Trauma and the Body: Sensorimotor Psychotherapy

Psychologists who work with survivors of trauma recognize the complexities inherent in this clinical population. Traumatized individuals often demonstrate debilitating and reoccurring symptoms consisting of dysregulated affect and somatic responses that have no clear relationship to the fragments they might recall in their narrative memory. While traditional “talk therapy” methods such as cognitive restructuring or prolonged exposure therapy are a part of trauma resolution, these methods often fail to address the more implicit, nonverbal components of trauma. Additionally, it is well known that a significant number of clients drop out of exposure treatments because they are unable to sustain the somatosensory components of memory that get activated in the retelling process. These repetitive mind-body triggers often leave a client in a repetitive cycle resulting in keeping past trauma “alive and activated” rather than moving towards full resolution.

Dramatic advances in neuroscience over the past decade have led to important insights about how the brain, mind and body process traumatic experience. We now know that physical, bodily feelings we experience act as substrates to our emotional states and often shape the decisions we make when faced with problems or dilemmas. One of the most robust findings from neuroscience comes from neuroimaging studies of traumatized individuals and the fact that the higher brain areas (cerebral cortex) are less active than in individuals who have not experienced severe trauma. Without well functioning higher brains, clients are prone to activate the amygdala which acts as an “alarm system” and governs the body’s physiological equilibrium. In essence, trauma and chronic stress often cause brain damage that result in atrophy of the hippocampus and an amygdala which is perpetually in the “on” position (Cozolino, 2006; Lanius, 2006).

Sensorimotor Psychotherapy was developed by somatic psychology pioneer Pat Ogden. Her approach draws heavily on the traditions of the Hakomi Method, a body-oriented psychotherapy developed by Ron Kurtz (Kurtz, 1990), knowledge from attachment research (Porges, 2003; Schore, 2003) as well as techniques from cognitive and dynamic therapy. Similar to Somatic Experiencing (Levine, 2005), Sensorimotor Psychotherapy is a bottom-up approach designed to reduce the dysregulated autonomic arousal patterns that often hijack a client’s ability to remain cognitively connected during the treatment process

Sensorimotor psychotherapy helps clients learn strategies to develop awareness about and track their body and emotional responses to triggering sensory cues they experience in day to day living. Pat Ogden’s method follows a three phased treatment approach (Chu, 2005; Herman, 1992) which incorporates developing somatic awareness and resources for stabilization. In phase one, a client might be asked to describe a time when she felt powerful and to drop inside and notice where in the body “powerful” is felt. Cues are often provided in the form of questions as often these clients are very unresourced somatically. Time is spent teaching clients to physically “anchor” both positive and negative emotions. This process encourages grounding, empowerment and increased awareness of the present.

Clients who are traumatized are characteristically vulnerable to both hyperarousal (feeling too much activation) and /or hypoarousal (feeling too little activation). Through somatic awareness and resourcing, clinicians as well as clients learn to work within a “window of tolerance” so that maladaptive arousal patterns are reduced. When clients work within this window, they can think and talk about their experiences and simultaneously maintain the cortical function that is necessary for integrating traumatic material on cognitive, emotional and sensorimotor levels.

Clients are then taught the concept of modulation so that they develop the ability to shift from negative states to positive states using sensorimotor anchors combined with mindfulness. For example, during an activated phase, a client might be asked to “find a place in your body that feels calm or neutral.” Sometimes a suggestion is made as in “notice the sensation you feel in your left earlobe right now.” Sensorimotor psychotherapy incorporates a level of attunement in the therapeutic relationship and through mindfulness and social engagement the patient develops the ability to develop a greater capacity to maintain optimal arousal even in the presence of triggering stimuli.

In phase two of Sensorimotor Psychotherapy, clinicians are taught to process traumatic memory by targeting repetitive sensory or physical symptoms that recur and get ignited by every day stimuli. Sensorimotor Psychotherapy suggests that the interpersonal sharing in words alone of internal experience may not be the core curative element in trauma resolution. Clients must be able to process material using a range of modalities at both the verbal and nonverbal level. (Solomon & Siegel, 2003). It is not the events themselves but the residue – the olfactory and auditory intrusions, sensations, etc. that often wreak havoc on the ability of our clients to function optimally. Clinicians learn to recognize how clients organize their traumatic experience and help them observe and study it rather than re-enact trauma related tendencies such as dissociation or other maladaptive defense responses. A client might be directed to “just notice” small micro movements like a lip quivering or a jaw tightening and then be directed to name an emotion or thought that goes with the bodily response and to “track what wants to happen next.”

