Book Review: The Simple Guide To Complex Trauma and Dissociation: What it is and How to Help, by Betsy de Thierry.

Professional or Personal Perspective? Professional.

Genre: Non-fiction. Psychology.

Yay or Nay: Not sure. A bit of both.

Completion Status: Completed (though almost DNF’d due to the mismatch between title and content).

Worth Owning? Not for me.

Cost: $22 Canadian; $16 US (paperback).

Publication Year: 2021.

Publisher: Jessica Kingsley Publishers.

(Library) Borrowed or Owned? Borrowed.

Pros:

  • Does define complex trauma in simple, easy to understand words.
  • Designed to be used as an introductory guide to dissociation for professionals and parents/caregivers dealing with traumatized children who exhibit difficult behaviours. (Explains that what looks like deliberately bad, defiant, or “naughty” behaviour may actually be the result of survival-based dissociation).
  • Mainly designed to address the issue of Dissociative Identity Disorder in children, and how to help children who experience it. (And to a lesser degree, less severe forms of dissociation.)
  • Uses a significant number of references that can be used for further reading.
  • Some of the later chapters on “what to do about it” are ones I really enjoyed and found had useful information in them. (Especially Chapter 5 – on recovery and what adults can do; Chapter 6 “Creating Safety”; & Chapter 7 “Learning to Feel”).
    • Of particular note, Chapter 7
      • describes why feelings, and also physical sensations can be so hard for traumatized children to deal with.
      • Brings attention to some of the problems that a “one size fits all” approach to mental health can cause.
        • Eg., Mindfulness that isn’t trauma sensitive, and breathing exercises as grounding exercises can both be re-traumatizing rather than helpful for children experiencing trauma, or who are still in survival mode after the end of traumatic experiences.
  • The book seems to be referring Steven Porge’s Polyvagal Theory as a basis for much of it’s information.

Cons:

