Book Summary: The Body Keeps the Score by Bessel van der Kolk
If you've ever felt stuck in a painful relationship pattern—where you or your partner react intensely to small triggers, disconnect emotionally when stressed, or struggle to feel safe even with someone you love—there's likely something deeper happening. Bessel van der Kolk's groundbreaking book "The Body Keeps the Score" offers a profound explanation: trauma literally reshapes the brain and body, affecting our capacity for trust, presence, and emotional connection.
As a couples therapist, you already understand that many relationship struggles aren't simply about communication problems or incompatibility. They're rooted in how our nervous systems have learned to protect us from past harm. Van der Kolk's research reveals that traumatic experiences don't just affect our thoughts—they fundamentally alter our physiology, our ability to regulate emotions, and how we show up in intimate relationships. When you understand this, you can help your couples transform not just their dynamics, but their capacity for genuine safety and love.
This summary explores what van der Kolk teaches about how trauma lives in the body, how it disrupts attachment and relationships, and most importantly—the practical pathways to healing that can unlock your clients' potential for deeper connection.
Part 1: The Rediscovery of Trauma
Chapter 1: A New Approach to Trauma
Van der Kolk opens his work by sharing his personal journey treating Vietnam War veterans—long before PTSD was even officially recognized as a diagnosis. These soldiers returned home with overwhelming symptoms: intrusive memories, emotional numbness, explosive anger, and a profound inability to feel safe. Yet when van der Kolk tried traditional talk therapy, something crucial was missing. Talking about the trauma didn't reliably heal it.
This observation became the foundation of van der Kolk's life work: trauma cannot be adequately treated through words alone. The nervous system needs something different. What he discovered is that trauma survivors often feel "unspeakable" in their bodies—they carry physical sensations and instinctive reactions that bypass conscious thought entirely. In your couples work, this shows up constantly. A partner might flinch at a touch that reminds them of something they experienced years ago, then feel shame and disconnection when they can't explain why. The body is speaking a language the conscious mind hasn't yet learned.
Chapter 2: Revolutions in Understanding the Mind
Before we could truly understand trauma, psychiatry took a significant detour. Van der Kolk traces how mental health treatment evolved from the 1960s onward, as medications became positioned as miracle cures. Psychiatrists increasingly relied on pills to manage symptoms, but medication alone often left the deeper imprint of trauma untouched. Patients could function better chemically, yet still feel trapped in their own bodies and relationships.
This matters for your couples because many people arrive at therapy on medications that may help with depression or anxiety but haven't addressed the root—the way their nervous system learned to interpret threat. Understanding this history helps you appreciate why your clients might have tried medication, found it partially helpful, yet still experience reactive patterns with their partner. The body's survival programming needs more than chemical intervention.
Chapter 3: Searching for the Roots of Trauma in the Brain
Everything changed when neuroscience gave us the tools to actually see inside the brain. PET scans and fMRI imaging revealed something revolutionary: when trauma survivors recalled their traumatic memories, their brain activity looked different. Regions responsible for language and rational thought would go quiet, while primitive survival centers lit up. In other words, reliving trauma literally deactivates the parts of the brain needed for speaking, reasoning, and connection.
For couples, this is illuminating. When your client becomes dysregulated because their partner said something that unconsciously reminded them of a past hurt, their prefrontal cortex—the wise, language-capable part of the brain—essentially goes offline. They're not being irrational or stubborn. They're operating from a brain in survival mode. This neurobiological reality shifts how you help couples extend compassion toward reactivity.
Part 2: This Is Your Brain on Trauma
Chapter 4: Running for Your Life—The Anatomy of Survival
Van der Kolk explains the autonomic nervous system—the intricate wiring that decides whether we fight, flee, or freeze in the face of threat. Under normal circumstances, this system flexibly adapts. A tiger appears; you become alert and ready. The tiger disappears; you calm down. But in trauma, this system gets stuck.
Traumatized people often live in a state of hypervigilance. Their nervous system remains convinced that danger is imminent. In a relationship, this manifests as someone who constantly scans for signs of rejection, betrayal, or abandonment. They might misinterpret a partner's busy day as lack of care, or interpret silence as anger. The body isn't lying—it's just stuck in an old survival pattern that no longer fits reality. Your role involves helping couples understand that one partner's reactivity often isn't about the other person at all; it's an old defense mechanism running on outdated software.
