Today, I had the pleasure of working with a mother and her daughter, on this day before mother’s day, with a colleague of mine at Esalen’s Carmel office. I noticed they had a bit of a southwestern accent as they spoke, and as we talked, they told me they were on vacation from Dallas, Texas. They were with a very unassuming gentleman who, as it turned out, had spent time on the California coast throughout his adult life. Interestingly, I made a number of assumptions about who they were without knowing them at all, like:

-He works in the oil industry
-Receiving massage is a part of “the California experience”
-They probably feel like they’ve landed on a strange planet
-They are most likely very conservative, etc.

After I finished my work, I had a moment to sit and chat with this gentleman, who revealed that his trip had a deeper purpose: To sit in Ed Ricketts’ laboratory in what is now Cannery Row in Monterey, because of his deep admiration for his holistic approach to science. He then told me that as a physicist, he understood the science behind the interconnectedness of all elements composing our universe. He also discussed his deep admiration for empirical scientists like Ricketts, who well before modern physics had proven that all things are interconnected, intuited this fact and was able to study the ocean’s ecosystems from this perspective. He cited poet Robinson Jeffers, and writer John Steinbeck as artist-philosophers grasping the same intuition as Ricketts. He then said how much it meant to him to simply be on the same piece of earth, Carmel, California, that had meant so much to these men he held in such high esteem.

At this point, I was completely mind-blown by the depth and breadth of knowledge of this unassuming person. I was also hoping our massages had been good enough to keep our clients asleep for 5-10 minutes, so that I could pick the brain of this very brilliant man. This is where it got very interesting! About thirty years ago, I made a trip to Brasil to visit healers getting extraordinary results via means not explicable through the physics that Isaac Newton described, nor through any science that I was familiar with. I became interested, as a bodyworker, in what explanations of reality might be behind the procedures I witnessed, and the results which I observed. I was introduced to the ideas of Quantum-Relativistic physics, which describe a universe containing interconnectedness as a fundamental feature. Mind, furthermore, is interconnected with, not separate from, matter and energy. On the basis of this knowledge, I began to ask myself the following questions:

-If everything that exists within this universe is interconnected, from the gross (matter and energy) to the subtle (processes of mind), can an intelligent being learn to focus mind in such a way that focused interactions of mind, matter, and energy become possible?

-Might something like that be what I was witnessing in the hands of the healers in Brasil?

-As a professional bodyworker, how does my inner state influence the quality of my work, and are the remarkable results I have witnessed in the sessions of master bodyworkers (Milton Traeger comes to mind) a result of their ability to focus mind in such a way that matter and energy respond in a self-organizing manner?

As a teacher of bodywork, these questions are of crucial importance in regard to how we train our students. Far too many schools emphasize a mechanical approach only to massage technique, which leaves little room for developing our students’ grasp of the intuitive side of this work. Since quantum theory demonstrates mathematically that everything within the boundaries of our universe, whether it be mind, matter, or energy, is interconnected, shouldn’t our methods for educating people about the nature of touch reflect that deeper reality? I will leave you to ponder that question, and apply it also to your work with clients in your private practices. Where do mechanical and intuitive approaches blend, and support each other in elevating the quality of our client’s lives? What is the role of training the mind through self reflective and meditative practices such that the interconnected fabric of this universe actually becomes palpable to us as we touch? Is it possible to develop that capacity, and is it then possible to teach?

In part two, I will recall more of my discussion with my physicist friend as I posed these questions to him.I will also discuss how some physicists view the universe itself as an intelligent, ever learning, evolving, and literally living process.
All the best to everyone!
Perry

This post was inspired by the following question I received by e-mail from a student a few weeks ago:

I have a question about massage that I think you can shed light on. I give my mom massage every few weeks. She has post polio syndrome and suffers from arthritis, migraines, chronic fatigue, and a lot of pain and tenderness. She cannot tolerate very deep work. The times that I work with her and her edge of the amount of pressure she can tolerate she will typically feel great in the hours following our session and then wake up the next day feeling like crap (headache, tense, pain). I remember you giving a great explanation of why this happens and I cannot remember all the details. Could you please enlighten me… again? Thank you!