  • There is a significant mismatch between the title and the content of the book. The main focus of the book is severe dissociation (think Dissociative Identity Disorder) in children who have experienced relational (complex/developmental) trauma, rather than on complex trauma itself per se. As such, there is only a small amount of information about what complex trauma is etc.
    • A much more accurate title would’ve been A Simple Guide to Severe Dissociation in Complex Trauma.
  • I found the book focused far too much on severe dissociation and not nearly enough on the overal concept of what complex trauma is.
  • It would’ve been nice if the promotional blurbs would’ve made it more clear that this series is designed to be used by therapists and parents caring for traumatized children, and not as general introductory guides to the subjects mentioned in titles.
  • Sometimes the book sacrifices accuracy of information for uniqueness of terminology. It’s as if the author was so determined to rephrase things in her own words, she chose words that were less accurate than the commonly agreed-upon language found in professional literature (including that intended for laypersons).
  • Also has a tendency to use words that are too colloquial, (in an effort to simplify the subject matter) instead of using the commonly used medical terms. (e.g. uses “fit” instead of “seizure”). For a guide that is intended for professional use, this is surprising (and disheartening).
    • Uses a lot of British colloquialisms (granted she is British), such as “fit” and “off with the fairies” in place of medical terms. This makes it hard for non-British readers to understand the content being discussed, unless they are thoroughly familiar with these colloquialisms.
  • Uses confusing terminology when trying to distinguish between complex trauma (or Type II and Type III) and singular trauma (or Type I, aka “simple” trauma). Often contrasts the term “complex trauma” with “trauma”, as if there are no commonalities between singular trauma and repeated trauma. A simple grammatical change (such as I used in the previous sentence) could’ve clarified this greatly.
  • The grammar was often poor, making it difficult to understand what was intended to be conveyed. E.g., there were often too many examples in one sentence to keep track of what the intent of the sentence was. Other times there were several thoughts conveyed in the same sentence, which was often confusing. Separating the different thoughts into separate sentences would’ve clarified things greatly.
  • The author seems to be confused as to whether the concepts of “developmental trauma” and “developmental trauma disorder” (as proposed by Bessel van der Kolk) are the same thing, or two different ones. She often uses the terms interchangeably. (For the record, they’re different. One describes a general concept, the other a diagnostic term for potential inclusion in the DSM – Diagnostic and Statistical Manual – put out by the American Psychological Association).
  • Uses outdated and/or pathologizing language when describing other disabilities.
    • Compares Autism to Fetal Alcohol Syndrome and Epilepsy. Calls them all “medical challenges”, and “health and wellbeing issues”. Seems awfully close to calling autism a disease, to my mind!
    • Similarly calls ADHD a “mental health issue”, rather than recognizing it as a neurodevelopmental condition.
    • Refers to PTSD as an “anxiety disorder” (it was removed from the anxiety category, and changed to a trauma related disability in 2013 when the DSM 5 came out)
  • Uses the term “dissociation” without defining it until many pages later. Uses the term repeatedly before she ever gets around to explaining what she means. (I was always taught that this was a fundamental error to avoid when engaging in academic or professional writing).
    • Also uses the term “complex dissociation” without ever defining it. Whether she’s trying to say “dissociation in complex trauma” or “severe dissociation” or “extensive dissociation”, or something else entirely is unknown. Some unexplained personal shorthand maybe?
  • In her initial discussions of dissociation as an “abnormal” trauma response, she never mentions that a certain degree of dissociation is a perfectly normal part of every human being’s daily life (even those who haven’t been traumatized). She only finally mentions this much later.
  • Sometimes it seems as if the author is using references to back up what are otherwise flimsy arguments (at least the way they are phrased in this book).
  • The author seems to have difficulty being consistent when describing complex trauma – sometimes she refers to it as a single event, (eg., pg. 127) rather than an series of ongoing ones. Sometimes she uses the terms “developmental trauma” and “complex trauma” interchangeably, and other times as if they are somehow different entities. (In any of my extensive reading on the subject, the two terms are always used synonymously).
  • I had a lot of trouble understanding her description of her “Daisy Theory” that she’s developed to explain dissociation in children. Her description of it was nowhere near the “simple, easy to understand” explanation she claimed. It wasn’t until the very end of the book, and several more uses of the theory in different chapters, that I finally understood what she was trying to say.
  • Refers to interoception as an intentional “reflective process” , rather than as one of the senses (I’ve often seen it referred to as the “seventh sense” in any reading on sensory integration/sensory processing, or neurodiversity I’ve done).
    • Doesn’t mention sensory integration dysfunction (or sensory processing disorder) as a potential primary cause of difficulties with introspection. Only references trauma as a cause.

How to Presume Competence Without Dismissing Disability Support Needs.

Photo by Pixabay on Pexels.com

© Copyright March 2024.

I’ve been thinking lately about a couple topics that are prominent in the disability community currently. 1. The “autism is/is not a disability” argument. 2. The “presume competence” movement/philosophy. And as I was writing my blog post on the first issue (forthcoming), it occurred to me that those autistics who insist on the blanket statement that “autism is never a disability” are denying (or rejecting) some important aspects of the second topic. I started to get really angry at those who insist that autism cannot ever be a disability. I got angry because I realized that their behaviour was another example of ableism and intolerance being inflicted on me by people who presumed to know better than I do what living in my body, with my brain is like. People who have never met me, and know nothing about me. I realized that these people are engaging in beliefs and behaviour that is the opposite of presuming competence.

My life is already far too full of this type of behaviour, this rejection of who I am and what I know about myself. I get it from both neurotypical people, and (sometimes) from other (nonautistic) disabled people. I don’t need it from other autistic people too.

Because I present as a highly intelligent, decidedly capable person, able to handle many of the vagaries life throws at me, many people assume that’s all there is to me, and to my life. They then presume to know me better than I know myself, and insist that they are better informed about what my abilities, what my limitations are. Even when they’ve just met me, or barely know me. Even when they only know one aspect of me. They negate all of the self-knowledge I’ve gained in the decades since my disability diagnoses, all of the problem-solving skills I’ve developed. They negate all of the self-care skills and acceptance of myself as someone with limitations that aren’t commonly valued by society, that I’ve gained. They negate all of the self-advocacy and negotiation skills I’ve learned through the years, and all of the effort, time, and energy I’ve put into personal development and growth as a person.