Chapter 5: The Downstairs Brain
Here van der Kolk goes deeper into the specific structures involved. The brain stem and limbic system—sometimes called the "downstairs brain"—handle survival, emotion, and body regulation. The neocortex or "upstairs brain" handles language, reasoning, and planning. When trauma activates the downstairs brain intensely enough, the person literally cannot access the upstairs brain's wisdom and perspective.
This neuroanatomy explains why trauma survivors often can't simply "think their way out" of their reactions. A partner might logically know their spouse loves them, yet feel terrified of abandonment. They're not being unreasonable; the downstairs brain has taken over. Couples therapy becomes more effective when both partners understand they're dealing with actual neurobiology, not character flaws or intentional hurtfulness.
Chapter 6: Betrayal Trauma and Broken Bonds
Many people carry trauma not from a single catastrophic event, but from broken trust in relationships. A parent who was emotionally unavailable, a caregiver who hurt them, a partner who betrayed them—these relational traumas deeply affect someone's ability to attach safely.
Van der Kolk explains that betrayal by a trusted person creates a particular kind of wound. The body doesn't know how to interpret safety when intimacy itself became associated with pain. This shows up dramatically in your couples sessions. Someone might unconsciously push away the very partner offering love, because attachment patterns formed in past relationships taught them to expect hurt. The paradox: they long for closeness, yet their nervous system defends against it. Understanding this dynamic—explored more deeply in Attached and Hold Me Tight—can help both partners shift from blame to compassion as they recognize how past attachment experiences shape current emotional bonds and safety.
Part 3: The Minds of Children
Developmental Trauma and the Window of Tolerance
When trauma happens to children, the consequences ripple across their entire development. Children depend completely on caregivers for regulating their nervous systems. If a parent is themselves dysregulated, overwhelmed, or abusive, the child's nervous system never learns healthy regulation patterns. This creates what van der Kolk calls a narrowed "window of tolerance"—the zone where a person can think clearly and respond flexibly.
Many adults in your couples sessions carry childhood trauma they've never directly addressed. Perhaps they grew up in chaos, or with a parent's rage, or with emotional neglect. Their nervous system learned that the world is unpredictable and people can't be trusted. Now, in their adult relationship, they might have a very narrow window of tolerance. Their partner's minor frustration feels like rage. A missed text feels like abandonment. The nervous system of a child-traumatized adult still operates as if threat is everywhere.
Attachment Injuries and Relational Patterns
Van der Kolk emphasizes that secure attachment is the foundation for all healthy functioning. Children with secure attachments develop better stress regulation, emotional awareness, and the ability to trust. Those without it carry a fundamental wound into adulthood.
In your couples work, you frequently see how childhood attachment trauma shapes current relationship struggles. Someone with an emotionally unavailable parent might become either anxiously seeking their partner's constant reassurance, or avoidantly dismissive of emotional needs. These aren't personality quirks—they're adaptive strategies that once protected a vulnerable child. Understanding their origin creates space for healing and change.
Part 4: The Imprint of Trauma
How Trauma Memories Work Differently
Van der Kolk makes a crucial distinction: trauma memories aren't processed like normal memories. In typical memory formation, the brain encodes an event, integrates it into our life narrative, and we can recall it with some emotional distance. Traumatic memories, by contrast, remain fragmented. They're stored as sensations, images, and bodily reactions without the narrative context that makes sense of them.
This explains why a trauma survivor might suddenly feel terrified, angry, or numb without consciously knowing why. A smell, a phrase, even the way their partner moves might trigger an implicit memory—the body remembering even though the conscious mind hasn't connected the dots. In couples therapy, when someone reacts seemingly "out of nowhere," they're often responding to these fragmented trauma memories.
The Body as Witness
Perhaps van der Kolk's most profound contribution is the concept that the body keeps score. Trauma isn't just a mental problem—it's encoded in physiology. Muscles tense and hold trauma patterns. The nervous system remains sensitized. Breathing becomes shallow. The body becomes a prison of past experiences.