This question relates to an important subject for anyone doing deeper therapeutic work with clients suffering from acute and/or chronic pain. By “deeper therapeutic work”, I mean not only methods which reach physically into the body’s deeper soft-tissue layers, but interventions such as acupuncture and osteopathy, which affect an individual’s energy system. Often, within 48 hrs. of receiving Deep Bodywork®, or an Esalen® Massage, patients will experience an aggravation of their complaints which can last for up to 48 hours. (On rare occasions aggravations can take up to 72 hrs. to appear, and last more than 48 hours. These cases are exceptions seen by practitioners working frequently with people suffering from acute and chronic pain.) This process can be disconcerting for clients because the body appears to be signaling that it is getting worse rather than better.

What is happening here, and why does the symptom picture of a client often worsen in the short term before improving? I have come to understand this process in the same way that I understand how the body produces fever or local inflammation as it battles microbial invasion. Although these processes are painful, they are an indication that the body’s immune responses are functioning effectively. The therapeutic aggravation experienced after an effective bodywork session is similar. As lesions within muscle, connective tissue, and bone are unwound, the body will focus energy, primarily in the form of increased fluid exchange, to the area(s) in question. Because these areas have become tender due to their acute or chronic distress, increased fluid activity will aggravate the sensations of pain in the short term. As tissues heal through an increase in this self-organizing activity, the pain will subside, and within 48 hrs. after the beginning of the aggravation, the actual healing result of our work becomes measurable. If your clients’ initial complaints have improved from what they were before you touched them, then they have experienced a classical therapeutic aggravation. If their complaints remain as they were before treatment, then one of two things may be happening:

A) You are dealing with a very complex case that requires long-term treatment, and involves the unwinding of organismic distress on many different levels. Trauma victims often exhibit this type of complexity, involving emotional as well as somatic barriers to healing. Improvements will be, particularly at first, very gradual, and test the practitioner’s ability to understand and appropriately unwind, layer by layer, the barriers to healing as they arise.

B) This is a case where some other organic process is involved that requires a different approach. Examples are undiscovered auto-immune disorders like Rheumatoid arthritis, Lupus, and Fibromyalgia which can generate recurring pain that responds quite differently to touch than in cases where such processes are absent.
Following are three examples from my clinical practice where therapeutic aggravations where apparent, but indicative of different pathological conditions responding differently to treatment with Deep Bodywork and Esalen Massage:

1) A client comes to me with severe lumbar pain, and I treat him once a week over the course of six weeks with deep bodywork. He aggravates according to the 48 hr. rule mentioned above, improving after the aggravation subsides, but the improvement doesn’t hold. The following week we are back to where we started. I suggest to him consulting with his physician to investigate if some other organic process might be involved, acting as a barrier to improvement. The results of his blood work show him to have rheumatoid arthritis.

2) A client comes to me, also with chronic back pain, this time so severe that he can barely stand and walk upright. He has been told by a specialist that he will need a spinal fusion to deal with the condition. He comes to me as a last resort in order to avoid surgery. I work with him over a nine-month period, once a week. Each session is followed by a very difficult aggravation, following the 48 hr. rule. Progress is very slow for the first three months. The client however reports that he senses the work is “doing something positive”. Starting around the fourth month, my client begins to report a marked change in his amount of pain, and his posture begins to improve. By the ninth month, his pain is almost completely gone, and his posture is almost normal. He still cannot tolerate strenuous physical activity, but spinal fusion surgery is no longer a consideration.

3) A woman in her early sixties comes to me with severe hip pain, and has been told she will need a hip replacement. I work on her, discovering an extremely tender trigger area in the Tensor fasciae-latae of the hip. I focus on this area, which creates an immediate aggravation, lasting about 24 hours. The pain in the hip completely disappears, as do any considerations of hip-replacement surgery. The hip has remained pain-free for ten years now. This result was achieved with 1 session lasting 75 minutes.

The above examples demonstrate how a therapeutic aggravation can occur in a variety of different situations, giving us, in each case, different information. In the first, the lack of improvement, despite the aggravation, indicated the probability of other organic factors involved in the client’s pain. In the second, progress was slow, yet steady, indicating the level of complexity of the case. A therapeutic aggravation occurred with each process of unwinding over a nine month period. The third case was a dramatic recovery after only one session, accompanied by a very uncomfortable aggravation of symptoms over a 24 hr. period, indicating a lesion, while very uncomfortable, of lesser complexity.

