Spreading the Word

The Trauma and Mental Health Report

Welcome back. This month I’m delighted to interview Dr. Robert T. Muller, PhD. Dr. Muller trained at Harvard, was on faculty at the University of Massachusetts, and is currently at York University in Toronto. He is a Fellow of the ISSTD for his work on trauma treatment, and his bestseller, Trauma & the Avoidant Client won the 2011 ISSTD award for the year’s best written work on trauma. It has been translated widely. He has a new book – Trauma & the Struggle to Open Up – which we’ll get into in the interview and is available on Amazon. Dr. Muller has lectured internationally and has been keynote speaker at mental health conferences in New Zealand and Canada. He founded an online magazine, The Trauma & Mental Health Report, which we’ll also talk about. The Trauma & Mental Health Report is now visited by over 100,000 readers a year – an impressive number for a niche topic! With over 25 years in the field, he practices in Toronto.

Shelley: The first thing I noticed about The Trauma & Mental Health Report is that it’s so dynamic. It’s not only about news and information but just as readily engages with the arts and culture, creative works and perspectives.

Dr. Muller: Yes, I’m glad you mention it because I’m trying to engage with different audiences. I’m trying to have a wide appeal to diverse audience groups. Not only therapists and researchers, but younger audiences and the general public as well. For example, high school students, college students. The content is often written by my doctoral students, where the writing can be well-informed and educated, but still connect to the general audience. It’s written in plain English and can be read and understood by anyone.

Shelley: That’s awesome. What does spreading the word mean to you? How do you see that connecting to your work?

Dr. Muller: To me, ‘spreading the word’ is about knowledge dissemination. That is, bringing an accurate understanding of trauma to a broader audience. Trauma is both so important and so widely misunderstood. I’ve tried to do this in both my writing and in my online work. In my new book, Trauma & the Struggle to Open Up, I try to speak to both therapists and clients. I make the writing understandable to both, while still being useful to the therapist. In my writing, it means “walking a tightrope,” so to speak.

Shelley: Can you elaborate on what walking on the tightrope involves?

Dr. Muller: Well, my parents were immigrants, my father was an upholsterer, they weren’t in the field of mental health at all. So, I imagine them sitting in the audience. I imagine people with broad life experiences sitting there, and I ask myself: Am I able to connect with them in my writing? Would they understand it? These are issues I grapple with.

Shelley: I love that. That’s such a human way to connect with your writing too. Do you feel that there is a theme you come back to, that you think particularly needs spreading?

Dr. Muller: Absolutely, yes. In my book I really focused on the therapy relationship. That’s a theme that really needs spreading. I think we have done a really good job in the field of helping people understand that you don’t just go in there with a therapist and ‘blaah’ spill your guts, and then everything’s going to be okay! We’re making progress in making it clear that strategies to stabilise and build a sense of personal safety prior to opening up excessively in trauma therapy is very important. Unless you engage in self-regulatory strategies, it’s going to be extremely difficult to do trauma work. I think we’re doing better in teaching that. And also, we’re doing better in making it clear that trauma memory is fragmented. I think people are learning that trauma memory doesn’t work the same way as everyday memory.

Trauma memory can be both hyper-focused on little details and large patches of memory will be absent, and it’s highly inconsistent. I think we’re doing better as a field in communicating that idea. What we’ve not done so well is teaching that in trauma work, people get better when the therapy relationship is navigated well. And this is true regardless of therapy modality. If you don’t have a good psychotherapy relationship, if you don’t build safety in the relationship and if you don’t navigate the ups and downs of the relationship with a certain degree of finesse, you’ll lose the client and the client will find themselves in another situation where they have yet another unsatisfying therapy experience. So that’s why I wrote the book, to really dig down and focus on the nuances of the psychotherapy relationship in trauma treatment. Yes, I focus on transference and countertransference, but also what are the enactments that happen, what are the ruptures and how do we repair those ruptures and see those moments of repair as an opportunity for change. And how does that become a corrective emotional experience in its own right.

That’s what I really focus on. And there isn’t a lot out there focusing on this issue. There are books on transference and countertransference that talk about patterns, but do they walk you through the nuance of what happens in the therapy relationship? Not so much. In my writing, I use many case examples. I also use a story-telling approach to go through what happens in the therapy relationship, how the story reflects the crisis that occurred in the relationship, and how that crisis was resolved. That’s how I focused the writing. I don’t think we’ve done that as a field. I think we can get better at teaching about common factors – there are a lot of silos. For instance, this person does CBT, this person does EMDR, this person does attachment – that’s fine, but there are a lot of common factors. Psychiatrist David Scharff says “good therapists are more alike than different,” and I think the common factors are important especially in trauma therapy. So much of what we do isn’t so focused on those technique-y pieces, but are in the process of sitting with, engaging with the person, validating, dealing with the sense of threat the person might feel both when they feel you validate or invalidate them and when they start to feel dependent on the relationship. If you’re empathic with them they may feel threatened even by that. We haven’t done well at drilling down into the common factors in trauma therapy.

Shelley: Do you see this kind of conversation in your teachings, and in talking with others?

Dr Muller: Yes. I lead a workshop ‘The relationship is your most powerful tool and biggest pitfall.’ It focuses on relational strategies in treating trauma clients. I’m certainly not the only one who does this. David Wallin does this and is fabulous. I think a lot of folks who are in the area of attachment do look at this, and of course I have an attachment focus in my own work.

Shelley: Thank you for participating in this month’s Spreading the Word. For more information check out the Trauma & Mental Health Report. Dr Muller also has an Amazon page profiling his work.

Spreading the word into the future I’m sad to say this is my final article as coordinator of Spreading the word. I’m honoured to have met so many great people and I’m pleased to wrap up the year. Thank you to Kate McMaugh for all of her support and encouragement. Spreading the word will soldier on into the future, just as soon as we get a new volunteer to coordinate/edit the feature! As for me – I won’t be far and I’ll always be spreading the word. If you feel you’re spreading the word about trauma and dissociation, out into the wider community, then we still want to hear from you! Tell us about your work by contacting ISSTD News Editor Kate on: If you are interested in meeting specialists in the area of trauma and dissociation, from all around the world, and talking to them about their work, then consider coordinating Spreading the Word. Contact Kate at the address above if you are interested.