American Journal of Clinical Hypnosis

ISSN: 0002-9157 (Print) 2160-0562 (Online) Journal homepage: https://www.tandfonline.com/loi/ujhy20

Pearlman, Laurie A., & Saakvitne, Karen W. (1995).

Trauma and the Therapist: Countertransference
and Vicarious Traumatization in Psychotherapy
with Incest Survivors. New York: W.W. Norton, xix,
pp.451, $40.00

Laura S. Brown Ph.D., ABPP

To cite this article: Laura S. Brown Ph.D., ABPP (1996) Pearlman, Laurie A., & Saakvitne,
Karen W. (1995). Trauma�and�the�Therapist:�Countertransference�and�Vicarious�Traumatization
in�Psychotherapy�with�Incest�Survivors. New York: W.W. Norton, xix, pp.451, $40.00, American
Journal of Clinical Hypnosis, 38:4, 298-299, DOI: 10.1080/00029157.1996.10403354

To link to this article: https://doi.org/10.1080/00029157.1996.10403354

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 Book Reviews
Book Review Editor: Etzel Cardena
Pearlman, Laurie A., & Saakvitne,
Karen W. (1995). Trauma andthe thera-
pist: Countertransference and vicari-
ous traumatization in psychotherapy
with incest survivors. New York: W.W.
Norton, xix, pp. 451, $40.00.
Vicarious traumatization I: The cost
ofempathy (46 minutes), Vicarious trau-
matization II: Transforming the pain (40
minutes). Videos distributed by Caval-
cadeProductions, Ukiah, CA. Purchase:
$150.00/each, two for $250.00. Rental:
$50.00/each, twofor $85.00. Comes with
Viewer's Guide: Treating therapists with
vicarious traumatization and secondary
stress disorders.
Laura S. Brown, Ph.D., ABPP
Seattle, WA
This book and the videos that comple-
ment it are not about hypnosis. How-
ever, they are likely to be of value to
clinical users ofhypnosis who treat sur-
vivors of repetitive trauma. In fact, this
volume represents what this reviewer
considers to be a new essential compo-
nent in the collection of any therapist
who ventures into the very challenging
yet profoundly rewarding field oftrauma
treatment. In Trauma and the therapist,
Pearlman and Saakvitne provide their
readers with a dense yet very readable
description ofthe experience ofthe thera-
pist who is exposed on a regular basis to
the painful stories, intense affects, and
sometimes difficult interpersonal styles
298
of clients who have been repeatedly vic-
timized. In the process ofoffering readers
this clinically rich material, the authors
present their theory of what they label
"Vicarious Traumatization" (VT) as a phe-
nomenon in the inner life of the therapist.
It is the concept ofVT, and its elucida-
tion in this book, that are central to its
significance as a contribution to the litera-
ture on trauma treatment. Vicarious trau-
matization is defined by Pearlman and
Saakvitne as the cumulative impact on
therapists ofbeing exposed, across many
clients and psychotherapy sessions, to
material thatwill transform therapists and
their world view. This framing ofVT as a
phenomenon that represents the phenom-
enological interface oftherapist and inter-
personal environment, goes beyond pre-
viously available paradigms of counter-
transference, "compassion fatigue," or
secondary traumatic stress. Because it is
a concept with profound utility for thera-
pists, this book is one that should accom-
pany the training of therapists of any
theoretical or technical orientation who
work with this population.
There are a number ofstrengths to this
book. They include an elegant description
of several models for understanding the
impact of trauma on functioning, includ-
ing a review of the constructivist self de-
velopment model (CSD) that was first pro-
posed in an earlier book by Pearlman and
her former colleague, Lisa McCann. This
integrationist review makes the book more
accessible to a wider range of therapists,
as few theoretical orientations are entirely
slighted. The book's flavor and some ofits
language lean toward the psychodynamic
Amer J Clin Hypn 38:4, April 1996
BOOK REVIEWS
at times, reflecting author Saakvitne's
deep roots in that tradition, but we are
never caught up in psychodynamic jar-
gon that might render the text unattrac-
tive to those of us unfamiliar with psy-
choanalytic concepts.
A second important strength of this
book is the manner in which it makes the
experiences oftherapists transparent. For
many traumatherapists, workingwith sur-
vivors canbecomea re-experiencing ofthe
shame, silence, and isolation that were an
aspect ofthe clients' trauma, adynamic that
theauthorsexaminecarefullyintheiranaly-
sis ofthe process oftraumatic transference/
countertransference reenactments in
therapy. This book goes a long way toward
breaking such isolation with a plethora of
vignettes that rang loud and true for this
reader. Anumberofthetherapistsforwhom
I consult, and for whose use I have recom-
mended this book, have had the similar
experience ofa positive shock ofrecogni-
tion in its pages.
Although the authors use as their para-
digmatic trauma the experience of child-
hood sexualvictimization, their model and
its utility is not limited to therapistsworking
with this population. Because this particu-
lar trauma is one that is very likely to elicit
thedynamics thatcontribute to VT, includ-
ing a destruction of the therapist's own
priorworldview, naivete, and sense ofper-
sonal safety, it seems an excellentchoice as
a focus for the development and presenta-
tion of the VT concept.
The only striking deficit I encoun-
tered in this volume, one which carried
over into the videotapes as well, was a
complete inattention to cultural diversity
and the interactionofculture with trauma
and VT. There were a number ofjunctures
in the book where this could have easily
been integrated into the discussion and
was not. In the videotapes, all of the
AmerJ Clin Hypn 38:4, April 1996
therapists appeared to be Caucasian. This
disappointing omission follows anunfor-
tunatetrendinotherwiseexcellentandclini-
cally rich literature on traumatic stress in
which issues of race, class and culture are
simply not present in the discourse.
The two videos that accompany the
book areless powerful, but a nice accompa-
niment to the reading experience. They
consist of many interviews with trauma
therapists discussing their experiences of
VT in the first video and strategies for
copingwithand reducingVT inthe second.
These interviews are accompaniedby com-
mentariesfromPearlman and Saakvitne in
which thebasic framework forthe concept
ofVT is described.
I do not think the videos stand well
alone without the book, although a help-
ful viewer's guide that consists ofa book
chapterby Pearlmanand Saakvitne with a
condensed introduction to the VT con-
cept is included. However, if I had not
read the book, I would have found the
videos harder to attend, since they are
purely talking heads with no other mate-
rials to entertain the eye. They would
probably be helpful in the context of a
course or workshop on working with
trauma survivors in which the instructor
would stop the tape after each comment
and invite class interaction; they simply
do not substitute for the book itself.
In summary, this is a book well worth
owning, reading, and re-reading. It has
already proved of help to me in dealing
with a number of complex and puzzling
clinical challenges. Most importantly, it
opens the discourse, previously hidden
in the private offices and lives oftrauma
therapists, about what happens to the
therapist's own view of the world when
exposed daily and hourly to tales ofinhu-
manity and terror, tales that are only too
likely to continue to be told in comingyears.
299