As a final caution: Be careful about working with cases of acute and chronic pain, because therapeutic aggravations can be difficult to guide people through. It is important to inform potential clients about how such aggravations work and to allow them to decide, on the basis of that information, if they wish to be touched or not. Second, be clear as to your own capabilities of guiding people through this process. If you have any doubts, it is probably better to refer individuals in acute or chronic pain to a more experienced practitioner.

Please feel free to post your comments and/or questions.

All the best to everyone!

Perry

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!
Perry

In Part 1 of “Deep Bodywork in the treatment of trauma related disorders and post-traumatic stress”, we discussed the importance of assessing our client’s state before we use touch as a part of dealing with the symptoms of trauma. We also discussed an honest assessment of our own capacities to deal with the manifestations of mobilized trauma energy, and the strength of the therapeutic alliance we share with a given client. After deciding that an individual is suited to receiving bodywork as a part of their healing process, there are a few basic things important to understand about the nature of trauma and how living organisms self-organize and heal.

1) Because traumatic situations either literally threaten our survival, or create the perception that our survival is threatened, an instinctual mechanism designed for self preservation is triggered. This is often referred to as the “fight/flight response”. It should actually be called the “fight/flight/freeze response”, and it is crucial to understanding what lies at the core of the traumatized person. ( For a deeper description of this phenomenon please see Peter Levine’s, Waking The Tiger.) It is this process of freezing which can create the seemingly intractable nature of trauma related symptoms and post-traumatic stress. Because both fighting and fleeing allow for a mobilization of vital energy during the potentially traumatic situation, the conditions for healing trauma are simplified if either strategy proves successful. If we find we can neither fight nor flee, a dissociative mechanism that “is like freezing” innately manifests, as a way of easing us into what could be a very painful, or lethal experience. Nature has actually acted compassionately in building this strategy into our instinctual makeup. Unwinding its effects can be very difficult.

2) Because the fight/flight/freeze response is mediated by the limbic system, brain stem, and spinal chord (all sub-cortical levels of the central nervous system which express themselves through feeling, sensing, and movement), verbally oriented therapies tend to miss the arenas where trauma, and post traumatic stress are to be found. Deep Bodywork and other somatic approaches are methods ideally suited to dealing with the core of trauma related symptoms, because they access our experience at a sensing and feeling level first, and verbally only as an important secondary process.

3) One way of thinking of trauma patients is that they are literally “frozen in space and time”, constellating around the traumatic event in an often unconsciously obsessive manner. This situation can be deeply anxiety producing, which requires any use of touch to be done extremely slowly. One of the hallmarks of Deep Bodywork is its slow, sensitive application. This allows the trauma patient to engage his or her felt-sense, our greatest tool in unwinding trauma.

Putting the above three elements together, we can understand that the use of Deep Bodywork in trauma related cases must be slow and sensitive in order to engage the felt-sense in a useful manner. The felt-sense, which is the aggregate of all of our information processing capacities melded into a felt impression of any given situation, has the power to thaw the stuck energy of trauma. As this energy begins to thaw, typical manifestations in our clients’ bodies can be trembling and shaking. I always assure my clients that “shaking is good. Let yourself shake.” Often the phase of shaking is followed by emotion, as the actual traumatic event gains access to memory. If we work slowly, engaging the felt-sense as we work, our client’s capacity to re-member, with our support, increases. Anchoring this positive change through connecting it to something positive in our clients experience is crucial at this point. This positive element can be a person, place, pet, or even a prize possession. The important thing is that it have the quality of being something like a “secure base” (Bowlby). Secure bases, according to Bowlby, are unique elements in the life of each person to which we attach, and around which we can create a stabile sense of self-hood. I once had a trauma client report to me during this process that maybe she would “trust herself to wear her red-dress again”, a prized possession that represented a certain celebration of her life energy and desire to have fun. As we imagined her putting it on after years of having left it in the closet, she was able to laugh and feel her longing for that long abandoned aspect of her experience.

Remember always to slow your work down when you observe the symptoms of trauma arising in a client. In part III, I will share some final considerations and a few case histories out of my clinical experience.

Namaste,
Perry

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.

Perry demonstrates the importance of using gravitation in your work to heal your clients and protect your own body.