The work of this phase helps clients to develop a felt sense that the danger is in the past. At the same time, they develop new, more empowering actions and experience remembering that is somatic or sensorimotor in nature. By limiting the amount of information the client must integrate and process (letting go of the story, emotions and cognitions) the focusing makes the ability to process more manageable and keeps arousal within the “window of tolerance.” When a client becomes overly stimulated, the focus is narrowed even more. For example:

“Let’s try to imagine putting the content of this story and the feelings into a container for a moment and just focus on your breathing– what do you notice about it? Is it tight? Heavy? Shallow? Fast? Is there a movement your body wants to make to help you with that feeling? Let’s just stay with your body and observe anything that wants to happen until you feel a bit more present and settled down. What do you notice now?”

By using mindful attention, the clinician learns to work the higher and lower edges of the “window of tolerance” to facilitate the successful integration of traumatic material. If a client gets frozen or stuck in a particular affect, she might be invited to try a few “experiments” to just see what happens. For example, if a client states “I can’t breathe” the clinician might say: “Would you be willing to try an experiment to see if we can work with your breathing? Let’s see what happens to your breathing when you sit up straight in the chair and hold your shoulders back. Just notice…. What happens to your breathing when you say the words I don’t deserve to be treated this way? Just notice….”

The more precise the question, the more deeply tuned in and mindful of body experience the client will become. Mindfulness questions such as “so do you notice your leg shaking when you get anxious?” result in creating an observing ego thereby causing the client to step back from and “have” an experience rather than “being in it.” Retraumatization is therefore reduced because the prefrontal cortex is able to remain “online.”

The work of phase three involves the mastery of somatic integration. In this phase, clients become more adept at the process of tracking their physical sensations and somatic responses and gradually become aware of a physical action that facilitates a feeling of competency and empowerment. Clients who have been traumatized sometimes have somatic pain that is the result of a movement that they were incapable of executing at the time of their abuse. Completing these truncated responses can be a stage of triumph for clients and provide a major shift in feelings of competency and relaxation. Often, clients who complete this process take on observable feelings of well-being; they smile, laugh and seem awakened.

As a clinician trained in many psychodynamic and cognitive techniques as well as newer approaches such as EMDR, IFS and DBT, I have found Sensorimotor Psychotherapy to be a powerful and effective technique for patients who have been chronically traumatized. As somatoform symptoms are particularly acute in this population, it seems important to combine the “talking cure” with the non-linguistic world of images, sensations and feelings created by the body to improve treatment efficacy.

References:

Chu, J. (2005). Guidelines for treating dissociative identity disorder in adults.

Cozolino, L. (2006). The neuroscience of human relationships: Attachment and the developing social brain. NY: Norton.

Herman, J. (1992). Trauma and recovery. New York: Basic Books.

Kurtz, R. (1990). Body-centered psychotherapy: The Hakomi method. Mendocino, CA: Life Rhythm.

Lanius, R.D. (2006). A review of neuroimaging studies and hyperarousal and dissociation in PTSD: Heterogeneity of response to symptom provocation. Journal of Psychiatric Research.

Levine, P. (2005). Memory, trauma and healing: Foundation for human enrichment. Retrieved August 2007, from www.healingtrauma.com/art_memory.html

Ogden, P., Minton, K. & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. NY: Norton.

Porges, S.W. (2003). Social engagement and attachment: A phylogenic perspective. Annals of the New York Academy of Sciences, 1008, 31-47.

Schore, A. (2003). Affect regulation and repair of the self. NY:Norton.

Solomon, M. F. & Siegel, D. J. (Eds.). (2003). Healing trauma: Attachment, mind, body and brain. NY: Norton.

Jan Beauregard, Ph.D. is the director of the Integrative Psychotherapy Institute in Fairfax, VA. Her clinical focus is trauma and addictive disorders. She can be reached at (703) 385-9667 Ext. 1 or ipivirginia@yahoo.com.

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