For couples, this manifests in countless ways. Someone might feel threatened by intimacy not because of anything their partner is doing, but because physical closeness activates implicit body memories of being hurt. They might experience sudden panic during sex, or dissociate during vulnerable moments. They're not being difficult; their body is reliving something the conscious mind may not even remember. Healing requires addressing not just thoughts and feelings, but the body's stored trauma.
Part 5: Paths to Recovery
Medication and Neurotransmitters
Van der Kolk doesn't dismiss medication—he recognizes it can help calm the nervous system enough that people can engage in deeper healing. Medications that increase serotonin or regulate other neurotransmitters can reduce hypervigilance and anxiety. However, medication alone rarely resolves the deeper imprint of trauma.
For your couples clients on psychiatric medication, understanding this nuance is important. Medication might reduce a partner's reactivity, but both partners still need tools for nervous system regulation and relational healing. Medication can open the window; other approaches help build the house.
Chapter 15: Language: Completing the Cycle
Talk therapy has an important role in trauma recovery, but only certain kinds. Van der Kolk distinguishes between forms of talk therapy. Traditional approaches asking trauma survivors to recount their trauma in detail can sometimes retraumatize. But other approaches—particularly those that help people make sense of their experience and their reactions—support healing.
In your couples sessions, you use language to help both partners understand what's happening beneath their conflicts. You name the trauma response. You explain how the nervous system works. This kind of language—psychoeducational, compassionate, explanatory—helps the brain begin to integrate fragmented memories into a coherent narrative. The couple moves from "you're impossible to be around" to "your nervous system learned to protect you this way, and here's how we can help it feel safe differently."
Chapter 16: Yoga and the Martial Arts—Reclaiming Your Body
Yoga offers something talk therapy alone cannot: the chance to consciously inhabit the body again. Many trauma survivors have essentially abandoned their bodies—dissociating from them as a survival strategy. Yoga is gentle re-entry. As people move mindfully, they reconnect with physical sensation. They learn that the body can be a source of pleasure and awareness, not just pain and threat.
For your couples clients, even basic yoga practice—or movement practices like tai chi or dance—can shift everything. When someone becomes reconnected with their body, they become more present in their relationship. They can feel touch as nurturing rather than threatening. They develop better interoception (awareness of internal bodily states), which supports emotional regulation. Partners often notice their significant other becoming calmer, more present, and more open to intimacy.
Chapter 17: Neurofeedback—Rewiring the Brain
Neurofeedback is a cutting-edge intervention where people learn to observe their own brain wave patterns and, through feedback, gradually teach their brain to self-regulate more effectively. Essentially, the brain learns from itself.
This approach is particularly powerful for people traumatized in childhood, when the brain was still developing its regulatory capacity. Through neurofeedback, adults can essentially build the regulatory pathways they missed. In your couples work, when one partner engages in neurofeedback, both partners often notice improved emotional stability and responsiveness. The client becomes less triggered, more thoughtful, better able to discuss difficult topics without dysregulation derailing the conversation.
Chapter 18: Rewiring Relationships—Internal Family Systems
Internal Family Systems (IFS) therapy beautifully complements couples work. IFS recognizes that within each person are multiple "parts"—different protective sub-personalities that developed to help us survive. A "protector" part might be the angry, defensive response. An "exiled" part holds the pain that required protection. A "Self" is the calm, compassionate awareness that can hold all these parts with compassion.
In couples therapy, understanding IFS transforms how you work with reactive partners. Rather than seeing reactivity as a character problem, you help them compassionately recognize that their angry protective part is trying to help—even though its strategy isn't working in the current relationship. When both partners learn to work with their own internal systems, they can approach their partner's reactions with curiosity rather than defensiveness. "That protector part is trying to keep you safe; let's understand what it's protecting you from."
Chapter 19: Restoring the Self—Psychomotor Therapy and PBSP
Psychomotor therapy and Pesso Boyden System Psychomotor (PBSP) involve structured physical and emotional processes where people literally re-experience their relationship struggles in a safe container. Through guided imagery and physical positioning, they can symbolically experience the reparative moments they needed but didn't receive.
This may sound abstract, but for couples whose trauma involves relational rupture—parents who weren't attuned, partners who were rejecting—these methods offer profound healing. They work with the body's memory, not just the thinking mind. Some couples report breakthroughs in empathy and connection after one or both partners engage in these approaches.