These people who insist that they know me better than I know myself usually condemn me for practicing self-advocacy, often for even believing in self-advocacy, because it looks differently than they think it “should”. They condemn me because, in their opinion, I “shouldn’t need help” with the task I’m asking for help in. They often believe that I shouldn’t need help with anything at all, because I’m “too intelligent”, or “too capable” to be disabled, or to have cognitive or energy limitations in that area, or with that specific task, or part of the task. (And don’t get me started on those people who don’t understand that many ordinary tasks are often filled with individual components of varying degrees of difficulty, which may or may not make the overall task difficult or impossible to carry out for neurodivergent people. People who’ve never heard of executive functioning, or movement disorders).

These people negate not only my individuality, but my competence, my intelligence, and the independence I do have, with their presumption. They disempower me by their very claims that they are “encouraging my independence” – by negating my need for help, for support,

This is a side of “presume competence” that many people overlook.

Presuming competence is sometimes narrowly construed as “presuming a nonspeaking person is capable of thinking, feeling, and learning to communicate in some kind of conventional fashion (whatever form of AAC they use)”. But it is so much more than that. Presuming competence in a broader sense means that, absent concrete (and accurate) evidence to the contrary, the assumption should be that the disabled person in question is capable of learning the same things (though often in a different way) that a nondisabled person is, and participating in society to the same level (if they choose) that a nondisabled person is automatically granted.

In addition to these more often considered aspects, presuming competence also needs to involve the presumption that a disabled person is capable of self-awareness, self-monitoring, and self-advocacy. That disabled people deserve to learn these things, that we have the same right to autonomy that nondisabled people have. Presuming competence needs to involve the assumption that disabled people are capable of learning and practicing these essential survival skills, even if the end result looks different than it would for a nondisabled person. Of course, this requires that the authority figures and peers surrounding these individuals respect them and their needs enough to help them learn to pay attention to these needs – all of them, even the “inconvenient” ones (by nondisabled definitions).

Here’s a list of some of the most prominent “do’s” and” don’t’s” I wish people would respect when dealing with me (and other people like me):

DO:

  • Do presume I know myself well enough to know when I need help.
  • Do presume I know myself well enough to know when I’ve reached the end of my energy resources.
  • Do accept my use of assistive technology, no matter how “different” or “odd” it looks to you.
  • Do accept my use of AAC (alternative and assistive communication) technology.
  • Do allow me to switch between speech and AAC use without comment or judgement.
  • Do presume that I know better than you do when, where, why and how I need help with a task.
  • Do presume I’m competent enough to learn these things if I don’t already know them.
  • Do teach me these skills to me (in a respectful manner) if I don’t know them.
  • Do provide me the experiences and the support I need to learn these new skills, so that they become reflexive.
  • Do encourage me to practice these skills often.
  • Do presume I’m capable enough to use these skills independently once I’ve practiced them enough for them to become reflexive.
  • Do trust me to know myself, and know when I need to use my self-advocacy skills once I’ve gained these skills. (Don’t assume you know better than I do. You don’t live in my body.)
  • Do trust that I’m good at looking after myself and using these survival skills, especially as I gain experience using them and with having my needs respected.
  • Do trust me to communicate my support needs once I’ve learned to. (Even if that’s with a distressed facial expression, or other agreed upon subtle nonverbal signal rather than words).
  • Do respect my intelligence, my self-development, my growth as a person.
  • Do trust me to be capable of growth.

DON’T:

  • Don’t tell me (especially repeatedly) that I can’t possibly know what I need, or that my limitations are different than experience tells me they are.
  • Don’t insist that my difficulties are, or aren’t, what you think they “must be” because of the way you experience the same task(s), or other nonautistic people (especially NT people) do.
  • Don’t tell me that I “must be” trying to manipulate you, or that I am “acting dependent”, or that I “don’t really need help” when I do ask for help with a task (especially specific help).
  • Don’t tell me I need a different kind of help than what I’ve asked for. (You don’t live in my body, so you don’t know what I need, even if you have experience with other people with my diagnosis).
  • Don’t tell me that if I know the specific help I need that I can’t need that help. (Knowing what to do and knowing how to do it are two different things.)
  • Don’t tell me that I could or should “do it myself”.
  • Don’t tell me I’m “being obstructionist” if I continue to insist I can’t do a task on my own, or that it will be too hard to do alone. (The consequences in terms of loss of functioning in other areas – or all areas – afterwards may be harmful to my health).
  • Don’t say the above invalidating phrases when the difficulties involved are typical for autism. (Really, really just don’t!)
    • If you’re not aware enough of the types of difficulties autistic people have, learn. Or find employment in another field. (If you’re a family member, rather than a service provider, and choose not to learn, – or think it’s “too hard” to – then keep your judgemental opinions to yourself).
  • Don’t insist “but you could do this before”, and use it as an excuse for why you won’t help with a task. The nature of autism, and the nature of invisible disabilities in general is that our abilities fluctuate (sometimes drastically) from one moment to another, one activity to another, and one environment to another.
  • Don’t see me as only a case study, or a burden, or an obligation. I’m a real person, just like you.
  • Don’t see me as a damaged version of you (or of NTs/nondisabled people in general). I’m a whole person, just as you are.
  • Don’t confuse intelligence with executive functioning, or motor planning, or coordination.
  • Don’t confuse intelligence with linguistic skill or fluency.
  • Don’t confuse intelligence, or linguistic ability with ability to read nonverbal behaviour and interpret social cues.
  • Don’t question my need for AAC or assistive technology in general. If I’m using it, then I’ve decided it will help me live my life.
  • Don’t belittle my need for assistive technology (AAC or otherwise), or try to “wean me off of it”.
  • Don’t criticize me if I need to remove myself from an overwhelming activity.
  • Don’t prevent me from leaving an overwhelming environment for a safer one.
  • Don’t criticize me if I need to cancel participation in an optional (or social) activity because I’m too overloaded or burnt out, and have decided to prioritize my own health instead.

In short: Respect me for who I am, and allow me to make my own (age appropriate) decisions about my own life. Don’t insist that I pretend (consciously or unconsciously) I can function at a nondisabled level all the time. I’m not a nondisabled person, and should not be expected to be one.

Book Review: The Simple Guide to Child Trauma: What it is and How to Help, by Betsy de Thierry.

Professional or Personal Perspective? Professional.

Genre: Nonfiction. Psychology.

Yay or Nay: Yay.

Completion Status: Completed.

Worth Owning? Probably.

Cost: $22 Canadian; $16 US. (paperback).

Publication Year: 2017.

Publisher: Jessica Kingsley Publishers.

(Library) Borrowed or Owned? Borrowed.

Pros:

  • Simple, straightforward, (mostly) accurate information.
  • Easy to understand.
  • A good introduction to the types, causes and consequences of childhood trauma in children.
  • Many practical suggestions for therapists and parents/caregivers of traumatized children.
  • Does a much better job of describing developmental trauma than her book The Simple Guide to Complex Trauma and Dissociation, (which focuses mostly on severe dissociation, and not much on what complex trauma is). My review of that one is now here.

Cons:

  • Some of the grammar is awkward, and other times it’s lacking completely, which makes it hard to comprehend what the sentence is trying to say.
  • Some of the self-regulation exercises suggested for use with children in chapter 3 are vaguely described (or perhaps poorly named. e.g “square breathing” – which seems to have nothing to do with squares at all; “strong sitting” – which has nothing to do with sitting, and only to do with complicated movements of the arms),
  • Some of the self-regulation exercises suggested for use with children in Chapter 3 are not described at all (e.g. “star jumps”), so implementing them would be difficult for a reader not already familiar with what it is. It does no good to describe the usefulness of an exercise if you don’t know what it is or how to do it. (How does this differ from regular jumping?)
  • Very much UK focused, both in vocabulary and in suggested resources (with a few US ones included). Also in assumptions or statements about the state of knowledge about trauma in practitioners.
    • Insists repeatedly that knowledge of trauma among psychologists and other mental health practitioners, especially those dealing with children, is virtually unheard of. This has not been the case in North America for many years now, so I’m assuming it’s a difference between countries, as I know knowledge of other forms of disability varies greatly in different countries.
    • *Trauma knowledge is generally still a specialty in North America, and needs to become more widespread and commonplace, but it’s far from unheard of for psychologists and their colleagues to be trauma-informed.