The Link Between Childhood Trauma and Mental Illness: Effective Interventions for Mental Health Professionals.

Barbara Everett and Ruth Gallop Sage Publications, Inc. Thousand Oaks, CA 2001, 330 pages $24.95 (paperback)

In The Link between Childhood Trauma and Mental Illness, Everett and Gallop have written a helpful handbook for mental health and rehabilitation professionals who do not necessarily specialize in work with survivors of childhood trauma but who may be both the first to hear clients' stories and to work most intensely with these clients when they are in crisis. The authors focus on childhood trauma that results from sexual and physical abuse, and they provide a thorough history of work done with survivors of those traumas, identifying theories that have underpinned that work and discussing barriers to individuals receiving help. They outline barriers that have occurred within clients themselves, within helping professionals, within systems of care, and within the culture as a whole. Everett and Gallop move smoothly from theory to practical application. They discuss how to identify indicators of childhood trauma, how to ask clients about abuse, how to listen to stories about abuse, how to effectively intervene with and treat trauma, how to help clients stay safe as they struggle with their issues, and how professionals can care for themselves as they experience the effects of secondary traumatization. The book is rounded out with three chapters by guest authors: "Crisis Care" by Lee Ann Hoff, "The Invisibility of Men's Pain" by John McManiman and "Racism, Oppression, and Childhood Trauma" by Kathy J. Lawrence.

Relying heavily on the research and clinical work of experts such as Herman, van der Kolk, and Courtois, the authors develop and propose using a multidimensional model that honors the complexity of childhood trauma and examines its connection to mental illness. This model takes into account factors such as genetics, biology, relationships with others, sense of self and worldview, the nature of traumatic experience, and the social and cultural contexts within which the trauma occurs. The model accommodates the various ways in which these factors interact and how these interactions indicate the impact of abuse and its links to mental disorders.

The authors bring strong professional credentials to the writing of this book. They both have clinical, administrative, academic, and consulting backgrounds with specialization in the areas about which they write. This book is well written, providing clear and thorough discussions of the topics it covers. Perhaps the greatest service it provides is in its examination of complex posttraumatic stress disorder as a diagnosis that would replace borderline personality disorder for survivors of childhood trauma.

Using Herman's conceptualization as a starting point, the authors articulate the clinical and political implications of a diagnosis of borderline personality and question whether any individual who has suffered childhood trauma should ever receive it. Describing the negative attitudes mental health professionals often direct toward clients diagnosed with borderline personality disorder and the subsequent inappropriate treatment clients may receive, the authors challenge professionals in the field to work within their multidimensional framework. The framework permits mental health professionals to see the impact of abuse through discernable symptoms and behaviors. Everett and Gallop report that beginning work within this framework allows for hope that positive changes in functioning can occur for survivors of childhood trauma.

Even though it is important to have included information about men's victimization and about the added burdens that victims of color face, the authors would have done better to have written these chapters themselves. The chapters by McManiman and Lawrence are interesting, and each would stand alone as an article or as chapters in an edited volume. In the format of this book, however, they seem tacked on, and the different voices with which they speak are jarring and distracting, particularly since they come before a final excellent chapter that deals with the importance of self-care for mental health professionals.

In summary, the authors have created the book they hoped to. It is a thoughtfully done, thorough, and helpful book for mental health professionals who often have to deal with survivors of childhood trauma but who do not have special training in this area of practice. Everett and Gallop state that they have written it for "psychiatric nurses, case managers, rehabilitation counselors, crisis and housing workers, occupational and physical therapists, family physicians, and social workers" (p. xi). I would recommend this book for all of these individuals, and I would add a further recommendation. I believe that this is an excellent handbook for graduate students in rehabilitation services, counselor education, and counseling or clinical psychology programs. Given the number of survivors of childhood trauma with whom they will come in contact, they need a set of tools such as the ones this book provides.

Peggy Lorah, D.Ed.
Director, Center for Women Students
The Pennsylvania State University