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.