Chapter 14 & 20: EMDR and the Power of Narrative
Eye Movement Desensitization and Reprocessing (EMDR) is perhaps the most researched trauma-specific therapy. As the client recalls the traumatic memory, the therapist guides bilateral eye movements (or other bilateral stimulation). Somehow, this bilateral activation helps the brain process fragmented trauma memories, integrating them into a coherent narrative that can be remembered without triggering full activation of the survival response.
EMDR is often remarkably effective, particularly for people traumatized as adults with a single event. After successful EMDR, someone might still remember what happened, but the memory loses its charge. It becomes a part of their history, not a current threat. In your couples work, when one partner has experienced effective EMDR, the shift in their reactivity can be dramatic. They're more present, less reactive, better able to engage in genuine intimacy.
Van der Kolk also emphasizes the power of community, creative expression, and narrative building. Theater, art, writing, and group work all support healing by helping trauma survivors reclaim their voice and sense of agency. Creative approaches activate different brain networks than talk alone, offering additional pathways to integration.
Key Takeaways
Trauma literally restructures the brain and body. It's not a character flaw or choice—traumatic experience causes neurobiological changes that affect how someone perceives threat, regulates emotion, and connects in relationships.
The nervous system can become stuck in survival mode. Hypervigilance, reactivity, and defensive patterns aren't character problems; they're adaptive strategies the nervous system learned when safety felt impossible.
Fragmented trauma memories live in the body. Unlike normal memories, traumatic memories remain fragmented as sensations, images, and instinctive reactions. A partner might react intensely without consciously knowing why.
Childhood trauma shapes adult attachment patterns. Those without secure childhood attachment often struggle to trust, fear abandonment, or unconsciously sabotage intimacy in ways that feel automatic rather than chosen.
Talk therapy alone is often insufficient. While language helps integrate and make sense of trauma, the body's memory requires additional approaches—movement, sensory work, bilateral stimulation, and somatic awareness.
The window of tolerance determines relational capacity. Traumatized people often have narrowed windows of tolerance, meaning they dysregulate quickly. Healing involves gradually expanding that window through nervous system regulation.
Multiple therapeutic approaches support healing. EMDR, yoga, neurofeedback, IFS, somatic therapy, creative expression, and community connection each activate different neural pathways and offer unique healing opportunities.
Recovery involves bottom-up and top-down work. Top-down approaches (like psychoeducation and narrative work) help the thinking brain. Bottom-up approaches (like yoga, somatic therapy, and EMDR) help the body and survival brain feel safe enough to update their threat assessment.
Relationships themselves can be healing or harmful. A secure, attuned partner can help regulate a traumatized person's nervous system. Conversely, relational trauma requires relational healing. This is why couples therapy is uniquely positioned to support healing.
Healing is possible at any age. The brain maintains neuroplasticity throughout life. Understanding trauma isn't destiny—understanding it is the first step toward rewiring the neural and somatic patterns that keep someone stuck.
Moving Forward: How Couples Therapy Becomes a Healing Relationship
Van der Kolk's research illuminates why so many couples find themselves in painful cycles that logic alone cannot resolve. When both partners understand that trauma responses are rooted in neurobiology—that the body keeps the score of past experiences—blame transforms into compassion. Reactivity becomes understandable. Defensiveness softens when framed not as intentional harm but as nervous system protection.
Your work as a couples therapist becomes even more powerful when informed by this trauma-informed lens. You're not just teaching better communication skills or conflict resolution. You're helping create a relational environment where both partners' nervous systems can gradually learn that safety is possible. You're explaining why they react the way they do. You're introducing tools that address the body's experience, not just the mind's narrative.
If you recognize these patterns in your clients—partners struggling to feel safe despite genuine love, reactivity that seems disproportionate to the situation, intimacy that triggers unexpected responses—van der Kolk's work offers a roadmap. It explains what's happening beneath the surface and points toward healing pathways that actually work.
At James M. Christensen Couples Counseling in Roseville, we understand that healing trauma isn't optional for couples seeking genuine connection. It's foundational. We're here to help you and your partner understand how your past is showing up in your present—and to guide you toward the safety, presence, and intimacy you deserve. If you're ready to move beyond patterns and into transformation, we'd be honored to walk with you.
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