Over the past 30 years I have treated many people with trauma related disorders in my private practice at the Esalen Institute in Big Sur, California. To be clear, trauma related disorders and post traumatic stress can manifest very differently in different people, depending on their personality structure, and specific traumatic history. A relatively psychologically “healthy” person, taken here to mean an individual with a stabile, consistent sense of self, will internalize trauma quite differently and respond to its treatment more readily than someone who is unstable. The reason for mentioning this fairly obvious fact is this: Body-oriented therapists treating victims of trauma need to determine the relative stability of their clients before they touch, because bodywork possesses enormous power to mobilize “stuck” traumatic energy, which can potentially destabilize an already fragile individual. Once a determination has been made that an individual is suitable for bodywork, and Deep Bodywork in particular, the therapist needs to proceed with great sensitivity, providing a “field of safety” within which a bond of trust can develop between client and practitioner. With seriously traumatized individuals, this means that a “therapeutic relationship” needs to develop over a series of sessions. It also means that the professional bodyworker should encourage such clients to seek psychotherapeutic support during treatment if they lack such skills in their own training.
How can we determine if a given client is suitable for a body oriented approach to healing trauma? Here are a few key things which are important to be aware of in answering this question:
1) First, is your client able to discriminate sensations, from feelings, from thoughts/memories, or do all of these experiences arise in a chaotic, indiscriminate manner? If your client’s experience is marked mainly by chaos, an approach which does not involve touch maybe better as a beginning. Being able to distinguish between these three important inner capacities is crucial to inner healing, and can take some time to develop in clients not familiar with inner exploration.
2) Does your client exhibit a relatively rapid “oscillation” between markedly different inner states? For example, is the emergence of an expression of anger (“My boss always treats me like I’m stupid!”) followed by smiling and laughing, or some expression of compassionate understanding? The point here is not that compassion following anger is “wrong”. Rather, it is the rapid oscillation of one state into another, without holding a given state in one’s “foreground” long enough to allow for adequate scrutiny that is the issue. This can indicate an inner state of “fragmentation” which, under enough stress, can literally end up with our clients “falling apart”. Mobilizing latent trauma energy is an anxiety producing experience for traumatized individuals, and can lead to their temporary, or even chronic destabilization.
3) As a practitioner, are you comfortable holding a safe space within which sensation, feeling, and verbal as well as somatic expressions of inner experience may occur? This might include novel bodily sensations, emotions such as fear, sadness, or rage, expressions like crying, or physical trembling and shaking. If your answer to any of the above questions is “no”, it’s a better idea to refer a client exhibiting signs of post-traumatic stress to someone experienced in such work.
4) Are you going to have the opportunity as a practitioner to see this individual consistently over a period of time, establishing a therapeutic alliance? Dealing with trauma is a complex, nuanced process which requires patience, skill, and time.
If you are unclear about any of the above issues regarding your clients inner state, your own capacities as a facilitator/therapist, or the availability and willingness of your clients for longer term work, you are well advised to direct clients exhibiting post traumatic stress to an experienced therapist.
Part two will address specific interventions, as well as contra-indications in working with trauma patients.