From 1991-96 I lived in Germany with my wife, Johanna, and taught somatic approaches to Gestalt Therapy at the Gestalt Institute of Dortmund (sadly, no longer in existence). I was introduced to a text by a man named George Downing which is one of the most valuable books I have ever read on working with the body in psychotherapy. (Two others are Kepner’s Body Process, and Peter Levine’s brilliant book on healing trauma, Waking the Tiger.) Downing’s book is unfortunately only available in German, and it’s title, translated is: The Body and the Word in Psychotherapy. As it turns out, Downing also lived and worked at Esalen for a period of time in the 1970’s, writing a great basic book on massage called The Massage Book.

What makes Downing’s book so practical for somatic practitioners is his structured understanding of the felt sense. He describes how to recognize it, and to harness it as a diagnostic tool. He also describes it’s component parts in a manner simple enough to make it useful to us in supporting our clients’ innate capacity to self-heal. He breaks the felt sense down into five general categories, some of which are composed of easily understood sub-categories. The five categories, which relate to 5 levels of conscious experience, are: Sensing; Feeling; Movement; Verbal Cognition; Visually oriented Cognition (the capacity to think and remember in pictures or scenes). Sensing can be subdivided into our perceptions of sensation originating from outside of the body, and Proprioception, the capacity to experience sensation generated inside of our bodies. One very helpful diagnostic tool that Downing suggests is observing if clients have the ability to utilize all of the five categories. Although everyone orients more powerfully toward certain categories over others, the inability to utilize one or more of the five categories can be important information about a given person. In the traumatized individual, it is quite typical that one or more of the categories reveals itself to be inaccessible, particularly when feelings and memories associated with their trauma are triggered. Remember, the five categories are a way to describe the structure of the felt sense, and the felt sense is the key to unwinding the effects of trauma. Sensitively applied bodywork is the quickest and most effective method for helping people access their felt sense, and whatever barriers may arise in it’s different component parts as a result of trauma.

Let’s look at an actual case study using an understanding of the structure of the felt sense to assess what is happening with the following individual:

Linda, a student of mine, asks me to work with her because she has episodic depression, which affects her work and intimate life. I have observed a breakdown in Linda’s felt sense under the effects of bodywork which follows this pattern: Fairly quickly after being touched, Linda’s breath begins to accelerate in synchrony with an elevated level of anxiety and feeling of “buzzing” in her body, due to hyperventilation. She has difficulty using words to describe her experience, and soon “loses touch with any sensation in her body”. Soon, any capacity to move her body is lost, and the only capacity which remains somewhat available to her is feeling, as she describes afterwards having felt “consumed by anxiety”, and “completely frozen/incapable of moving or speaking”. Witnessing the almost complete breakdown of Linda’s felt sense, I realized that we will have to restore her capacity to sense, feel, move, and describe her experience verbally before a deeper exploration of the content of her trauma is possible. We work together once a week over a six month period, and I used focused touch to hold her awareness in parts of her body which have historically gone numb. I don’t let her hyperventilate, slowing her breath down and having her stay in eye contact with me to manage her anxiety. In addition, we focus on the feeling of support she experiences in relationship to her boyfriend, creating a “secure base” for her in the realm of feeling. By slowing the pace of her internal experience down, focusing her awareness bit by bit on her sensing and feeling body, helping her slowly articulate what she was experiencing, and creating secure bases for her along the way, by the sixth month she was able to begin the work of delving into the content of the trauma at the root of her difficulty. We worked an additional 3 months on this content, after which she and her boyfriend got married and moved to another city. She has stayed in touch with me via e-mail, and reported that her episodic depressions are much less severe, and no longer keep her from working as a physical therapist nor incapacitate her in her intimate relationship.

The value of the above case history is that it highlights a few important points about working with trauma patients that have been discussed in parts 1, 2 and 3 of this article:

1) That clients must be assessed for the appropriateness of a touch based approach to working with trauma because of its’ power to mobilize “stuck” trauma energy. (No sooner would one touch Linda than she would begin to experience anxiety and hyperventilate.)

2) Practitioners must also assess their capacity to navigate the complex waters of trauma before touching, and be prepared to become a “secure base” for their clients over a period of time. Manifestations such as trembling and shaking, unpredictable emotional and energetic releases, and memories of traumatic events can arise under the influence of competent, sensitive bodywork.

3) Restoring the “felt sense” in its’ five major manifestations is crucial to the inner exploration necessary when working with trauma. (Remember, the realm of “sensation” has two sub-categories: Sensation from the environment, and proprioception, which mediates sensations arising internally.)

4) Working slowly, and making sure that progress is anchored through finding secure bases other than ourselves along the way. This also simplifies the process of separating from the therapist when that time comes, anchoring progress within the continuity of the daily life of the client.

Namaste, and good luck!