics
Rebuilding Shattered LivesReview - Rebuilding Shattered Lives
The Responsible Treatment of Complex Post-Traumatic and Dissociative Disorders
by James A. Chu
John Wiley & Sons, 1998
Review by Kelly Lemmon-Kishi, ACSW CTS
Jul 31st 2000 (Volume 4, Issue 31)

Rebuilding Shattered Lives is a state-of-the-art guide that has much to offer those who work with clients with complex PTSD and Dissociative Disorders. Compassionate, eloquent, and balanced, James Chu takes a strong stand for rational and responsible treatment. Responsible treatment means having strong theoretical cohesion linking research with practice, being exquisitely sensitive to clients' inner worlds while maintaining objectivity, and living the belief that clients have ultimate responsibility for wresting their own demons. Chu follows his own advice and writes with the honesty, flexibility, integrity, and humor that he advocates for clinicians, making his book a delightful read as well as an authoritative text.

Chu is writing for mental health practitioners who already have a solid background in trauma theory and research. He seems to assume that the reader will be familiar with the work of Judith Herman, Lenore Terr, Bessel van der Kolk, Diane Russel, Richard Kluft, and other acclaimed researchers who have spent the last two decades building empirical knowledge base for trauma theory and testing therapies. Rebuilding Shattered Lives starts where Trauma and Recovery ends - the treatment of the condition Judith Herman so eloquently described.

This is Chu's first book, although he has authored many articles and book chapters. As the director of the McLean Hospitial Dissociative Disorders and Trauma Program, assistant professor of Psychiatry at Harvard Medical School, and past president of the International Society for the Study of Dissociation, Chu is an eminent researcher, practitioner, and teacher. This book advocates and demonstrates the masterful and timely use of eclectic treatment modalities including cognitive behavioral therapy, several psychodynamic therapies, and family systems work. Rebuilding Shattered Lives is no cookbook; Chu emphasizes the need for a sound theoretical framework to guide the clinician in using a variety of techniques differentially.

"Part one" grounds the reader in trauma theory and its historical development.

The first five chapters provide the theoretical underpinnings for the treatment strategies that are detailed in the next section. Exceptionally well written and grounded in the research, these chapters also demonstrate Chu's empathy with the challenges of therapeutic work for therapists as well as clients with complex PTSD - often known as borderline personality disorder.

In the chapter "The nature of traumatic memories of childhood abuse," Chu takes on one of the biggest controversies in the trauma field - the issue of recovered memories. His conclusion is that "…horribly abused children do forget. However, when individuals begin to recover memories of past traumatic events, it remains unclear to what extent these memories reflect the actual events." In this realm as in all others, Chu's emphasis is on responsible treatment. While he shows that "there is little evidence that direct questioning about abuse per se results in false memories of abuse," he also strongly cautions that "therapists must be careful not to enquire about possible abuse in a way that even subtly suggests a particular kind of response," should "avoid coming to premature conclusions when there is insufficient evidence to support the actual occurrence of abuse," and must "scrupulously avoid regressive clinical practices" (p. 70).

The second section, focusing on "Treatment principles for complex trauma-related disorders," is the heart of the book. It is required reading for anyone working with this population. He explains and advocates for stage-oriented treatment. He focuses on the first stage of treatment; what must be accomplished BEFORE directing attention specifically to the abuse experiences is contained in the mnemonic SAFER: consistent and healthy Self care and Symptom control, Acknowledgment of the key role of early trauma, maintaining appropriate level of Functioning, non-destructive and therapeutic Expression of feelings, and Relationship issues (particularly the therapeutic relationship) must be in place to create a solid foundation before the client engages in any sort of reworking or abreaction of the abuse. All five chapters are gems, but the excellent discussion of suicidality and suicide management in the chapter on self care and brilliant, empathetic, and humorous analogy about trust issues in the chapter on boundary issues are particularly valuable.

The last three chapters are rather different from the rest of the book. It is as if four interesting papers on issues that no book on PTSD can be without are appended. Although addressing important issues such as acute care, "impossible patients," and pseudodissociation, these chapters are an unpleasant change from the smooth comprehensive writing of the earlier 11 chapters. There are many important warnings about commonsense clinical pitfalls, however, that make the chapters well worth reading.

Rebuilding Shattered Lives offers no easy answers or quick solutions. Responsibly treating survivors of severe and chronic abuse takes time, resources, creativity, skill, and a dedication to clinician self care that does not mesh well with managed care dictates, but it is the only path to healing.

Kelly Lemmon-Kishi has been in private practice since 1994, offering individual and family therapy as well as disaster response services in Japan. She is currently in the US pursuing a Ph.D. in Clinical Social Work at the Smith College School for Social work.


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